Storing the mentally ill and suicidal persons in the new asylums

I recently blogged about anti-suicide smocks as an effective, but unacceptable way of reducing suicides in incarcerated inmates, whether prisoners in US jails or detainees in Gitmo.

There is evidence that anti-suicide smocks reduce suicides, but they are often used to justify keeping suicidal persons in inhumane settings. Because the smocks prevent suicide, they become an excuse for not providing more appropriate, less restrictive care. Anti-suicide smocks can become a form of cruel and unusual punishment.

I referred to two prison settings in Massachusetts. Billerica House of Correction reduced suicides by requiring at-risk persons wear anti-suicide smocks.  Hampden County Correctional Center had adopted enlightened measures that made anti-suicide smocks unnecessary.

Then I came across a brilliant longread article, one of The Desperate and the Dead series  on the treatment of the severely mentally ill from the Boston Globe’s Pulitzer Prize winning Spotlight investigation team.

There may be no worse place for mentally ill people to receive treatment than prison yet a growing number end up in the ‘new asylums’

The article to which the link above takes you has an excellent 4 minute video giving a prisoners’ first person account of not being able to get appropriate treatment.

I strongly recommend the Boston Globe article, as well as the longer series of which it is part.*

The article documents how of the more than 15,000 prisoners discharge from Massachusetts jails and prisons, more than a third suffer from mental illness. Over a third of inmates being released from state prisons with mental illness will be locked up again, which is higher than the percentage of those without mental health problems.

There is  a lack of mental health treatment in Massachusetts prisons for persons known to have mental health problems:

Altogether, specialized mental health treatment units in the 15 Massachusetts prisons have space for 285 inmates ­­— 10 percent of the 2,900 with diagnosed mental illness, and less than half of the 725 whose illnesses are designated as serious by prison officials.

What treatment is provided occurs under bizarre circumstances that are unlikely to allow the therapeutic relationship needed for therapy to be effective.

Even in the units with the best available care, treatment is distorted by security demands. Inside the 19-bed Secure Treatment Program at maximum-security Souza-Baranowski, group therapy sessions take place in a room dominated by a semicircle of six imposing metal cages painted periwinkle blue, known as “therapeutic modules.” Each inmate is locked into his or her own cage for group talks — thick plastic spit shields between them — to eliminate the risk of violence. Even during outdoor recreation time, each inmate is locked into his own large metal cage.

The situation in Massachusetts prisons has attracted the attention of the federal government.

Seven of 15 prisons in Massachusetts are federally designated “health professional shortage areas” in the realm of mental health, meaning they exhibit “extreme need” for more clinicians and employ fewer than one psychiatrist per 2,000 inmates.

The Globe also documents that prisoners with mental health problems are discharged under circumstances likely to exacerbate those problems:

The Harvard-led Boston Reentry Study found in 2014 that inmates with a mix of mental illness and addiction are significantly less likely than others to find stable housing, work income, and family support in the critical initial period after leaving prison, leaving them insecure, isolated, and at risk of falling into “diminished mental health, drug use and relapse.”

The released prisoners get little assistance in obtaining the vital  follow-up to whatever treatment they got within prison, incluing renewing prescriptions for medication :

Last year, 90 percent of the estimated 6,000 inmates with mental illness who were released from jails and prisons got little or no help from DMH [Department of Mental Health] as they tried to find treatment in the community, according to numbers provided by the state.

healthcare-not-handcuffsThe Globe article provides first-person accounts from prisoners and prison officials that convey an utter helplessness in coping with the harsh experiences facing the mentally ill, while imprisoned and when there are released. I highly recommend the article.

[Not everybody agrees with the Spotlight series or my assessment of it. For a critical response to the series, see Response to The Boston Globe Spotlight Series ]

*But here is a  link to three brief videos for the rest of the series:

The mental health care system in Massachusetts is broken

When despair meets deadly force

Crisis in the woods