Preserving mental-health care for prisoners: A life-and-death budget issue
State officials and the Concerned Lifers Organization, a prisoners' group, have a common goal: better psychiatric care in prisons and on the outside.
Washington DOC
Seventeen Washingtonians have been murdered over the past 13 years by men whose violent psychiatric disorders were known to authorities before they committed the crimes.
Of the nine men who killed those people, the most recent and notorious is Maurice Clemmons, who shot four Lakewood police officers a year ago after being paroled despite a documented history of mental illness.
Before Clemmons' murder spree, in a scathing 2008 article headlined “State pays in blood for flawed mental health system,” the Seattle Post-Intelligencer described 11 of the “preventable tragedies.” Award-winning reporter Carol Smith (now a senior writer at Investigate West), wrote that state laws combined with an “overburdened, ineffective mental health care system” enabled the homicides.
Chad Lewis, a family services specialist with the state Department of Corrections (DOC), agrees. “The common thread in those cases is mental illness,” Lewis said, and marshaling resources to deal with mentally ill offenders is a top priority for DOC Secretary Eldon Vail: “We're not oblivious” to the need for improvement. “We're more than just aware.”
The Concerned Lifers Organization at Monroe Correctional Complex is equally concerned. The group is currently trying to improve mental health care inside prison walls, through a series of presentations to visitors including UW Medical School residents in psychiatry and others interested in ensuring better treatment of people with mental illnesses.
Earlier this fall a friend who has led CLO religion seminars for many years asked me to join a group of five people invited to attend one of these presentations. At the prison's front desk we turned our pockets inside out, gave officials our car keys, and filed through a metal detector. A woman who manages family services programs joined our group and led us through a series of locked doors and yards, where razor wire coiled atop fences between guard towers, into a room with a circle of chairs. Forty inmates straggled in, greeted each of us in turn, and sat down with us.
The CLO was founded at Monroe in 1978 by prisoners “doing ‘life without,’” as they aptly call serving their sentences of life without possibility of parole. Members mentor shorter-term convicts in life skills and values that could help keep them from re-offending after completing their sentences. They host visiting groups of at-risk teens and tell them about the life behind walls that looms ahead of lawbreakers. They sponsor religion classes, lead a book club, and raise funds to provide poor students in the surrounding community with college scholarships.
Last December, shocked by the Clemmons murders, the CLO wrote a collective letter of sympathy to relatives of the police officers who died. Through their labor at the prison rate of 42 cents per hour they raised enough to donate about $2,000 to the families.
Prisons like Monroe have become America’s de facto new asylums. It’s a truth so often repeated that the phrase has become a cliché. As rising numbers of Americans with chronic psychiatric disorders are incarcerated, the total share of prison inmates in the U.S. with serious mental illnesses has climbed to 16 percent. This is the most conservative estimate, according to "Confronting Confinement," a 2006 report of a national commission on safety and abuse in America’s prisons. Many estimates put the number closer to 36 percent, or even 54 percent when individuals with anxiety disorders such as PTSD are counted in.
The unintended and awkward medical role of prisons debuted with the steady release of patients from big mental hospitals, a shift that began half a century ago. By 1996 this “deinstitutionalization” had reduced hospital populations by 90 percent. During the Reagan years many state asylums were shut down entirely to save public funds, and few of the community clinics that were promised as replacements got built. Since then, despite the fact that most people with mental illness can recover and live productive lives if they receive proper care, public programs for treating psychiatric disorders have been chronically underfunded across the country and in Washington state.
The consequences are visible on our city sidewalks and in our parks. People with untreated mental illnesses wander around disoriented and incapable of insight into their actions. Most are harmless (statistically speaking, they’re far less dangerous to your health than a ride in a car), and street thugs prey on them. Some try to medicate their disturbing symptoms with alcohol or street drugs, and some break the law. A 2003 report from Human Rights Watch, "Ill-Equipped: U.S. Prisons and Offenders with Mental Illness," quotes a former lead psychiatrist at Washington’s McNeil Island Corrections Center as saying, “The severity of the mental illness of those coming in is increasing…. The prisoners often have no idea how they ended up here.”
Monroe superintendent Scott Frakes summed up today's situation: “Too often people get the help they need only because they step over the line, have a law enforcement encounter, go to prison, and get assessed.” Necessary medical treatment follows those assessments because, Frakes said, “There are two groups in the United States with a Constitutional right to health care: veterans and prisoners.”
So although Americans in general have no right to mental health care, some get it as a belated sort of fluke — dragged in hooked to punishments for helplessly irrational actions.
The night I visited Monroe, a panel of inmates summed up prison policies regarding the diagnosis and treatment of mental illness and questioned whether prison staff always follow recommended policy. They also spoke about the fears that lead prisoners to mask their symptoms.
For example, they’re afraid that staff use antipsychotic medications not for therapeutic purposes but to tranquilize and control, and that inmates who seek treatment will be branded as weaklings who “can’t handle their time” or as crazy “dings” (“dingalings”). Others fear losing their eligibility for conjugal visits, for opportunities to transfer to units with more privileges, or for Family Sunday, an event like a fair, which one panelist summed up as “for fathers, one of the best things going.”
One speaker told us how he came to be serving a life sentence under the Three Strikes statute. When he was 12 his two sisters were killed before his eyes in a bizarre attack. He started drinking to forget, but remained functional enough as an adult to hold a job as a union ironworker. “I married a woman who helped me stay drunk and out of trouble for years,” he said, but when the marriage ended he lost his job and committed robberies while intoxicated. He said that staff during his first two confinements failed to follow a Western State Hospital directive printed on the record he showed us: With proper treatment, it is unlikely [this man] would re-offend. He concluded, “The system could have fixed me 30 years ago but didn’t.”
A shy man in his 20s who committed a murder when he was 15 told the audience that counseling at Green Hill School juvenile center helped him develop some of the skills he needed to start managing terrors and antisocial impulses born of what he called “family issues.” But when he aged out of Green Hill, he said, a friend he made at Monroe who had paranoid schizophrenia hanged himself after staff stopped his prescription for antipsychotic medications. The young man said the suicide terrified him, but when he asked for psychiatric help, he was basically told to get over it. Now he’s “scared of asking” for therapy.
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Comments:
Posted Fri, Nov 19, 10:03 a.m. Inappropriate
I received the following email from Ari Kohn:
Judy, Your article is important, and I very much appreciate what you wrote, but it seems to shift the responsibility for this abysmal debacle from the governor and Legislature to the electorate. In that regard, I disagree. The fact is the Legislature and governor by making wise decisions instead of running away from politically unsafe issues have money to fund the solution to this quagmire. They just have to make the correct choices (not only the politically safe choices). I agree with your final sentence / paragraph, but the fact is the overriding blame / fault lies at the feet of this governor, past governors, the current Legislature, past legislatures, and, above all, legislative leadership such as Lisa Brown, Frank Chopp, Jim Hargrove….
And, BTW, as to throwing Dan Pacholke's environmental issue into the mix, that is the poorest analogy I’ve seen in a long time.
Very best regards, Ari
Ari Kohn
Post-Prison Education Program
Post Office Box 45038
Seattle, WA 98145-0038
(206) 524-3333
http://www.postprisonedu.org
“If a community values its children it must cherish their parents” --John Bowlby, Reporting to the World Health Organization, “Maternal Care and Mental Health”
Posted Fri, Nov 19, 12:14 p.m. Inappropriate
In 2003, revered GOP King County Prosecutor Norm Maleng and Rep. Ruth Kagi led a very broad bipartisan coalition of prosecutors, defense attorneys, sheriffs, judges and human services advocates to reduce the sentences of nonviolent drug offenders by 25% and transferred some of the savings to drug court, at a savings now valued at $60 million. Now is the time to end prison for non-violent drug offenders, since it only makes them worse. If that saves $180 million, we could reasonable spend $30 million of drug court and alternative sentences with community supervision. Medicaid prescription drugs must be continued and community mental health beefed up.
Posted Fri, Nov 19, 10:22 p.m. Inappropriate
What is wonderful about this article is that it sheds light on the realities of our mental health system, particularly in prisons. I am continuously amazed by the lack of realization on the part of the public and legislature that the impact of underfunding mental health services has on our community. As deinstitutionalization occurred, we failed to provide an adequate alternative and still do. With many evidence-based practices in place, now more than ever, we should succeed in treating mental illness and facilitating recovery. Yet it only gets worse due to lack of funding, leading to issues of crime, homelessness, substance abuse and unemployment. Many complain about how these issues reflect on our community and cost us money yet nothing is done to address how the system perpetually keeps people stagnant and oppressed.
It especially disturbs me that prisoners with mental health issues or concerns are not able to receive help when they ask for it, not to mention fearing the consequences of identifying symptoms and seeking assistance. People cannot go about changing their lives without the guidance and support of others to question their stance. As members of society, we have a responsibility to provide care, leadership, and hope to those on wayward paths, and our government is desperately failing at that.
Thank you for the insightful article. Hopefully, the people who need to see it will.
Posted Sun, Nov 21, 12:03 p.m. Inappropriate
"..During the Reagan years many state asylums were shut down entirely to save public funds.."
Since President Reagan had absolutely nothing to do with state mental health institutions I suppose you are simply identifying the years between 1981 and 1989. Just happens to coincide with the rise of disco. Hmmm.
Posted Sun, Nov 21, 4:46 p.m. Inappropriate
Amnon Shoenfeld sent me this email:
You make some great points about the need for community mental health services, and the quotes from Bruce Gage, Mike Walls and Scott Frakes are right on target. I disagree with the critical comments by Ari Kohn. I think the example you gave about the cuts in the Sustainable Prison Project simply illustrated the point you were making about cuts in nonessential programs, and I definitely disagree with his comment that the governor and legislature is to blame and can fix the budget problem by making the right choices. The electorate voted for an Eyman initiative that makes it impossible to raise taxes or fees, and they voted against the income tax on the richest people in our state. The poorest and most in need will bear the brunt of almost all the cuts while the wealthiest have never had it better.
Amnon Shoenfeld, Director
King County Mental Health, Chemical Abuse and Dependency Services Division
Posted Sun, Nov 21, 5:20 p.m. Inappropriate
Kieth, when Reagan was Governor of California, he shut down many mental hospitals in the state. From a U.S. history textbook on the Web: Governor Reagan "dismantled the public psychiatric hospital system, advocating instead a community-based housing and treatment system to supplant it. Critics argued that not enough state funding was devoted to the change." (http://www.u-s-history.com/pages/h1958.html)
When Reagan became President, he rescinded the Mental Health Systems Act of 1980, originally signed by Jimmy Carter. This law "was considered a landmark in mental health care policy. The key to the proposals included an increase in funding for Community Mental Health Centers and continued federal government support for such programs. But this ran counter to the financial goals of the Reagan administration; these were of course to reduce federal spending, reduce social programs, and transfer responsibility of many if not most government functions to the individual states. So, the law signed by President Carter was rescinded by Ronald Reagan on August 13, 1981. In accordance with the New Federalism and the demands of capital, mental health policy was now in the hands of individual states....
“Cuts in funding for mental health services continued throughout the 1980s, with the emphasis being on the provision of services via the private sector. Overall, the number of beds available to the mentally ill in public and private hospitals dropped over forty percent between 1970 and 1984 (Reamer, 1989). Most of this decline was due to cuts in public hospitals. During the 1980s, the number of beds provided by general hospitals in psychiatric wards and in private hospitals for the mentally ill increased. In 1970, there were 150 private psychiatric centers; in 1980, there were 184; by 1988, there were 450 in the United States. General hospitals offering psychiatric services increased from 1,259 in 1984 to over two thousand in 1988 (Reamer, 1989, 25; LaFond and Durham, 1992, 115-16). With such growth in the private sector, there were substantial profits to be made in mental illness, assuming that the patient had adequate health insurance. Those without medical insurance frequently did not receive adequate care…"
The latter two paragraphs are from a paper by Northeastern University professor Alexandar R. Thomas (Electronic Journal of Sociology, 1998), "Ronald Reagan and the Commitment of the Mentally Ill: Capital, Interest Groups, and the Eclipse of Social Policy." The paper also explains the central role the ACLU and other civil liberties advocates played in deinstitutionalization and is well worth reading in its entirety. http://www.sociology.org/content/vol003.004/thomas.html
Posted Wed, Nov 24, 6:07 p.m. Inappropriate
The man who killed another man with a hatchet on Capitol Hill Monday had been through Mental Health Court. Apparently he has paranoid schizophrenia, but rarely took his medications.
http://seattletimes.nwsource.com/html/localnews/2013513644_slaying25m.html
Scary story — looks like the killing was totally random.
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