For Mentally Ill Inmates, Health Care Behind Bars is Often Out of Reach

By Elizabeth Chuck, msnbc.com

A man who was declared suicidal by a New Mexico jail and alleges he was then left to rot in solitary confinement for nearly two years is just one of many former inmates who say they were denied essential mental health services while incarcerated at that detention center, which like others across the country has struggled with how to treat the mentally ill.

Stephen Slevin, 57, made headlineslast week when a jury awarded him $22 million after he alleged inhumane treatment in the Dona Ana County Detention Center following his arrest in August 2005 on charges of driving while under the influence and possession of a stolen vehicle.

But a search of Dona Ana County court records reveals the detention center was also hit with a class-action lawsuit six months prior to Slevins', in which 13 former inmates alleged their constitutional rights to mental health care had been "continually and persistently ignored."

The lawsuit was settled in 2010, with a judgment of $400,000 for the plaintiffs and a commitment from the county to change its practices.

According to criminal justice experts, many other jails and prisons have struggled to adequately handle mentally ill inmates. Few areas of the country, they say, have the money and resources and staff to handle such a challenging population.

"The Supreme Court has established that you have a constitutional right to a basic level of adequate health care, which now includes mental health care," Thomas Hafemeister, an associate professor at the University of Virginia School of Law, told msnbc.com. "They've recognized that there tends to be limited resources in this setting. As long as a qualified professional has examined the inmate and exercised his or her judgment as to what needs to be done, that's all that is required."

'Cruel and unusual'

But Hafemeister, who has written about alternatives to the traditional criminal justice system for the mentally ill, explained that the definition of a "qualified professional" is a loose one.

"Some would argue for inmates, all that is required is medication," he said, meaning anyone with a medical degree, from a physician to a psychiatrist, could be considered qualified.

"Often it's very expensive. They're only willing to come in for an hour a week, and they zoom through very quickly. It can be a very cursory examination," Hafemeister said.

Slevin was detained for 22 months, released in June of 2007 without ever having been given a trial. By the time he was freed, he was deemed mentally incompetent, and his charges were dropped.

The rest of the story is here.

California Prison Psychologist Charged With Faking Rape

The Associated Press
Originally Published December 9, 2011

Laurie Ann Martinez

She split her own lip with a pin, scraped her knuckles with sandpaper and had her friend punch her in the face. Investigators say she even ripped open her blouse, then wet her pants to give the appearance she had been knocked unconscious.

But it was all part of what authorities said Friday was an elaborate hoax by the woman to convince her husband she was raped so they could move to a safer neighborhood.

Charges filed by the Sacramento County district attorney allege Laurie Ann Martinez, a prison psychologist, conspired with the friend to create the appearance that she was beaten, robbed and raped by a stranger in April in her Sacramento home.

Martinez, her friend and two co-workers eventually told police the whole thing was a setup to convince Martinez's husband that they needed to move from a blighted, high-crime area three miles north of the state Capitol.

It didn't work. Instead, the couple filed for divorce six weeks after the April 10 incident, according to court records.

"If all you wanted to do is move, there's other ways than staging a burglary and rape," said Sacramento police Sgt. Andrew Pettit. "She went to great lengths to make this appear real."

Martinez, 36, a psychologist for the California Department of Corrections and Rehabilitation, reported she had come home that day to find a stranger in her kitchen, authorities said.

"As she tried to run away, the suspect grabbed her and hit her in the face," court records say in describing what she told police. "She lost consciousness and then when she awoke she found her pants and underwear pulled down to her ankles."

Missing from her home were two laptop computers, Martinez's purse, an Xbox video game console, a camera and numerous credit cards that Martinez said the stranger had stolen.

In reality, the items were all at the home of her friend, Nicole April Snyder, authorities allege. Investigators say Martinez had Snyder punch her in the face with boxing gloves they bought for that purpose.

The entire story is here.

Ethics, Psychology, and the Prison Mess

Stephen A. Ragusea, PsyD, ABPP

Guest Blogger

Recently on one of my psychology list serves, one colleague posted the following, 

“I witnessed an inmate in a county jail who was acutely psychotic, and was kept in solitary confinement for almost two years, naked, lying in his/her own urine and feces. There was no heat in the cell, and the human wastes leaked into adjoining cells. Numerous official and professional persons were aware of this poor person's plight, and no one did anything (or at least anything that was within their ability and authority) to end the inmate's suffering. Apparently, this is acceptable practice here in Florida, as all persons were found to be practicing appropriately.”

Unfortunately, the situation described above by one of our colleagues is not uncommon.  In my many years of work in prisons I’ve observed similar scenarios many times.  I too have scene naked prisoners lying in their own filth.  I’ve seen prisons where an entire block of 40 men was on suicide watch.  I’ve seen a prisoner who was elderly, demented, and paranoid sent to prison repeatedly after being prosecuted for making “Terroristic Threats.”  I’ve seen a psychotic bipolar prisoner tied to a metal chair and drenched with a fire hose to make him “behave.”

Dr. Ragusea

As has been true for more than two decades, the United States incarcerates a higher percentage of its population than any other nation in the world.  Most prisoners are under the age of 30 and approximately 15% of the total are people who meet the DSM-IV criteria for a mental illness.  About half of that 15% are diagnosable as seriously mentally ill, suffering from problems like schizophrenia and bi-polar disorder.

According to a 215-page report (ISBN: 1564322904) by Human Rights Watch, “One in six U.S. prisoners is mentally ill. Many of them suffer from serious illnesses such as schizophrenia, bipolar disorder, and major depression. There are three times as many men and women with mental illness in U.S. prisons as in mental health hospitals.”  One of the report’s authors, Jamie Felner, observed, “Prisons have become the nation’s primary mental health facilities.” 

Prisons have become the nation’s primary mental health facilities.

How did we get into this mess?  Some of it started when politicians decided that they could get elected and stay elected by being “tough on crime.”  They voted for mandatory minimum sentences, taking discretion away from the judiciary.  And, although approximately half of these prisoners were convicted of non-violent, drug related offenses, rather than voting for funding to pay for alcohol and drug treatment, our elected officials decided to spend our hard-earned tax dollars on building more prisons.  The result of this national movement was that we currently incarcerate approximately 1% of our population.  More than 2.5 million Americans now live behind bars.  That’s the equivalent of every man, woman and child in the cities of Philadelphia, Columbus, and Seattle.

A few years ago the Tallahassee Democrat reported, “Florida's law enforcement and corrections systems are rapidly evolving into the state's de facto mental health treatment providers. More often than not, our law enforcement officers, prosecutors, defense attorneys, judges and parole officers are being forced to serve as the first responders and overseers of a system ill equipped to deal with an underfunded treatment system that's stretched beyond capacity.”

To a large degree, the tax money for building and operating prisons was stolen from our public mental health system.  Part of John Kennedy’s vision for Camelot included a national system of well-funded community mental health centers that would serve the mentally ill in their own hometowns, thereby permitting the closing of a well-developed system of state mental hospitals that had been providing inpatient treatment for the severely mentally ill.  Those of us old enough to remember the 1970s recall an era of widely available, well funded, mental health care provided through local Community Mental Health Centers.  Oddly enough, the systematic under-funding and disempowering of our Mental Health Centers coincided with the increase in funding of the prison system to support the “Get Tough on Crime” movement that spread like a well-intentioned plague from sea to shining sea.

Psychologists should be leading the battle for prison reform.  I would argue that we have an ethical obligation to do so.  Specifically I reference the preamble of our ethical code, which states:As doctors of behavior, academic psychologists should be researching new solutions to our social problem of crime and punishment.  Clinical psychologists who work in the system should be developing and implementing alternative treatment models for the imprisoned mentally ill.  And, all psychologists should be demanding government action to correct this inhumane, ill-conceived, foolishness.  Can you imagine a hundred thousand psychologists remaining passively silent as 275,000 mentally ill Americans are mistreated?   We are.   Can you imagine America’s psychologists saying nothing as prisons are turned into “the nation’s primary mental health facilities?”  We have.

Psychologists are committed to increasing scientific and professional knowledge of behavior and people’s understanding of themselves and others and to the use of such knowledge to improve the condition of individuals, organizations, and society.  Psychologists respect and protect civil and human rights and the central importance of freedom of inquiry and expression in research, teaching, and publication.  They strive to help the public in developing informed judgments and choices concerning human behavior.

If you think these issues are important, say so to the leadership of your state and national Psychological Associations.  Talk to your elected representatives.  Contribute your time and energy to make things change.

We can do better. It is our ethical responsibility as psychologists to do better.

References

American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. American Psychologist,Vol. 57, 1060-1073. 

Johnson, Suzanne Bennett.  Quotation retrieved from her website at http://sbjforapa.com/statements/response-to-abpp.

If you have specific suggestions for topics to be covered in The Ethics Corner, please e-mail me with your suggestions.  My e-mail address is ragusea@aol.com. 

Nation's Jails Struggle With Mentally Ill Prisoners

By NPR staff

Three hundred and fifty thousand: That's a conservative estimate for the number of offenders with mental illness confined in America's prisons and jails.

More Americans receive mental health treatment in prisons and jails than in hospitals or treatment centers. In fact, the three largest inpatient psychiatric facilities in the country are jails: Los Angeles County Jail, Rikers Island Jail in New York City and Cook County Jail in Illinois.

"We have a criminal justice system which has a very clear purpose: You get arrested. We want justice. We try you, and justice hopefully prevails. It was never built to handle people that were very, very ill, at least with mental illness," Judge Steve Leifman tells Laura Sullivan, guest host of weekends on All Things Considered.

A failing system

When the government began closing state-run hospitals in the 1980s, people with mental illness had nowhere to turn; many ended up in jail. Leifman saw the problem first-hand decades ago in the courtroom. When individuals suffering from mental illness came before him accused of petty crimes, he didn't have many options.

"What we used to do, which I tell people was the definition of insanity [...] was they would commit an offense, the police would arrest them, they'd come to court, they'd be acting out so we would order two or three psychological evaluations at great expense, we would determine that they were incompetent to stand trial and we'd re-release them back to the community and kind of held our breath and crossed our fingers and hoped that somehow they'd get better and come back and we could try them," he says.

Instead, many disappeared and got re-arrested. Sometimes within minutes.

"They'd walk out the door, they were ill, they'd act out, because [the jail] is next to the courthouse there are several officers out there, and they'd get re-arrested," he says.

Not only was the system inefficient, it was costly as well. When Leifman asked the University of South Florida to look at who the highest users of criminal justice and mental health services in Miami-Dade County, researchers found the prime users were 97 people, individuals diagnosed primarily with schizophrenia.

"Over a five-year period, these 97 individuals were arrested almost 2,200 times and spent 27,000 days in the Miami-Dade Jail," Leifman says. "It cost the tax payers $13 million."

More information can be found here.