By Evelyn Morales
Losing the mentally ill within the S.C. Dept. of Corrections
People with mental illness can be found almost anywhere. Unfortunately, as long-term treatment and adequate community mental health resources wane due to continued budget cuts, many of them are slipping through the cracks and ending up behind bars.
Protection and Advocacy for People with Disabilities, Inc., (P&A) a non-profit organization in Columbia, determined that about 10 percent of the inmate population in South Carolina suffers from varying forms of mental illness. However, treatment is often inconsistent â€“if it is given at allâ€”and guards, who are not always trained to detect symptoms, often misunderstand or mishandle mentally ill inmates. To say nothing of the physical and psychological abuse they sometimes suffer at the hands of fellow inmates.
Currently, the formulary of medicines at the South Carolina Department of Corrections often does not include the prescribed drugs that inmates with mental illness need to treat their condition. To add insult to injury, even if inmates could afford to pay for their medication from an outside pharmacy (with the inmateâ€™s physicianâ€™s approval) access is commonly denied by the SCDC. A fact sheet available on the P&A web site, gives the following example of a mentally ill inmate lacking medication within the Department of Corrections:
â€œA paranoid schizophrenic who drinks his own urine. He suffers from hallucinations and delusions and believes that while heâ€™s sleeping doctors come into his cell and perform surgery on him. For most of the past 14 years, he has been isolated in a small cell 23-24 hours a day. He is scheduled to receive injections of antipsychotic medication every three to four weeks, but these are often late, on one occasion by nine weeks.â€
On June 20, 2005, P&A filed a class action lawsuit against the SCDC and the State of South Carolina on behalf of inmates with mental illness. So far, there have been three amendments to the suit, the most recent being in 2007, which expanded the suit to include, as a defendant, SCDC Director, Jon Ozmint. Due to the sensitivity of the lawsuit, representatives of P&A were advised by attorney, Dan Westbrook, of Nelson Mullins Law Firm, not to comment on the case until it goes to trial.
The suit alleges that the defendants are in violation of the state constitution by not providing for the â€œmaintenance, health, welfare...â€ of the inmates and by allegedly violating an Article stipulating that â€œ...cruel, not corporal, nor unusual punishment be inflicted.â€
The lawsuitâ€™s description of conditions and treatment of inmates with mental illness at state correctional institutions stirs images of medieval asylums where patients were often tortured under the guise of treatment. Presently, the suit claims, this treatment consists largely of lock up units where mentally ill patients are placed. The Plaintiffs give the following examples:
-â€œ Inmates in lock up units who exhibit suicidal or self destructive behavior are not always given immediate clinical attention, as required by SCDC policy, but instead may be beaten, gassed, and placed in restraint chairs for extended periods of time.â€
- â€œAt times the stench of urine and feces is pervasive (in lock-up units).â€
-â€œSome inmates have reported to a lock up cell to find it covered with the blood, urine or feces of its previous inhabitant.â€
James L. Head, Jr., Senior Vice President of the South Carolina Hospital Association, says he is concerned that too many people are in jail or prison because they need treatment for a real medical problem and there was no place else for them to go.
â€œI suspect our jails and prisons are full of people who could be leading productive, happy lives if they could just get the treatment they need,â€ Head says. â€œPeople do recover from mental illness, but they donâ€™t recover in jail. Yet our society seems willing to build new jails and prisons instead of putting more resources into mental health treatment.â€
According to Tony Gordon, Director of Recovery Ministries at Oliver Gospel Mission, 30 percent of the homeless people that they serve have a mental illness.
The question of how people with mental illness end up in jail can be a complicated one. Sometimes, they are homeless and arrested for trespassing. Some become victims of their own psychotic episodes, not realizing what they are doing, while others may not be able to find work and turn to stealing. Without adequate care for inmates with mental health issues, they are eventually released back into society, but likely in worse condition than when they went in.
Shelly Silva, mother of an SCDC inmate with a mental illness, knows this all too wellâ€¦ and so do I. Mrs. Silva is my mother and her son, who I will refer to as Anthony, is my brother.
Anthony entered the corrections system a long time ago â€“ as a juvenile. Even at that time, he was physically abused as an inmate and won a lawsuit against the South Carolina Department of Juvenile Justice when he was just 16 years old. This year Anthony will be 30 and he is currently incarcerated. He has been in and out of the stateâ€™s correctional system several times.
When he was 17, my mother learned that Anthony was diagnosed with dual diagnoses of schizo-affective disorder with borderline features and substance abuse. Breaking and entering to steal and support his marijuana use at age 18 was his introduction to SCDC. Since entering the SCDC, she says Anthonyâ€™s mental health issues have not been appropriately considered or addressed, treatment has been inconsistent, and didnâ€™t get his medication.
Anthony is one of the few mental health patients included in the law suit against SCDC. My mother believes that the way he was treated within the system ultimately lead to additional charges against him, making it hard for him to ever be released and receive the treatment he and so many others need outside the SCDC.
â€œMy concern about Anthony is that there is no interest and no adequate educational or safety measures provided for mental health inmates,â€ she says. â€œBecause of this, they are more subject to physical and sexual abuse by other inmates and correctional officers due to blatant disregard and ignorance of mental health issues.â€
But, she said, doesnâ€™t condone the criminal activities that put Anthony behind bars; she just believes that proper treatment from the outset could go along way to prevent his recidivism.
â€œI am Anthonyâ€™s mother and I will always love and support him but do not condone or justify any negative behaviors as a result of his mental health illness,â€ she says. â€œI just advocate for the importance of mental health treatment for all inmates in SCDC with mental health issues.â€
When Anthony was previously released in 2007 from an SCDC institution, no one in our family was alerted. He was released in a psychotic state, put on a two-hour bus ride with the general public and arrived in his hometown completely disoriented and distraught. Shortly after, he assaulted someone with a knife and ended up in Alvin S. Glenn Detention Center for over a year awaiting his sentencing for which he is currently serving time. At the sentencing he had a black eye.
The S.C. Dept. of Mental Health: Shrinking and Underfunded
The SCDC isnâ€™t the only government department that is culpable for the well being of the mentally ill. The South Carolina Department of Mental Health provides treatment and services for the mentally ill, as well, though the department concedes that they currently arenâ€™t provided the complete resources they need to meet demand.
â€œAt a time when there is more knowledge than ever before on effective treatments for mental illnesses... the available resources for public mental health services are in sharp decline,â€ says Mark Binkley, General Counsel for the SCDMH. â€œWhile the Department of Mental Health is still providing timely and effective treatment services to thousands of South Carolinians, staff is reminded frequently that the agency currently doesnâ€™t have sufficient resources to meet the ever-growing need for such services.â€
With mental health services sharply in decline in our communities, it makes sense that a portion of the mentally ill population ends up in jails and prisons. Prior to the mid-1980s, these people would commonly be admitted to a different type of institution â€“ a psychiatric one, if needed. However, this is no longer common practice.
The South Carolina Department of Mental Health embraced the trend toward community-based treatment for people with mental illness in the mid 1980â€™s, and has consistently closed in-patient facilities in the state since that time. The number of people with mental illness being treated in the community, as opposed to in in-patient psychiatric facilities, has also increased. Even though Mr. Binkley stated that the department doesnâ€™t have sufficient resources, the SCDMH stands behind community-based treatment.
â€œPeople who have a serious mental illness do better clinically when treated in the community rather than living in state mental hospitals,â€ Binkley says. â€œThey get better faster and stay better longer when they receive services in their community, if these programs meet their needs and are well organized and easily available. The closeness of family, friends, and community support aids in their recovery process.â€
According to the March 4 meeting minutes of the South Carolina Mental Health Commission, the SCDMH is planning an additional $14 million dollar reduction in in-patient services to include reduction of 101 beds among their facilities. According to the minutes, staff, too, will be reduced and wait times in the emergency room for mental health services will increase. The department is also planning a $14.1 million reduction in their community mental health centers, as well, noting that since 2005, the community mental health centers have lost a total of 450 positions and that reduction of staff would mean â€œ65,965 fewer clinical services delivered in the community.â€
According to P&Aâ€™s suit against the SCDC, in 2003, the SCDMH conducted a study of the mental health system in place within the SCDC. Some of the discoveries made include that the only psychiatric facility within the SCDC for the entire state, Gilliam Psychiatric Hospital in Columbia, does not have programming that meets the needs of mentally ill inmates.
SCDC Health Services Director, John Solomon, stated that the percentage of inmates with mental illness is between 11 and 12 percent, or 2,760 inmates out of the 23,000 inmates the SCDC has within their institutions. SCDC Director of Communications, Josh Gelinas, clarified that the responses to the questions asked by Columbia City Paper for purposes of this article, â€œare responses specifically to your questions, not any pending litigation.â€
Gilliam Psychiatric Hospital has only 88 beds to serve these 2,760 inmates and according to Solomon, â€œthe equivalent of four full-time employeesâ€ on their psychiatric staff. When asked if he felt that Gilliam is sufficient to treat inmates with mental illness state-wide, Solomon says, â€œYes.â€ However, when asked what he would like to see improved regarding inmates with mental illness, he did not address any desire to change current procedures within the department; instead he put the matter squarely on the communityâ€™s shoulders.
â€œIâ€™d like to see inmates get greater access and involvement with community services when they are released from prison,â€ he said.
Another avenue (or at least a supplemental one) could be that the SCDC and SCDMH improve and expand the services they provide for the mentally ill. Perhaps then, less people with mental illness would end up behind bars and if they do, they would be provided the services and medications needed to assist in their recovery and rehabilitation.