Treatment of mentally ill prisoners changing

After more than seven years of litigation, the Indiana Department of Correction is instituting major changes by providing treatment and mostly eliminating solitary confinement for severally mentally ill prisoners.

The changes are coming as part of a proposed settlement agreement in a lawsuit brought by the American Civil Liberties Union of Indiana and the Indiana Protection & Advocacy Services Commission. In October 2008, the two organizations filed a complaint in federal court, charging the DOC with violating the Eighth Amendment by confining prisoners who have serious mental illness in “excessively isolated and harsh conditions,” which exacerbated their conditions, and by failing to provide adequate mental health care.

The settlement in Indiana Protection & Advocacy Services Commission, et al. v. Commissioner, Indiana Department of Correction, 1:08-CV-01317, was announced Jan. 27.

The plaintiffs said the agreement will “fundamentally transform the way seriously mentally ill prisoners are treated” in state prisons and will affect “hundreds if not thousands of prisoners in Indiana” by providing better access to mental health care and no longer holding them without treatment in solitary confinement.

Under the agreement, “seriously mentally ill prisoners” are defined as those having a diagnosis or recent history of a major mental illness such as schizophrenia, psychotic disorder, major depression or bipolar disorder who are suicidal. The settlement also includes prisoners diagnosed with an intellectual or developmental disability in the definition of “seriously mentally ill prisoners.”

Indiana Attorney General Greg Zoeller’s office, which represented the DOC in this lawsuit, noted the proposed agreement still has to be reviewed by the court to determine if the settlement is “fair, reasonable and adequate” under the federal rules. It will not go into effect until the individuals affected have been notified of the agreement and the court conducts a required hearing.

“As this proposed agreement still awaits approval by the court, it would not be appropriate for us to comment further,” said attorney general spokesman Bryan Corbin.

However, the state’s penal system is already implementing the changes outlined in the agreement by providing treatment for the seriously mentally ill inmates. It has also increased correctional personnel and mental health staffing.

Falk

“I think in many ways this was very liberating to people in the DOC because they were able to do the right thing and I don’t think they had to be convinced what that was,” said Ken Falk, ACLU of Indiana legal director. “I think they were very aggressive in pursuing this. It was very admirable.”

The agreement, if approved, will be in place for three years during which time the plaintiffs will be able to monitor the DOC to ensure full compliance. The parties do have the option of extending the agreement.

Also, the DOC will pay the plaintiffs’ attorney fees of $585,000.

22 hours, 45 minutes alone

The dispute between the plaintiffs and the DOC resulted in a four-day bench trial in 2011 with Judge Tanya Walton Pratt in the U.S. District Court for the Southern District of Indiana finding the state’s correctional system was violating the Eighth Amendment’s prohibition against cruel and unusual punishment.

In the entry following bench trial issued in December 2012, the District Court described the conditions of the so-called segregation units where inmates may be kept up to four years.

It found prisoners in these units were held in individual cells for up to 22 hours and 45 minutes each day, although some were kept in their cells all day. Each cell was small, typically 13 feet by 6 feet, and contained a bed, usually a concrete or metal frame that was attached to the wall or floor, and a sink/toilet unit.

The inmates ate their meals in their cells but they would be taken out for up to an hour of recreation by themselves each day and a 10- to 15-minute shower three times a week. They were locked in the small showers and sometimes had to remain there for long periods until the correctional staff released them. Whenever the prisoners were removed from their cells, they were placed in hand restraints and sometimes in leg restraints as well.

Of the DOC’s prison population of 26,753 in January 2010, the court cited findings that 22 percent were seriously mentally ill. Treatment for these inmates was largely limited to medication and conversations with the mental health staff.

The court found when seriously mentally ill prisoners are placed in segregation, they may begin to decompensate with 10 days to two weeks.

Watson

Indiana University Robert H. McKinney School of Law clinical professor Frances Watson responded to the ACLU and DOC settlement with one word – “amen.” Watson is a former chief public defender in the Marion County Public Defender Agency and directs the criminal defense clinic and the wrongful conviction clinic at the law school. She is also a board member of the ACLU of Indiana.

“I think our whole U.S. prison system is something we should hang our heads in shame about,” she said.

Watson explained no one doubts that the mentally ill individual who has committed a crime should be sentenced to prison, but the issue is what the penal system should do. While the Constitution does not require that prisoners be coddled, the lawsuit recognized the DOC has to do more.

She is hopeful the agreement will reduce the misery by providing better resources and more appropriate treatment for the seriously mentally ill.

Settlement terms

Under terms of the pending settlement agreement, seriously mentally ill prisoners, with some exceptions, cannot be placed in restrictive status housing or solitary confinement. Also, these inmates must receive “minimum adequate treatment” that includes:

• An individualized treatment plan, created by a team of mental health professionals and correctional staff, that will be reviewed at least every 90 days;

• 10 hours of therapeutic programming each week including group and individual sessions;

• Recreation and showers; and

• Additional therapy and out-of-cell time where possible and appropriate.

In addition, the DOC will utilize existing facilities and programs as well as develop new facilities and programs for these prisoners. The specialized mental health programs in place for male inmates are located at:

• New Castle Psychiatric Facility with 128 beds and 123 occupants;

• Special Needs Unit at the Wabash Valley Correctional Facility with 134 beds and 98 prisoners; and

• Pendleton Treatment Unit/INSIGHT (Intent on Shaping Individual Growth with Holistic Treatment) at the Pendleton Correctional Facility with a capacity for 250 and current population of 192.

Female prisoners with severe mental illness can be housed in the Special Needs Unit at the Indiana Women’s Prison which, at present, has a population of 38.

Both Watson and Dawn Adams, executive director of the Indiana Protection & Advocacy Services Commission, pointed out the problems within the DOC were a reflection of the breakdown of mental health services in the larger community. Individuals are not getting treatment and they are committing crimes that possibly could have been averted if they had received proper medication and medical help.

“The mental health system is broken on the outside,” Adams said. “People aren’t able to get help on the outside so now our prisons are the largest mental health hospitals around, and that’s not what they were designed to do.”•