Wednesday, December 16, 2009

NY prison system opens unit for mentally ill (update)

By MARY ESCH, Associated Press Writer
POSTED: December 15, 2009

ALBANY - The first inmates moved Tuesday into a new state prison unit for disruptive mentally ill prisoners that was created in response to a lawsuit filed by an advocacy group in 2002.

The 100-bed Residential Mental Health Unit at Marcy Correctional Facility in Oneida County was designed by the state corrections and mental health agencies under the terms of a 2007 settlement with Disability Advocates.

The nonprofit group sued to improve treatment of mentally ill prisoners and to stop putting inmates with serious mental illness and disciplinary issues in solitary confinement.

Inmates in the new unit will receive more mental health care, therapeutic programming and exercise.

Of the 58,690 inmates in New York state prisons, 7,844 are diagnosed with mental illness, including 2,359 with serious mental illness, said Erik Kriss, spokesman for the Department of Correctional Services.

Inmates designated as seriously mentally ill are those with schizophrenia, delusional disorder, psychotic disorder, major depression and bipolar disorder. The designation also includes suicidal inmates and those driven by psychosis or depression to harm themselves.

About 200 of those with serious mental illness have confinement sanctions for disciplinary violations, Kriss said. Traditionally, such inmates are moved to an S-block, a special housing unit with lockdown cells that reduce the need for security personnel.

The Disability Advocates lawsuit claimed that prisoners with mental illness throughout New York did not get adequate mental health treatment, and as a result, many of them were being punished with long sentences of solitary confinement, severe restrictions on property and visits, and no access to out-of-cell programming.

The lawsuit said isolation and idleness led to severe psychiatric deterioration in these isolation units, including acts of self-mutilation and even suicide.

The new mental health unit at Marcy has about 100 corrections employees and 26 Office of Mental Health employees, compared with 38 employees when it was an S-block, Kriss said.

Kriss said inmates in the new unit have constant access to both prison and mental health staff. Each inmate has at least four hours daily of programming and therapy.

''No other prison system to our knowledge affords the inmate patients the amount of time of out-of-cell programming and therapy, including group therapy and group interaction, as the RMHU,'' Kriss said.

Saturday, December 5, 2009

Texas executes man at centre of mental disability row

Defence attorneys for Bobby Wayne Woods argued for state to spare inmate following low scores on IQ tests

Chris McGreal in Washington, Friday 4 December 2009 15.28 GMT

Texas has executed a child killer at the centre of a bitter dispute over what defines legal mental impairment after several courts ruled that he could be put to death despite a low IQ.

Bobby Wayne Woods, 44, was killed by lethal injection for raping and murdering his girlfriend's 11-year-old daughter after the US supreme court denied a last minute appeal by lawyers who argued that the condemned man fell within a ruling by the same court in 2002 that the mentally impaired could not be sentenced to death.

After being told that the supreme court had refused to intervene, Woods' last words were: "Bye. I'm ready."

Tests on Woods in prison put his IQ as low as 68, below the widely accepted cut off for mental impairment of 70. However, in pursuing the death penalty, the state fell back on other tests conducted when he was a child that put his IQ as high as 86.

Maurie Levin, a University of Texas law professor who represented Woods, said that he is "transparently childlike and simple" and described the execution as "a travesty".

Despite the supreme court ruling seven years ago barring the death penalty for the mentally impaired, individual states are left to decide what defines severe learning disabilities. The court said that an IQ test of "around 70" was an indicator but did not set a specific test.

Recent studies have shown that men with IQ scores lower than 70 have been executed in several states, including Texas and Alabama.

Earlier this week, the Texas board of pardons and paroles, voted unanimously that Woods, who has been described as barely literate, should be executed. The Texas attorney general, Greg Abbott, argued to the supreme court that the IQ tests on Woods were unreliable.

"The only experts to ever conclude that Woods was mentally retarded did so after he had committed this murder and had motivation to underperform," he said.

Richard Hattox, who prosecuted Woods, defended the execution.

"Woods testified, and the jury watched him reason and think and debate with me and his own lawyers," he said. "If he was going to claim mental retardation, having him testify was a mistake, because that took away any doubt."

Woods raped and slit the throat of Sarah Patterson after abducting her with her brother, Cody. The boy was badly beaten but survived.

The children's mother, Schwana Patterson, was refused permission to watch the execution because she served a prison sentence for failing to protect her daughter from sexual abuse by Woods.

Woods was the 24th person executed by Texas this year.

Sunday, August 30, 2009

Florida failing to meet mental health responsibilities

State funding for mental health and addiction services continues to fall in a shortsighted policy that fails to tackle problems before they escalate into far more costly outcomes.

When legislators descend on Tallahassee in the coming weeks to lay the foundation for next year’s regular session, they should bear in mind that Florida ranks 48th in mental health funding and 35th in alcohol and drug treatment funding — both abysmal national marks for a state 15th in per capita wealth.

When families in crisis cannot secure behavioral health services, they often end up in emergency rooms, behind bars or out on the streets.

And when budget cuts force the closure of hundreds of treatment beds throughout the state — including 39 beds at Manatee Glens — the societal problem intensifies.

While medical costs soar — witness the impassioned national debate over universal health care — mental health care funding drops. The state of Florida has not adjusted funding to account for medical inflation in more than two decades, according to Manatee Glens CEO Mary Ruiz.

At what cost?

This summer, Manatee Glens, the county’s hospital for mental health and addiction treatment, closed the Adolescent Recovery Center, for teenagers with substance abuse and mental health problems. Juvenile clients of the center, a residential unit with 16 beds that provided care for six to nine months, must now find services at a center in Sarasota.

Several other Manatee Glens units, which provide a lifeline to thousands of clients, are threatened — including the Children’s Crisis Unit, for those who are a danger to themselves or others, and the Walk-In Center, which serves uninsured families.

Manatee Glens, a not-for-profit institution, does not survive on state funding alone — the county and private money provide a significant share. But, Ruiz says, the state’s portion of the hospital’s annual budget has plunged from 85 percent to 55 percent during her 20-year tenure. The current budget stands at $25 million.

Ironically, Florida’s lone mental hospital, G. Pierce Memorial Hospital in Arcadia, closed in 2002 over a lawsuit that accused the state of shortchanging patients with fatal results — at least 10 patient deaths and injuries to others blamed on underfunding.

Upon closure, those patients were dispatched to various community mental health providers, and Manatee Glens received 26 clients and a promise of state funding. That money has evaporated during legislative budget cuts, and those 26 beds have been lost.

The Pierce lesson has been lost on the Legislature, as has the funding pledge. Are we doomed to repeat the past, with deadly results?

As Florida ponders spending hundreds of millions of dollars on new prison construction as the inmate population surges past 100,000, that question becomes all the more critical.

Earlier this year the Legislature failed to remedy that situation by not passing the Community Mental Health and Substance Abuse Treatment and Crime Reduction Act. The reform bill would have established mental health courts, pre-arrest jail diversion programs and law enforcement crisis intervention teams, among other measures.

Proponents, including the judicial, law enforcement and mental health communities, vow a reintroduction of the bill in the 2010 session.

According to the state Department of Children and Families, Florida spends some $250 million annually to pay for 1,700 forensic hospital beds for inmates with mental illness, and that expenditure is expected to double over the next decade.

Far more significant, though, is the number of inmates with mental illness — 17,000, and that, too, is forecast to double in 10 years. The projected cost for additional prisons, beds and services for that unfortunate growth is a staggering $3.6 billion.

Community-based treatment is key to keeping the mentally ill out of the justice system, the kind that Manatee Glens provides. That’s a more prudent and thrifty way of dealing with this particular problem.

But lawmakers should also address the broader issue, the entire spectrum of mental health services. Children, teenagers and adults should not be denied treatment for want of funding, else they, too, get caught up in the legal system or otherwise become a burden on society — by overcrowding emergency rooms or roaming the streets.

Even now, too many Manatee families are falling through the cracks. Ruiz says Manatee Glens serves one out of 30 families here, but with appropriate funding could help one out of 10.

The Legislature’s shortsighted policies of the past must be abandoned in favor of a big-picture, humanitarian vision.

Sunday, July 19, 2009

New court ready for mentally-ill inmates

Program will seek to move prisoners into treatment plans and out of the jail.

By Suevon Lee
Staff writer

Published: Sunday, July 19, 2009 at 6:30 a.m.
After more than a year of planning, Marion County's first mental health court opens Monday.

Funded in part by a federal grant, the nascent court is strongly modeled after similar programs established around the state, including one in Gainesville.

These programs seek to steer non-violent misdemeanor defendants with mental illness toward treatment programs instead of jail cells.

The Marion version will serve as a division of the county court and, much like the special drug and DUI courts, will be presided over by a county judge who works with the State Attorney's Office, Public Defender's Office and representatives from agencies like The Centers.

"When I first started [as a judge] seven years ago, I saw some situations that just kind of cried out for attention," said County Judge Jim McCune, who spearheaded the plan. "Mentally ill people tend to stay in the jail longer. There's nothing going on to get them out."

The Marion County Mental Health Court, one of more than 200 already established in the United States, seemingly couldn't launch at a better time.

According to Marion County Sheriff's Office projections, in 2007 there were between 327 and 1,287 mentally ill inmates at the Marion County Jail. That range is expected to increase to 459 to 1,804 by 2012 and to 1,553 to 6,101 by 2030.

In Florida alone, it's estimated that 125,000 individuals with serious mental illness are booked into jails each year.

Bob Sharpe, CEO of the Tallahassee-based Florida Council for Community Mental Health, said mental health courts have proven to be a reliable arm of the criminal justice system.

"It's had the effect of reducing the number of individuals with mental illness placed in jail. It's helped connect them with the mental health system where they may not have had exposure to the system before," he said.

The potential cost savings cannot be overlooked, either.

"It's cheaper to provide recovery services outside of a jail setting. Many participants [would be] getting treatment through government providers for mental health services," said Diana Williams, president of the National Alliance on Mental Illness' Marion County chapter. "There's just a better place for them. I'm glad we're finally on board with that."

The way the court will work is this: Misdemeanor defendants with no pending felony or DUI charges will be referred to the program through a judge, prosecutor, public defender or law enforcement officer.

If the defendant agrees, treatment providers will work with the State Attorney's Office and judge to determine if the defendant is qualified.

Eligible participants must have a mental illness that is chronic and persistent, such as bipolar disorder, schizophrenia or a major depressive disorder.

If accepted, the defendant will undergo a 12-month treatment program that includes weekly appearances before the judge, regular meetings with a case manager, required attendance at therapy and rehabilitation sessions, and compliance with certain drug and alcohol regulations.

Successful completion could result in a dropped charge; violations could lead to sanctions ranging from community service to jail.

"We need to start small," said McCune, emphasizing that he wants no more than 25 participants enrolled at a time.

"We need to be careful as to how we load this, so we can space it out and get our dynamics clearly worked out. I want to be real careful who gets in the program, and how we time people getting into the program."

The nation's first mental health court was founded in Broward County in 1997. County Judge Ginger Lerner-Wren, who to this day presides over the docket, said her goal was a "pure diversionary court model."

"The main problem is that for decades, individuals with various types of mental disabilities were really, blindly almost, being trans-institutionalized from hospital settings into jail settings," she said. "The criminalization of persons with mental illness is a very profoundly tragic social phenomenon."

The Alachua County Mental Health Court in Gainesville, an 8-year-old program that Marion's is strongly modeled after, functions less like an official proceeding than an informal dialogue between judge and participant.

One day last week, in a regular, chestnut-brown paneled courtroom, participants were seated on benches as the judge entered. Garbed in a black robe, the judge nodded and greeted the individuals, then called each to the lectern, one by one.

Seated in the jury box were representatives from local treatment centers.

"It's nice to see you. You're doing well," County Judge Denise R. Ferrero said to one defendant. "I'm impressed that you're willing to work with the doctors and not just increase the medication yourself."

At one point, the judge asked the room to applaud the "Participant of the Week," a middle-aged man whose commitment to the program earned him a certificate. He left the room smiling.

Other participants did not fare as well.

"I see you had a setback this week," the judge said to a woman whose drug test did not come back clean. "I want you to be successful," she added before sanctioning her to eight hours of community service.

That type of tough encouragement is what keeps the mental health court successful, said Sherry Browne-Davis, who works in the Alachua County court. "We try to empower them to make better decisions. We try to encourage rebuilding the foundation they had before they came to us," she said. "Nobody fits into one box. We really do try to look at every individual individually as well as whatever the setback is and to try and get them back on track."

The first meeting with team members to discuss referrals to Marion County's mental health court is Monday; the first court session is not until early August. Officials are eager to start.

"There is a need for social services [like mental health court] in the community, especially with the population of individuals we have. We've run into people who have had mental health issues before," Marion County Assistant State Attorney Toby Hunt said. "We see them over and over again. We're not addressing their problem. We're addressing the criminal part of it."

To McCune, the court would not have been possible without cooperation from various agencies and investment from community leaders.

"The strength of our program is that we have taken the time to get all the stakeholders finally working together," he said. "We could have put a program together on paper and said, 'Here it is, we can launch,' but it would have been superficial at best. It would have had no meat, no staying power to it."

Above all, McCune added, the significance of the community's gradual awareness of mental illness can't be overstated.

"That takes something of a sea change," he said. "I think we're coming around."

Saturday, June 20, 2009

Artistic freedom

WUWF art exhibit features works by Escambia County Jail inmates

Rebecca Ross

Behind bars, art blooms.

In a small room at the Escambia County Jail, male inmates let their creativity run free. Using paint and pencils, some participants in the Captured Art program create idyllic scenes of bright skies and blue oceans. Others incorporate darker images —skulls and tombstones — to tell a story.

Several of those original works are now on display, through July 24, at Gallery 88, inside the WUWF Studios on University Parkway.

The Captured Art program began at the Escambia County Jail in 2007 with a volunteer teacher and donated supplies. According to Sybil Sahuque and Sharon Giraud, who began the program, its initial goal was to aid inmates with mental health issues.

"We're amazed at how far we've come since we started," said Sahuque, who serves as the program's sole art instructor. "Now there is a waiting list to get in."

"We never thought it would take off the way it did," Giraud said. "To think that we began with paper and mechanical pencils as only art supplies, we've certainly come a long way."

The popular program, funded mainly through donations of money, materials and the sale of participants' art work, is now open to inmates with exemplary behavior who pass an arts aptitude test. Because of space constraints, 10 or fewer men are accepted into the program at a time.

Sharon Gossett, a Sheriff's Department employee who works with the program, said that Captured Art brings about positive changes in participants.

"Their self-esteem has been encouraged, they want to further their education in art and maybe begin a career with what they have learned," she said. "And they have asked if they can invite the younger inmates into the program to try and mentor to them so that they do not make the same mistakes in life."

Former inmate Clarence Williams, 52, said he found self-worth through the program.

Recently released from jail, Williams was a guest of honor at the "Art from the Inside Out" opening reception Thursday.

"I always knew how to draw, but I never considered myself an artist until I got in the art group in prison," he said. "It helped me realize that I can do positive things with my life. It has made me want to do something with my art, now that I'm out."

Lynne Marshall, director of promotions & outreach at WUWF Public Media, said that the "Art from the Inside Out" exhibit is a perfect means to showcase the prison's unique art program.

"We've done several shows that highlight an issue or cause, such as hospice or breast cancer awareness," Marshall said. "When I heard about the Captured Art program and went to the jail and visited these men, I was just so moved by their stories and their work. I felt it was something that we needed to share with the community."

Susan Watson, regional director of the American Civil Liberties Union of Florida, hopes the exhibit will raise community awareness regarding the need for a mental health court.

"It's really important that we take a look at how to treat inmates with mental illness," Watson said. "The exhibit is also an opportunity to show the community some of the good things that are happening at the jail. This is a humane program that allows inmates to express themselves in a positive manner."

Sahuque, Giraud and Watson hope that the exhibit will inspire artistic volunteers to start a similar program for female inmates.

"Some wonderful things have come out of the Captured Art program," Watson said. "They should be shared."

Additional Facts
Want to go?
- WHAT: "Art from the Inside Out" exhibit.

- WHEN: On display through July 24.

- GALLERY HOURS: 8 a.m. to 5 p.m. Monday through Friday (excluding holidays).

- WHERE: Gallery 88, inside the WUWF Studios, 11000 University Parkway.

- COST: Admission is free.

- SPONSORS: National Council on Alcoholism and Drug Dependence, the Prison Book Project, Escambia County Jail Captured Art program, WUWF Public Media and the ACLU of Florida.

- DETAILS: 474-2787, or online at Those interested in viewing or purchasing additional art may contact Sharon Gossett at 436-9823.

Death of mentally-ill inmate raises question of care

01:00 AM EDT on Sunday, June 21, 2009
By Steve Peoples

Journal State House Bureau
He banged his head against the wall until his teeth were loose, says one investigator. He clawed at his chest to get the devil out.

So, prison officials moved James Davis-Reed to a special segregation cell within the “Super Max” unit of the Adult Correctional Institutions on March 27.

It is the safest place the prison offers mentally-ill inmates.

The six-cell “observation and stabilization” area is relatively quiet. Prisoners are held in isolation under 24-hour video surveillance. Psychiatrists visit three times a week.

It’s more common for staff to use restraints on suicidal inmates there, as was the case for Davis-Reed that Thursday morning.

His final hours are still under investigation.

Prison officials have confirmed he was locked in four-point restraints — bound to his bed at the wrists and ankles — “for a short period” in the morning. After the restraints were removed, 24-year-old Davis-Reed was left alone and naked — he had stripped off his gown — under motion-activated video surveillance, in a 7-foot by 10-foot cell.

A prison spokeswoman said that Davis-Reed “was on the highest level of observation.” She could not say, however, when guards realized he had stopped breathing.

Just one state official, Mental Health Advocate H. Reed Cosper, has been willing to publicly discuss the young man’s death in detail.

“He rolled himself up into a fetal kind of ball, which is kind of a regressive behavior for a really sick guy. And he managed to roll his head into a crevice between the bed and the wall, and he couldn’t get out,” said Cosper, among those investigating the incident. “He suffocated, kind of like being crucified. He didn’t suffocate in two minutes. He suffocated in 45 minutes, or 30, I don’t know.” It’s unclear if Davis-Reed was trying to kill himself.

The state police are investigating, as is the ACI. The medical examiner has ruled the death was the result of “positional asphyxia.”

No one disputes these basic facts: James Davis-Reed left the prison in an ambulance and was pronounced dead at Rhode Island Hospital on March 27. He died after spending 35 days at the ACI, transferred there after spending the previous 1,273 days in the forensic unit of the state hospital for mentally-ill prisoners.

“There are mentally-ill people for whom prison is toxic,” Cosper says. “This man was too fragile to be in prison.”

Department of Corrections Director A.T. Wall says his staff did the best it could.

“We can never say ‘no’ when a court sentences an offender to us. On any given day we have hundreds of mentally-ill offenders — diagnosed, in treatment, and on medication. The overwhelming majority adjust and are doing fine in the population,” Wall said. “Our staff worked very hard with James and the treating psychiatrist was distraught over his death, as were many of the staff that worked with him. They grieved when he died.”

JAMES DAVIS-REED had largely cooperated with the doctors after his arrest four years ago.

There was little doubt that he was a dangerous man.

He had traveled through the night of June 27, 2005, from Far Rockaway, N.Y., to Rhode Island to find his ex-girlfriend, Tiffany Joiner. He snuck in through her kitchen window at the Oxbow Farm housing complex in Middletown just after 9 a.m., and found a 10-inch kitchen knife in a drawer.

He first attacked Joiner’s 14-year-old brother, who was watching TV on the couch. Davis-Reed stabbed the boy several times in the neck, chest and back before chasing Joiner and her new boyfriend up the stairs.

The couple suffered minor stab wounds as they tried to barricade themselves in an upstairs bathroom.

The police arrived before anyone was killed.

They chased Davis-Reed through the apartment and out the back door before pinning him to the ground.

Middletown police officer Mark Minnella’s narrative described the moment immediately after the arrest: “The subject was crying and covered in blood. I asked the subject why he stabbed the other party, and his reply was, ‘I love ’em like a brother.’ ” Everyone survived the attack, including Joiner’s 5-year-old brother, who was taken to the hospital to be treated for shock.

The State of Rhode Island took custody of Davis-Reed later that day, June 28, 2005, when he was 20 years old.

His first stop was the state prison.

A judge ordered a mental competency exam less than two months later. On Aug. 26, Davis-Reed was deemed incompetent to stand trial and moved to the forensic unit of Eleanor Slater Hospital, the locked unit for mentally-ill criminals.

An incompetent defendant, according to state law, is someone who “is unable to understand the character and consequences of the proceedings against him or her and is unable to properly assist in his or her defense.”

The goal is to restore the defendant to competency through treatment, said Stacy P. Veroni, chief of the criminal division for the attorney general’s office. “Someone can be insane and competent to stand trial. … It doesn’t have to do with his mental state at the time he committed the offense. It has to do with whether the defendant can generally understand the court process.”

Davis-Reed’s public defender, Paul Tondreau, says all involved with the case agreed that his client was not fit for trial. Tondreau said the forensic unit was more appropriate for Davis-Reed. “He was getting treatment there in a setting that was preferable to the prison.”

He responded well in the small hospital unit, where he was medicated and received constant attention. After more than a year of treatment, he was reevaluated and on Dec. 4, 2007, he was deemed competent to stand trial, according to court records. Tondreau did not challenge the competency ruling, but requested that Davis-Reed be allowed to stay at the hospital until the case was resolved in court. The attorney general’s office did not object, and Davis-Reed would spend two more years in Eleanor Slater.

While still living in the mental hospital, Davis-Reed ultimately pleaded guilty to five felony counts and signed off, in September 2008, on a plea bargain that capped his prison time at 15 years.Tondreau did not raise the insanity defense, which might have kept Davis-Reed out of prison. “The client has the final say,” the public defender said recently. “It’s his decision.”

Superior Court Justice Melanie Wilk Thunberg accepted Davis-Reed’s plea bargain on Feb. 20, 2009, and ordered him to the ACI. Tondreau did not object. After more than three years in a state mental hospital, Davis-Reed was transferred to the prison that day.

Prison officials had less than 24 hours’ notice he was coming.

THE ADULT Correctional Institutions holds Rhode Island’s largest collection of the mentally ill.

One day in mid-May, at least 567 inmates, or 23 percent of the “sentenced male population,” were prescribed psychotropic medication for mental illness, according to figures provided by the Corrections Department. These do not include the intake center or the women’s unit. Of the 567 inmates, 213 were taking antipsychotic drugs for the most serious diagnoses, such as schizophrenia.

Despite the numbers, the prison’s clinical director, Frederic C. Friedman, said the ACI has “a small number of people with serious mental illness. The number of truly psychotic is small.”

It’s unclear if Davis-Reed was among the “truly psychotic.” State officials have refused to discuss his health, citing medical privacy laws. And court records relating to mental competency have been sealed.

After leaving the 20-bed mental hospital, he spent his first 34 days at the intake center — a chaotic, crowded environment that holds 1,148 inmates.

Friedman said Davis-Reed spoke to a “weekend psychiatrist within 24 hours” and visited a psychiatrist and social workers “several times” in the subsequent weeks, typical treatment for inmates.

Cosper, the mental health advocate, has suggested that ACI doctors may have changed Davis-Reed’s medications after the transfer. Citing medical privacy laws, prison officials refused to answer that question.

The ACI has partnered with the University of Rhode Island’s College of Pharmacy to control ballooning medication costs by switching to generic drugs in many cases, a collaboration that prompted a national award less than two weeks after Davis-Reed’s death.

Taxpayers spent $180,857 on antipsychotic medication for prisoners between February and April of this year, according to information Friedman provided.

He said he works to ensure that prison psychiatrists are aware of cheaper drug options, but says that specific prescription decisions are left to inmates’ psychiatrists.

“I’m concerned that in this area of fiscal restraints, the impression is being created that we sacrificed, sent somebody to the bottom line. It simply isn’t true,” said Wall. “The clinical staff was actively working with this guy and he was working with us.”

It’s unclear what triggered Davis-Reed’s deterioration. He went downhill relatively quickly at the ACI — after steadily improving over three years at Eleanor Slater Hospital.

“He had engaged in some self-injurious behavior which called upon us to place him in a smaller setting,” Wall said, declining to describe the behavior. It was Cosper who said that Davis-Reed had been knocking his head against the wall to the point of loosening his teeth, and clawing at his chest “to get the devil out.”

The smaller setting was the ACI’s observation and stabilization unit within maximum security, a special area established roughly three years ago for those with the most serious mental problems.

State law affords prison officials another option. In extreme cases, the corrections director or the director of the state Department of Mental Health, Retardation and Hospitals may file a court petition to have a mentally-ill prisoner transferred to Eleanor Slater Hospital.

Corrections officials could account for a handful of such petitions in recent years; MHRH couldn’t detail any.

The Department of Corrections did not file a petition in Davis-Reed’s case, though they acknowledge that the prisoner had become a danger to himself.

“He is by no means the only inmate who has been self-injurious in our setting. Sadly, we’re accustomed to seeing that behavior. It may not be routine, but it is not particularly rare,” Wall said. “And he had been with us for only five weeks. Lots of mentally-ill inmates have trouble settling down at first whenever there’s a change in circumstance.”

JAMES DAVIS-REED is among dozens of inmates who have died while in the care of Rhode Island’s prison system in recent years.

Altogether, 62 people died at the ACI since Jan. 1, 2000, according to data provided by the Department of Corrections. It’s difficult to say how many were mentally ill.

Davis-Reed is the only one listed as having died from “positional asphyxia.” But the prison details 13 suicides over that time, including 11 by hanging. Four inmates died from drug overdoses or acute drug withdrawal.

Rhode Island is hardly the only state in which prisoners die.

In 2006, 8 inmates died in the Ocean State, 39 died in the Massachusetts’ state prison system, 25 in Connecticut, 7 in Vermont, and 6 each in New Hampshire and Maine, according to U.S. Department of Justice statistics.

“I recognize that our job is, insofar as it’s possible, to keep everybody safe. It’s a very tall order,” Wall said. “Our record is very good. But we work with a very difficult population on a number of fronts, including mental health. Tragic outcomes can and do occur in all kinds of settings, correctional and hospital. I do not think it means that we, or I, am responsible for that outcome.”

Monday, June 15, 2009

Michael Goforth: Evidence mounts to make changes in mental health and jails

By Michael Goforth (Contact)
Monday, June 15, 2009

“We tend to use a criminal justice model for a disease and it just doesn’t work,” Judge Stephen Leifman told me in a telephone conference earlier this year. “We can’t afford to keep doing what we’re doing.”

Leifman, a special adviser on criminal justice and mental health for the Florida Supreme Court, was talking about the financial and social costs of housing the mentally ill in municipal, county and state jails.

Of an estimated 600,000 Floridians with mental illness, about 125,000 needing immediate treatment are booked into jails or prisons each year. The cost for a mentally healthy inmate is about $40,000 per year. For a person with mental illness in a state-operated psychiatric hospital, the annual cost is about $140,000

In addition, the numbers are increasing and it’s estimated that over the next decade, the state would have to build a new prison each year to keep up with the number of mentally ill inmates.

And, that doesn’t include the costs for expanding county jails for their mentally ill populations, which has been occurring on the Treasure Coast in recent years.

Speaking recently at a briefing on Capitol Hill, Leifman said, “Our criminal justice system was never intended to be the safety net for the public mental health system. Unfortunately, though, that is exactly what it has become. Too often, people land in jail for minor offenses directly related to symptoms of untreated mental illnesses because of inadequate system of community-based services and supports.

“Only through systemwide collaboration and partnerships can we begin to close the revolving door to the criminal justice system which, today, results in increased recidivism, devastation to our families and communities, wasteful government spending, and the shameful warehousing in jails and prisons of some of the most vulnerable and neglected members of our communities.”

Leifman was speaking in conjunction with release of the first significant study of mental health and jails in about two decades. That study by the Council of State Governments Justice Center and Policy Research Associates found that about 17 percent of inmates in the study suffered from “serious” mental illness.

That study, however, looked at only about 20,000 inmates at five jails. Using those figures, it was estimated that about 2 million seriously mentally ill persons are booked into jails in the United States each year.

But, it’s not just those with serious mental illness who are being housed in jails. Based on medications required, about a third of those booked into the St. Lucie County Jail each year suffer from some form of mental illness. The cost for a mentally ill person charged with a misdemeanor averages $35,000 per stay. The cost for a mentally ill person charged with a felony is about $64,000 per stay.

In March, U.S. Sen. Jim Webb, D-Va., introduced the National Criminal Justice Commission Act of 2009, which calls for a national commission to undertake an 18-month study of the impact of putting the mentally ill in jail and how the criminal justice system can be reformed to address the problem.

U.S. Sen. Pat Leahy, D-Vt., has been pushing for reauthorization of the Mentally Ill Offender Treatment and Crime Reduction Act, which would provide federal grants to state and local governments to create or expand mental health courts, offer treatment and training programs to provide support and services to reduce repeat offenders, and to train police in how to react to situations involving persons with mental illness.

In addressing the results of its study, the Council of State Governments Justice Center said, “Too often there are people incarcerated who have serious mental illnesses, oftentimes for minor offenses, who would be better served in the community. Though jails have a constitutional mandate to treat the mental illnesses of individuals under their supervision, they are ill-equipped to meet the needs of those with serious mental illness.

“Policies have relied on outdated data to determine the scope and nature of this problem. As state and local governments face significant budget shortfalls, grapple with growing jail populations, and slash spending for community-based mental health services, there has not been a more critical time for policymakers to consider the implications of this prevalence study.”

Study results are clear. Too many people with mental illness are in jails who should not be there. They can be better served and more cheaply served through community programs.

But, as time goes on without comprehensive actions, those will mentally illness and their families are abused and taxpayers are forced to pay far more than they should for far too little.

Monday, April 6, 2009

Early intervention works for mentally ill

OUR OPINION: They belong in treatment facilities, not in jails and prisons
You see them all the time: People who aimlessly wander the streets, obviously homeless and obviously in need of attention for their mental illnesses. Ever wonder what happens to them? Far too many end up in jail or prison, at great and unnecessary expense to taxpayers.

To keep just 1,700 of these people locked up, as Florida currently does, costs $250 million each year. When they are released from prison, as inevitably all of them are, their mental-health conditions have worsened.

There is a better way. Instead of warehousing these people in prisons, the state can diagnose and treat their illnesses. It can use supportive diversion programs in community-based facilities to put them on a path of recovery. This can be done at a fraction of the cost of locking them up.

This is what can be accomplished if state legislators approve HB 7103 and SB 2018. The legislation carries the ponderous title, Community Mental Health & Substance Abuse Treatment & Crime Reduction Act. Yet it represents years of work by a coalition of public and private leaders, including Gov. Charlie Crist, former Florida Chief Supreme Court Chief Judge R. Fred Lewis, Miami-Dade Circuit Court Judge Steve Leifman and others.

A Senate committee considers the bill this week and other committee hearings await before a floor vote is taken. The bills deserve the enthusiastic support of all lawmakers. If it becomes law, the proposal would achieve that legislative rarity of doing a public good while being revenue neutral (meaning it doesn't require new money) at the outset, and save the state hundreds of millions of dollars in the long term.

This would be possible because the state would begin to reverse its extraordinarily wasteful practice of putting mentally ill people who commit crimes in prison instead of treating their illnesses. Florida is not alone in doing this, but it would become the model for other states to emulate.

The law would allow Florida to use community-based mental-health resources to intervene with the mentally ill before they go to jail or prison. This is what typically happens:

A mentally ill person commits a minor offense, say being disorderly. A police officer arrives, and attempts to calm the situation. The person, under emotional duress, is unable to comply, becomes more disruptive and is arrested on a more-serious charge.

This is where the legal insanity begins. Because the mentally ill person is unable to understand the charges, he is sent to a criminal-forensic hospital where, with the help of medications, he is calmed enough to face trial. If convicted, he is sent to prison where there is no treatment for his mental illness. If exonerated, he is released, untreated, and certain to suffer another emotional episode, which starts the process anew.

The proposal would authorize pilot projects in Miami-Dade, Tampa-St. Petersburg, Leon County and the Pensacola area. The programs would use managed-care principles, using appropriate diagnosis and medication, trauma services, drug and alcohol intervention and rehabilitative services such as education and job training. The intervention will give the mentally ill the help they need to everyone's benefit.

Sunday, April 5, 2009

Prison nation

Friday, April 3
There are few industries more recession-proof than prisons, especially in this country.
The United States has the world's highest incarceration rate, with 2.3 million people behind bars. Despite having only 5 percent of the world's population, we have 25 percent of the world's reported prison population.

Ours is a nation that loves retribution. The flip side to "zero tolerance," mandatory sentencing laws and "get tough" policies on crime is that about 1 out of every 31 American adults is either in prison, jail or on supervised release. And all this costs us, as a nation, about $68 billion a year.

The picture is even worse in Vermont. According to data compiled by the Pew Center on the States, between 1996 and 2006,

Vermont's prison population doubled in size -- from 1,058 to 2,123 inmates -- and the corrections budget went up 129 percent -- from $48 million in fiscal year 1996 for $130 million in fiscal year 2006.

The percentage of the state budget devoted to corrections has risen from 4 percent of the general fund in 1990 to 10 percent of the general fund in 2008. Our state's incarceration rate has increased 80 percent over the past decade, compared to a national average of 18 percent.

At the current rate of growth, the state will either have to ship more prisoners to out-of-state facilities -- which would cost about $82 million -- or spend $206 million to build new prisons in Vermont.

In the ongoing budget battle, it has been more or less decided that more prisoners will be shipped out of state to corporate-run private prisons, since it is cheaper. But is that the real solution to the problem of an out-of-control corrections budget?
Vermont has the dubious distinction of being one of five states (Connecticut, Delaware, Michigan and Oregon are the others) that spend more on corrections than on their higher education systems. Is that the kind of state we want to be?

In Parade magazine this week, U.S. Sen. Jim Webb, D-Va., wrote about the urgent need to reform our nation's criminal justice system. With so many of our fellow citizens in jail, Webb wrote that "either we are home to the most evil people on earth or we are doing something different -- and vastly counterproductive. Obviously, the answer is the latter."

Webb believes one of the biggest problems is that we have swamped the criminal justice system with low-level drug offenders.

According to the U.S. Department of Justice, nearly 48 percent of all drug arrests in 2007 were for marijuana offenses and nearly 60 percent of all people in state prison serving sentences for drug offenses had no history of violence or of significant selling activity.

And while blacks comprise 12 percent of the U.S. population, they account for 37 percent of those arrested, 59 percent of those convicted and 74 percent of those sentenced on drug charges.

The other factor driving the increase in the prison population is mental health. The Department of Justice estimates 16 percent of adult inmates -- more than 350,000 -- suffer from mental illness, and the percentage is even higher among juveniles.

That is why Webb says he has introduced legislation to "create a national commission to look at every aspect of our criminal justice system with an eye toward reshaping the process from top to bottom."

He believes it's time for Americans to ask some hard questions. Why are so many of our citizens in jail compared to other nations? What is this costing us in tax dollars and lost opportunities? How can we change our nation's drug policies? How can we better diagnose and treat mental illness? How can we make our prisons a place for rehabilitation rather than violence and hate?

These are questions most politicians would rather not answer. It's easier to pass a gay marriage law in our legislature that it is to pass a law that would decriminalize marijuana possession. It's easier to advocate sending more people to jail for longer stretches in the name of public safety than to honestly deal with all the factors that make the United States the world's No. 1 jailer.

We need more lawmakers at every level of government who are brave enough to deal with a criminal justice system that is a national disgrace, to make the necessary changes and to come up with better ways to keep our nation safe.

Monday, March 30, 2009

Editorial: Mental Health

Better treatment

Court-ordered outpatient treatment for the mentally ill is effective for the individual and less expensive for the state. But in Pennsylvania, it's rarely used.
That's because the state's outdated 1976 mental-health law requires ill people to be a "clear and present danger" to themselves or others before a judge can order them to get treatment.

By the time people with mental illness deteriorate to that point, outpatient services are often not appropriate. They usually end up hospitalized.

If such people receive community-based treatment before they deteriorate too far, the results are positive. But people with mental illness often don't recognize they need help, and won't agree to treatment voluntarily.

Forty-two states have some form of assisted outpatient treatment for the mentally ill. And a bill pending in the state Senate would bring Pennsylvania up to date in providing round-the-clock outpatient services. (The New Jersey Senate is also considering similar legislation).

Sponsored by Sen. Stewart Greenleaf (R., Montgomery, Bucks), SB 251 would allow judges to order outpatient mental-health treatment for people involuntarily for up to six months. It would apply only to patients who have been hospitalized at least twice within the previous three years, or have been involved in a serious violent incident within the past four years.

The new standard would be a "likelihood" of danger for receiving treatment involuntarily. The bill provides for a court hearing and legal representation for the mentally ill person.

New York state implemented such a law in 1999. Five years later, a report showed that individuals in the program experienced 77 percent fewer psychiatric hospitalizations, 87 percent fewer incidents of incarceration, and 74 percent less homelessness.

Greenleaf said he's mindful of Pennsylvania's history with the mentally ill, in which too many people were institutionalized and forgotten. "We're not going back to the bad old days," he said.

Rather, mental-health advocates say, the problem now is that too many people don't receive treatment before coming into contact with the criminal-justice system. About 20 percent of prison inmates suffer from mental-health issues. Those who do end up in prison tend to stay in prison longer than other inmates, costing the state more money and denying themselves effective treatment.

Supporters estimate that court-ordered outpatient treatment would benefit about 500 people in Pennsylvania annually. They say the service network is already in place to help such people in most counties.

Greenleaf said the legislation would not cost the state more money because Medicaid pays for these services. That aspect needs to be explored more thoroughly. While the state could very well save money with fewer prisoners and fewer state hospital commitments, some county human-service agencies might face greater demand for their services.

The state Senate should move ahead with this legislation, the goal of which is more effective patient care, fewer hospitalizations, and fewer incarcerations.

Sunday, March 29, 2009

Mentally ill could benefit from bill


Published: Wednesday, March 25, 2009 at 1:00 a.m.

Responding to the growing problem of mentally ill Floridians ending up in jails and prisons, lawmakers are moving forward on a sweeping initiative that will help better identify and treat those residents. Proponents call it one of the most significant rewrites of the state mental health law since the Baker Act was passed in 1971, reforming the way the mentally ill are committed for treatment.

Although the program is ambitious, it will start off on a small scale, with three pilot projects and will not require new state funding.

But advocates say it has the potential to save the state billions of dollars in the long term by improving the treatment of the mentally ill and keeping them out of costly prison beds or forensic treatment centers.

"This bill will without a doubt ensure a more fair treatment of people with mental illness. It will not only add fairness but effectiveness to the system," said Rep. Yolly Roberson, D-Miami, as the proposal was endorsed by the House Criminal and Civil Justice Policy Council on Tuesday. "It's a win-win for all parties."

Miami-Dade Judge Steven Leifman, who has spearheaded the legislation as a special adviser to the state Supreme Court on criminal justice and mental health, said the proposal is designed to bring the state's handling of mentally ill citizens in line with new treatment systems that can help those residents avoid ending up in jails or prisons.

"We've pushed a lot of people into the criminal justice system that don't need to be there," Leifman said.

A 2007 report to the Supreme Court found on a daily basis there were about 70,000 Floridians with a serious mental illness who were in prisons or jails, or under some type of correctional supervision. The report said that annually more than 125,000 Floridians with mental illnesses were being booked into county jails.

"The vast majority of these individuals are charged with minor misdemeanor and low-level felony offenses that are a direct result of their psychiatric illnesses," the report found.

Leifman said the mentally ill prisoners were the fastest growing segment in the state prison system, saying a projection shows it could cost the state more than $3 billion over the next decade to build new prison space and maintain those beds for that population. The other escalating demand is being put on the state's forensic facilities -- where persons charged with a felony but deemed mentally incompetent are sent until they have recovered enough to stand trial.

Florida is now spending roughly $250 million a year on 1,700 forensic beds, which gives it the distinction of running one of the most costly systems in the country. At the same time, the state has been criticized by national mental health groups for being near the bottom when it comes to spending on mental health programs outside of the criminal justice system.

"We've deep-ended our system so poorly that there aren't enough resources to provide the level of services that we now know are required to keep people out of the criminal justice system," Leifman said.

The new bill aims to target people who can be diverted from the criminal justice system, while also providing better treatment for the approximately 6,000 inmates with serious mental illnesses who are released from prison each year.

About half of those inmates end up going back to prison, Leifman said. The measure has the support of key state agencies including the Department of Children and Families, the Department of Corrections and the Agency for Health Care Administration.

DCF Secretary George Sheldon, who oversees the forensic treatment centers, said the current system does not make sense in that many felons who are sent to the centers spend enough time there in recovery only to be released back into the community for "time served" once they are deemed competent to stand trial.

Under the proposal, state officials hope to use some of the money now slated for the forensic beds for the upfront treatment initiatives, thus saving the state money in the long run. "It's a much more sensible use of money," Sheldon said. "What we're doing right now is the true definition of insanity."

Leifman said another advantage of the plan is that the federal government will pay a majority of the program's costs -- through the Medicaid -- as long as the mentally ill are being treated in the community and are not being sent into the criminal justice system.

The measure calls for pilot programs to be established in South Florida, the Tampa Bay region and the Pensacola area.

A similar bill is sponsored by Sen. Mike Fasano, R-New Port Richey, in the Senate.

This story appeared in print on page BN1

Saturday, January 17, 2009

Many in U.S. Prisons Lack Good Health Care

Report finds high rate of chronic disease that often goes untreated
Posted January 16, 2009
By Amanda Gardner

HealthDay Reporter

FRIDAY, Jan. 16 (HealthDay News) -- The 2.3 million Americans currently being held in correctional facilities across the country suffer a much higher rate of serious and chronic illness than the general population does, a new report finds.

These individuals -- representing about 1 percent of the total U.S. population -- also have difficulty accessing care both inside and outside the correctional system, according to research published online Jan. 15 and set to appear in the April issue of the American Journal of Public Health.

It's the first such study to look at the health of all inmates nationwide at once, the researchers said.

"We largely ignore mental health in our society, and it's exacerbated here," said Craig Blakely, associate dean for academic affairs and professor of health policy and management at the Texas A&M Health Science Center School of Rural Public Health in College Station. "The findings suggest that health and mental health problems are linked to higher rates of arrest and incarceration."

"Devoting more resources to community mental health care could reduce crime rates and reduce incarceration," added study author Dr. Andrew P. Wilper, an instructor in medicine at the University of Washington School of Medicine.

Largely due to the war on drugs, the U.S. prison population has increased fourfold in the past 25 years, surpassing any other nation in the world in number of people incarcerated per capita, according to background information in the paper.

Prisoners have a constitutional right to health care via the Eighth Amendment concerning cruel and unusual punishment, yet such services are often sorely lacking, the report's authors contend.

Good data on the subject is also lacking, Wilper added. He said that he filed two federal government freedom-of-information requests -- both of which were denied -- to review copies of an U.S. Surgeon General's report on prison health care.

In their study, the authors analyzed responses contained in two Bureau of Justice Statistics surveys: the 2002 Survey of Inmates in Local Jails and the 2004 Survey of Inmates in State and Federal Correctional Facilities.

"Of these roughly 2 million inmates, about 800,000 suffered from a chronic condition that generally requires medical attention: diabetes, hypertension, a prior heart attack or a previously diagnosed cancer, among a few other diagnoses," Wilper said.

Compared to non-incarcerated citizens, inmates in state jails were 31 percent more likely to have asthma, 55 percent more prone to have diabetes, and 90 percent more likely to have suffered a heart attack.

In federal, state and local jails, 38.5 percent of inmates, 42.8 percent of inmates and 38.7 percent of inmates, respectively, had a chronic medical condition.

Among inmates with mental conditions that had been treated on the outside, 69.1 percent of federal prison inmates, 68.6 percent of those in state facilities, and 45.5 percent of those in local jails were not taking their medication at the time of their arrest. The treatment rate for mental health woes tripled after incarceration.

Fourteen percent of those in federal prisons, 20 percent of state prison inmates and 68.4 percent of those in local jails had not yet seen a health-care provider since their incarceration, despite persistent health problems, the report found.

"There's some alarming data that suggests that those [inmates] with chronic conditions don't get the care they need when incarcerated and that's Eighth-Amendment illegal," Blakely said. "The whole war on drugs has made a disaster of our judicial system and created a nightmare we can't control."

"Given the huge cost of incarceration, we're foolish not to ensure that inmates get the basic care that would allow them to have a better chance of rehabilitation," he continued. "This suggests the need for universal access to health care."

More information

Visit the U.S. National Commission on Correctional Health Care for more on this issue.

Gassing mentally ill inmates is out

A judge rules that it qualifies as cruel and unusual punishment.

By Paul Pinkham Story updated at 2:33 AM on Wednesday, Jan. 14, 2009

Two mentally ill inmates suffered unconstitutional cruel and unusual punishment at the hands of Florida State Prison officials who disciplined them with pepper spray, tear gas and other chemical agents, a judge has ruled.

But the same punishment was appropriate for four other prisoners who sued the Department of Corrections on similar grounds, U.S. District Judge Timothy Corrigan of Jacksonville wrote in a lengthy order finalized Monday after a five-day bench trial in September.

Corrigan made the distinction based on the mental condition of the individual inmates at the time they were disciplined. The order means the department can no longer use chemical agents on prisoners who lack the capacity to follow orders or control their behavior, said Jacksonville attorney Buddy Schulz, who represented the inmates.

"It's significant because it's the first time a federal judge has found this type of use of force unconstitutional as it relates to seriously mentally ill inmates who are incapable of conforming to the rules of the prisons," Schulz said.

Corrigan gave lawyers for the state until Feb. 10 to come up with terms of an injunction and Schulz's team until Feb. 24 to voice objections. He directed both sides to work together, and Schulz said he's hopeful for a dialogue for reform with Corrections Secretary Walter McNeil, who has shown interest in prison mental-health issues.

Lawyers for the prison system didn't return phone calls Tuesday.

Constitutionality was the only issue at trial. Individual claims by the prisoners had been resolved previously.

Corrigan found that the use of chemical agents against recalcitrant prisoners isn't by itself unconstitutional. But he wrote that such force loses its disciplinary purpose and "becomes brutality" when inmates are gassed who cannot control their actions because of mental illness.

Former Florida State Prison Warden Ron McAndrew, now a corrections consultant, called the ruling a vindication of mental-health policies he had in place in the 1990s.

"It's a great success for the people of Florida in terms of reducing the torture of inmates in Florida's prisons, especially those that are mentally disturbed," McAndrew said.

He testified at trial that his policies were abandoned when he was replaced in 1999 by James Crosby, leading to hundreds more gassings. Crosby later became corrections secretary, then went to prison himself for taking kickbacks., (904) 359-4107

State Lawmakers Look at Death Penalty Change

Thursday, January 15 2009
One state defense attorney is asking legislators to guarantee justice and fairness by banning the execution of death row inmates who suffer from severe mental illness.

Attorney Kimberly Stevens spoke to a legislative committee on Thursday asking them to remove the death penalty as a sentencing option for some suspects accused of first-degree murder.

According to the Associated Press, the new legislation would allow a judge to declare a suspect to have a severe mental disability. If convicted, the person would face a maximum sentence of life in prison without parole.

State law already bars a death sentence for the mentally retarded and North Carolina juries also can find a defendant not guilty by reason of insanity.

The bill could be considered after the Legislature meets later this month.