This is what happens when we use criminal justice to deal with the mentally ill

You've probably heard the phrase, "A society is judged based on how it treats its (fill in the blank)."

How about its most vulnerable, needy populations? Like the mentally ill.

From the Raleigh News and Observer:

Central Prison's new $155 million medical center replaces the prison infirmary, built in the 1960s, and the mental health facility, built in the 1970s.

An internal review of conditions inside North Carolina's Central Prison found that inmates with serious mental illnesses were neglected by staff and locked away in fetid cells.

That neglect, which included the failure to properly track anti-psychotic medications, may have contributed to the death of at least one inmate, a 2011 report says.

The review, obtained by The Associated Press through a public records request, found:

Inmates inside the Raleigh prison were left isolated for weeks of "therapeutic seclusion," sometimes without clothing or a mattress, in cells described as roach-infested and with human waste puddled on the floor.

Others were strapped to their bunks in an improper manner that allowed them to bang their heads against the concrete wall.

Chronic understaffing led to situations where the sick went untreated and suicidal inmates sometimes went unmonitored.

Jennie Lancaster, chief operating officer for the N.C. Department of Correction, said the agency is working to improve conditions, provide remedial staff training and fill long-vacant positions.

No prison staff were fired or disciplined following the internal review.

'Fixes' under way

"This is a difficult population, and it presents safety challenges, it presents behavior challenges," Lancaster said. "When you've got an offender who you clean his cell and then two hours later he's taken feces and he's smeared it all over the cell again, and you've got someone down in another cell and they're acting out ... if you're limited in your staff, it's not the ideal thing, but you have to prioritize what you're doing."

The review of conditions inside Central's mental unit was performed last spring by two prison system nurses.

Lancaster said living conditions for inmates will improve when the state this month opens a new $155 million health care complex at Central.

She said the agency long pushed to secure funding for the new building because of deficiencies with the current mental unit, a 144-bed facility dating to the 1970s.

The new prison hospital will have 216 inpatient mental health beds. There is also increased funding to hire more staff.

"These inmates are highly unpredictable and unstable," the report says, adding that they require the highest level of care and treatment because their mental illnesses and extreme behaviors can lead to "life-threatening situations."

But the report says the state failed to provide such care to the inmates.

There are MILLIONS of people with mentally illnesses in the nation's prisons and jails. Most of them are nameless, faceless, and unknown to those of us living in free society. But it is our duty, by law, to provide for their care and custody.

Drugs poorly tracked

Years of budget cuts, hiring freezes and high turnover led to staffing shortages in critical jobs, especially nurses and doctors. Staff failed to maintain up-to-date records, track medications or respond to calls for medical help.

The report says that nurses acknowledged not knowing which inmates were which and that patients were given too much prescribed medication or none at all.

On April 7, 2011, an inmate was listed as receiving nine doses of powerful psychiatric drugs that included lithium and Thorazine, even though he'd already been transferred to another prison the day before.

The report also said there "have been a number of deaths due to medical conditions," including an inmate who died in October 2010 as the result of "complications of lithium toxicity."

That information appears to match the case of Levon Wilson, a Winston-Salem man with bipolar disorder arrested on misdemeanor charges on Aug. 31, 2010, and sent to Central Prison for safe-keeping while awaiting trial.

Dangers of lithium

Lithium is often prescribed to treat manic symptoms common with bipolar disorder. However, taking too much lithium can be deadly. Those taking the drug must be carefully monitored with routine blood tests because of a long list of known side effects, including impaired kidney function and obstructed bowels.

An autopsy report shows Wilson was transferred from the prison to WakeMed Hospital in Raleigh on Sept. 30, 2010, with "moderately high levels" of lithium in his bloodstream. He died 10 days later.

The cause of death is listed as "complications of lithium therapy," which led to kidney and bowel problems. Still, the state doctor performing the autopsy declared Wilson's death as "natural."

DOC officials refused to release a separate internal review of Wilson's death, citing federal medical privacy laws.

Inmates often isolated

The 2011 report also says understaffing led to patients going unsupervised, despite orders they be carefully watched because they had tried to harm themselves.

Inmates cut themselves and swallowed nails, batteries and shards from plastic eating utensils. The review found numerous inconsistencies and contradictions in written records of observational rounds.

The report also found that inmates in "therapeutic seclusion" were often locked in cells for extended periods without being let out for meals, recreation time or to shower. An officer stated that patients in "therapeutic seclusion" didn't get a shower because they're suicidal, but the review found most weren't suicidal but rather had "unpredictable behaviors."

An inmate placed in isolation on Feb. 1, 2011, was ordered by a doctor to be allowed one hour per day alone in the unit's day room. A review of his records found no evidence he was let out of his cell before April 19, a stretch of 78 days.

Prison system policy says no inmate can be kept in seclusion for more than a week without special approval from an internal review committee consisting of a doctor, a nurse and a prison administrator.

Isolated inmates ate meals in their cells and sometimes hoarded food, leading to infestations of roaches and ants.

Being alone is damaging

Solitary confinement can be psychologically damaging even for healthy people, said Dr. Stuart Grassian, a Boston psychiatrist who studied the issue while on the faculty of Harvard Medical School.

Grassian said the conditions described in the North Carolina report could cause permanent psychological harm for inmates suffering from chronic disorders such as schizophrenia.

"When you take a person like that and put them in solitary confinement, obviously what happens is they become more and more paranoid," Grassian said. "Because these are progressive disorders, once they have deteriorated you really don't have much of an opportunity to get them back."

Grassian said there is nothing therapeutic about long-term seclusion, which he said increases the risk of abnormal behavior and suicide.

At Central, mentally ill inmates who attempted to harm themselves sometimes had their clothes, blanket and mattress removed, leaving them in an empty cell with only a "safety blanket or smock."

"If given a safety blanket, the inmate would have to choose to cover either his body or rusty bunk and lie naked," the report says. "Staff stated that at times, the inmates prefer to lie on the floor."

Report cites filthy cells

The review also noted the strong smell of urine throughout the facility, with sick inmates left to live in their own filth.

The report cites a March 16 incident where an inmate was reported as needing a bath and his cell cleaned.

"They only had two officers for three floors and during the weekend they only had one officer," the report says. "The evening nurse stated she would 'try' to have it taken care of that evening."

Nearly a week later, on March 22, the same patient appeared stiff and lethargic.

"Upon inspection of the patient's cell, the floor was noted to be sticky; the room had a strong odor of urine and puddles of yellowish, light brown fluid on the floor," the report said.

Nurses were also observed failing to wash their hands or change latex gloves between patients when providing injections, potentially helping to spread blood-borne diseases such as HIV and hepatitis C.

Vicki Smith, executive director of the advocacy group Disability Rights North Carolina, doubted moving the mental unit to a new building would fix the systemic problems.

She called for "big changes that really improve the care and treatment they are providing to these vulnerable and very ill prisoners."

Mental health issue

The report is not the first time North Carolina's prison system has faced questions about harsh treatment. It's been revealed in recent years that prison staff have used nylon straps similar to a dog leash to tether inmates; pepper-sprayed a nude, incapacitated inmate having a panic attack in his cell; and been convicted of felony charges for using billy clubs to severely beat a shackled inmate.

As for the Central Prison problems, Lancaster said, it wouldn't be fair to point the finger at any single official. Several positions for doctors and key administrators were vacant, she said.

Officials said they have addressed 57 of 84 issues identified in a corrective action plan.

State Sen. Thom Goolsby, co-chairman of the Senate appropriations committee for Justice and Public Safety, said he first learned of the critical report after the AP sought its release.

The Wilmington Republican wants to know why no one at the prison was held responsible.

"I want some answers, because this can't be allowed to happen again," Goolsby said. "We punish people for their crimes, but when you have someone with a mental illness you have to treat the disease. Not helping people, not seeing that they get their medication and are treated like human beings, is just wrong in every sense of the word."

http://www.newsobserver.com/2011/11/14/1642506/prison-neglects-the-ill.html