Monday, April 26, 2010

Half of Oregon's prison population has a mental illness; system tries to adapt

From The Statesman-Journal in Oregon:

Nearly half of Oregon's 14,000 prisoners — 6,797 — are mentally ill, according to the Department of Corrections.

This troubling convict population has boomed during the past decade and now is 10 times larger than the mental patient population at the 627-bed Oregon State Hospital in Salem.

Alarmed by the rising number of mentally ill convicts, prison officials plan to create a new multipurpose mental health center at the Oregon State Penitentiary in Salem, just south of the state hospital.

The penitentiary's "super max" unit, officially called the Intensive Management Unit, will be converted into three therapy-minded units.

For two decades, the IMU has operated as a tightly controlled compound within the now-2,000-inmate prison. It corrals belligerent and disruptive inmates — some mentally ill — in their cells for more than 23 hours per day.

By the end of this year, the two-story IMU facility will get a facelift to soften its austere environment, and will begin serving a therapeutic role.

"With the types of programs we want to bring in there, we need to bring in some acoustic sound proofing and lighten it up with some paint," said Brian Belleque, DOC administrator for the west side institutions.

Mental health services are planned for three of the four units in the IMU building:

-A 49-bed mental health infirmary will provide "crisis stabilizing" treatment for acutely mentally ill offenders, including inmates who attempt suicide or commit other acts of self-harm.

-A 65-bed day-treatment unit will provide mental health services for inmates coming out of the crisis-care unit. The so-called "step down" program also will provide preventative mental health services for inmates, designed to help them cope with their illnesses and avoid crises.

-A 73-bed behavioral unit will provide specialized services and supervision for disruptive mentally ill inmates who otherwise might end up in isolation cells.

Another change in the looming makeover of the IMU calls for Oregon's death row to occupy one unit of the building. Condemned killers currently are housed in another part of the penitentiary.

The IMU opened in 1991 as one of the nation's first so-called "super max" prison units.

Costing about $10 million, the 192-bed facility was designed to take the steam out of troublesome inmates who "compromised the safety of the prison system."

Prisoners can get dispatched to IMU for varied reasons, ranging from assaults on fellow inmates to prison drug dealing to hurling urine or feces at officers.

Security protocols go to extraordinary lengths in the IMU. When an inmate leaves his cell, usually to shower or exercise, he is handcuffed, tethered with a leash and escorted by two officers.

The only way to get out of the super-max unit is to obey the rules and pass multi-level requirements.

Prison officials say the IMU has paid safety dividends by removing assaultive and disruptive convicts from the general prison population, thereby helping to keep the peace behind prison walls.

But IMU critics long have complained that inmates are subjected to cruel stints of extreme isolation, sensory deprivation and profound loneliness.

With the end of the state penitentiary's IMU, some inmates now held in the compound will be relocated to another "super max" IMU at the Snake River Correctional Institution in eastern Oregon.

And some IMU inmates with mental health needs will reside in the new units at the Salem prison.

The price tag is estimated at $80,000 for remodeling work at the penitentiary's IMU, adding more bunks at Snake River's IMU and other changes, officials said.

"The overall cost is actually pretty minimal given the scope of the project," Belleque said.

State prisons and county jails in Oregon increasingly have become warehouses for mentally ill criminals.

Oregon isn't alone. What's sometimes called "criminalization of the mentally ill" has become a national trend.

"We're in line with most of the other departments of corrections in other states," said Jana Russell, the Oregon prison system's assistant administrator for mental health services. "A good 50 percent of the population with mental health diagnoses seems to be the standard now."

By comparison, mentally ill inmates made up 13 percent of Oregon's prison population in 2001.

Prison statistics for that year show 1,362 inmates were diagnosed with mental illness, and the prison system housed 10,200 inmates.

The number of mentally ill inmates has climbed steadily since then. Reasons given for the troubling trend range from a spike in drug-induced psychoses linked to methamphetamine abuse to shortages of community-based mental health services.

"I think that one of the issues is related to the resources that are currently available in communities where folks live," Russell said. "When there are no mental health services, things obviously don't go well for those folks."

In Oregon, criminal defendants found guilty of crimes but insane at the time go to the state hospital's forensic program for treatment instead of to prison.

It's hard to pin down why far more mentally ill criminals land in the prison system than at the state hospital, but mental health advocates say some prisoners diagnosed with mental illness may not have been ill when they committed their crimes. In other cases, defense attorneys may have opted against pursuing an insanity defense, reasoning that a prison sentence would prove to be shorter than a stay at the state hospital.

In a prison system bulging with mentally ill inmates, minimal care is the norm. All of the nearly 7,000 inmates diagnosed with mental illness are eligible for "case management," meaning periodic meetings with a mental health specialist.

"When their symptoms are active, they receive care," Russell said. "However, we focus most of our resources on the highest-needs inmates."

Though the penitentiary has an existing psychiatric unit with about the same number of beds as the planned 49-bed infirmary, officials emphasized that the new crisis-care unit will be complemented by the two adjacent mental health programs.

"It doesn't complete our mission, but it's a giant step forward," Russell said.

Suicides occur in isolation
For years, mentally ill inmates have been among the disruptive inmates placed in prison disciplinary segregation units and IMUs. In some cases, extreme isolation and mental illness have proved to be a deadly combination.

Since August 1998, at least 28 inmates have committed suicide in Oregon's prison system. The majority hanged themselves in segregation cells.

A 2007 Statesman Journal examination of prison suicides found that more than half of the inmates who took their own lives had known psychiatric problems.

Prison officials said the new behavioral unit will provide specialized help for some mentally ill inmates who otherwise might land in segregation cells.

"They're not going to be locked down in their cells," Russell said. "They're going to be out of their cells for hours a day interacting with a mental health specialist or others in a group if their behavior is appropriate."

The Salem prison was selected for the expanded mental health programs after prison officials postponed construction of a new prison complex in Junction City, previously earmarked to house specialized programs for mentally ill and elderly inmates.

The penitentiary will serve as the hub of mental health care at least until the Junction City complex gets built, officials said.

DOC plans now envision completion of a 532-bed minimum-security prison in Junction City in the fall of 2014, and completion of a 1,262-bed medium-security prison at the same site in the spring of 2019.

"It's a stopgap to kind of catch us up to where we should have been over the last 10 to 15 years, and to get us through the next 10 years, if that's when Junction City comes on line," Belleque said about the penitentiary's larger role in mental health care.

Corrections officials said the looming changes at the penitentiary shouldn't rekindle Salem leaders' concerns about playing host to five state prisons and the state mental hospital.

"We're not increasing the population in Salem. We're not increasing the institutions in Salem," said Chane Griggs, assistant director of public services for the DOC. "The inmates are still going to release into the counties in which they committed their crimes. Those are key issues that are not changing with this."