Former employees of Houston-based Turning Point, Inc., a private, for-profit company which contracted with Texas to provide substance abuse treatment in its state jail system, are revealing how supervisors pressured them to falsify Addiction Severity Index (ADI) scores to downplay mental illness issues and exaggerate alcohol and substance abuse.
Melissa Cantu was a therapist for over a decade before taking a job as a substance abuse counselor for a Turning Point rehabilitation program at the Dominguez State Jail. Stress from the "abusive workplace" she discovered there caused her to experience insomnia and break out in hives before she finally decided to quit the job only months after she was hired.
Cantu had been pressured to have the ASI scores of prisoners show that they were strong substance abusers without serious mental health issues. She was told to not to score the psychiatric component of the ASI greater than "one," the lowest score on the test, indicating that no mental health treatment was necessary. This meant that prisoners with serious psychiatric issues would be denied mental health treatment and placed into a substance abuse treatment program instead.
"Some clearly had anxiety, possible schizophrenia or bi-polar disorder," Cantu said. "But if they had a history of mental disorders, they wouldn't get the right treatment for it. Because if the psychiatric score came back as a five, you'd have to go back and change it to a one or a two."
Former Turning Point counselor Mark VanHudson agrees. He quit his job a few days after being hired. The reason—he was ordered not to classify as mentally ill a prisoner who had described to him in detail how he would commit suicide.
"A significant number of these people clearly manifested severe mental illness, some diagnosable and recognizable on the spot, some with suicidal tendencies," said VanHudson. "Directors instructed us to ignore them—they are asking the counselor to ignore literally life and death indications."
The counselors were also told to exaggerate the substance dependency scores. This led to prisoners who had been clean and sober for decades being funneled into substance abuse programs they did not need and could not use.
"We would get some guys with no history of substance abuse or dependency," Cantu said. "A guy who drinks occasionally would be pushed into the program. There would be nothing in their histories, no DUIs, no DWIs, no indication that says they ethically deserve to be in a substance rehab program. They didn't meet the criteria at all."
Another former Turning Point counselor going under the pseudonym Patricia Jones said that she had to remove herself from an "unethical" work environment in which she was required to deem social drinkers alcoholics.
"Having a beer once a week or even one a year would be considered 'alcohol abuse' in the program, but it's clearly not," according to Jones. "[The supervisor] wanted to make them look worse than they were. Some of these guys didn't even do drugs, they didn't have an alcohol issue, they weren't addicted, but we were supposed to classify them as addicts."
The former therapists also criticized Turning Point for lax, unstructured therapy sessions with little one-on-one time with the prisoners and using unqualified, undereducated employees to conduct the sessions. VanHudson also noted that the ASI is ineffective in the correctional setting because it focuses on substance abuse within the preceding 30 day s whereas most of the tested prisoners had been incarcerated longer than that.
"Why were we even using this instrument in this setting? It didn't make sense," said VanHudson.
Little about the issues the former counselors are complaining about makes sense if one assumes that the main purpose of the program is to rehabilitate substance abusers. As usual, things make more sense when you follow the money. Then it becomes clear that the main purpose of the program is to make money.
Turning Point operates its state jail program under a contract from the state. For fiscal years 2008 through 2012, Turning Point received $11 million from the Texas Department of Criminal Justice. It has another $5.64 million contract to operate its program, which has a capacity of about 180 prisoners, at six state jails from September 2012 through August 2014. To justify the lucrative contracts, prisoners must be feed into the program. To facilitate this, supervisors made counselors' retention of their jobs dependent upon fudging the numbers to keep the program at maximum capacity.
Skewing the numbers was not just requested, "it was demanded, employees can't keep their jobs if they don't comply," said VanHudson.
"We were told, 'You guys gotta keep your numbers up if you want to get paid," Cantu said. "If the numbers are up, you keep your job."
So, according to the former counselors, Turning Point kept the numbers up and fed mentally ill prisoners into the program regardless of the consequences to the prisoners or any counselors with a conscience. Ironically, this fits right in with the apparent priorities of Texas, which ranks 49th in per-capita spending on mental health issues. Spending on substance abuse treatment is all right, funding mental health care, not so much.
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