Pennsylvania: Settlement Means Better Care for Severely Mentally Ill Prisoners

by David M. Reutter and Derek Gilna

Severely mentally ill prisoners in Pennsylvania state prisons will receive improved treatment and live in better conditions following the settlement of a civil rights lawsuit filed by the Disability Rights Network of Pennsylvania (DRNPA) against the Pennsylvania Department of Corrections (PDOC). The agreement, reached on January 5, 2015, follows improvements made by the PDOC after the suit was filed in March 2013.

“We are extremely pleased with the settlement,” said DRNPA Chief Executive Officer Peri Jude Radecic. “It guarantees that inmates with SMI (severe mental illness) in our state will be free of the horrific conditions of the RHU (restricted housing units) and will receive appropriate mental health treatment and other services. Now they will be able to maintain their mental stability, take advantage of the parole-eligibility programming, and serve their sentences in a way that does not punish them for merely having a serious mental illness.”

The 36-page settlement resolves DRNPA’s lawsuit alleging that Pennsylvania’s practice of segregating severely mentally ill prisoners in restricted housing violated the Eighth and Fourteenth Amendments. [See: PLN, April 2013, p.34]. The suit claimed that prison officials routinely placed severely mentally ill prisoners who were judged incorrigible or unable to adjust to the general population in segregation. Because the confined conditions would exacerbate their psychoses, the suit contended, the prisoners would exhibit behavior that prompted guards to issue misconduct reports which, in turn, extended the prisoners’ stay in segregation, thus perpetuating what became a never-ending cycle.

An independent investigation by the U.S. Department of Justice revealed that over the past year, more than 1,000 PDOC prisoners who exhibited signs of mental illness had been in solitary confinement for at least 90 days, and almost 25 had been in segregated housing for a year or more. The probe followed the discovery that the State Correctional Institution at Cresson “routinely subjected prisoners with [mental illness] to solitary confinement under conditions that violated their constitutional rights and their rights under Title II of the Americans with Disabilities Act (‘ADA’), 42 U.S.C. Subsection 12131.”

The PDOC, the Justice Department report continued, “subjects prisoners with mental disabilities to prolonged periods of solitary confinement under harsh conditions where prisoners have difficulty accessing adequate mental health care, which constitutes an excessive risk to the prisoners’ mental health.”

“The manner in which PDOC uses solitary ... involves a number of factors that in combination violate the Eighth Amendment. (See: Perkins v. Jesus, 855 F.2d 1021, 1024-25 (3d Cir. 1988)),” the report stated. It also characterized the conditions of confinement to be “dehumanizing and cruel,” citing feces-smeared walls, a lack of clean bedding and excessive verbal abuse from many guards, including one incident in which guards taunted a mentally-disabled prisoner – daring him to kill himself, saying they wanted to see his feet dangling and repeatedly chanting “one, two, three” to harass him.

The findings echoed the results of a DRNPA study which found that as of December 10, 2012, over 800 male and female prisoners diagnosed with serious mental illnesses were held in segregated housing, comprising a full one-third of the segregated population statewide. The study also noted that prisoners were locked in their cells for 23 hours each weekday and 24 hours on weekends and holidays. One-third were confined in solitary and the rest were double-celled, often with cellmates who themselves may have exhibited psychotic or violent behavior.

“The result is a Dickensian nightmare, in which many prisoners, because of their mental illness, are trapped in an endless cycle of isolation and punishment, further deterioration of their mental illness, deprivation of adequate mental health treatment, and inability to qualify for parole,” DRNPA stated in its complaint.

The settlement agreement contains sweeping, comprehensive changes in how the PDOC must handle severely mentally ill prisoners. The department is required to give every offender entering the system a psychological evaluation within seven days; the assessment must be made within 72 hours if the prisoner has a known history or exhibits observed symptoms of mental illness. Prisoners diagnosed as severely mentally ill must have an Individual Recovery Plan (IRP) in place within 20 days that requires they “receive clinically appropriate mental health care that is consistent with their [plan] and all clinical contacts will be documented.”

Moreover, the settlement requires that by July 1, 2016, the PDOC will place no severely mentally ill prisoner in restricted housing “absent Exceptional Circumstances” which make it impossible to house the offender in a Diversionary Treatment Unit, Secure Residential Treatment Unit, Residential Treatment Unit (RTU) or other appropriate unit. Prisoners on the active mental health list in general population “may be housed in a RTU for as long as it is clinically determined that such a level of mental health care is necessary,” and they will enjoy the same privileges as prisoners in general population unless restricted for clinically-appropriate reasons in their IRP.

If a mentally ill prisoner is “a threat to the safety and security of staff” or other prisoners, the PDOC must provide Secure Residential Treatment housing, requiring the prisoner to be “offered a minimum of twenty hours of out-of-cell time per week, consisting of ten hours of Structured Activity and ten hours of Unstructured Activity. More time will be given if progress in treatment or IRP goals would be enhanced.” The same conditions are applied under the settlement agreement to prisoners who commit disciplinary infractions and are housed in Diversionary Treatment Units.

The settlement contains a number of provisions to enhance training and ensure the competency of employees assigned to watch over and care for severely mentally ill prisoners. Psychology staff must visit the Residential Housing Unit five times per week. Any prisoners who are determined to have an elevated risk of suicide must be evaluated by a psychiatrist, and those determined to pose a serious suicide risk must be placed in a Psychiatric Observation Cell with randomly-timed observations at least every fifteen minutes.

In cases when a severely mentally ill prisoner presents a non-emergency security threat, the settlement requires that a mental health professional, “a person who is appropriately trained in crisis intervention, or a member of the Hostage Negotiation Team will be notified and that person will attempt to de-escalate the situation so that force is not necessary and/or to reduce the level of force required.” The agreement also puts in place procedures for the use of restraint chairs.

The PDOC faces a January 1, 2017 deadline for training 1,000 staff members in Crisis Intervention Training. To assure compliance with the settlement, Dr. Kathryn A. Burns, M.D., will serve as the initial Technical Compliance Consultant.

“This settlement has teeth,” said DRNPA lead counsel Robert W. Meek, commenting on the effectiveness of having in place a monitor who reports to the court. See: Disability Rights Network of Pennsylvania v. Wetzel, U.S.D.C. (M.D. Penn.), Case No. 1:13-cv-00635.

Additional sources: www.justice.gov, Associated Press

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