Mentally ill inmates get warehoused at the ACI (continued)

THE TREATMENT of mentally ill prisoners is a national problem. In an October 2003 report, the New York City-based Human Rights Watch states that three times as many mentally ill people are in prison than mental hospitals. "Our research suggests that few prisons accommodate their mental health needs," states the 215-page report.

As if writing a supporting brief for Muhammad’s case, the report observes, "Some [mentally ill inmates] deteriorate so severely that they must be removed to hospitals for acute psychiatric care. But after being stabilized, they are returned to the same segregation conditions where the cycle of decompensation begins again. The penal network is thus not only serving as a warehouse for the mentally ill . . . it is acting as an incubator [emphasis in the original] for worse illness and psychiatric breakdowns."

Wall agrees that Human Rights Watch describes the "default position" in prisons around the country, but not in Rhode Island. "It doesn’t happen here that way," he says. "There’s an enormous level of compassion here."

"In the last five years," agrees Roberta Richman, the Department of Corrections’ assistant director of rehabilitative services, "I believe our system has made tremendous strides in the management and care of mental illness."

Mental health professionals also commend Wall and Richman for improvements, but they say much more needs to be done. "It may not be perfect, but in recent years the department [of Corrections] has done a better job," observes Elizabeth Earls, president and CEO of the Rhode Island Council of Community Mental Health Organizations.

Mental health treatment begins when new prisoners are examined by a nurse after arriving at Intake, Richman says. Those who have taken psychotropic drugs are referred to a clinical social worker, who may seek help from a psychiatrist. Once it is confirmed that the inmate takes drugs for mental illness, they receive the medication. DOC also works with MHRH to learn whether new inmates received community mental health services before their arrest. Meanwhile, hundreds of cases involving mental illness and minor offenses, like trespassing or creating a public nuisance, are diverted from the criminal justice system through "mental health courts" in Providence and Kent counties.

Those confined at the ACI receive their medications, adds Richman. And in a recent change designed to prevent the cycle that torments some inmates, Richman says, the ACI’s mental health staff may ask wardens to waive disciplinary bookings when rule violations are the result of mental illness.

In addition, over the last three years, DOC has strived to help mentally ill inmates reenter the outside world. The six percent of inmates with the most serious mental illness receive discharge plans in joint meetings with MHRH and the Providence-based nonprofit agency Fellowship Health Resources, Richman relates. They also get help finding supervised housing and are scheduled for appointments with their local community mental health services agency. Finally, their progress is monitored for a year.

But those who fall short of qualifying for this program merely receive discharge planning and appointments with the local mental health agency, and there is evidence that released prisoners quickly abandon mental health services. In June 2003, the Special Legislative Commission to Study Services to Persons with Mental Illness in the Criminal Justice System reported that 80 percent of prisoners referred to the Newport County Community Mental Health Center failed to keep their initial appointment. Another 12 percent failed to keep follow-up appointments.

The problem of mental illness in prison has grown since 1980, as the US prison population has increased by 240 percent to 6.5 million people, according to the Consensus Project. Longer sentences for drug crimes and the general "get tough on crime" attitude in state legislatures have caused much of the population increase, says Human Rights Watch, as has the movement to deinstitutionalize the mentally ill.

Statistics in Rhode Island reflect national findings that about one in six prisoners have mental illness. According to DOC psychologist Friedman’s May 2004 sworn statement, 550 ACI inmates — about 16 percent — are on drugs for mental illness.

Yet only about two a year, according to MHRH and DOC statistics, are transferred from the prison to the MHRH’s Forensic Unit for psychiatric care. Richman says the statistic shows the success of DOC’s diversion and prison-based mental health programs.

Cosper, though, says it demonstrates the need for more inmates to be transferred to MHRH’s care. Spangler opposes putting more inmates in the Forensic Unit, however, saying it should be reserved for those needing the intensive care provided in a hospital. As for Wall’s proposal for an additional step-down facility, she says, "That’s a public policy conversation . . . that needs significant discussion."

Told of her response, Cosper says Spangler is ducking the issue. "If she wants to build another unit, that’s great," he says, but in the interim, more mentally ill inmates should be treated in the Forensic Unit. "It’s too bad if the Forensic Unit provides too restrictive a milieu," Cosper concludes. "They shouldn’t be in prison." Under state law, he explains, it is Spangler’s job — not Wall’s — to properly care for the mentally ill.

CONVINCED THAT HIS father was possessed by evil spirits, Rahsaan Muhammad beat him to death in Providence in July 1994. Four weeks before the murder, Muhammad was admitted to a mental hospital for treatment of psychosis after he was found wandering the streets of Atlanta. Released after eight days, he killed his father within the next month. Shortly after the murder, Muhammad walked into the Providence Center, a mental health facility on Hope Street in Providence, and confessed. Convicted of second-degree murder, he was sentenced to 22 years in prison.

Since his imprisonment, Muhammad has been transferred four times from the ACI to MHRH’s Forensic Unit for treatment of the signs of serious mental illness. He was treated three times for several months and returned to the ACI, only to be returned later to the Forensic Unit with the same serious symptoms.

The Department of Mental Health, Retardation and Hospital’s treatment goal, says Cosper in his court complaint in US District Court, "was to shoot him up with medications and get him back to jail." Although Wall says that DOC does more than just administer medications, the Consensus Project’s report notes, "Staff at many correctional facilities [around the country] have over-relied on the use of psychotropic medications." Drugs should only be a part, "not the central focus," of an inmate’s treatment plan, the report argues.

DOC’s efforts with Muhammad seem to have been unsuccessful. Cosper’s complaint against MHRH states, "Each time that Mr. Muhammad was returned to the prison, he decompensated, and he was not able to manage his behavior or to cope with prison routines." Punishment for prison rule violations resulted, and Muhammad was "locked down" in an isolation cell for 23 hours a day. "These punitive interventions," Cosper concludes, "naturally, contributed to the exacerbation of his psychosis."

In June 1999, during MHRH’s fourth attempt to return Muhammad to the general prison population, Cosper blocked the transfer in Superior Court. The prisoner has remained since then in the Forensic Unit, although he no longer requires the hospital-level care it provides.

In January 2002, the state Parole Board granted Muhammad parole, effective in July 2003, conditioned upon his application and admission to the civil wards of Slater Hospital. MHRH has since refused to admit Muhammad to the less restrictive care environment, denying him the opportunity for parole. MHRH director Spangler declines to say why, but MHRH makes just one argument in legal documents to buttress its contention that Muhammad belongs at the ACI and not in a mental health facility: that a judge may not determine who is voluntarily admitted to Slater Hospital. "There is no cause of action which could allow the court to order a hospital to accept a person as a voluntary patient," Deborah Clark, MHRH legal counsel, writes in one memo.

In February 2004, Cosper filed a Superior Court motion to force the Department of Mental Health, Retardation and Hospitals to move Muhammad to the civil wards — a change, he says, mandated by state mental health law. Spangler, according to state statute, is required to "provide for the proper care, treatment and restraint" of mentally ill people in her custody. Now that Muhammad no longer requires the high level of care provided by the Forensic Unit, Cosper contends, Spangler must move him to less restrictive care — the locked wards of the Adult Psychiatric Unit at Slater Hospital. Returning Muhammad to the ACI, Cosper says, will merely renew the cycle of rule violations, punishment in segregation, aggravated psychosis, and transfer back to the Forensic Unit for drug therapy.

This pattern ensures that mentally ill inmates, after serving their entire sentences, are then released into the community without restrictions or support, Cosper says, making it more likely they will become more ill and commit another crime.