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Mental Health Care in South Carolina Prisons Found Unconstitutional

Mental Health Care in South Carolina Prisons Found Unconstitutional

by David M. Reutter

On January 8, 2014, a South Carolina state court entered judgment in a decade-long class-action lawsuit, finding that mental health care in the South Carolina Department of Corrections (SCDC) exposed seriously mentally ill prisoners to a substantial risk of harm, and that the SCDC knew about such deficiencies but “failed to take reasonable measures to abate that risk.”

Since the class-action suit was filed in 2005 the SCDC has fought it “tooth and nail,” spending “hundreds of thousands of tax dollars,” Judge J. Michael Baxley wrote. That money “would be better expended to improve mental health services delivery in SCDC,” he noted.

“The evidence in this case has proved that inmates have died in the South Carolina Department of Corrections for lack of basic mental health care, and hundreds more remain substantially at risk for serious physical injury, mental decompensation, and profound, permanent mental illness,” Judge Baxley stated following a five-week trial. “As a society, and as citizen jurors and judges make decisions that send people to prison, we have the reasonable expectation that those in prison – even though it is prison – will have their basic health needs met by the state that imprisons them. And this includes mental health. The evidence in this case has shown that expectation to be misplaced in many instances.”

The court cited six areas of deficiency that led to its finding of unconstitutional care and treatment of the SCDC’s 3,500 seriously mentally ill prisoners. First, it found the prison system’s mental health program was “severely understaffed, particularly with respect to mental health professionals.”

Next, mentally ill prisoners were “exposed to a disproportionate use of force and segregation (solitary confinement) when compared with non-mentally ill” prisoners. At some facilities, force was used on up to 44% of mentally ill prisoners, which was “a rate two and a half times greater than non-mentally ill prisoners.”

The court found that SCDC guards “routinely” gassed mentally ill prisoners with pepper spray “in amounts that exceed manufacturer instructions and at closer distances than the manufacturer directs.” The SCDC also commonly placed prisoners in physical restraints “for predetermined blocks of time in set, four-hour increments,” including in restraint chairs that forced them into “a painful, ‘crucifix’ position.”

Two video-recorded incidents evidenced a “broken” mental health care system. In both cases, the prisoners had cut themselves. One of the videos showed the prisoner’s “intestine coming out of his abdominal wall” as guards tightened the chair’s restraints, which put “additional pressure on his abdomen.”

Judge Baxley further found that the SCDC lacked a sufficient program to maintain accurate and complete treatment records, that its screening and evaluation process to identify mentally ill prisoners was ineffective, and that the administration of psychotropic medications was inadequately supervised and evaluated. Finally, the court held the SCDC’s policies and practices concerning suicide prevention and crisis intervention were insufficient, resulting in unnecessary loss of life. The order cited the death of prisoner Jerome Laudman, who died of hypothermia in 2008 after spending 11 days in solitary confinement while naked.

As a remedy, the court ordered the SCDC to submit a plan within six months that includes the development of screening and mental health programs, increases mental health staff, ensures the maintenance of treatment records and the proper administration and evaluation of psychotropic drugs, and implements a program to identify, treat and supervise prisoners at risk of suicide.

“This litigation does not occur in a vacuum,” Judge Baxley wrote. “What happens at the Department of Corrections impacts all of us, whether it is from the discharge of untreated seriously mentally ill individuals from prison into the general population, or tremendously increased costs for treatment and care that might have been prevented, or the needless increase in human suffering when use of force replaces medical care. The decisions of our Courts reflect the values of our society. To that end, our state can no longer tolerate a mental health system at the South Carolina Department of Corrections that has broken down due to lack of finances and focus.”

Following the court’s ruling, the SCDC developed a remedial plan and opened the Self-Injurious Behavioral Unit at the Kirkland Correctional Institution, for prisoners at risk of hurting themselves, in July 2014. On January 15, 2015, the parties agreed to a plan that will phase in $8.6 million in state funding over a three-year period to improve mental health care, that includes “significant” modifications to SCDC policies and procedures, and that requires improved staff training among other provisions.

“Implementation of this plan will be a challenge and will require a great deal of cooperation, however, this is a first step and we look forward to making our prisons safer for the public servants in corrections, inmates and the community,” stated SCDC Director Bryan P. Stirling.

The first-year installment of the funding for the remedial plan was included in the governor’s executive budget. Additionally, a bill was introduced in the state legislature to treat certain mentally ill defendants through mental health courts in each county rather than sending them to prison. The bill, S.426, passed and was signed into law in June 2015.

The prisoners in the class-action suit were represented by Protection and Advocacy for People with Disabilities, Inc. The case remains pending a final settlement. See: T.R. v. South Carolina Department of Corrections, Court of Common Pleas, Fifth Judicial Circuit (SC), Case No. 2005-CP-40-02925.

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Related legal case

T.R. v. South Carolina Department of Corrections