Mentally ill inmates get warehoused at the ACI Releasing these offenders without the necessary care or structure makes it more likely they will commit another crime BY STEVEN STYCOS

FIVE WEEKS AGO, Roger Bruyere of West Warwick used his bed sheets to hang himself in the maximum-security section at the Adult Correctional Institutions.

Bruyere had a lengthy criminal record, including convictions for arson, larceny, and assault with a dangerous weapon. He had an extensive history of mental illness while in prison, including two hospitalizations at the locked Forensic Unit at the state Department of Mental Health, Retardation and Hospitals (MHRH). Similar problems extended to his uncle, Joseph Bruyere, who hanged himself at the ACI in July 1993 after earning the nickname "The Sticker" for stabbing himself in the abdomen at least 30 separate times during his incarceration. And, at the time of Roger Bruyere’s death, says Department of Corrections (DOC) spokeswoman Joy Fox, he was one of the few prisoners being forced to take mental health medications, thanks to a court order.

This history — culminating in Bruyere’s death on October 26 — makes him the latest illustration of Rhode Island’s failure to adequately treat mentally ill prisoners, according to Reed Cosper, the state’s gubernatorially appointed mental health advocate. Seriously mentally ill inmates should be treated in a mental health facility, Cosper insists, not a prison filled with regular criminals. "Roger’s death," he comments, "is a sterling example of why."

In DOC’s defense, Fox says clinical workers at the ACI monitored Bruyere regularly and saw no indication that he would try to kill himself. Cosper, however, contends that Bruyere might still be alive if the state prison had a specific ward for mentally ill prisoners, or if he had been under the care of the Department of Mental Heath, Retardation and Hospitals.

It’s too late to help Roger Bruyere, but Cosper is fighting to pry loose better mental health services for others at the state prison in Cranston, and his crowbar is named Rahsaan Muhammad.

Cosper is suing the MHRH in US District Court in Providence for failing to provide Muhammad, a convicted murderer, with appropriate treatment for his mental illness. MHRH is struggling to send Muhammad back to the ACI, Cosper says, when it should be providing him with mental health services in a locked ward of Eleanor Slater Hospital. The importance of the case extends far beyond the treatment of the 31-year-old Providence man. MHRH’s failure to properly treat Bruyere, Muhammad, and other mentally ill prisoners, Cosper contends, not only harms them, it endangers all Rhode Islanders by often releasing the offenders into the community without adequate treatment and follow-up. "Do you want mentally ill people discharged with just bus fare?" he asks. "It’s also inhumane."

It’s also a huge problem. Nationally, only about five percent of the population suffers from mental illness, but a 1999 US Department of Justice survey found that about 16 percent of prisoners have mental illness. Meanwhile, studies compiled by the Consensus Project, an effort financed by the Lexington, Kentucky-headquartered Council of State Governments, indicate that mentally ill inmates spend more time behind bars than other prisoners, and are likely to return to jail within several years of their release.

Because the Department of Mental Health, Retardation and Hospitals is best equipped to treat the mentally ill, Cosper wants MHRH to take on more of these inmates and to move them into the locked wards at the state’s Eleanor Slater Hospital, then unlocked wards, and eventually group homes as they respond to treatment. Currently, only a small number of prisoners with serious mental illness receive services in MHRH’s Forensic Unit, a 20-bed locked facility at the Pastore Center in Cranston. And even these, says Cosper, are heavily medicated and their mentally illness reoccurs after they are returned to the prison population.

"Muhammad," Cosper explains, "is the vehicle to force MHRH to treat some prisoners like they have some responsibility for them."

COSPER CONCEDES THAT the DOC has improved its handling of the mentally ill in recent years, but he calls the reforms inadequate. "They have made incremental steps that can bring glacial change over a century," he says, "when they should be doing it now."

Kathleen Spangler, director of the Department of Mental Health, Retardation and Hospitals, refuses to discuss the Muhammad case, saying, "Our policy is to never talk about specific patients in the hospital. It violates their privacy." She points, however, to increased cooperation between MHRH and DOC. "Tremendous forward strides have been made within the Department of Corrections," she says. "What had been a lack of service is no longer a lack of service."

Department of Corrections Director A.T. Wall declines to comment on the Muhammad case, noting that Cosper’s lawsuit is against MHRH, not DOC. He also declines to say whether some people in prison should be in a mental institution, declaring, "Our mission is to implement the decision made by the court, whether or not the person suffers from mental illness."

Wall — who in a July article in a national publication for prison administrators called the ACI "the largest mental institution in the state" — nonetheless acknowledges that mental health care is a huge concern. In an interview with the Phoenix, he defends DOC’s treatment of mental illness among its 3500 prisoners, stating, "We believe we can manage the overwhelming majority of mentally ill inmates." Wall adds, "In the last five years, I believe our system has made tremendous strides in the management and care of mentally ill inmates."

In a sworn statement made in the Muhammad case, however, Frederic Friedman, DOC’s clinical director of psychology, agrees with Cosper. Mentally ill inmates, especially those with a history of violence like Muhammad, should move from prison into a long term "step-down" facility, Friedman says, before being released into the community. "[T]he Department of MHRH should cooperate with the Rhode Island Parole Board," Friedman concludes, "in order to plan a safe transition for Mr. Muhammad out of the prison."

That safe transition, says Cosper, should start where Muhammad presently sits — MHRH’s Forensic Unit — awaiting the outcome of his case. The unit is reserved for those who are too mentally ill to stand trial or who have developed mental illness after sentencing and require hospital-level care. Cosper argues that the 20-bed Forensic Unit is far too small and should be expanded, perhaps, to 300 beds. "Any prisoner who is sufficiently impaired by mental illness, who cannot comply with prison routines," he says, "should be placed in a therapeutic milieu, and right now we have only one and that’s the Forensic Unit."

Some states take a different approach, establishing special mental health units inside their prisons. The Massachusetts Department of Correction, for example, operates Bridgewater State Hospital, a secure psychiatric facility, to treat inmates with serious mental illness. Several other states, according to the Consensus Project, have multi-level housing for inmates with serious mental illnesses, including "maximum-security medical units, step-down, post-acute housing and transitional housing units."

Wall agrees that Rhode Island needs to move in this direction, noting, "What the state lacks right now is a structured step-down environment for mentally ill offenders."