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The Warehousing of New Hampshire’s Mentally Ill
The Warehousing of New Hampshire's Mentally Ill
by David M. Reutter
Despite over 30 years of litigation, mentally ill prisoners at the New Hampshire State Prison (NHSP) are still not receiving care to treat their conditions. In fact, with NHSP adopting the trend of locking prisoners down in Special Housing Units (SHU), NHSP's mentally ill are probably worse off than when litigation started, if that?s possible.
Challenges to NHSP's overall conditions of confinement began when prisoner Jaan Laaman brought suit in federal court in 1975. Relevant to this article, the Laaman action culminated in a 1990 Consent Decree that became a settlement agreement ratified in April 2001 after the original decree was vacated under the Prison Litigation Reform Act, see: Laaman v. Warden, New Hampshire State Prison, 238 F.3d 14 (1st Cir. 2001). That agreement solely focused on the care of mentally ill prisoners and how that care would be delivered. Any violation of the agreement was to be enforced via actions in the state courts.
As so often happens in prison litigation, NHSP and state officials failed to comply with the agreement. By 2004, several NHSP prisoners were forced to bring an action in New Hampshire Superior Court to enforce the agreement. The matter went to trial in December 2005, which displayed an ugly picture of conditions for NHSP's mentally ill.
As part of the Laaman settlement, NHSP was to create a Residential Treatment Unit (RTU), which is a distinct unit with the benefits of a therapeutic community. When the settlement needed implementation, New Hampshire's Correctional Commissioner, Philip Stanley, decided that "architectural and space limitations" prevented an RTU at NHSP. So, he ordered Dr. Knoll to devise an alternative.
Dr. Knoll devised a two-pronged plan as a conceptual alternative to an RTU. The plan had an in-patient housing component located in the Secure Psychiatric Unit (SPU), called SNOP (Special Needs Offender Program), and an outpatient component that was to be located in the prison outpatient Mental Health Unit, called IOP (Intensive Outpatient Program).
Because the IOP prong was never implemented, Dr. Knoll was left with only the SNOP to replace the RTU, which he designated RTP. The RTP had no guards trained to deal with the types of prisoners under their care, and the few therapeutic groups that existed were held only intermittently. While many RTP prisoners were ready for discharge to an RTU, they were kept in the SPU because prison clinicians recognized those prisoners would decompensate if released to open population, and there is no RTU to send them to. So, they remained "warehoused: in the state's most secure psychiatric unit.
Because the RTU was never created, prisoners had to qualify for placement in the SPU to receive treatment of their mental illness. That called for adverse actions by the prisoner, as under New Hampshire law a prisoner can only be placed in the SPU if "found to be dangerous to themselves or others," and "the individual cannot be safely maintained and treated in the correctional facility." As such, mentally ill prisoners could only receive treatment if they qualify for psychiatric hospitalization by decompensating to a degree they become a clear danger to themselves or others.
At least six group therapies have been identified as necessary at NHSP. Under Laaman, they are to be created when identified as needed by the Chief of Mental Health and Director of Medical and Forensic Services. Yet, the groups have never been created or offered to prisoners.
NHSP's Mental Health Unit is so understaffed that the "non emergency waiting list for psychiatry is 5 to 6 months." The Laaman settlement required a minimum of 8 clinicians for mental health services. For years, it has been below that level despite the mental health caseload growing substantially.
The mentally ill in SHU have it the worst. They are held in small cells 23 hours a day. Typically, 20 to 30 SHU prisoners have a serious mental illness and are on psychotropic medications. Most suicides and serious suicide attempts in the entire New Hampshire prison system occur in the SHU. The isolation and lack of programs cause further deterioration of mentally ill prisoners, psychiatrists and clinicians testified at trial.
SHU prisoners on psychotropic drugs or participating in the one available program must be seen by a clinician every 14 days. Rather than have these periodic clinical appointments, those prisoners were seen by a doctor during rounds of their unit, which consisted of asking: "How are things going?" This is a stark contrast from the required out of cell clinical visit in a private setting where the patient can have a face to face talk with a clinician about serious mental health concerns.
Those SHU prisoners requiring a precautionary mental health watch were removed from their cells and required to stay in the "dayroom." In the dayroom, they had no toilet, often being forced to urinate on the floor.
No mattress or blanket was furnished, and the only place to sit while clothed only in boxer shorts was a cold cement floor. There a prisoner could languish for days while being "watched."
Another large problem was the refilling or renewal of medications. No system existed to monitor when a prisoner needed a refill; he had to complete and file a form requesting the refill. This often resulted in the mentally ill prisoner failing to submit the form at all or in time to receive the medication without running out.
Sometimes, a prisoner would not seek a refill because he was feeling better, only to relapse when the medication was out of his system. It would then take weeks to get the refill process complete and to restabilize the prisoner.
As so often happens, prison officials placed the blame on the prisoners. As the prisoners argued, "there is something inherently wrong with a system that depends on the inmate to initiate the refill process and a system in which a refill slip and the refilled medication must go through multiple hands and delivery points without a computerized tracking mechanism." Further delays occur when a prisoner's housing is changed.
The Superior Court agreed, for on May 22, 2006, the Court entered, an order that basically follows the prisoners' proposed order. That order required full compliance with the Laaman settlement, requiring an RTU, increased staffing, group therapies, a system to track and follow-up on medication needs, software to manage mental health treatment, and clinical appointments for SHU prisoners every 14 days.
Prison officials were given 60 days to file a compliance plan with the Court. Perhaps, this Court order will finally result in the treatment of NHSP's mentally ill, which has been neglected for over 30 years. See: Holliday v. Curry, New Hampshire Superior Court, Case No: 04-E-203.
by David M. Reutter
Despite over 30 years of litigation, mentally ill prisoners at the New Hampshire State Prison (NHSP) are still not receiving care to treat their conditions. In fact, with NHSP adopting the trend of locking prisoners down in Special Housing Units (SHU), NHSP's mentally ill are probably worse off than when litigation started, if that?s possible.
Challenges to NHSP's overall conditions of confinement began when prisoner Jaan Laaman brought suit in federal court in 1975. Relevant to this article, the Laaman action culminated in a 1990 Consent Decree that became a settlement agreement ratified in April 2001 after the original decree was vacated under the Prison Litigation Reform Act, see: Laaman v. Warden, New Hampshire State Prison, 238 F.3d 14 (1st Cir. 2001). That agreement solely focused on the care of mentally ill prisoners and how that care would be delivered. Any violation of the agreement was to be enforced via actions in the state courts.
As so often happens in prison litigation, NHSP and state officials failed to comply with the agreement. By 2004, several NHSP prisoners were forced to bring an action in New Hampshire Superior Court to enforce the agreement. The matter went to trial in December 2005, which displayed an ugly picture of conditions for NHSP's mentally ill.
As part of the Laaman settlement, NHSP was to create a Residential Treatment Unit (RTU), which is a distinct unit with the benefits of a therapeutic community. When the settlement needed implementation, New Hampshire's Correctional Commissioner, Philip Stanley, decided that "architectural and space limitations" prevented an RTU at NHSP. So, he ordered Dr. Knoll to devise an alternative.
Dr. Knoll devised a two-pronged plan as a conceptual alternative to an RTU. The plan had an in-patient housing component located in the Secure Psychiatric Unit (SPU), called SNOP (Special Needs Offender Program), and an outpatient component that was to be located in the prison outpatient Mental Health Unit, called IOP (Intensive Outpatient Program).
Because the IOP prong was never implemented, Dr. Knoll was left with only the SNOP to replace the RTU, which he designated RTP. The RTP had no guards trained to deal with the types of prisoners under their care, and the few therapeutic groups that existed were held only intermittently. While many RTP prisoners were ready for discharge to an RTU, they were kept in the SPU because prison clinicians recognized those prisoners would decompensate if released to open population, and there is no RTU to send them to. So, they remained "warehoused: in the state's most secure psychiatric unit.
Because the RTU was never created, prisoners had to qualify for placement in the SPU to receive treatment of their mental illness. That called for adverse actions by the prisoner, as under New Hampshire law a prisoner can only be placed in the SPU if "found to be dangerous to themselves or others," and "the individual cannot be safely maintained and treated in the correctional facility." As such, mentally ill prisoners could only receive treatment if they qualify for psychiatric hospitalization by decompensating to a degree they become a clear danger to themselves or others.
At least six group therapies have been identified as necessary at NHSP. Under Laaman, they are to be created when identified as needed by the Chief of Mental Health and Director of Medical and Forensic Services. Yet, the groups have never been created or offered to prisoners.
NHSP's Mental Health Unit is so understaffed that the "non emergency waiting list for psychiatry is 5 to 6 months." The Laaman settlement required a minimum of 8 clinicians for mental health services. For years, it has been below that level despite the mental health caseload growing substantially.
The mentally ill in SHU have it the worst. They are held in small cells 23 hours a day. Typically, 20 to 30 SHU prisoners have a serious mental illness and are on psychotropic medications. Most suicides and serious suicide attempts in the entire New Hampshire prison system occur in the SHU. The isolation and lack of programs cause further deterioration of mentally ill prisoners, psychiatrists and clinicians testified at trial.
SHU prisoners on psychotropic drugs or participating in the one available program must be seen by a clinician every 14 days. Rather than have these periodic clinical appointments, those prisoners were seen by a doctor during rounds of their unit, which consisted of asking: "How are things going?" This is a stark contrast from the required out of cell clinical visit in a private setting where the patient can have a face to face talk with a clinician about serious mental health concerns.
Those SHU prisoners requiring a precautionary mental health watch were removed from their cells and required to stay in the "dayroom." In the dayroom, they had no toilet, often being forced to urinate on the floor.
No mattress or blanket was furnished, and the only place to sit while clothed only in boxer shorts was a cold cement floor. There a prisoner could languish for days while being "watched."
Another large problem was the refilling or renewal of medications. No system existed to monitor when a prisoner needed a refill; he had to complete and file a form requesting the refill. This often resulted in the mentally ill prisoner failing to submit the form at all or in time to receive the medication without running out.
Sometimes, a prisoner would not seek a refill because he was feeling better, only to relapse when the medication was out of his system. It would then take weeks to get the refill process complete and to restabilize the prisoner.
As so often happens, prison officials placed the blame on the prisoners. As the prisoners argued, "there is something inherently wrong with a system that depends on the inmate to initiate the refill process and a system in which a refill slip and the refilled medication must go through multiple hands and delivery points without a computerized tracking mechanism." Further delays occur when a prisoner's housing is changed.
The Superior Court agreed, for on May 22, 2006, the Court entered, an order that basically follows the prisoners' proposed order. That order required full compliance with the Laaman settlement, requiring an RTU, increased staffing, group therapies, a system to track and follow-up on medication needs, software to manage mental health treatment, and clinical appointments for SHU prisoners every 14 days.
Prison officials were given 60 days to file a compliance plan with the Court. Perhaps, this Court order will finally result in the treatment of NHSP's mentally ill, which has been neglected for over 30 years. See: Holliday v. Curry, New Hampshire Superior Court, Case No: 04-E-203.
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Related legal case
Holliday v. Curry
| Year | 2006 |
|---|---|
| Cite | New Hampshire Superior Court, Case No: 04-E-203 |
| Level | State Trial Court |
| Injunction Status | N/A |