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Massachusetts’ Mental Health Treatment Policies Prove Deadly for Public, Prisoners

by David M. Reutter

As America’s prisons continue their transformation into mental health institutions, little thought is given to mentally ill prisoners who languish within the harsh confines of prison environments with little if any treatment. That all changes, at least temporarily, when a mentally ill prisoner who has been held in solitary confinement for years is set free without any supervision, and then commits multiple murders.

While the mainstream media recently covered such a story about a homicidal ex-offender – who was released from the Massachusetts Department of Correction (MDOC) and killed a newlywed couple in Washington state several months later – as well as the usual sound bites and hand wringing, past history proves that once the furor dies down it will be back to business as usual.

For the past several decades America’s prison system has become the new warehouse for the mentally ill, which is no secret among those overseeing our nation’s detention facilities. Eventually, about 95 percent of those incarcerated will one day be released; they will either successfully reintegrate into society or prey upon it. That, of course, presupposes that the mentally ill survive their time behind bars.

A December 2007 special series in the Boston Globe revealed that the likelihood of a mentally ill person surviving a prison sentence in the MDOC unmaimed has become less and less likely. In fact, it appears that our public policy of curtailing the use of mental health institutions and criminalizing mental illness, which began in the 1950s and hit its pinnacle in the 1980s, has transformed the mentally ill into outcasts reminiscent of lepers during Biblical times. That harsh policy leaves the mentally ill largely to their own devices whether they receive treatment or not, then sends them to prison “colonies” once they exhibit behavior that deviates from societal norms.

Making Them Sicker

Prisons, by their very nature and design, are secretive places tucked away in mostly rural communities, hidden from public view. They are perfect for isolating people who are considered difficult to deal with or undesirable. With a substantial reduction in mental hospital beds nationwide, prisons now house the patients who were once held in such asylums.

It is conservatively estimated that at least 25 percent of MDOC’s 11,500 prisoners suffer from some type of mental illness and thus have a heightened risk of suicide or self-harm.
Over the past decade, MDOC prisoners have engaged in more than 3,000 self-inflicted injuries or suicide attempts; 513 of those occurred in 2006. Within the last three years there have been 15 successful suicides in MDOC prisons – a rate three times higher than the national average. Alarmingly, 11 of those suicides were committed by prisoners in segregation, many of whom were mentally ill.

An independent study of the MDOC’s high suicide rate, released in February 2007, determined that prison policies and practices had contributed to the problem. “Confining a suicidal inmate to their cell for 24 hours a day only enhances isolation and is antitherapeutic,” the report stated. MDOC officials agreed to adopt the study’s recommended changes, but such policy changes do not alter the state’s systemic approach to how mentally ill prisoners are handled.

“The Department of Correction did not ask to become the state’s biggest psychiatric facility, but it is,” said Leslie Walker, director of Massachusetts Correctional Legal Services.

A prisoner afflicted with mental illness does not have full control over his actions. When confronted with the daily rigors of prison life, which can be difficult for even the most mentally sound person, inadequate treatment can lead down a slippery slope to madness. Inescapably, mentally ill prisoners violate institutional rules, which results in disciplinary infractions that grease the slide.

Prisons require prisoners to adhere to rules and policies that regulate every aspect of their lives. These rules may seem trivial and petty to the average prisoner, but for the mentally ill they are often insurmountable obstacles.

The cycle begins with a guard trying to enforce the rules. It escalates with the use of physical force to obtain compliance, or when the mentally ill prisoner acts out with his own violence. In other instances the guard simply tires of repeatedly telling the same prisoner to comply with the rules, over and over again. Either way the result is a disciplinary charge that lands the prisoner in segregation.

For most mentally ill prisoners, this is the point where they are unable to stop the momentum towards psychological crisis unless they receive intervention in the form of mental health treatment. In the MDOC, segregation means solitary confinement 23 hours a day.

Solitary confinement “is the worst possible thing you can do to someone who is psychotic,” said State Rep. Ruth B. Balser, chairperson of the Legislature’s Joint Committee on Mental Health and Substance Abuse. “It will only make them sicker.”

“That’s the danger of the larger prison culture we’re creating,” observed Dr. Scott A. Allen, a former prison physician in Rhode Island and co-director of the Center for Prison Health and Human Rights at Brown University. “As a society now, we’ve taken mental health problems into this prison setting, and we’re dealing with them in a punitive way.”

Driven to Despair

Experts say that long-term stints in solitary confinement can adversely and irrevocably affect the mental condition of people who were of sound mind before they were isolated. For mentally ill prisoners, the effects are catastrophic; emotional desperation is the most common side effect of time spent in “the hole.”

Yet to maintain strict discipline, prison officials use severe consequences such as segregation in a 6-by-9 foot cell for 23 hours a day to deter most sound-minded prisoners from misbehavior. Sentences that can extend for decades. That deterrent doesn’t work well with the mentally ill. In October 2007, the MDOC had 345 prisoners in segregation.

Solitary confinement is a terrible policy when implemented long term, especially as a response to mental illness. “It leaves you alone with your own delusions,” stated Dr. Matthew P. Dumont, a Cambridge psychiatrist. “It is actually the stupidest and most dysfunctional thing to do to a mentally ill prisoner.”

“You’re taking people who are vulnerable and can’t cope in society, and putting them in the worst possible situation imaginable,” agreed Dr. Carl Fulwiler, a psychiatrist and prison consultant who is an assistant professor at the University of Massachusetts Medical School.

Prison guards are ill-equipped and ill-trained to handle a mass influx of the mentally ill. Frustrated with having to deal with mentally disturbed prisoners who act out, don’t follow directives, become violent or threaten suicide, guards sometimes respond by saying, “You know what? Do it! I’ll be back in ten minutes, twenty maybe,” said an unnamed guard quoted in the Boston Globe. “You can’t help it, it just comes out.”

The real culpability lies with those who are in charge of prison mental health care.
Presumably these officials are fully qualified to handle mentally unstable prisoners. A recent MDOC report into one prisoner’s suicide, however, refutes that presumption. “Due to the overall culture of the institution, mental health staff at MCI-Cedar Junction have a rather high threshold for how they assess and address an inmate’s acting-out behaviors and overall mental health status,” the report concluded.

Even when mentally ill prisoners feel despair, they are afraid to seek assistance. That fact was conspicuous in a suicide note left by MCI-Cedar Junction prisoner Glen Bourgeois, who had been in solitary confinement in the prison’s 10-Block segregation unit for over four months at the time he hung himself on December 26, 2007.

“Consider my sentence paid in full,” Bourgeois wrote. “I did the only thing I felt I could do to stop my headaches. I have planned this for almost a month. There was no one I could ask for help without being put in worse living conditions than I am in already.”

It would seem that solitary confinement is the end of the line, but a prisoner can actually devolve to lower depths within the oppressive prison environment. The “worse living conditions” that Bourgeois chose to avoid by killing himself were placement in a strip cell or 4-point restraints.

A strip cell is equipped with a concrete slab, lights that remain on 24 hours a day, and a toilet and sink. The prisoner is placed naked into this barren concrete crypt, where he usually stays for 72 hours if he remains calm.

Then there is the worst situation, 4-point restraints, which is where MCI-Cedar Junction prisoner Hakeen Obba, 33, found himself. The concept of 4-pointing is simple: The prisoner is strapped spread-eagle to a bed in the middle of a solitary confinement cell, the solid steel door is closed, and a guard maintains “eyeball watch” over the fully restrained prisoner.

Obba had been cited 210 times for misconduct while in segregation. Despite behavior that included urinating on the floor and spreading feces on his cell walls, he never received a mental health evaluation. When guards observed him spreading feces on the door and window of his cell on November 12, 2000, they received permission to 4-point him until he stopped his disruptive behavior.

Later that evening, Capt. Ronald R. Picard confronted Obba while 4-pointed. Picard grabbed a cup that a guard was using as a spittoon, which was full of sunflower seeds and tobacco juice. He then tilted the cup over Obbas mouth. As he walked away, Picard warned Obba about his conduct: “If you don’t behave, my officers will pour shit down your throat. Because I can do anything I want to you.”

“This is cruel,” Obba was heard saying on videotape. “This shouldn’t be for a dog … I’m a human being … I’m not an animal.” For that act of sadistic abuse, Picard was suspended for three days. He was later fired for using excessive force on a prisoner who had a history of suicide attempts. On January 22, 2001, two months after the incident with Captain Picard, Obba ended his misery by hanging himself.

A Cell Warrior

In the normal course of things it seems that an untreated, imprisoned psychotic will self-destruct in one way or another, typically through self-maiming or suicide. Another form of self-destruction occurs when a mentally ill prisoner acts out violently, resulting in loss of good time or new criminal charges that net an extended prison sentence.

Although prison officials tend to incubate mentally ill prisoners in closet-sized 6-by-9 foot cement cells secured by solid steel doors, eventually – inevitably – they will be unleashed upon society. One such prisoner, Daniel Tavares, Jr., was freed after serving 16 years in MDOC facilities for manslaughter. For a young couple on the other side of the country, the prison system’s deficient mental health treatment proved fatal.

Tavares suffered from bipolar disorder and anxiety attacks, for which he was treated with psychiatric medications. In his early years he had confrontations with law enforcement for robbery and theft. An attempt to avoid jail time by completing a drug rehab program failed when he was caught stealing and abusing drugs. Neighbors feared his explosive temper.

After an evening of drinking and taking LSD in 1991, Tavares began hearing voices. Those voices, he said, drove him into a homicidal rage that caused him to start swinging a 12-inch knife, stabbing his mother, Ann Tavares, over a dozen times. Police found 14 vials of psychiatric medications on Tavares’ bedroom dresser when they searched his mother’s home. He was charged with homicide and faced life in prison.

Yet Tavares’ mental condition prevented prosecutors from seeking a murder conviction. “We have to prove that he possessed a sound mind ... If we can’t prove that, he’s found not guilty,” stated Tavares’ prosecutor, Paul F. Walsh, Jr., in a Boston Globe interview. Instead, a plea agreement for manslaughter was reached, which resulted in a 17-20 year sentence.

As with other mentally ill prisoners, Tavares could not cope with the routine of prison life. He landed squarely on the slippery slope to solitary confinement. During his term of incarceration, Tavares received over 100 serious disciplinary tickets. “He was what guys refer to as a cell warrior,” said an anonymous MCI-Cedar Junction guard. “He was always making trouble from his cell.”

Prison guards kept close watch on Tavares’ regular violent outbursts. The only treatment he received was psychiatric medications and segregation “therapy.” He lashed out not only physically to anyone who passed by his cell, but also wrote letters to family members and public officials threatening them with physical harm.?“He threatened to kill me,” said Tavares’ father, Daniel Tavares, Sr. “He said he’d come down here when he got out and break all my ribs and maim me.”

Normally, prison officials prefer to handle misconduct internally. This policy not only gives the appearance that they are in control, but also keeps their dirty laundry from becoming the topic of public debate. After Tavares used a cast on his hand to slam a guard in the face on December 1, 2005, however, MDOC officials decided to depart from that policy. They asked the Worcester District Attorney’s office to file assault charges.

Although the DA agreed, the paperwork was not done until a prison release officer called to inquire about the charges over a year later. That allowed Tavares’ lawyer to argue that prison officials were improperly trying to use an old charge to lengthen his prison stay.
Nor did the MDOC turn him over to Florida on an outstanding warrant. Instead, Tavares was released on June 14, 2007 after serving seven years in solitary confinement.

He was not so much as interviewed by a social worker to see if he was able to cope in the free world; within days he fled to Washington state to meet a woman he had met through a prison pen-pal service. It was simply assumed that MDOC’s treatment of Tavares’ mental health problems was sufficient to protect society.

That assumption was shattered on November 17, 2007. After a night of doing drugs, Tavares went to the Graham, Washington residence of newlyweds Brian and Beverly Mauck. He shot Brian, 30, once in the face and twice more in the head. Beverly, 28, tried to run but Tavares shot her in the head, too. He then laid her body on top of Brian’s and covered them with a blanket as a “sign of respect.”

The next day Tavares went to the local police station. “He was going to help us catch the bad guys,” said Detective Ed Troyer. Instead, Tavares confessed to the murders; he pled guilty in February 2008 and is now serving a life sentence without parole.

The motive for the double murder remains unclear. It may have resulted from a disrespectful remark made by Brian over a $50 debt for a tattoo, or perhaps Tavares was affected by the abuse and lack of treatment he received in prison. In 2004 he had asked a Globe reporter, “How many times can you kick a dog before he bites back?”

Those who had close associations with Tavares, including his family, knew that he had serious mental problems that required treatment to prevent him from exploding into a homicidal rage. During his many years in MDOC facilities, those problems were almost completely ignored. Two people died as a result.

“Frequent Flier”

A peek into the life of Nelson Rodriguez reveals the ugly realities of allowing the mentally ill to languish untreated until they end up in prison, where the lack of treatment continues in even worse forms.

Born to 18-year-old Mildred DeJesus, Rodriguez quickly demonstrated that he “was not normal.” He exhibited violent outbursts, began to expose himself sexually and preyed upon his toddler stepbrothers.

As a little boy, Rodriguez was tormented by a monster he named Freddie. In his dreams the monster would kill his friends, eat his mother and throw him into water burning with fire. Tests indicated he had a low IQ and suggested some form of brain damage.

In frustration, his mother turned him over to the state. Rodriguez then bounced from foster home to foster home and did a six-week stint in a psychiatric hospital. When he turned 18 he was no longer eligible for services from the Massachusetts Department of Social Services, but was prohibited from receiving help from the Department of Mental Retardation until he was 22.

Without assistance from his family or the state, he landed in a homeless shelter. Between 1997 and 2002, Rodriguez did several stints in county jails for petty larceny, breaking and entering, and property damage. A fascination with the Teenage Mutant Ninja Turtles brought out Rodriguez’s mental health demons.

He began taking kung fu lessons. Then he bought a sword at a local pawnshop. On one summer night in 2003, Rodriguez used the sword to stab another homeless man in the shelter’s bathroom. While in jail awaiting trial, he attempted to hang himself. A doctor at Bridgewater State Hospital who evaluated Rodriguez emphasized in a written report, in italics, that he had a “very real, very substantial risk” of self-harm.

Once remanded to the MDOC, Rodriguez’s inability to cope resulted in outbursts that landed him in segregation, where he spent almost 145 days. “He is someone who definitely should not have been in isolation because of his condition. There’s no question about that,” said Terry Kupers, a national specialist on mental illness among prisoners.

Prison employees knew Rodriguez as a “frequent flier,” a codename for someone who requires constant attention by mental health staff. Despite that designation, the only attention he received was psychiatric medication, which was inexplicably changed the day before he killed himself. “Putting [mentally ill prisoners] in segregation and then closing the solid steel door to their cell is like asking them to commit suicide,” Kupers stated.

Prior to Rodriguez’s December 20, 2005 suicide at the South Walpole facility, he was “not on the radar screen” of prison mental health staff despite an extensive file documenting his mental illness, noted a subsequent MDOC report.

“We don’t have enough expertise,” acknowledged Dr. Kenneth L. Applebaum, former mental health director for UMass Correctional Health, which provides medical and mental health treatment for most state prisoners. “And we don’t have the services that those people need in the system. It is, in my opinion, an unmet need.”

MDOC prisoner Mark Cunningham had needs that went unmet, too. He cut his arms and legs, tried to kill himself, and eat sharp objects to cause internal injuries. He was placed in solitary confinement; in early 2007 he committed suicide by hanging.

Policy Change: Not a Good Idea

“History will look back on this era and wonder why we were locking up so many people who were sick,” said State Rep. Ruth Balser. “Mentally ill people should not be locked up 23 hours a day, mutilating themselves and killing themselves. They are human beings.”

Rep. Balser proposed banning the practice of putting mentally ill prisoners in solitary confinement, instead using secure live-in treatment units. Similar legislation to remove mentally ill prisoners from segregation cells was passed in New York in 2006 following a “Ban the Box” campaign, but the bill was vetoed by then-Governor Pataki. [See: PLN, Feb. 2007, p.32].

It was anticipated that Massachusetts Governor Deval Patrick, who had prior experience as the head of the Department of Justice’s civil rights division, would endorse the proposal. After all, he had previously criticized the failure of prison officials to adhere to “notions of humanity and decency” when housing mentally ill prisoners.

In a 1996 letter to Maryland Gov. Parris M. Glending, Patrick wrote, “Where conditions of segregation greatly exacerbate mental illness, and the period of segregated confinement is prolonged or indefinite, feasible alternative custodial arrangements should be explored.”

In response to the Boston Globe’s 2007 investigative series, Gov. Patrick stated, “What I’ve been reading about and what I’ve heard about is horrible.” Yet when Public Safety Secretary Kevin M. Burke was asked what Patrick’s administration thought about Rep. Balser’s legislative proposal, Burke’s response was “We don’t think that’s a good idea.”

Balser admitted the issue was mainly about finances. “The biggest challenge is not a lack of willingness … but we’re facing a $1 billion deficit, so everything has to be looked at in terms of cost,” she said. It would cost $2.4 million to $4 million to set up live-in treatment units in the MDOC, plus an additional $12,000 per bed per year above the regular cost of incarceration.

The legislature budgeted $1 million to start the process last year, and 60 treatment beds were scheduled to open at the Souza-Baranowski Correctional Center; however, Rep. Balser referred to that inadequate response as a “Band-Aid.”

Advocates of the proposal say the state will save money due to reductions in mental health emergencies and psychiatric referrals to Bridgewater State Hospital. What is missing from that conversation, though, is the additional cost savings from preventing future crimes, avoiding the prosecution of those crimes, and halting future incarceration of mentally ill prisoners who will almost certainly reoffend without adequate treatment before they are released. The Mauck family would likely agree that the financial cost is worthwhile if it saves the lives of future potential victims.

Unfortunately, once the furor over this issue dies down the shadow of indifference will once again enshroud the state’s prison system. Inevitably, another MDOC facility’s closet-sized solitary confinement cell will unleash yet another mentally ill prisoner who is tormented by abusive conditions and years of non-treatment. “There are more Danny Tavares’ in [prison] than I care to count,” observed Massachusetts Correctional Legal Services director Leslie Walker.

Will the political will ever be found to force needed changes, or will mentally ill prisoners continue to be victimized – and victimize others – due to the state’s failed policies and practices related to mental illness behind bars?

One organization isn’t waiting for an answer. On March 8, 2007, the Disability Law Center, which serves as the Protection & Advocacy Agency for Massachusetts, filed suit against the MDOC in federal court. The lawsuit raises claims under the Americans with Disabilities Act, and argues that keeping mentally ill prisoners in solitary confinement violates the Eighth Amendment.

The Center is demanding the construction of residential treatment centers plus 15 hours of therapy a week for mentally ill prisoners. Settlement negotiations with the state are ongoing. See: Disability Law Center, Inc. v. Mass. Dept. of Correction, U.S.D.C. D.Mass., Case No. 1:07-cv-10463-MLW.

Sources: Boston Globe, Seattle Times, Metrowest Daily News, Telegram & Gazette, New York Times,

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Related legal case

Disability Law Center, Inc. v. Mass. Dept. of Correction