AUDIT ON PRISON MENTAL HEALTH TREATMENT
Inmate care declines
Turnover, lack of therapists partly to blame
By CARLOS CAMPOS
The Atlanta Journal-Constitution
Published on: 06/23/07
Mentally ill inmates in Georgia's prison system — many of whom are eventually released — are not getting enough treatment and care, and in some cases are getting worse due to a host of problems outlined in a recently-conducted independent audit.
Inmates suffer from a lack of therapy and counseling as a result of insufficient staffing, employee turnover, technological glitches and other concerns, problems that persist in spite of previous audits that sounded the same alarm, the report says.
The consequences are grave, according to an Atlanta human rights law firm tracking the issue. Six mentally ill inmates have either been slain, or killed themselves, since October 2005 at three of the 33 Georgia prisons that care for inmates who need specialized mental health treatment.
"From our experience, when you don't have enough mental health professionals to oversee this population, people start dying, people start coming out of prison in body bags," said Sarah Geraghty, a lawyer for the Southern Center for Human Rights.
The report is critical of the "lockdown" of some mentally ill inmates in isolation cells for 23 hours a day, causing them to "clinically deteriorate" or "not clinically improve." Given that roughly 95 percent of inmates are eventually released, it means that thousands of mentally ill criminals return to the street as sick — or sicker — than before.
The 37-page audit, obtained by The Atlanta Journal-Constitution under the state's Open Records Act, calls the problems "serious" and "systemic."
The health of mentally ill inmates isn't the only issue on the line. Taxpayers could again end up footing the bill for costly litigation related to poor mental health care.
Threat of suit looms
The prison system estimates it spent "millions" of dollars complying with a series of consent orders from a 1984 federal class-action lawsuit covering every aspect of prison conditions, including deficiencies in its mental health care system. The system was released from federal supervision in 1998.
The threat of another costly federal lawsuit looms large, because the Southern Center for Human Rights — which specializes in prison and jail conditions — has set its sights on mental health care delivery in Georgia prisons.
Department of Corrections officials acknowledge many of the problems cited by correctional health care expert Dr. Jeffrey L. Metzner, but say some of the most serious results of poor mental health care — violent attacks on inmates and staff — have recently gone down inside of Georgia's prisons even as the number of ill inmates has grown.
"There are cracks in the system," said James DeGroot, supervisor of the Department of Corrections' mental health services division. "The system's not broken, but we do have to tend to the infrastructure now stressed by the rapid growth."
DeGroot provided the AJC with numbers of incidents involving mental health inmates that show suicides dropped from 6 in 2005 to 2 in 2006 and one so far in 2007; assaults on prison staff fell from 371 in 2005 to 308 in 2006; assaults among inmates fell from 971 in 2005 to 821 in 2006.
The number of homicides, however, has grown. There was one homicide in 2005 and one in 2006 among the mentally ill population. But there have been two slayings of mental health inmates so far in 2007. Five of the alleged perpetrators in this year's homicides were also mental health inmates.
Southern Center lawyers are confident they can document at least two more violent deaths among the mental health population, Geraghty said.
DeGroot said the deaths must be put in a broader context.
"I don't want to abdicate responsibility for any homicides, suicides or assaults — one is too many," DeGroot said. "But the incidents are relatively low. "
The report was addressed to Georgia Department of Corrections Commissioner James Donald, who declined an interview request for this article.
Metzner, who was paid $10,000 to conduct the audit at the prison system's request, declined comment and deferred questions to the state Department of Corrections.
More mentally ill inmates
Robin Graham, whose mentally ill son Bryan was hospitalized following a scuffle with guards, said she has had a difficult time getting proper treatment for him.
"They look at them simply as 'they broke the law,' not 'they have a problem,'" said Graham, who has hired a lawyer to look into her son's incident. "And there's hundreds of thousands of cases across the United States of people who have had mental illness and done something [illegal] and are never paid any attention to. Your departments of correction, your police forces, your judicial systems have no clue. Absolutely none"
Prison officials say they are dealing with a potentially volatile, difficult population, some of whom have compounded their illnesses with drug abuse.
About 16 percent of the prison population in Georgia receives mental health services.
Those services range from routine outpatient treatment — medication and therapy similar to what functioning people in private life get — to hospitalization for the sickest. Inmates with more serious problems are segregated from the general population in mental health wings inside prisons. Thirty-three of the state's prisons and probation detention centers offer mental health services.
The number of mentally ill inmates in Georgia's prisons has surged since 1999, the year after the system was released from the supervision of federal court. But as the population of mentally ill inmates has grown, the amount of professional help provided to them has gone down.
In August 1999, there were 132 counselors who provided 2,382 hours of psychiatric and psychological help to 4,425 mentally ill inmates, according to Metzner's report. In December 2006, 188 counselors provided 1,830 hours of care for 8,054 inmates.
Prison officials have been repeatedly warned of the shortcomings.
Geraghty, of the human rights group, called the persistent problems "disturbing." "The mental health caseload is skyrocketing and the number of mental health professionals is plummeting."
While under the supervision of the federal courts, the prison system increased staffing levels to make sure mentally ill inmates were cared for. DeGroot said the prison system "began losing ground" in 2000 because of budget cuts.
As a result, unlicensed counselors — who are allowed in prison — are not receiving clinical supervision, raising "serious risk management issues," Metzner wrote. Turnover and vacancy rates among mental health staff and correctional officers in prisons are also high. At Chatham County's Coastal State Prison alone, the vacancy rate among guards is about 40 percent, according to the report.
DeGroot said 2006 — the year covered by the most recent Metzner report — was particularly bad because of a spike in the number of sentenced inmates transferred from crowded county jails into the prison system. "We've grown so fast in calendar year '06 that without the staff growing now there are cracks in the infrastructure," DeGroot said.
Basic therapy
DeGroot led a tour June 13 for an AJC reporter and photographer of some of the mental health units at Phillips State Prison in north Gwinnett County.
The housing units were clean, and most of the inmates appeared calm while participating in therapeutic exercises. Some stared off into space, some held their heads in their hands and some rocked back and forth or twitched nervously.
Therapists talked to the inmates about the importance of proper hygiene in one class. In another, a therapist asked a group of mentally ill inmates to name their favorite color and their reason for choosing it.
An African-American inmate responded "white." When asked by the therapist why he chose white, he matter-of-factly responded "That's the color I am. I'm just in disguise."
A couple of the inmates who spoke with an AJC reporter said they felt safe and treated well inside the mental health wing by most staff members and guards. They had minor complaints about being forced to take medication, or the occasional surly prison guard.
In contrast, Geraghty of the Southern Center for Human Rights showed the AJC a folder full of photos of mental health inmates who had cut themselves at Phillips State Prison.
Some of the inmates had cut their forearms, throats and chests, spilling blood onto their cell floors and uniforms. The photos were gathered during a 2004 lawsuit against the prison system in which the center claimed an "epidemic of self-injury" among mental health inmates at Phillips.
Graham, who had a son at Phillips (he is now at Georgia State Prison in Reidsville), said she's not surprised by the report's findings. "They're basically nonexistent," Graham said of corrections' mental health services.
Graham said there were a few mental health personnel who have been helpful to her. But mostly, she felt ignored and kept in the dark about her son's needs.
On March 21, her son attacked a female prison guard at Phillips. When asked why, according to a report of the incident, he told authorities "Jesus told him to do it." Graham, who suffers from shizo-affective disorder, landed in an Atlanta hospital with a collapsed lung, cracked ribs and other injuries in the ensuing scuffle with guards who responded to the attack. Graham, who was serving five years for assaulting a Cobb County police officer, now faces additional criminal charges in Gwinnett.
DeGroot said he doesn't think the prison system's mental health system is in crisis.
"We could improve. The staff's hearts, most of them, are in the right place, and doing a good job. I think we're providing help to people who for so long have not received much, if any, help. We're dealing with the most disenfranchised population."
Sunday, June 24, 2007
Saturday, June 23, 2007
The criminalization of mental illness under capitalism
Friday, June 22, 2007
By: Crystal Kim
Prisons replace hospital care
The writer is a member of the Party for Socialism and Liberation and research coordinator of a free-standing psychiatric clinic.
Whether it is Cho Seung-Hui and the Virginia Tech killings or Angela Yates and the murders of her young children, mental illness is an underlying factor in many tragedies in the United States. Approximately 1,000 homicides a year are committed by mentally ill individuals who are not receiving proper treatment.
This comes as no surprise. In the United States—the richest country in the world—the healthcare system is not designed to treat the mentally ill. Rather, mental illness is ignored until the problem explodes.
The largest mental health facility in the United States is not a hospital. It is the Los Angeles County Jail, which holds 3,000 mentally ill inmates on any given day.
The more than 10,000 mentally ill inmates incarcerated in New York state prisons surpass the number of patients in the state’s psychiatric hospitals.
About 10 percent of prisoners suffer from mental illness. Most have committed misdemeanors caused either in whole or in part by psychiatric disorders. They need treatment, not incarceration. Yet, the federal government and state authorities use tax dollars to keep them locked up in subhuman conditions, exacerbating the problem.
This alarming trend began in the 1960s. Since then, jails and prisons have become the new psychiatric hospitals for the mentally ill. Driven by corporate greed, the mentally ill in the United States are being punished for their mental ailments.
Working-class people with mental health problems are the most vulnerable to becoming victims of the system.
Corporate and government collaboration
In 1955, 560,000 people in the United States were being treated for mental health problems in state hospitals. Adjusting for population increase, we would expect there to be about 930,000 individuals being treated in state hospitals today. This is not the case. Fewer than 55,000 people are being treated in such facilities.
Where then are the hundreds of thousands of people with mental health issues? Most are imprisoned by, or otherwise caught up in, the legal system. Between 170,000 and 300,000 mentally ill individuals suffer today in jails and prisons. Another 500,000 are on court-ordered probation.
Since 1960, more than 90 percent of state psychiatric hospital beds have been eliminated. Mental health professionals and sociologists call this "deinstitutionalization." As a result of this phenomenon, many mentally ill patients who need hospital care are in prison instead.
What’s behind deinstitutionalization? In short, the culprit is capitalism.
In 1952, French surgeon Henri Laborit began experimenting with a drug called chlorpromazine. Chlorpromazine was originally developed to treat allergies, but Laborit tested it to see if it could sedate his patients before surgery. Laborit found that chlorpromazine made his patients feel very relaxed. Laborit convinced his colleagues, psychiatrists Jean Delay and Pierre Deniker, to administer chlorpromazine to schizophrenic patients. To their surprise, the most disturbed patients became calm and placid. This was a major breakthrough in psychopharmacology.
Upon hearing about the success of chlorpromazine as a psychiatric drug, the pharmaceutical company that had developed chlorpromazine, Rhone-Poulec, sold the rights to another pharmaceutical company—Smith Kline & French. Known today as GlaxoSmithKline, it is the second largest pharmaceutical company in the world. In 2006, GSK earned $13billion in profits.
Smith Kline flew Deniker all around the United States to speak with psychiatrists about the psychiatric treatment properties of chlorpromazine. The company hoped it could sell chlorpromazine on the U.S. market. When this plan failed, Smith Kline undertook a new approach.
Smith Kline arranged for Deniker to meet with state legislators. Deniker explained to them that state governments could save millions of dollars by prescribing chlorpromazine to mentally ill patients housed in state hospitals. He argued that this would allow patients to be deemed well enough to be discharged. This, of course, would earn Smith Kline billions in profits.
Without regard for whether a patient could continue to afford the drug after discharge, and ignoring its dangerous side effects, state legislators were thrilled by the prospect of no longer having to fund treatment for the mentally ill. State hospitals were already under fire for cruel and inhumane treatment of mentally ill patients. Such treatment was depicted in the popular novel-turned-film "One Flew Over the Cuckoo’s Nest."
With chlorpromazine, state legislators were able to kill two birds with one stone. They could save millions of dollars by emptying psychiatric hospital beds, while also escaping public criticism for the appalling quality of treatment in state hospitals. The lawmakers enthusiastically accepted Smith Kline’s proposal.
Smith Kline marketed chlorpromazine under the name Thorazine. In the first eight months on the market, it was administered to over 2 million patients. In the first 10 years, it was administered to 50 million people. Within 15 years, Smith Kline’s revenues had doubled three times.
The advent of Thorazine, followed by the establishment of Medicaid and Medicare, led the White House to believe that perhaps state psychiatric hospitals were not necessary at all.
In 1963, President John F. Kennedy signed the Community Mental Health Centers Act. This law authorized Congress to spend up to $3 billion to build a national network of community mental health centers to replace state psychiatric hospitals. Congress proudly stated that the community mental health centers would allow even the most severely ill patients to be near home as long as they were taking Thorazine.
State hospitals began emptying their beds almost immediately. Between 1955 and 1994, the number of patients in state psychiatric hospitals decreased from over 500,000 to less than 100,000. From 1963 to 1980, alone, the inpatient population fell more than 75 percent.
The community mental health centers that were promised by Kennedy and Congress, however, were never built. The promise of $3 billion in funding was a big lie. The government turned its attention to "more pressing" matters, namely prosecuting the war of aggression against the Vietnamese people and covering up the Watergate scandal.
Hundreds of thousands of mentally ill patients were dumped onto the streets. This was due to government collaboration to meet the capitalists’ bottom line. By the 1980s, many former patients began arriving in jails and prisons. This trend is called "transinstitutionalization."
Into the prison system
The U.S. population increased by 16 percent between 1980 and 1995. In that period, the number of incarcerated people rose from 501,886 to 1,587,791—an increase of 216 percent!
Have people in the United States become that much more "criminal?" No. The repressive capitalist state apparatus has been extended. Deinstitutionalization has made jails a "repository" of the mentally ill. Instead of being treated as a medical matter, mental illness is being punished as a criminal matter.
A 1973 study of Santa Clara County in California shows that the county jail population rose 300 percent in four years. This jump followed the closure of Agnews State Psychiatric Hospital, located in the same county. (L.A. Teplin, "Journal of Hospital & Community Psychiatry," 1983)
A 1992 Public Citizen survey showed that 29 percent of jails in the United States incarcerate people who have no charges against them but are simply waiting for a psychiatric evaluation, a hospital bed, or transportation to a psychiatric hospital.
Moreover, most severely mentally ill people in jail are incarcerated because they have been charged with a misdemeanor due to an underlying psychiatric disorder. (E.F. Torrey, "Out of the shadows: Confronting America’s mental illness crisis." John Wiley & Sons, 1997)
For example, one mentally ill prisoner in Miami was arrested 26 times in six years for minor crimes such as panhandling and being a "sanitary nuisance." A schizophrenic prisoner in Denver was jailed over 28 times in two years for causing disturbances. In his lifetime, he had been jailed over 100 times.
On average, the mentally ill are jailed six times longer than other inmates charged with the same crime.
Case in point: Miami
What are the conditions like for the mentally ill in U.S. jails and prisons?
Former Washington Post reporter Pete Earley got an unprecedented look at Miami’s main jail—Miami-Dade Pretrial Detention Center. Earley’s investigation was prompted when his own son was thrown into the criminal "justice" system due to a severe mental illness. Earley described his observations of the Miami jail in "Crazy: A Father’s Search Through America’s Mental Health Madness." (G.P. Putnam’s Sons, 2006)
Earley’s description is purely observational, not analytical. Nonetheless, he gives valuable insight into the plight of the mentally ill.
According to Earley, on an average day Miami-Dade Pretrial Detention Center has 700 inmates on antipsychotic drugs. Most of these inmates get locked up on the ninth floor, officially known as the "primary psychiatric unit" but referred to as the "forgotten floor." Inmates are held in large group cells with as many as 50 persons in each cell.
The guards on the ninth floor do not receive special training on how to handle mentally ill inmates. Nurses on the ninth floor earn $2,000 less per year than nurses in Miami hospitals.
The ninth floor has three wings, one of which is reserved for suicidal inmates. Mentally ill inmates who have attempted suicide are held in solitary confinement in cells that have shatter-resistant glass fronts. They are kept naked, and the temperature of the entire wing is kept at around 50 degrees F (10 degrees C) to deter "trouble."
Each cell has a plastic bed built so the prisoner can be strapped to it spread-eagled. Suicidal inmates are not given sheets, blankets or pillows. They are not allowed to have any sort of entertainment, including radio, magazines and books. They have nothing to do but sleep or look out the glass front. Under these sadistic conditions, a suicidal individual’s mental health can only further deteriorate.
There is only one psychiatrist for the entire ninth floor, which allows him to spend an average of 12.7 seconds with each inmate on any given day. He has no authority or time to perform comprehensive mental exams. There is no doctor-patient confidentiality.
The psychiatrist is required to prescribe cheaper drugs to mentally ill inmates even if they report responding well to a different drug. Switching drugs can cause a mentally ill person’s condition to rapidly deteriorate. But this is a risk that Miami’s decision-makers are willing to take to cut down on expenses.
This is a snapshot of what life is like for hundreds of thousands of mentally ill people in the United States today.
Crisis rooted in capitalism
Until the early 19th century, the mentally ill were regularly imprisoned. The work of activists like Dorothea Dix forced legislators to build psychiatric hospitals so that the mentally ill could be treated.
Two hundred years later, the gains have been negated by the inexhaustible greed of capitalists and the politicians they keep in their pockets.
The U.S. mental health system is one example of the wanton greed enforced by the capitalist system. Capitalism upholds the ownership of private property by a few rich capitalists, while the rest of us are exploited in varying degrees. Capitalism is geared toward generating profit, not attending to people’s needs.
Capitalism has made illness into a source of billions in profits for pharmaceutical giants like Pfizer and GlaxoSmithKline each year.
It is cheaper for the state, and more profitable for private corporations, to imprison mentally ill people than to treat them. State governments pay private companies that run psychiatric hospitals regardless how much care they provide their patients and how good or bad that care is. Keeping beds empty increases the owners’ profit margins. Therefore, hospitals push toward prematurely discharging patients rather than ensuring them sufficient treatment.
It does not have to be this way.
The healthcare system must be stripped of its profit motive. This would ensure that patient care is the very top priority. Funding could be used for research and better training of healthcare workers, so that the deplorable conditions common in state psychiatric hospitals of the past are not repeated. Without the profit motive governing health care, aggressive, community-based, long-term follow-up care and treatment could become a reality.
This can only happen through a monumental struggle to reorganize health care so that it benefits people and not predatory drug companies, insurance companies and private hospitals. The healthcare system, along with capitalism itself, must be overturned to meet the needs of all people, especially those with mental illnesses who need help the most.
By: Crystal Kim
Prisons replace hospital care
The writer is a member of the Party for Socialism and Liberation and research coordinator of a free-standing psychiatric clinic.
Whether it is Cho Seung-Hui and the Virginia Tech killings or Angela Yates and the murders of her young children, mental illness is an underlying factor in many tragedies in the United States. Approximately 1,000 homicides a year are committed by mentally ill individuals who are not receiving proper treatment.
This comes as no surprise. In the United States—the richest country in the world—the healthcare system is not designed to treat the mentally ill. Rather, mental illness is ignored until the problem explodes.
The largest mental health facility in the United States is not a hospital. It is the Los Angeles County Jail, which holds 3,000 mentally ill inmates on any given day.
The more than 10,000 mentally ill inmates incarcerated in New York state prisons surpass the number of patients in the state’s psychiatric hospitals.
About 10 percent of prisoners suffer from mental illness. Most have committed misdemeanors caused either in whole or in part by psychiatric disorders. They need treatment, not incarceration. Yet, the federal government and state authorities use tax dollars to keep them locked up in subhuman conditions, exacerbating the problem.
This alarming trend began in the 1960s. Since then, jails and prisons have become the new psychiatric hospitals for the mentally ill. Driven by corporate greed, the mentally ill in the United States are being punished for their mental ailments.
Working-class people with mental health problems are the most vulnerable to becoming victims of the system.
Corporate and government collaboration
In 1955, 560,000 people in the United States were being treated for mental health problems in state hospitals. Adjusting for population increase, we would expect there to be about 930,000 individuals being treated in state hospitals today. This is not the case. Fewer than 55,000 people are being treated in such facilities.
Where then are the hundreds of thousands of people with mental health issues? Most are imprisoned by, or otherwise caught up in, the legal system. Between 170,000 and 300,000 mentally ill individuals suffer today in jails and prisons. Another 500,000 are on court-ordered probation.
Since 1960, more than 90 percent of state psychiatric hospital beds have been eliminated. Mental health professionals and sociologists call this "deinstitutionalization." As a result of this phenomenon, many mentally ill patients who need hospital care are in prison instead.
What’s behind deinstitutionalization? In short, the culprit is capitalism.
In 1952, French surgeon Henri Laborit began experimenting with a drug called chlorpromazine. Chlorpromazine was originally developed to treat allergies, but Laborit tested it to see if it could sedate his patients before surgery. Laborit found that chlorpromazine made his patients feel very relaxed. Laborit convinced his colleagues, psychiatrists Jean Delay and Pierre Deniker, to administer chlorpromazine to schizophrenic patients. To their surprise, the most disturbed patients became calm and placid. This was a major breakthrough in psychopharmacology.
Upon hearing about the success of chlorpromazine as a psychiatric drug, the pharmaceutical company that had developed chlorpromazine, Rhone-Poulec, sold the rights to another pharmaceutical company—Smith Kline & French. Known today as GlaxoSmithKline, it is the second largest pharmaceutical company in the world. In 2006, GSK earned $13billion in profits.
Smith Kline flew Deniker all around the United States to speak with psychiatrists about the psychiatric treatment properties of chlorpromazine. The company hoped it could sell chlorpromazine on the U.S. market. When this plan failed, Smith Kline undertook a new approach.
Smith Kline arranged for Deniker to meet with state legislators. Deniker explained to them that state governments could save millions of dollars by prescribing chlorpromazine to mentally ill patients housed in state hospitals. He argued that this would allow patients to be deemed well enough to be discharged. This, of course, would earn Smith Kline billions in profits.
Without regard for whether a patient could continue to afford the drug after discharge, and ignoring its dangerous side effects, state legislators were thrilled by the prospect of no longer having to fund treatment for the mentally ill. State hospitals were already under fire for cruel and inhumane treatment of mentally ill patients. Such treatment was depicted in the popular novel-turned-film "One Flew Over the Cuckoo’s Nest."
With chlorpromazine, state legislators were able to kill two birds with one stone. They could save millions of dollars by emptying psychiatric hospital beds, while also escaping public criticism for the appalling quality of treatment in state hospitals. The lawmakers enthusiastically accepted Smith Kline’s proposal.
Smith Kline marketed chlorpromazine under the name Thorazine. In the first eight months on the market, it was administered to over 2 million patients. In the first 10 years, it was administered to 50 million people. Within 15 years, Smith Kline’s revenues had doubled three times.
The advent of Thorazine, followed by the establishment of Medicaid and Medicare, led the White House to believe that perhaps state psychiatric hospitals were not necessary at all.
In 1963, President John F. Kennedy signed the Community Mental Health Centers Act. This law authorized Congress to spend up to $3 billion to build a national network of community mental health centers to replace state psychiatric hospitals. Congress proudly stated that the community mental health centers would allow even the most severely ill patients to be near home as long as they were taking Thorazine.
State hospitals began emptying their beds almost immediately. Between 1955 and 1994, the number of patients in state psychiatric hospitals decreased from over 500,000 to less than 100,000. From 1963 to 1980, alone, the inpatient population fell more than 75 percent.
The community mental health centers that were promised by Kennedy and Congress, however, were never built. The promise of $3 billion in funding was a big lie. The government turned its attention to "more pressing" matters, namely prosecuting the war of aggression against the Vietnamese people and covering up the Watergate scandal.
Hundreds of thousands of mentally ill patients were dumped onto the streets. This was due to government collaboration to meet the capitalists’ bottom line. By the 1980s, many former patients began arriving in jails and prisons. This trend is called "transinstitutionalization."
Into the prison system
The U.S. population increased by 16 percent between 1980 and 1995. In that period, the number of incarcerated people rose from 501,886 to 1,587,791—an increase of 216 percent!
Have people in the United States become that much more "criminal?" No. The repressive capitalist state apparatus has been extended. Deinstitutionalization has made jails a "repository" of the mentally ill. Instead of being treated as a medical matter, mental illness is being punished as a criminal matter.
A 1973 study of Santa Clara County in California shows that the county jail population rose 300 percent in four years. This jump followed the closure of Agnews State Psychiatric Hospital, located in the same county. (L.A. Teplin, "Journal of Hospital & Community Psychiatry," 1983)
A 1992 Public Citizen survey showed that 29 percent of jails in the United States incarcerate people who have no charges against them but are simply waiting for a psychiatric evaluation, a hospital bed, or transportation to a psychiatric hospital.
Moreover, most severely mentally ill people in jail are incarcerated because they have been charged with a misdemeanor due to an underlying psychiatric disorder. (E.F. Torrey, "Out of the shadows: Confronting America’s mental illness crisis." John Wiley & Sons, 1997)
For example, one mentally ill prisoner in Miami was arrested 26 times in six years for minor crimes such as panhandling and being a "sanitary nuisance." A schizophrenic prisoner in Denver was jailed over 28 times in two years for causing disturbances. In his lifetime, he had been jailed over 100 times.
On average, the mentally ill are jailed six times longer than other inmates charged with the same crime.
Case in point: Miami
What are the conditions like for the mentally ill in U.S. jails and prisons?
Former Washington Post reporter Pete Earley got an unprecedented look at Miami’s main jail—Miami-Dade Pretrial Detention Center. Earley’s investigation was prompted when his own son was thrown into the criminal "justice" system due to a severe mental illness. Earley described his observations of the Miami jail in "Crazy: A Father’s Search Through America’s Mental Health Madness." (G.P. Putnam’s Sons, 2006)
Earley’s description is purely observational, not analytical. Nonetheless, he gives valuable insight into the plight of the mentally ill.
According to Earley, on an average day Miami-Dade Pretrial Detention Center has 700 inmates on antipsychotic drugs. Most of these inmates get locked up on the ninth floor, officially known as the "primary psychiatric unit" but referred to as the "forgotten floor." Inmates are held in large group cells with as many as 50 persons in each cell.
The guards on the ninth floor do not receive special training on how to handle mentally ill inmates. Nurses on the ninth floor earn $2,000 less per year than nurses in Miami hospitals.
The ninth floor has three wings, one of which is reserved for suicidal inmates. Mentally ill inmates who have attempted suicide are held in solitary confinement in cells that have shatter-resistant glass fronts. They are kept naked, and the temperature of the entire wing is kept at around 50 degrees F (10 degrees C) to deter "trouble."
Each cell has a plastic bed built so the prisoner can be strapped to it spread-eagled. Suicidal inmates are not given sheets, blankets or pillows. They are not allowed to have any sort of entertainment, including radio, magazines and books. They have nothing to do but sleep or look out the glass front. Under these sadistic conditions, a suicidal individual’s mental health can only further deteriorate.
There is only one psychiatrist for the entire ninth floor, which allows him to spend an average of 12.7 seconds with each inmate on any given day. He has no authority or time to perform comprehensive mental exams. There is no doctor-patient confidentiality.
The psychiatrist is required to prescribe cheaper drugs to mentally ill inmates even if they report responding well to a different drug. Switching drugs can cause a mentally ill person’s condition to rapidly deteriorate. But this is a risk that Miami’s decision-makers are willing to take to cut down on expenses.
This is a snapshot of what life is like for hundreds of thousands of mentally ill people in the United States today.
Crisis rooted in capitalism
Until the early 19th century, the mentally ill were regularly imprisoned. The work of activists like Dorothea Dix forced legislators to build psychiatric hospitals so that the mentally ill could be treated.
Two hundred years later, the gains have been negated by the inexhaustible greed of capitalists and the politicians they keep in their pockets.
The U.S. mental health system is one example of the wanton greed enforced by the capitalist system. Capitalism upholds the ownership of private property by a few rich capitalists, while the rest of us are exploited in varying degrees. Capitalism is geared toward generating profit, not attending to people’s needs.
Capitalism has made illness into a source of billions in profits for pharmaceutical giants like Pfizer and GlaxoSmithKline each year.
It is cheaper for the state, and more profitable for private corporations, to imprison mentally ill people than to treat them. State governments pay private companies that run psychiatric hospitals regardless how much care they provide their patients and how good or bad that care is. Keeping beds empty increases the owners’ profit margins. Therefore, hospitals push toward prematurely discharging patients rather than ensuring them sufficient treatment.
It does not have to be this way.
The healthcare system must be stripped of its profit motive. This would ensure that patient care is the very top priority. Funding could be used for research and better training of healthcare workers, so that the deplorable conditions common in state psychiatric hospitals of the past are not repeated. Without the profit motive governing health care, aggressive, community-based, long-term follow-up care and treatment could become a reality.
This can only happen through a monumental struggle to reorganize health care so that it benefits people and not predatory drug companies, insurance companies and private hospitals. The healthcare system, along with capitalism itself, must be overturned to meet the needs of all people, especially those with mental illnesses who need help the most.
Thursday, May 31, 2007
Florida Supreme Court Reduces Death Sentence Because of Mental Illness
The Florida Supreme Court reduced a death sentence to life without parole because of the defendant's serious mental illness. The court noted that this was "one of the most documented cases of serious mental illnesses this court has reviewed." In its decision rejecting the trial judge's death sentence for Christopher Offord (pictured), the justices unanimously held that the death penalty was a disproportionate punishment due to Offord's long-standing mental problems. Medical records show that Offord, who was convicted of killing his wife in 2004, suffers from schizophrenia and bipolar disorder and has been in and out of institutions since he was a young boy. The trial judge had imposed a death sentence despite the fact that she found Offord had committed the murder under the influence of extreme mental or emotional disturbance and lacked the capacity to appreciate the criminality of his conduct. The jury had unanimously recommended a death sentence.
(Associated Press, May 24, 2007). See Mental Illness.
(Associated Press, May 24, 2007). See Mental Illness.
Friday, May 18, 2007
Social workers could ease jail crunch
BY LORETTA TACKETT
PAINTSVILLE HERALD EDITOR
The Department of Public Advocacy (DPA) will submit a 2008 budget proposal which includes money to put a social worker in each of its 30 state offices, including Pikeville, hoping to address the revolving door of the justice system by getting more than half of their clients out of jail and into treatment.
Approximately 68 percent of DPA clients suffer from substance dependency and 58 percent are mentally ill, said DPA Commissioner Ernie Lewis, asserting DPA is concerned with lack of treatment options in overcrowded local jails, including the Big Sandy Regional Detention Center (BSRDC).
The Administrative Office of the Courts (AOC) shows the BSRDC, which is located in Paintsville and houses inmates from Johnson, Martin, Magoffin and Lawrence counties, held 181 inmates in a 110-bed facility last year.
DPA Public Information Officer Dawn Jenkins said Friday there were 200 in a 134-bed capacity - increased by a change in space requirements for each inmate by state law due to statewide overcrowding in jails - and one-third were sleeping on the floor.
In a 2006 visit to Pike County Jail, a University of Kentucky researcher found 236 inmates in a 142-bed facility - 89 of whom were state inmates - and one-half were on the floor, according to a special report the DPA called "Realizing justice during difficult times."
Incarceration rates in Kentucky are skyrocketing, says the DPA, with public defenders caseloads growing for the seventh consecutive year.
Over 300 salaried public defenders represented 140,000 cases last year, Lewis said, which was a 4.3 percent growth and the highest number of cases in DPA history.
The Paintsville office, which serves Johnson, Lawrence, Martin, and Magoffin counties, had 1,600 cases for four attorneys.
The problem in Eastern Kentucky has been complicated with the appearance of federally-funded programs like Operation UNITE, which makes drug-related arrests and offers some assistance to prosecution, but not to defense.
The problem prompted the DPA to hold public forums in 2005 out of concern for ineffective counsel and led to assistance from the 2006 General Assembly, decreasing the number of new cases opened per attorney.
The DPA received funding during the last legislative session to hire 36 more attorneys statewide, Lewis said, adding the goal is to get the caseload down to 400 per lawyer, which is still above the national average.
The 2006 General Assembly also funded the Social Worker Pilot Project, putting a social worker in the public defender's offices in Morehead, Owensboro, and Covington, and will place a fourth one in Bowling Green in July.
"The focus is to work with persons with substance abuse, mental illness, or both and treat them so they don't come back into the justice system," said Jenkins, adding Lewis has been meeting and will meet with legislators, judges and defenders in all trial regions before the 2008 General Assembly to seek support for a social worker in all 30 offices across the state.
The goal is to address the root causes of criminal behavior such as chronic alcohol and substance abuse, mental illness, and illiteracy, Jenkins reported
The project would cost about $1.2 million, Lewis said, asserting, "We think the state will actually save money."
"And better yet, save lives," said Public Defender Jay Barrett, who has been serving as trial division director for the DPA.
The DPA reported the Commonwealth saves $47.12 every day a Kentucky inmate is treated rather than jailed, and a program like the social work project resulted in $15 million in savings for Rhode Island.
Asserting the DPA does not have scientific evidence concerning the effectiveness of the Social Worker Pilot Project yet, as researchers at the University of Louisville are working on it, Jenkins said social workers are making referrals to whatever is available, similar to the way drug court works.
"We have to expand treatment," Lewis said, as only 20 percent of the 68 percent with substance abuse problems are getting treatment.
Many are sleeping on the floor while in withdrawal from drugs, a condition about which Lewis said, "You're not going to get better."
"The BSRDC facility is overcapacity most of the time and without mental health and substance abuse treatment," said Paintsville Public Defender Howe Baker. "Many of our clients will continue to return to the criminal justice system unless we can address their root problem."
PAINTSVILLE HERALD EDITOR
The Department of Public Advocacy (DPA) will submit a 2008 budget proposal which includes money to put a social worker in each of its 30 state offices, including Pikeville, hoping to address the revolving door of the justice system by getting more than half of their clients out of jail and into treatment.
Approximately 68 percent of DPA clients suffer from substance dependency and 58 percent are mentally ill, said DPA Commissioner Ernie Lewis, asserting DPA is concerned with lack of treatment options in overcrowded local jails, including the Big Sandy Regional Detention Center (BSRDC).
The Administrative Office of the Courts (AOC) shows the BSRDC, which is located in Paintsville and houses inmates from Johnson, Martin, Magoffin and Lawrence counties, held 181 inmates in a 110-bed facility last year.
DPA Public Information Officer Dawn Jenkins said Friday there were 200 in a 134-bed capacity - increased by a change in space requirements for each inmate by state law due to statewide overcrowding in jails - and one-third were sleeping on the floor.
In a 2006 visit to Pike County Jail, a University of Kentucky researcher found 236 inmates in a 142-bed facility - 89 of whom were state inmates - and one-half were on the floor, according to a special report the DPA called "Realizing justice during difficult times."
Incarceration rates in Kentucky are skyrocketing, says the DPA, with public defenders caseloads growing for the seventh consecutive year.
Over 300 salaried public defenders represented 140,000 cases last year, Lewis said, which was a 4.3 percent growth and the highest number of cases in DPA history.
The Paintsville office, which serves Johnson, Lawrence, Martin, and Magoffin counties, had 1,600 cases for four attorneys.
The problem in Eastern Kentucky has been complicated with the appearance of federally-funded programs like Operation UNITE, which makes drug-related arrests and offers some assistance to prosecution, but not to defense.
The problem prompted the DPA to hold public forums in 2005 out of concern for ineffective counsel and led to assistance from the 2006 General Assembly, decreasing the number of new cases opened per attorney.
The DPA received funding during the last legislative session to hire 36 more attorneys statewide, Lewis said, adding the goal is to get the caseload down to 400 per lawyer, which is still above the national average.
The 2006 General Assembly also funded the Social Worker Pilot Project, putting a social worker in the public defender's offices in Morehead, Owensboro, and Covington, and will place a fourth one in Bowling Green in July.
"The focus is to work with persons with substance abuse, mental illness, or both and treat them so they don't come back into the justice system," said Jenkins, adding Lewis has been meeting and will meet with legislators, judges and defenders in all trial regions before the 2008 General Assembly to seek support for a social worker in all 30 offices across the state.
The goal is to address the root causes of criminal behavior such as chronic alcohol and substance abuse, mental illness, and illiteracy, Jenkins reported
The project would cost about $1.2 million, Lewis said, asserting, "We think the state will actually save money."
"And better yet, save lives," said Public Defender Jay Barrett, who has been serving as trial division director for the DPA.
The DPA reported the Commonwealth saves $47.12 every day a Kentucky inmate is treated rather than jailed, and a program like the social work project resulted in $15 million in savings for Rhode Island.
Asserting the DPA does not have scientific evidence concerning the effectiveness of the Social Worker Pilot Project yet, as researchers at the University of Louisville are working on it, Jenkins said social workers are making referrals to whatever is available, similar to the way drug court works.
"We have to expand treatment," Lewis said, as only 20 percent of the 68 percent with substance abuse problems are getting treatment.
Many are sleeping on the floor while in withdrawal from drugs, a condition about which Lewis said, "You're not going to get better."
"The BSRDC facility is overcapacity most of the time and without mental health and substance abuse treatment," said Paintsville Public Defender Howe Baker. "Many of our clients will continue to return to the criminal justice system unless we can address their root problem."
Sunday, May 13, 2007
Limit to death penalty sought
Bill would protect the mentally ill
Andrea Weigl, Staff Writer
James Floyd Davis was sentenced to death for killing three people during a workplace shooting more than a decade ago at a Buncombe County tool plant. At least one psychiatrist has concluded that Davis was experiencing paranoid delusions and believed he was waging a "holy war" against co-workers conspiring against him.
A bill pending before the legislature would allow Davis, 59, who was diagnosed in 1973 as schizophrenic, to use his delusions at the time of the killings to try to have his death sentence overturned.
State Sen. Eleanor Kinnaird, a Carrboro Democrat, has proposed allowing defendants with severe mental illness to avoid the death penalty if they were too mentally ill to understand their actions at the time of their crimes. The defendant could either ask a judge to rule on the issue before trial or ask a jury to consider it during the trial's sentencing. Those already on death row could file an appeal.
Kinnaird said the bill does not allow these defendants to avoid prosecution or punishment; they could still be charged and face spending the rest of their lives in prison.
But prosecutors oppose the bill, saying the measure is so broad that it could be applied to all murder defendants facing the death penalty.
"Every time, some hired gun comes in and espouses there's mental illness," said Buncombe County District Attorney Ron Moore, whose office prosecuted Davis. "We haven't tried anyone capitally in this state without some kind of diagnosis."
The bill does not say which diagnoses qualify someone as being severely mentally ill. Rather, the bill defines severe mental illness as someone being unable to appreciate the wrongfulness of their conduct, to use rational judgment or to conform their conduct to the law. Each side is likely to present competing testimony from mental health experts, and the question would be decided by a judge or a jury.
Moore said the jury in Davis' trial considered evidence about his mental illness and still sentenced him to death. Moore said a psychiatrist recently found Davis competent enough to fire his lawyers and drop his appeals. He described Davis as "lucid" and "articulate" during recent court hearings.
The rationale behind the bill is similar to successful efforts in recent years to outlaw the death penalty for juveniles and the mentally retarded: a killer's young age, limited mental functioning and severe mental illness make them less culpable for their crimes and not deserving of the death penalty.
"By a certain reasoning, people with certain mental illnesses can be held responsible, but they aren't the worst of the worst because of the illness that they have," said Richard Dieter, executive director of the Death Penalty Information Center, a nonprofit anti-death penalty group based in Washington.
Mental health advocates agree, saying the bill extends the protection already available to those who are mentally retarded to those with severe mental illness.
"These people probably have no real understanding of what occurred," said Julia Leggett, a lobbyist for the Alliance for Disability Advocates.
A few states eyeing it
North Carolina is one of at least three states, including Indiana and Washington, considering such a proposal. Connecticut is the only state that has such a law.
In a poll earlier this spring, 52 percent of 574 North Carolina voters surveyed said they would not support the death penalty for those with severe mental disability. The poll was released by N.C. Policy Watch, a progressive think tank, that hired Public Policy Polling to conduct the survey, which had a margin of error of 4 percentage points.
Last year, the American Bar Association, as well as The American Psychiatric Association and the American Psychological Association, passed identical resolutions about mentally ill defendants and the death penalty. The resolutions said defendants should not be executed if they had severe mental illness at the time of the crime or if their illness prevents them from helping their lawyers handle their appeals, leads them to give up their appeals or makes them unable to understand the purpose of their execution. North Carolina's legislation does not go that far.
But at least one of Davis' lawyers hopes the bill could help Davis and others on death row.
"There is a significant number on death row who are suffering from mental illness," Asheville lawyer Leah Broker said. "I don't think they got fair trials, especially in my client's case. It would give another avenue for review."
She said Davis' trial lawyers didn't present enough evidence about his history of mental illness that she believes could have swayed jurors. Davis' appeal based on those issues was filed in 2000 and has never been heard, she said.
On May 17, 1995, Davis killed co-workers Gerald Allman, Frank Knox and Anthony Balogh and injured Larry Codgill. Davis had been fired two days before the shooting. Knox's widow, Phyllis Knox, declined to comment about the legislation, although she has previously said she opposes the death penalty.
Staff writer Andrea Weigl can be reached at 829-4848 or andrea.weigl@newsobserver.com.
Andrea Weigl, Staff Writer
James Floyd Davis was sentenced to death for killing three people during a workplace shooting more than a decade ago at a Buncombe County tool plant. At least one psychiatrist has concluded that Davis was experiencing paranoid delusions and believed he was waging a "holy war" against co-workers conspiring against him.
A bill pending before the legislature would allow Davis, 59, who was diagnosed in 1973 as schizophrenic, to use his delusions at the time of the killings to try to have his death sentence overturned.
State Sen. Eleanor Kinnaird, a Carrboro Democrat, has proposed allowing defendants with severe mental illness to avoid the death penalty if they were too mentally ill to understand their actions at the time of their crimes. The defendant could either ask a judge to rule on the issue before trial or ask a jury to consider it during the trial's sentencing. Those already on death row could file an appeal.
Kinnaird said the bill does not allow these defendants to avoid prosecution or punishment; they could still be charged and face spending the rest of their lives in prison.
But prosecutors oppose the bill, saying the measure is so broad that it could be applied to all murder defendants facing the death penalty.
"Every time, some hired gun comes in and espouses there's mental illness," said Buncombe County District Attorney Ron Moore, whose office prosecuted Davis. "We haven't tried anyone capitally in this state without some kind of diagnosis."
The bill does not say which diagnoses qualify someone as being severely mentally ill. Rather, the bill defines severe mental illness as someone being unable to appreciate the wrongfulness of their conduct, to use rational judgment or to conform their conduct to the law. Each side is likely to present competing testimony from mental health experts, and the question would be decided by a judge or a jury.
Moore said the jury in Davis' trial considered evidence about his mental illness and still sentenced him to death. Moore said a psychiatrist recently found Davis competent enough to fire his lawyers and drop his appeals. He described Davis as "lucid" and "articulate" during recent court hearings.
The rationale behind the bill is similar to successful efforts in recent years to outlaw the death penalty for juveniles and the mentally retarded: a killer's young age, limited mental functioning and severe mental illness make them less culpable for their crimes and not deserving of the death penalty.
"By a certain reasoning, people with certain mental illnesses can be held responsible, but they aren't the worst of the worst because of the illness that they have," said Richard Dieter, executive director of the Death Penalty Information Center, a nonprofit anti-death penalty group based in Washington.
Mental health advocates agree, saying the bill extends the protection already available to those who are mentally retarded to those with severe mental illness.
"These people probably have no real understanding of what occurred," said Julia Leggett, a lobbyist for the Alliance for Disability Advocates.
A few states eyeing it
North Carolina is one of at least three states, including Indiana and Washington, considering such a proposal. Connecticut is the only state that has such a law.
In a poll earlier this spring, 52 percent of 574 North Carolina voters surveyed said they would not support the death penalty for those with severe mental disability. The poll was released by N.C. Policy Watch, a progressive think tank, that hired Public Policy Polling to conduct the survey, which had a margin of error of 4 percentage points.
Last year, the American Bar Association, as well as The American Psychiatric Association and the American Psychological Association, passed identical resolutions about mentally ill defendants and the death penalty. The resolutions said defendants should not be executed if they had severe mental illness at the time of the crime or if their illness prevents them from helping their lawyers handle their appeals, leads them to give up their appeals or makes them unable to understand the purpose of their execution. North Carolina's legislation does not go that far.
But at least one of Davis' lawyers hopes the bill could help Davis and others on death row.
"There is a significant number on death row who are suffering from mental illness," Asheville lawyer Leah Broker said. "I don't think they got fair trials, especially in my client's case. It would give another avenue for review."
She said Davis' trial lawyers didn't present enough evidence about his history of mental illness that she believes could have swayed jurors. Davis' appeal based on those issues was filed in 2000 and has never been heard, she said.
On May 17, 1995, Davis killed co-workers Gerald Allman, Frank Knox and Anthony Balogh and injured Larry Codgill. Davis had been fired two days before the shooting. Knox's widow, Phyllis Knox, declined to comment about the legislation, although she has previously said she opposes the death penalty.
Staff writer Andrea Weigl can be reached at 829-4848 or andrea.weigl@newsobserver.com.
Sunday, May 6, 2007
Hundreds of mentally ill youth prisoners can’t see psychiatrist
Elizabeth Hernandez
May 4, 2007 - 9:37PM
AUSTIN — Young inmates on psychotropic medications at one Texas youth prison have not seen a psychiatrist since January, health providers told lawmakers Friday.
State lawmakers said they were shocked at yet more revelations of problems involving the state’s juvenile corrections agency, this time detailing major gaps in health coverage for incarcerated boys and girls.
Sen. John Whitmire, D-Houston, said health care in the Texas Youth Commission "ain’t worth a damn" and questioned whether the state should continue its contract with the University of Texas Medical Branch. He is co-chairman of a legislative committee charged with investigating the agency.
"It’s so bad, I think we need to start over, like from scratch," Whitmire said. "We got to throw this one out."
At Evins Regional Juvenile Center in Edinburg, mentally ill inmates see a psychiatrist by teleconference only and do not have face-to-face visits, a youth commission official said. At West Texas State School in Pyote, where alleged sexual abuse by administrators grabbed the attention of lawmakers in February, the doctor and psychiatrist have never even met, said Dr. Sheri Talley, who is the doctor at Pyote.
About one-third of 250 people at West Texas State School have psychiatric problems, Talley said.
At Corsicana Residential Treatment Center, there are two part-time psychiatrists for 170 youth, all of whom are diagnosed with serious mental illness and sent there to stabilize before beginning their "socialization" program at other youth commission facilities.
One of the psychiatrists is leaving at the end of May, said Nancy Slott, the agency’s health services administrator.
At Ron Jackson State Juvenile Correctional Complex in Brownwood, children have not seen psychiatrists since January, meaning mentally ill youth are on psychotropic medicine with no oversight, officials said.
There are 460 youth living in the two-prison complex.
Slott said she has hired a contract psychiatrist to go to the school there once a week beginning May 14. He will commute from San Antonio, she said.
Because it is difficult to recruit child psychiatrists to Edinburg, the youth commission lets mentally ill youth there visit with a psychiatrist in Austin by teleconference. He is available eight hours a week, Slott said.
The psychiatric problems are among many the agency’s new leaders are trying to address, said youth commission spokesman Jim Hurley. He did not know of any plans to send a psychiatrist to Brownwood before May 14 but said the agency will do what it takes to get youth proper care.
Teleconferencing for health care, like that done at Evins, is becoming increasingly popular as a way to bring medical care to rural areas, Hurley said.
"Obviously, the best would be a face-to-face meeting, but if we’re having trouble making something available, we’ve got to do something to bring medical care," he said.
The intake unit in Marlin, near Waco, where all youth are processed, is "wholly inadequate" because it is not big enough and does not ensure patients’ confidential conversations with health providers won’t be overheard, said Sandra Ferrara, director of youth services for UTMB.
Whitmire asked why lawmakers didn’t learn of these problems sooner.
Dr. Ben Raimer, UTMB’s vice president and chief executive officer for community health services, said he told the Legislature that UTMB needed more money in years past, and even asked to get out of the contract.
"There is no oversight in the current system," he said.
Elizabeth Amazeen, the facility nurse manager at Giddings State School, where children who commit murder are sent, said in the past year she has seen more mentally ill and more violent youth in the infirmary.
"They are hurting each other; they are hurting the staff," Amazeen said.
"Our nurses are weary. They cannot keep up with the injuries they are seeing."
____
Elizabeth Hernandez covers the state capital for Valley Freedom Newspapers. She is based in Austin and can be reached at (512) 323-0622.
May 4, 2007 - 9:37PM
AUSTIN — Young inmates on psychotropic medications at one Texas youth prison have not seen a psychiatrist since January, health providers told lawmakers Friday.
State lawmakers said they were shocked at yet more revelations of problems involving the state’s juvenile corrections agency, this time detailing major gaps in health coverage for incarcerated boys and girls.
Sen. John Whitmire, D-Houston, said health care in the Texas Youth Commission "ain’t worth a damn" and questioned whether the state should continue its contract with the University of Texas Medical Branch. He is co-chairman of a legislative committee charged with investigating the agency.
"It’s so bad, I think we need to start over, like from scratch," Whitmire said. "We got to throw this one out."
At Evins Regional Juvenile Center in Edinburg, mentally ill inmates see a psychiatrist by teleconference only and do not have face-to-face visits, a youth commission official said. At West Texas State School in Pyote, where alleged sexual abuse by administrators grabbed the attention of lawmakers in February, the doctor and psychiatrist have never even met, said Dr. Sheri Talley, who is the doctor at Pyote.
About one-third of 250 people at West Texas State School have psychiatric problems, Talley said.
At Corsicana Residential Treatment Center, there are two part-time psychiatrists for 170 youth, all of whom are diagnosed with serious mental illness and sent there to stabilize before beginning their "socialization" program at other youth commission facilities.
One of the psychiatrists is leaving at the end of May, said Nancy Slott, the agency’s health services administrator.
At Ron Jackson State Juvenile Correctional Complex in Brownwood, children have not seen psychiatrists since January, meaning mentally ill youth are on psychotropic medicine with no oversight, officials said.
There are 460 youth living in the two-prison complex.
Slott said she has hired a contract psychiatrist to go to the school there once a week beginning May 14. He will commute from San Antonio, she said.
Because it is difficult to recruit child psychiatrists to Edinburg, the youth commission lets mentally ill youth there visit with a psychiatrist in Austin by teleconference. He is available eight hours a week, Slott said.
The psychiatric problems are among many the agency’s new leaders are trying to address, said youth commission spokesman Jim Hurley. He did not know of any plans to send a psychiatrist to Brownwood before May 14 but said the agency will do what it takes to get youth proper care.
Teleconferencing for health care, like that done at Evins, is becoming increasingly popular as a way to bring medical care to rural areas, Hurley said.
"Obviously, the best would be a face-to-face meeting, but if we’re having trouble making something available, we’ve got to do something to bring medical care," he said.
The intake unit in Marlin, near Waco, where all youth are processed, is "wholly inadequate" because it is not big enough and does not ensure patients’ confidential conversations with health providers won’t be overheard, said Sandra Ferrara, director of youth services for UTMB.
Whitmire asked why lawmakers didn’t learn of these problems sooner.
Dr. Ben Raimer, UTMB’s vice president and chief executive officer for community health services, said he told the Legislature that UTMB needed more money in years past, and even asked to get out of the contract.
"There is no oversight in the current system," he said.
Elizabeth Amazeen, the facility nurse manager at Giddings State School, where children who commit murder are sent, said in the past year she has seen more mentally ill and more violent youth in the infirmary.
"They are hurting each other; they are hurting the staff," Amazeen said.
"Our nurses are weary. They cannot keep up with the injuries they are seeing."
____
Elizabeth Hernandez covers the state capital for Valley Freedom Newspapers. She is based in Austin and can be reached at (512) 323-0622.
Saturday, May 5, 2007
Mentally ill inmates get state boost
New initiatives and centers open to provide psychiatric treatment.
By ASSOCIATED PRESS
Published May 4, 2007
JACKSONVILLE - A $16.6-million infusion from state leaders and new initiatives will allow the Department of Children and Families to meet state requirements to get mentally ill inmates into hospitals and out of county jails.
Last fall, mental-health advocates and court officials lambasted the state for failing to meet a state law, resulting in hundreds of severely ill inmates being locked up in county jails for months instead of moving them to psychiatric hospitals in 15 days as required by law. Some judges threatened to fine former DCF Secretary Luci Hadi and hold her in contempt.
DCF statistics indicate the situation is improving.
In early January, there were 270 people on the waiting list for mental health facilities for more than 15 days, said Al Zimmerman, a DCF spokesman. By the middle of next week, that number should be zero, Zimmerman said.
DCF officials have contracted with GEO Care, which runs the South Florida Evaluation and Treatment Center in Miami, to oversee new beds at two facilities owned by the state that were turned into treatment centers.
In March, an unused Department of Corrections building in Miami became the South Florida Evaluation and Treatment Center Annex and an empty Department of Juvenile Justice building in Martin County is now Treasure Coast Forensic Treatment Center.
The two new centers have about 400 staff members to care for 275 mentally ill patients.
As part of legislation approved Wednesday and sent to Gov. Charlie Crist, the Legislature is funding 39 new beds, plus keeping open the beds it funded in December.
The legislation sets aside about $4-million to pay for community grants to try to keep people out of jail and $2.5-million for in-jail treatment.
The in-jail treatment programs are operating already in Pinellas and Orange counties, but Zimmerman said officials would like to see it go statewide.
"This bill is a win-win for everyone, " said Sen. Gwen Margolis, D-Bay Harbor Islands. "For those who are mentally ill, it moves them to centers
By ASSOCIATED PRESS
Published May 4, 2007
JACKSONVILLE - A $16.6-million infusion from state leaders and new initiatives will allow the Department of Children and Families to meet state requirements to get mentally ill inmates into hospitals and out of county jails.
Last fall, mental-health advocates and court officials lambasted the state for failing to meet a state law, resulting in hundreds of severely ill inmates being locked up in county jails for months instead of moving them to psychiatric hospitals in 15 days as required by law. Some judges threatened to fine former DCF Secretary Luci Hadi and hold her in contempt.
DCF statistics indicate the situation is improving.
In early January, there were 270 people on the waiting list for mental health facilities for more than 15 days, said Al Zimmerman, a DCF spokesman. By the middle of next week, that number should be zero, Zimmerman said.
DCF officials have contracted with GEO Care, which runs the South Florida Evaluation and Treatment Center in Miami, to oversee new beds at two facilities owned by the state that were turned into treatment centers.
In March, an unused Department of Corrections building in Miami became the South Florida Evaluation and Treatment Center Annex and an empty Department of Juvenile Justice building in Martin County is now Treasure Coast Forensic Treatment Center.
The two new centers have about 400 staff members to care for 275 mentally ill patients.
As part of legislation approved Wednesday and sent to Gov. Charlie Crist, the Legislature is funding 39 new beds, plus keeping open the beds it funded in December.
The legislation sets aside about $4-million to pay for community grants to try to keep people out of jail and $2.5-million for in-jail treatment.
The in-jail treatment programs are operating already in Pinellas and Orange counties, but Zimmerman said officials would like to see it go statewide.
"This bill is a win-win for everyone, " said Sen. Gwen Margolis, D-Bay Harbor Islands. "For those who are mentally ill, it moves them to centers
Thursday, May 3, 2007
Friday My View: Mental health isn't simply a safety issue
By Maggie Labarta
MY VIEW
Kudos to Gov. Charlie Crist for swiftly signing an executive order that establishes the Gubernatorial Task Force for University Campus Safety, which will review all security measures on Florida's college and university campuses.
One of the benefits of this important response to the tragic events at Virginia Tech will be the increased dialogue regarding the treatment of students with mental illness. As this occurs, we should consider a few important points.
The first is that the overwhelming majority of people with mental illness are not violent. In general, those with a mental illness are more likely to be the victims than the perpetrators of violent crime. The tragedy in Blacksburg should not make us afraid of those with mental illness, but it should make us realize that mental illness cannot be ignored without consequences.
Without early and consistent care, the condition of those who suffer from certain illnesses can deteriorate, making their symptoms more severe and increasingly difficulty to treat.
Second, for far too many Floridians, mental illness remains untreated because of a lack of sufficient investment in our state's mental-health system. Florida currently ranks 48th in the country in per-capita spending for mental-health services, 47th in Medicaid spending for child beneficiaries, and 43rd in Medicaid spending for adult beneficiaries.
Florida also ranks second in the number of homeless, first in the number of substantiated reports of child abuse and neglect, second in the number of children in juvenile detention facilities, and third in the number of prison inmates in comparison with other states.
A significant portion of these problems can be traced to the lack of mental-health care. It is an embarrassing and unfortunate testimony to our lack of commitment to care for those with mental illness; we are not adequately funding proven and cost-effective local mental-health programs.
The success of these programs in communities across our state proves time after time that treatment and community supports work and that access to local mental-health care is the key to providing those with mental illnesses with much-needed help at a reasonable cost to taxpayers.
Without adequate investment in the mental-health system through the funding of community-based services, we will by default be investing in hospital inpatient services, emergency-department care, shelters, foster care, juvenile detention facilities, jails and prisons.
Or worse.
Today's college campuses are more vulnerable than ever to problems associated with untreated mental illness simply because more young people than ever with mental illness are in school.
The Americans with Disabilities Act bans the exclusion of students because of mental illness, but is there enough support on campus for ill students suddenly faced with the additional financial, social and academic pressures of college life?
Florida's institutions of higher learning are assessing their capacities to deal with an increasing number of students with mental illness and are working toward needed changes. Undoubtedly, however, some of these students will require services that will be beyond our colleges' and universities' capacities to meet those needs, and they will rely on community-based programs to help.
Our communities with colleges and universities have an excellent history of collaboration on these issues, but often, students and others end up encountering mental-health services through the legal system instead. Just as we wrongly depend on emergency departments to be the front door for physical health care (instead of focusing more on routine and nonemergency care), jails often end up being the front door for mental-health care.
We must reach these people sooner - long before they are referred for treatment by the courts. That is accomplished through the recognition that mental illness can affect anyone and needs early identification.
We must remove the stigma of mental illness, continue efforts to educate the public on the facts about mental health, and encourage people to seek treatment early. Identification works only if there is an adequately funded array of community-based programs that can provide care after screening and early identification.
Establishing a task force focused on campus safety is a needed and important step. But identification and communication is just part of the battle to prevent another tragedy as happened at Virginia Tech.
Our failure to treat mental health is one of the significant health issues in this state. Until we are serious about addressing it, the number of people left untreated until they commit a crime will continue to increase. And that is an unnecessary risk that none of us should be willing to take.
Maggie Labarta is the chairman of the board for the Florida Council for Community Mental Health and the CEO of Meridian Behavioral Healthcare in Gainesville. Contact her at maggie_labarta@mbhci.org.
MY VIEW
Kudos to Gov. Charlie Crist for swiftly signing an executive order that establishes the Gubernatorial Task Force for University Campus Safety, which will review all security measures on Florida's college and university campuses.
One of the benefits of this important response to the tragic events at Virginia Tech will be the increased dialogue regarding the treatment of students with mental illness. As this occurs, we should consider a few important points.
The first is that the overwhelming majority of people with mental illness are not violent. In general, those with a mental illness are more likely to be the victims than the perpetrators of violent crime. The tragedy in Blacksburg should not make us afraid of those with mental illness, but it should make us realize that mental illness cannot be ignored without consequences.
Without early and consistent care, the condition of those who suffer from certain illnesses can deteriorate, making their symptoms more severe and increasingly difficulty to treat.
Second, for far too many Floridians, mental illness remains untreated because of a lack of sufficient investment in our state's mental-health system. Florida currently ranks 48th in the country in per-capita spending for mental-health services, 47th in Medicaid spending for child beneficiaries, and 43rd in Medicaid spending for adult beneficiaries.
Florida also ranks second in the number of homeless, first in the number of substantiated reports of child abuse and neglect, second in the number of children in juvenile detention facilities, and third in the number of prison inmates in comparison with other states.
A significant portion of these problems can be traced to the lack of mental-health care. It is an embarrassing and unfortunate testimony to our lack of commitment to care for those with mental illness; we are not adequately funding proven and cost-effective local mental-health programs.
The success of these programs in communities across our state proves time after time that treatment and community supports work and that access to local mental-health care is the key to providing those with mental illnesses with much-needed help at a reasonable cost to taxpayers.
Without adequate investment in the mental-health system through the funding of community-based services, we will by default be investing in hospital inpatient services, emergency-department care, shelters, foster care, juvenile detention facilities, jails and prisons.
Or worse.
Today's college campuses are more vulnerable than ever to problems associated with untreated mental illness simply because more young people than ever with mental illness are in school.
The Americans with Disabilities Act bans the exclusion of students because of mental illness, but is there enough support on campus for ill students suddenly faced with the additional financial, social and academic pressures of college life?
Florida's institutions of higher learning are assessing their capacities to deal with an increasing number of students with mental illness and are working toward needed changes. Undoubtedly, however, some of these students will require services that will be beyond our colleges' and universities' capacities to meet those needs, and they will rely on community-based programs to help.
Our communities with colleges and universities have an excellent history of collaboration on these issues, but often, students and others end up encountering mental-health services through the legal system instead. Just as we wrongly depend on emergency departments to be the front door for physical health care (instead of focusing more on routine and nonemergency care), jails often end up being the front door for mental-health care.
We must reach these people sooner - long before they are referred for treatment by the courts. That is accomplished through the recognition that mental illness can affect anyone and needs early identification.
We must remove the stigma of mental illness, continue efforts to educate the public on the facts about mental health, and encourage people to seek treatment early. Identification works only if there is an adequately funded array of community-based programs that can provide care after screening and early identification.
Establishing a task force focused on campus safety is a needed and important step. But identification and communication is just part of the battle to prevent another tragedy as happened at Virginia Tech.
Our failure to treat mental health is one of the significant health issues in this state. Until we are serious about addressing it, the number of people left untreated until they commit a crime will continue to increase. And that is an unnecessary risk that none of us should be willing to take.
Maggie Labarta is the chairman of the board for the Florida Council for Community Mental Health and the CEO of Meridian Behavioral Healthcare in Gainesville. Contact her at maggie_labarta@mbhci.org.
Sunday, April 29, 2007
Change mental-health services
Albert "Lee" Mountjoy
April 29, 2007
Changes need to be made in how Florida treats the mentally ill. I grew up in Christiansburg and Blacksburg, Va. The tragedy at Virginia Tech hit close to home for me on many levels.
Mass killer Seung-Hui Cho is another example of why the public needs to be educated, brought out of the "dark ages" concerning the treatment of mental illness.
Just like cancer, diabetes or heart disease, mental illness is a medical condition, a very serious medical condition. It is not something a person is too weak or not moral enough to control.
When people with diabetes experience the symptoms of their disease, they are immediately treated with insulin or sugar to prevent the most serious consequences of coma or death. When people show up at an emergency room with chest pain, they are immediately triaged, given an EKG and baby aspirin to prevent a full coronary.
But when mentally ill people ask for help at a mental-health facility in Florida because they are experiencing new symptoms or an increase in the intensity of their illness, the response is, "Come back if you become suicidal or homicidal." I cannot begin to understand the reasoning behind a professional telling a person in crisis, asking for help, "You're not sick enough yet. Come back when you have a plan for suicide or a desire to kill." Is that what professionals call "rational thinking"?
There needs to exist in mental-health facilities in Florida a standard triage protocol as exists in all emergency rooms. When mentally ill people ask for help because their medication is not working, they are experiencing new or an increased intensity in the symptoms of their illness, help should always be available. They should never be turned away.
Who can say that by the time a person reaches the point of suicidal or homicidal thoughts taking form, they will continue being able to reach out for help before a tragedy occurs? The nation saw the answer to that question at Virginia Tech.
Those who do understand the problems in Florida's mental-health facilities suggest the solution is too costly. State mental-health facilities are understaffed; personnel are underpaid and overburdened. My response is, "one ounce of prevention is worth more than one pound of cure." Prisons for mentally ill inmates, lifetime incarcerations and the loss of productive citizens like those victims at Virginia Tech cost the state and the federal government far more than allocating more money for psychotropic medications and treatment.
Please do not wait one more day, one more suicide or one more tragedy to make the needed changes. Educate the public and allocate the funding today.
Albert "Lee" Mountjoy lives in Kissimmee.
Activists fight jails' solitary cell rules
By JAY STAPLETON
Staff Writer
DAYTONA BEACH -- It's called "the buck naked cell."
For mentally ill inmates placed in solitary confinement at the Volusia County Branch Jail without clothing to prevent suicide, the experience is frightening.
And demeaning.
But the practice is commonly used in jails and prisons throughout the country, and what some lawyers find most troubling is that the practice is used for people who have yet to stand trial.
"Telephones constantly ringing. Other inmates screaming. Sleep is difficult," inmate Brett Roberts testified during a court hearing on his treatment Wednesday. "I began to bang my head on the door, and I was told by an officer the governor was there to evaluate me for the death penalty."
Human rights activists say mentally ill inmates, who are increasingly finding themselves in county jails as social service budgets are slashed, are at special risk of abuse. Roberts' claims of taunts by those watching him, including jokes about his genitals, are plausible, they said. Prison officials did not address his specific claims, but said protocols were followed.
Calling for change, an attorney with the National Prison Project of the American Civil Liberties Union said Thursday there are alternatives to "stripping a person," including giving inmates suicide-proof gowns. Other options include closer monitoring of possibly suicidal inmates and building cells that make suicide "very difficult."
But such care is staff-intensive and costs more.
"That's why many resort to the far-cheaper option of throwing someone naked into a bare concrete cell," said David C. Fathi, who has brought lawsuits against jails and prisons throughout the country over how mentally ill people are treated in confinement.
In calling jails and prisons "asylums of last resort," Fathi says cost is most often the reason prisoners are held naked, a practice the group finds inhumane and unnecessary. An appeals court recently compared the practice "to a 1930s Soviet gulag," he said.
Roberts, 26, of Titusville spent a month locked up at the county jail for a violation of probation. There was no indication Roberts, who was first diagnosed with bipolar disorder at 19, was psychotic or a danger to himself or others when he was moved here Feb. 12, according to testimony.
He'd pleaded no contest to a charge of fleeing from officers at a traffic stop and got probation. He was doing well and holding a job.
"People couldn't even tell I was mentally ill," Roberts said.
But when his court-ordered urine sample tested positive for marijuana, he was sentenced to spend six months in the county jail.
Within two weeks, paranoia and delusions that he was going to be killed prompted officials to move Roberts into seclusion. He was placed in a bare cell with a bunk, a toilet, a sink and no movable objects. The medication he got was not what Roberts had requested, and jail doctors never checked with the inmate's physician, he testified.
At times, Roberts testified, he was strapped into a restraint chair and sprayed with a chemical stunning agent because he did not comply with corrections officers. He refused to take his medication, according to testimony.
"He didn't start to get bad until he came to Volusia County," said Virginia Chester, his assistant public defender.
She argued Roberts should complete his sentence at home, claiming the mental breakdown was preventable and his civil rights were violated.
Circuit Judge William Parsons had ordered Roberts released last month until a hearing to determine whether he endured cruel and unusual punishment.
But the judge found the way Roberts was treated was neither cruel nor unusual.
"What does the jail do?" he pondered.
How Roberts was handled "beats the heck out of hanging yourself," he said.
He found care was taken to avoid injury to Roberts. There was no evidence his mental condition worsened because of a change in his medication, the judge said in disagreeing that a constitutional violation occurred.
All agreed, including the county's head of inmate mental-health treatment, who testified jail is not the place for those proven to be mentally ill.
But Dr. David Hager, director of mental-health services for Prison Health Services, defended the psychiatric treatment, saying Roberts was medicated under approved practices. Hager saw Roberts three times at the jail and said he had started "to stabilize."
Asked by attorney Chester if his treatment was humane, Hager answered, "That's a difficult question to answer in a corrections setting. A correctional setting is a different world, with different priorities."
Prosecutor Carine Jarosz told the judge Roberts shouldn't be allowed to use his mental illness as an excuse.
"He still did the crime," she said. "And he still needs to be punished accordingly."
The American Civil Liberties Union has called for reform of how mentally ill inmates are treated. A federal judge in New York is reviewing the settlement in a lawsuit that could impact how mentally ill inmates are treated in other states, including Florida, in the future.
The New York agreement calls for extensive reviews of all prisoners sent to solitary confinement.
The National Prison Project's Fathi said more reform is needed.
"The fact that so many (people with mental illness) end up in jails and prisons because there's no place else for them needs to change."
jay.stapleton@news-jrnl.com
Wednesday, April 25, 2007
New Rules for Confining the Mentally Ill
April 25, 2007
By SARAH KERSHAW
New York State would more closely scrutinize its use of solitary confinement for mentally ill prison inmates under the proposed terms of a legal agreement scheduled for review by a federal judge on Friday.
New York is one of several states that have faced lawsuits over the means used to punish mentally ill prisoners, and, under a settlement reached last week, it has agreed to consider changes in how it uses solitary confinement as a disciplinary measure with the mentally ill.
Many advocates hail the agreement as a watershed in prison reform because of the effects long sentences in isolation have had on the most vulnerable prisoners, including suicide and self-mutilation.
Some mentally ill inmates serve months to years in punitive segregation, locked up for 23 hours a day and sometimes restricted to a diet of cabbage and a pasty flour loaf three times daily for up to 30 days for misbehaving.
Disability Advocates Inc. and the Legal Aid Society of New York sued the state over the practices five years ago, and the resulting agreement goes before Judge Gerard E. Lynch of the Southern District of New York on Friday for final review.
If the agreement is approved, as expected, the state will not be barred from the use of solitary confinement, or punitive segregation, to discipline mentally ill prisoners, but it would have to provide far more assessment and services for mentally ill inmates in solitary. In addition, the state would be required to review the reasons for and the length of proposed segregation sentences.
Many mental health advocates believe that the New York settlement will create pressure on other states to review their policies of confining mentally ill prisoners.
Others, including state lawmakers and advocates, said the agreement was only a small step toward stopping inhumane treatment of these prisoners. Many of those advocates were particularly disheartened last fall when Gov. George E. Pataki vetoed a bill that would have banned the use of solitary confinement for the mentally ill in New York.
"We see the settlement as a step in the right direction because it provides additional resources and services for treating the mentally ill in prison," said Robert Gangi, executive director of the Correctional Association of New York, an advocacy group that is now lobbying the new administration in Albany to stop sending mentally ill prisoners into isolation. "But it falls far short of the policy changes that are needed to ensure humane and appropriate treatment for all the mentally ill people in prison."
In New York, with one of the largest prison populations in the country, mental illness has been diagnosed in about 8,400 of the 63,000 inmates, according to the State Office of Mental Health. The number of inmates has decreased significantly in the last few years, but Mr. Gangi said the number of mentally ill prisoners was rising, possibly because the condition is being more accurately diagnosed.
Under the agreement, mentally ill prisoners sent to solitary confinement would be entitled to leave their cells for therapy and treatment for two to four hours daily. Their placement in solitary confinement would have to be preceded by extensive reviews, all prisoners entering the system would be screened for mental illness, and the state would be required to provide some mentally ill prisoners with alternative residential housing.
State officials said that because of both the agreement and their own budgetary priorities, they had set aside an additional $9 million in the 2007-8 fiscal year for programs within existing prisons and new or renovated facilities to accommodate mentally ill inmates, a total of $57.5 million dedicated to mentally ill inmates.
The agreement also stipulates that New York prisons, which local and national advocates say are unique in using restricted diets to punish prisoners already in segregation, cannot use the cabbage-and-loaf punishment for more than seven days with mentally ill prisoners without "exceptional circumstances."
Lawyers who brought the suit and national prisoner rights advocates said the New York settlement was unique in covering all mentally ill prisoners, from the time they enter the system until they leave, whereas some states have merely stopped sending prisoners with major mental illnesses to prisons with especially harsh conditions.
"The proof of the pudding is in the eating," said David C. Fathi, senior staff counsel with the American Civil Liberties Union’s national prison project, who has handled several cases around the country regarding the treatment of mentally ill inmates. "We will have to see how this is implemented. But on paper, it is very significant, a victory and a step forward."
He added, "Now we can point to New York and say, if New York can do it, why can’t you do it?"
Sunday, April 22, 2007
Mentally ill posing challenge for TYC
State leaders ask if the prisons are really the best places for such juveniles.
By LISA SANDBERG
Copyright 2007 Houston Chronicle Austin Bureau
AUSTIN — Texas Youth Commission staff have to watch for more than just poor behavior when looking after Zachariah Tarver — they have to ensure he's not hanging himself, slicing his veins, writing on the walls with his blood or drinking cleaning fluid.
It's not easy. Tarver has done these things before, threatening or attempting suicide at least a half-dozen times in the 10 days after he was plucked from a psychiatric hospital and sent to TYC late last year, agency records indicate.
The youth, now 18 and confined to TYC's Corsicana Residential Treatment Center, has spent virtually every day since his arrival on suicide watch. He hallucinates, and he responds to questions from doctors with a smile, no matter what is asked of him, according to the records, which were provided by his family.
Psychiatrists hired by TYC diagnosed him with major depression, bipolar and schizoaffective disorders and drug dependence.
Now, as state leaders work to overhaul TYC, many are asking the question: Are juvenile prisons the best settings for mentally ill youths like Tarver?
He had two brushes with the law, including taking his father's car without permission, before being sentenced to TYC last year for driving without a license and violating curfew.
"I personally don't think that the mentally ill should be treated like law violators if their medical problems are causing the behavior," said Sen. John Whitmire, D-Houston, who co-chairs the joint legislative committee investigating the myriad problems that beset the agency.
Whitmire said confining juveniles who are mentally ill should be a last resort.
In the wake of a scandal involving reported sexual or physical abuse of inmates by guards at several TYC facilities, lawmakers are promising to substantially reduce the system's offender population and make it a place for seriously delinquent youths whose behaviors aren't caused by illnesses.
But they're also grappling with issues of public safety since some mentally ill inmates have committed violent offenses.
A bill making its way through the Legislature would keep those with misdemeanor convictions out of the TYC system and would provide local communities more resources to treat most mentally disturbed youths in community-based settings closer to home.
The task is daunting, given the number of youths with mental health issues who wind up in TYC.
The agency decided mental health services were required for nearly 38 percent of the 2,700 youths it received in 2005.
Leaving in worse condition
Until she resigned under pressure last week, Corrine Alvarez-Sanders, TYC's assistant deputy executive director for rehabilitative services, had worked with young inmates for 15 years and said too many who are mentally ill don't get appropriate treatment and leave in worse condition than when they arrived.
Secured lockups are appropriate for some mentally ill offenders with violent tendencies, but every one of those would be better served in smaller residential treatment centers, she said.
"I don't want to say that all of our facilities are producing outcomes that are worse. But what's clear to us is the interventions don't match the specialized needs that are present," Alvarez-Sanders said.
All too often, poorly trained staff extend the TYC terms of mentally ill inmates, confusing a mental health issue with a bad attitude or anti-social behavior, she said.
Excessive confinements
She's seen those with borderline intelligence disciplined for failing to complete written assignments they were incapable of doing.
"I'm not going to minimize the fact that we have kids in our care that are confined for excessive lengths of time," she said.
Juveniles entering TYC spend several weeks at the Marlin Orientation and Assessment Unit, 25 miles east of Waco, undergoing a battery of psychological, emotional, vocational and chemical dependency tests.
Those deemed suffering from severe mental disorders are assigned to either the Corsicana Residential Treatment Center or the Crockett State School, which have specialized psychiatric care, higher staff-to-offender ratios and rehabilitative programs tailored to their needs, Alverez-Sanders said.
But, clearly, not everyone who needs mental health services gets them.
Severe problems
Marquieth Jackson has spent 3 1/2 years at TYC but only one month at Corsicana, where no one could handle him, said the attorney representing his Houston family. Jackson was sent to a facility in Beaumont that specializes in drug treatment.
No one could dispute that Jackson suffered from severe emotional and behavioral problems when he was sent to TYC at 12 for violating probation by breaking a window, one of his numerous encounters with police.
Before he ever stepped foot in TYC, he'd been diagnosed as being bipolar and depressed, with schizoaffective and attention deficit hyperactivity disorders, according to TYC records provided by his mother, Tarsha.
By age 4, he'd been kicked out of day care for aggressive behavior. At 10, he assaulted a teacher.
He was committed twice to psychiatric hospitals and received intensive counseling from the Mental Health and Mental Retardation Authority of Harris County.
Incapable of following rules
Tarsha Jackson said her son has received virtually no mental health treatment or medicine since arriving at TYC. (The agency cannot discuss specific cases.)
Like most offenders, Marquieth came into the system with a nine-month minimum sentence. His mother said he's too mentally ill to follow TYC rules. "I tell them, 'You've had him since he was 12. If he hasn't been able to work your program in 42 months, what are you going to do? Keep him until he's 42?' "
In a sign that things may indeed be changing, Tarsha Jackson received word recently that her son, who's now 15, would soon be discharged on a mental health release.
She's relieved but insists she's realistic about the difficulties ahead.
"We're going from (the unit) to (a psychiatric) hospital. No pit stops," Jackson said.
Zachariah Tarver's mother, Terri Lovelace, is still waiting to hear whether her son soon will be released.
lsandberg@express-news.net
RESOURCES
MENTAL DISORDERS
Texas Juvenile Probation Commission statistics indicate 38 percent of TYC inmates arriving in 2005 suffered from mental health disorders, although the agency indicated the number could be as high as 50 percent. Of those deemed mentally impaired by the agency:
• 11 percent: Confined for nonviolent misdemeanors;
• 17 percent: Confined for violent felonies;
• 20 percent: Confined for nonviolent felonies, such as car theft or burglary;
• 3 percent: Confined for violent misdemeanors, such as noninjury assault
Saturday, April 21, 2007
School Violence: The psychology of youthful mass murder and what to do about it
Practical Police Psychology
with Dr. Laurence Miller
Q: Just when we were so preoccupied with the fear of terrorism, now comes news of the deadly Virginia Tech shooting. It looks like school violence is back in the news. What causes someone to commit mass murder? What are the effects on individuals and communities? How can law enforcement and the general public best prevent, respond to, and recover from episodes of school violence?
A: School violence is not really back in the news because it never left. Most recently eclipsed by the war on terror, incidents like Virginia Tech – as with Littleton, Columbine, and others – remind us that most killers of Americans are still our own citizens and that many of these murders take place where we expect them least, our schools. This column will provide some insight into the psychology of this modern form of mass murder and provide some practical recommendations for preventing, responding to, and recovering from school violence.
Demographics of School Violence
The good news is that youth violence as a whole has been decreasing in frequency since the 1970’s. However, during the same period, the severity of juvenile violence has dramatically increased, with a greater number of homicides and involving more potent weapons. In addition, students are committing violence at increasingly younger ages. According to National School Safety Center, almost 3 million crimes are committed on or near a school campus each year, accounting for 11 percent of all reported crimes in the United States.
In this context, high-profile multiple murders on school campuses, horrific though they may be, are still relatively low-frequency events. Much more common are the everyday instances of bullying, harassment, and nonlethal violence that occur on school campuses across the nation and the world. These, too, can be psychologically traumatizing and may set the stage for episodes of explosive violence.
School Victimization
The kinds of intimidation and harassment that would get an employee fired at almost any job is routinely tolerated by school authorities when it occurs between students. In virtually every case of school violence studied, the perpetrators had been harassed or persecuted in some way by other students and their efforts to have their cases resolved by school authorities were rebuffed or ignored. Of course, a far greater number of bullied students suffer in silence without seeking to redress their injustice with a greater atrocity.
Peer victimization is the experience of being a target of the aggressive behavior of other students. Indirect aggression is carried out through a third party or in some way that conceals the identity of the aggressor. Relational aggression is behavior which damages peer relationships and acceptance within the social group. In verbal victimization, the student’s status is attacked or threatened with words and this can be exceedingly vicious and damaging to a student’s psyche and self-image.
Studies have shown the effects of school victimization to include lowered self-esteem, increased loneliness and isolation, anxiety and panic attacks, depression and suicidal thoughts, psychosomatic symptoms, and posttraumatic stress disorder. Victimized children miss more days from school, suffer impaired academic performance, and make more trips to the doctor.
Only rarely, do disturbed, desperate students resort to violence but, when they do, it often highlights systemic problems that have occurred for a long time – a strong parallel with workplace violence.
School Violence Perpetrators
For all the media attention given to school violence, very little empirical work has been done in the psychology of this kind of youthful mass murder. Accordingly, much of what we know about school violence perpetrators has been extrapolated from studies of other types of mass murder, especially older perpetrators of workplace violence, who have been studied for several decades, as opposed to school shootings, which are a more recent phenomenon.
The cycle of violence typically begins when the student undergoes an event or series of events that he perceives as the "last straw" in a cumulative series of humiliations. Based on his predisposing personality and psychological dynamics, his reaction will consist of some combination of persecutory ideation, projection of blame, and violent revenge fantasies. As thoughts and emotions stew, the student isolates himself from the input of others and enters a mode of self-protection and self-justification in which a violent act may come to be perceived as "the only way out." The actual commando-style mission may be executed impulsively and all at once, or it may undergo numerous revisions and months of planning. The violent act itself may be carried out alone or with the collaboration of like-minded compatriots. In most cases, the episodes end with the death of the perpetrator(s), either by their own hand or by responding law enforcement authorities.
Preventing School Violence
Academic administrators who remain unmoved by the human costs of school violence might want to consider the potential legal and financial liabilities. In Stoneking v. Bradford Area School District, 1988, the court found that, if a school is aware of dangerous and unlawful activities on its premises and takes insufficient action to address them, it may be found liable under the 14th amendment. School officials may be protected from liability, however, if they can demonstrate due diligence in their prevention of crime on campus.
Accordingly, the following recommendations are adapted from a large body of work in the area of workplace violence that can be productively applied to the academic setting. Law enforcement officials, in particular, should be aware of these concepts because local police departments are typically the main agencies contacted by schools for advice on violence prevention programs, and they are almost always the first to be called when a crisis erupts.
Clear Policies. Schools should have clear, strong, consistent, written policies against bullying, intimidation, and harassment. They should have effective security programs, a standardized, confidential, and user-friendly reporting system, a supportive faculty, open channels of communication, and training in verbal negotiation and conflict resolution skills. Schools must have a clearly understood policy of zero tolerance for violence. This should be contextualized as a safety issue, the same as with rules about fire prevention or disaster drills. Plans should be in place that specify how threats are reported and to whom, as well as a protocol for investigating threats.
Safe Discipline. As in the workplace, many acts of violence relate to the perpetrator feeling he was treated unfairly by the administration; some of this relates to confusion over the very zero-tolerance policy cited above. Schools should develop an individualized disciplinary program that strikes a balance between a too heavy-handed approach that might discourage reporting and participation, and a too lax approach that gives the impression of ambivalence and lack of control. Discipline should occur in stages, with a clear policy and rationale for each action taken. School officials should not be afraid to "pull rank" where student safety is concerned.
Safe Suspension or Expulsion. If it comes to that, suspension or expulsion from school can be clear and firm, without being inhumane. This should include a systematic process of documentation of the precise behaviors and rule violations that have necessitated these actions. The student and his family should be treated with reasonable respect, but should understand that the action is final and will be backed up. The student should be informed of any counseling or other services offered by the school for the transition period. For behaviors that constitute criminal acts, school officials should report these to local law enforcement or their own school police if they have them.
Responding to School Violence
Sometimes, despite the best efforts at prevention, a dangerous situation begins to brew and a violent incident becomes a distinct possibility. Or the incident just erupts explosively and personnel have to respond immediately. In either case, the effectiveness of the response will be determined by how thorough the pre-incident planning and training have been.
Warning Signs of Impending Violence. It’s always best for school officials to know their individual students, but generic warning signs include deterioration or changes in dress, speech, facial expression, increased agitation, anxiety, isolation and/or depression, evidence of substance use, or preoccupation with violent events in the media. Almost always, the student’s peers will know something is up way before parents or teachers, which is why a safe and confidential reporting system is so important.
Defusing Violence. Planning and training for defusing potentially violent episodes should be developed, put in place, and reviewed periodically. Elements of such a protocol include initial actions to take when danger begins to escalate, codes and signals for summoning help, chain of command for handling emergencies, appropriate use of verbal control strategies and body language, scene control and bystander containment, tactics for dealing with weapons, and hostage negotiation procedures.
Recovering From School Violence
The crisis is not over when the police and TV crews leave. Students or faculty may have been killed, others wounded, some held hostage, and many psychologically traumatized. Schools should proactively establish policies, procedures, and training for responding to the aftermath of a violent incident, and the plan should include the following elements.
Law Enforcement, Physical Security, and Cleanup. A school representative should be designated to work with local, regional, and/or federal law enforcement. Within the limits of safety, the crime scene should be kept intact until investigators have gone over the area. There should be someone assigned to immediately check, protect, or restore the integrity of the school’s data systems, computers, and files. Physical cleanup of the area, pending approval from law enforcement, should be conducted in as respectful a manner as possible.
Mental Health Mobilization. This includes a prearranged plan for school representatives to contact local mental health professionals immediately, arrange for the clinicians to meet first with school officials for updates and briefings, conduct crisis counseling with affected students, faculty, and families, and arrange follow-up schedules for mental health clinicians to return for psychological services as needed.
Student and Family Interventions. Another designated school official should notify the victims’ families of the incident and be ready to offer them immediate support, counseling, and referral services. The school should arrange time off for grieving and traumatized students and faculty. After the initial stages of the incident have passed, mental health clinicians should help students and school officials find ways of memorializing the victims.
Media and Public Relations. A media spokesperson or public information official should be designated to brief the media and shepherd them away from grieving students, family members, and faculty. School officials should cooperate with law enforcement authorities as to the timing and content of news releases.
Legal Issues and Post-Incident Investigations. These measures include notifying the school’s legal counsel who should be asked to respond to the scene, if necessary. Investigatory questions include the nature of the perpetrator(s), their relationship to fellow students and faculty, history of disciplinary action or suspension, specific circumstances or institutional stressors that may have led to the incident, the role of mental illness or substance abuse, any warning signs that should have been heeded, and a thorough review of the school’s overall security, threat assessment, and critical incident response protocols.
In summary, if any good can come out of a school violence episode, it will be in the form of improved policies and procedures that adopt a best-practices model to the prevention, response, and recovery to and from any kind of institutional mass violence. In these efforts, law enforcement agencies have a vital role to play.
More on the VA Tech Active Shooter Incident NOTE: To learn more about this topic, see:
Miller, L. (1999). Workplace violence: Prevention, response, and recovery. Psychotherapy, 36, 160-169.
Miller, L. (2001). Workplace violence and psychological trauma: Clinical disability, legal liability, and corporate policy. Part I. Neurolaw Letter, 11, 1-5.
Miller, L. (2001). Workplace violence and psychological trauma: Clinical disability, legal liability, and corporate policy. Part II. Neurolaw Letter, 11, 7-13.
Miller, L. (2002). How safe is your job? The threat of workplace violence. USA Today Magazine, March, pp. 52-54.
Miller, L. (2002). Posttraumatic stress disorder in school violence: Risk management lessons from the workplace. Neurolaw Letter, 11, 33, 36-40.
Laurence Miller, PhD is a clinical and forensic psychologist and law enforcement educator and trainer based in Boca Raton, Florida. Dr. Miller is the police psychologist for the West Palm Beach Police Department, a forensic psychological examiner for the Palm Beach County Court, and a consulting psychologist with several regional and national law enforcement agencies. Dr. Miller is an instructor at the Criminal Justice Institute of Palm Beach County and at Florida Atlantic University, and conducts continuing education and training seminars around the country. He is the author of numerous professional and popular print and online publications pertaining to the brain, behavior, health, law enforcement, criminal justice, and organizational psychology. His latest books are Practical Police Psychology: Stress Management and Crisis Intervention for Law Enforcement (Charles C Thomas, 2006) and the forthcoming Mental Toughness Training for Law Enforcement and Street Psychology 101 (Looseleaf Law Publications). Dr. Miller can be contacted at (561) 392-8881 or online at docmilphd@aol.com.
Disclaimer: This article is for educational purposes only and is not intended to provide specific clinical or legal advice.
Colleges face surge of troubled students
By DAVID CRARYAP
NATIONAL WRITER
NEW YORK -- Across America, college counseling centers are strained by rising numbers of mentally ill students and surging demand for mental health services - a challenging trend as campus officials try to identify potential threats like the unstable Virginia Tech gunman.
And even when serious emotional problems are detected, university officials often feel constrained in how they respond due to an array of laws and policies protecting students' rights and privacy.
"The number of people coming to colleges who've had psychiatric treatment has increased tremendously," said Dr. Gerald Kay, a psychiatry professor at Wright State University and chair of the American Psychiatric Association committee on college mental health.
"Now they're able to come to college - that would not have been the case earlier," Kay said. "You've got a very large number of people who may have some vulnerabilities. It has stressed the availability of resources."
Reasons for the surge include the Americans with Disabilities Act, which gives mentally ill students the right to be at college, and increasingly sophisticated medications which enable them to function better than in the past.
Recent surveys and studies underscore the scope of the increase.
A survey last year by the American College Health Association found that 8.5 percent of students had seriously considered suicide, and 15 percent were diagnosed for depression, up from 10 percent in 2000. The Anxiety Disorders Association of America found that 13 percent of students at major universities and 25 percent at liberal arts colleges are using campus mental health services.
Dr. Chris Flynn, director of Virginia Tech's counseling center, has declined to discuss details of gunman Cho Seung-Hui's case, but said the center's staff - which includes a psychiatrist and 11 psychologists - treats about 2,000 students per school year.
In December 2005, a magistrate ordered Cho to undergo an evaluation at a private psychiatric hospital after two women complained about annoying calls from him, and an acquaintance reported he might be suicidal. An initial evaluation found probable cause that Cho was a danger to himself or others as a result of mental illness, but court papers indicate he was free to leave the hospital within days - a step allowed only if hospital officials judged him no longer a danger.
"We have to provide services to students with mental illness - it's not grounds to exclude them from our property," Flynn said. "We cannot discriminate against the mentally ill, nor do we want to."
He said the type of complaints lodged against Cho by the two women are a common and challenging phenomenon on campuses nationwide.
"It is very difficult to predict when what someone perceives as stalking is stalking, and then how it might translate into violence later," Flynn said. "Clearly, if anyone had any warning about a violent incident, people would have stepped in and acted."
Psychologist Sherry Benton, assistant director of counseling services at Kansas State University, has conducted research concluding that students' mental health problems are more complex and severe than 20 years ago.
"We're well aware that problems are getting worse, but what hasn't happened is increasing funding for mental health services," she said. "Most centers are now overwhelmed. Business has gone up and up, but budgets have remained the same or been cut, and that's a huge problem."
One factor, Benton said, is that mental health services are usually not among the categories assessed during colleges' periodic accreditation reviews. If schools needed good services to remain accredited, they might invest more, she said.
Benton views the rising demand for campus mental health services as a good news-bad news development.
"We do get a lot more students into college who have mental illness but are no problem whatsoever," she said. "They do need support and use medication; they go on to lead full, productive lives."
On the downside, she and her colleagues see stress levels among students far higher than a generation ago due to increased workloads and financial strains, often coupled with lack of healthy lifestyles.
Complicating the overall picture is a web of laws and policies that limit the options for worried staff members. Troubled students generally can't be forced to obtain treatment, and privacy laws may limit sharing information about them, even to the extent that some parents have sued schools - including the Massachusetts Institute of Technology and the Oregon Institute of Technology - for not advising them of their children's serious disorders.
Nonetheless, officials on many campuses have set up committees to pool information about students with emotional or behavioral problems so patterns can be detected in what might otherwise be seen as isolated incidents. The trick, officials say, is to find the proper balance between respecting a student's rights and protecting the university.
"That's the tightrope administrators have to walk," said Wright State's Gerald Kay.
"The issue in most instances is how do you bring these people into some sort of treatment."
Benton said any student who issues threats should be dealt with forcefully, regardless of privacy guidelines.
"Safety trumps confidentiality every time," she said. "If someone is a danger to themselves or others, then confidentiality is out the window and you notify who you need to notify to ensure the safety of them and those around them."
Peter Lake, a law professor at Stetson University, contends that officials on many campuses have been too deferential to privacy concerns, at the risk of safety at their schools.
"There's a false consciousness of privacy in higher education - as an institution, we don't like to share information," he said.
"Now, you're going to be seeing a greater emphasis on a management team or a safety czar - someone whose job it is to look at students' overall profiles," Lake said. "It's not only a good idea - it's an idea we can't live without."
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On the Net:
American College Health Association: http://www.acha.org/
Thursday, April 19, 2007
Jump in troubled students alarms mental counselors
SPOTTING THE WARNING SIGNS
Erika Hobbs and Leslie Postal
Sentinel Staff Writers
April 19, 2007
The shootings at Virginia Tech exposed a college trend that worries campus mental-health counselors: rising numbers of troubled students who may not be getting the help they need.
Cho Seung-Hui was reported to police and spent time in a psychiatric hospital, Virginia officials said Thursday, but none of that intervention prevented him from killing 32 people and himself this week.
Mental-health officials at several Florida campuses said they face the same budget constraints and privacy considerations that complicated efforts to help Cho, a sullen student who alarmed English instructors with his violent writings.Despite their best efforts, officials said, someone can slip through the cracks.
"We could tell you today the students that keep us awake at night," said Lesley Sacher, director of Thagard Student Health Center at Florida State University.
College counseling centers across the country report not only an upswing in the number of patients who visit the clinics, but also a surge in the number of freshman students with mental-health problems.
A 2006 National Survey for Counseling Center Directors done by the University of Pittsburgh shows that 92 percent of counseling-center directors nationwide reported concerns about an increased number of students with serious problems.
They also reported jumps in the numbers of students who hurt themselves and those who sought crisis counseling during the past two years.
Clinic directors in Florida say that often the best they can do is screen students carefully and stay alert.
For example, Sacher said mental-health professionals see many students who saw psychiatrists in high school, who take medication to cope and need additional care in college. They are "extra-bright, unbelievably talented, but extraordinarily fragile," she said.
Waits can take weeksBut getting help for them can be difficult.At FSU, students wait three to five weeks to see Sacher's two psychiatrists. Three years ago, the center, which serves FSU's 40,000 students, didn't have any. Last fall, the University of Florida's director of student affairs pleaded with the state for more money for its clinics.
The University of Central Florida has one counselor for every 3,250 students. Industry standards call for one for every 1,000 to 1,500 people. Like officials at the other universities, David L. Wallace, the UCF counseling center's director, said he could double his staff and "it would not be out of line."His counselors deal with emergencies and problems that can be handled quickly, referring students with chronic and more-intense issues to off-campus facilities. They do not have much time for prevention and training programs that might, for example, help students recognize signs of depression in classmates.
"These are the things that so often get put on the back burners," Wallace said. "There is strong recognition there is need for more help, and sometimes the funding is just not available."Campus clinics only see those students who want help, of course.
How to reach the rest, including students such as Cho, is much harder.
In November and December 2005, two women complained to police at Virginia Tech that they had received "annoying" calls and computer messages from Cho, police said.
After the second complaint, the university obtained a temporary detention order and took Cho away for psychiatric evaluation because an acquaintance reported he might be suicidal, authorities said.
About the same time, Cho was referred to the university's counseling service after an English instructor expressed alarm at his writings, police said. It is not clear whether he followed through with treatment.
'It's a difficult thing'Counselors, teachers and administrators in Florida said they walk a fine line not only in picking out who might be a threat, but also in what to do about it.
Thomas Krise, chairman of UCF's English department, said he thinks his Virginia colleagues tried to help Cho.
"It's a difficult thing," Krise said. "English professors are very well-trained, but we're not trained as counselors or psychiatrists. . . . It doesn't sound to me like they missed something.
"The screenplays and assignments that alarmed classmates and instructors were filled with violence, profanity and other vulgarities -- not much different at first glance from video games and gore films on the market today.
Students often write that way, and creativity doesn't indicate mental illness, educators said.
"Stephen King is not chopping up people and putting them in the basement" just because his writing depicts horrific acts, said Stephen Schlow, chairman of UCF's film department.
But since Monday's massacre, the issue of disturbed students has been a frequent topic of conversation.
"That's almost all we've talked about in my office," Schlow said."My guess is that if it were truly disturbed, we would notice it," he added. "That doesn't mean if we said the person is truly disturbed, we would get any more action than they got in Virginia."
Schools can be stymied
Universities have limited options when a student refuses counseling. They can't force an adult to seek care and can't legally contact parents without permission. Most won't expel a student for refusing treatment.
What administrators often do is focus on a behavior. If a student won't stop cutting himself, making suicide threats or stalking others, Florida schools often step in and recommend he take a break to recuperate, said Wayne Griffin, director of UF's Counseling Center.
Peter Lake, a law professor at Stetson University and co-author of The Rights and Responsibilities of the Modern University, said universities need better systems for reporting and intervening in such problems.
A dean may not know faculty has talked to a distressed student or that the student faced trouble with police. Campuses need a strong central system and policies in place to get help quickly, including those that permit professionals to warn the community if a patient poses a danger.Officials at FSU and UF say they have similar systems in place. But after Virginia Tech, they say, every higher-education institution will be reviewing its policies to ensure they catch distressed students before disaster happens.
"This will change higher ed forever," Lake said.
Erika Hobbs can be reached at ehobbs@orlandosentinel.com or 407-420-6226.
Leslie Postal can be reached at lpostal@orlandosentinel.com or 407-420-5273.
Information from The Associated Press also was used.
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