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North Carolina Prisons Slow to Change Attitudes about Mentally Ill Prisoners

North Carolina Prisons Slow to Change Attitudes about Mentally Ill Prisoners

by David M. Reutter

The head of North Carolina’s Division of Adult Correction and Juvenile Justice is calling for more than $20 million in additional state funding to pay for changes in the way the state prison system takes care of its approximately 4,600 mentally ill prisoners – 12% of North Carolina’s total prison population.

The request by corrections commissioner W. David Guice came in the wake of the high-profile dehydration death of mentally ill prisoner Michael Anthony Kerr on March 12, 2014 after more than a month in solitary confinement, when the water to Kerr’s cell had twice been disconnected. [See: PLN, May 2015, p.60]. Guice made the request when he appeared before a December 11, 2014 meeting of the Joint Legislative Oversight Committee on Justice and Public Safety that was convened to examine the state’s treatment of mentally ill prisoners.

Guice requested $16 million to hire 308 new employees to help manage mentally ill prisoners, plus additional funding to operate 72 beds for mentally ill prisoners at Central Prison in Raleigh that are in place but not being used due to budget cuts, according to Terri Cartlett, the prison division’s deputy director of health services. The facility currently operates 144 beds for mentally ill prisoners, Cartlett said.

The corrections commissioner also called on lawmakers to provide funding to hire 76 new probation officers with the specialized expertise required to manage mentally ill parolees, and asked for $1.4 million to modernize all medical recordkeeping throughout the system, some of which is still done on paper.

Guice’s requests received a less-than-enthusiastic reception from some lawmakers. State Senator Buck Newton said there may be a flurry of proposed legislation in 2015 addressing mental health issues in North Carolina’s prison system, but cautioned against expecting a comprehensive legislative package.

Part of the problem in getting an accurate look at the full extent of how mentally ill prisoners are treated across the state is a lack of a uniform tracking system for the mentally ill held in jails administered by counties, according to Eddie Caldwell, general counsel for the North Carolina Sheriffs’ Association.

In addition to his request for more funding, Guice told legislators about steps the corrections department has taken to better respond to the needs of mentally ill prisoners, including instituting crisis intervention training for prison staff and reviewing all policies for how to deal with prisoners who have been diagnosed with mental health problems. Guice warned, however, that “the needed fixes – more therapy, more medical oversight, specialized units – won’t be cheap, especially in a system that’s already underfunded.”

North Carolina’s prison system has faced mounting criticism that reforms promised both before and after Michael Kerr’s death have been slow to materialize. Kerr, 53, incarcerated at the Alexander Correctional Institution, died during a 165-mile, three-hour trip to Central Prison in Raleigh. According to prison records he had been held in solitary confinement for 35 days prior to his death, and spent the last five days of his life handcuffed and unresponsive in his cell. Authorities said prison officials twice turned off the water to his cell after he intentionally flooded it.

A report published by the Human Rights Policy Seminar at the University of North Carolina (UNC) School of Law blasted the state for its use of solitary confinement, especially as a means of controlling mentally ill prisoners. The 216-page report, based on research and interviews with prisoners, condemned solitary confinement as “torture,” reaching the “straightforward and simple” conclusion that “solitary confinement is ineffective at decreasing violence within prisons; it is ineffective at preserving public safety; it is ineffective at managing scarce monetary resources; and it violates the boundaries of human dignity and justice. Prison officials and the courts must find a way to end the practice without delay.”

The blame, according to UNC law professor Deborah M. Weissman, the report’s collaborating author, can be traced to the abysmal state of the general mental health care infrastructure overall.

“Mental health systems in NC are underfunded and fail to provide critical care and services to many individuals who, as a consequence of their mental health illnesses, wind up in prison,” Weissman wrote in an email to watchdog organization Solitary Watch. “Either due to a lack of care, lack of training, or lack of other alternatives, individuals whose mental illness manifests as criminal behavior are sent to prison where their situation further deteriorates.”

An investigative report published by INDY Week, entitled “Prison System Short on Psychologists, Long on Mentally Ill Inmates,” cited evidence of a serious shortage of mental health personnel in North Carolina prisons. State Department of Public Safety spokesperson Pam Walker told the publication that as of November 3, 2014, nearly one-third of the 98 positions for prison psychologists were vacant; for senior psychologists, the vacancy rate skyrocketed to 60%. In addition, Walker said, 22% of the 1,314 nursing positions in state prisons were vacant, leaving the system with a huge gap in the number of medical professionals needed to provide mentally ill prisoners with daily care.

The state denied, however, that unfilled positions pose a threat to prisoners who have mental health problems. Terri Cartlett, deputy director of health services, insisted that mentally ill prisoners are not “in any additional danger because of the staff vacancies.”

Vicki Smith, the executive director of Disability Rights NC, a non-profit organization, took an opposing view.

“In any facility where you find a high rate of vacancy, you have a lot of workers putting in overtime,” Smith told INDY Week. “If you have people working a lot of overtime, they’re not getting downtime. Poorly trained, overworked staff always contribute to abuse and neglect.”

An independent Disability Rights NC investigation into Michael Kerr’s death found “severe deficiencies” in the state prison system’s care for mentally ill prisoners. On October 3, 2014, the organization wrote to Governor Pat McCrory, urging him to declare a hiring emergency to address mental health staff shortages.

INDY Week noted that “Two years ago, the North Carolina prison system promised change after blaming staff shortfalls for the problem of mentally ill prisoners left isolated in cells splattered with human waste,” but “mental health advocates say they are still waiting for prison officials to deliver on that promise.”

In the wake of Kerr’s death, the Department of Public Safety fired nine employees and demoted two others. In addition, two more employees resigned. One of the demoted employees, John Monguillot, who lost his position as assistant director of mental health in the state’s Western Region, was later employed as the psychological services coordinator at the Marion Correctional Institution. According to a May 21, 2015 news report, Monguillot challenged his demotion, settled his claim and was transferred to the Forsyth Correctional Center; he reportedly received a raise and was awarded back pay and attorney’s fees.

Kerr’s maltreatment might have caught the public’s attention, but his death was by no means the first of a mentally ill state prisoner. In 1997, Glen Mabrey, a Vietnam veteran who suffered from mental illness, died under similar circumstances, succumbing to dehydration while being held in solitary confinement with the water to his cell disconnected.

In September 2010, Levon Wilson was one of several prisoners who died due to medical conditions. Wilson, who was diagnosed with bipolar disorder, was taken to WakeMed Hospital in Raleigh from Central Prison. According to an autopsy, he had “moderately high levels” of lithium in his blood.

The Raleigh News Observer wrote that Wilson’s death resulted from “complications of lithium therapy,” which led to kidney and bowel problems. Despite that finding, the state doctor who performed the autopsy declared Wilson’s death “natural.”

A 2011 internal review of conditions at Central Prison determined that staff routinely neglected the needs of prisoners diagnosed with serious mental illnesses. According to the News Observer, “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 internal report went on to describe nurses who admitted not knowing which prisoners were which and patients who were sometimes given too much prescribed medication or none at all.

The same report detailed incidents in which mentally ill prisoners, left unsupervised, “cut themselves and swallowed nails, batteries and shards from plastic eating utensils.” The internal review also cited numerous inconsistencies and contradictions in the written records of staff members who conducted observation rounds. Investigators found that prisoners held in “therapeutic seclusion” were often locked in their cells for extended periods without being released for meals, recreation time or showers.

The state has since taken some steps to reform the treatment of mentally ill prisoners. Governor McCrory signed legislation in 2015 authored by Senator Shirley Randleman, who had chaired a study committee that recommended mental health training for law enforcement, attorneys and judges. The new law is intended to reduce jail time and speed up the process for placing mentally ill prisoners in treatment facilities.

Raleigh police have embraced Crisis Intervention Team (CIT) training for 150 officers, or about 19% percent of its force, although mental health advocates said they would like to see more of the force receive such training. Gerry Akland, president of the Wake County chapter of the National Association on Mental Illness, who has trained police in the CIT method, said the training needs to improve to help officers develop a sense of when to ignore a crime committed by the mentally ill and when to divert someone to jail.

“So far, the training has not gone into that kind of depth,” Akland stated. “Those are tough things for an officer to deal with.”

“It’s not that they [the mentally ill] are pathological misfits; their brains have been damaged,” said Rich Munger, with the Buncombe County Department of Health and Human Services. “Lots of people – legislators, persons in the criminal justice system – don’t understand this. We’ve not turned that corner in this country at all. We’re not even close to it.” Mental illness must be treated as a health issue, Munger said, much like cancer or strokes.

One of the biggest challenges is changing the culture of old-school corrections staff, according to prison psychologist Stephen Lucente. “Maybe there are some biological brain issues here and not just some knucklehead guy banging on the door. It’s going to take a while to change the culture, the feel of how the old-style prisons were run,” he observed.