Better prison mental health care sought

Cost estimated in the millions
By Beth Healy and Michael Rezendes, Globe Staff, May 2, 2007

State legislators, reacting to the recent spate of suicides in Massachusetts prisons, sought assurances from prison officials yesterday that they were taking greater precautions with mentally ill inmates to prevent further deaths.

But public safety officials, who promised more training and better equipped units, acknowledged those changes will cost millions and that money has yet to be approved.

One concrete change for troubled inmates: Those who hurt themselves or try to commit suicide are no longer punished with a disciplinary report in addition to being moved to segregation. In the past, those inmates have been denied telephone calls to family, contact with lawyers, outdoor time, and even clothing and showers.

In segregation, "Almost all prisoners were stripped of their clothing . . . and issued a safety smock," said Lindsay M. Hayes, the author of a suicide study commissioned by the state last year, during testimony yesterday.

Now, mental health clinicians will judge whether each suicidal inmate in segregation can have those rights, Veronica Madden , associate commissioner at the state Department of Correction , told members of the joint committees on Public Safety and Homeland Security and Mental Health and Substance Abuse.

Madden said the department is adopting virtually all the recommendations in the Hayes report. But the biggest change -- the establishment of residential treatment units, or alternative housing units for mentally ill inmates -- can come only if the Legislature approves millions of dollars in its 2008 capital budget to build them. The Correction Department wants to create more than 140 beds for inmates with serious mental illnesses and behavioral problems.

James R. Pingeon , litigation director for Massachusetts Correctional Legal Services, which represents inmates, said residential treatment units have been proposed before but haven't materialized. The current conditions in segregation, he said, are contributing to the state's high suicide rate.

"Segregation is in itself an extreme stressor that makes it more likely there will be suicides," Pingeon said. Of the 15 suicides in the state over the past three years, he said, seven inmates were in segregation, and five were in cells with segregation-like conditions.

Dr. David G. Power , a Cambridge psychologist who has consulted to the state, described some segregation cells as "gothic" and said mental health watch cells were in "alarmingly poor condition," often dirty, overheated, and with poor ventilation.

"It's difficult to walk through Cedar Junction and not feel like you've descended into Dante's Inferno," he said.

Mary Beth Heffernan , undersecretary for criminal justice in the state's Executive Office of Public Safety, which oversees the Correction Department, tried to assure lawmakers yesterday that $30 million in new funding in the governor's proposed budget would help improve inmate healthcare, including mental health services.

Part of the funding is to go to better training of correction officers, as called for by Hayes, and for overtime. The latest class of officers, which graduated last Friday, received eight hours of training on dealing with mentally ill prisoners, up from four hours in the past, according to Madden. Those officers will be part of a new protocol to check on suicidal inmates every 15 minutes, instead of every half hour, she said.

State Representative Michael A. Costello, cochairman of the Public Safety Committee, asked whether the department would stick to its promises of more training. "I'm hoping that we don't hear back from the DOC that we cut back on training due to financial considerations," he said.

Heffernan pledged that that would not happen.

But the problems of handling mentally ill inmates are deep and extend to the UMass Correctional Health Program, which provides mental health care in state prisons and is bidding to renew its contract. Hayes said, during his investigation, clinicians told him they often had no choice but to approve inmates for segregation -- even those at risk -- because there was nowhere else for them to go.

"Few if any inmates were ever diverted from segregation, because there were no alternative housing options," Hayes said.

When asked by a legislator whether the state has stopped segregating inmates with serious mental illnesses for months and years at a time, Madden said the practice had not stopped.