Is incarceration an alternative to psychiatric treatment

Southern State Correctional Facility is just off the highway in Springfield. One of Vermont's seven prisons, it deals with the largest percentage of inmates with serious mental health concerns.
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State Of Mind: Mental Health & Corrections: Is Incarceration an Alternative to Psychiatric Treatment By JANE LINDHOLM Enlarge image Credit Courtesy, the Vermont Department of Corrections Southern State Correctional Facility in Springfield treats some of Vermont’s most severely ill inmates In VPR's special series 'State of Mind," we're looking at the increasing pressure on Vermont's mental health system. It's been in the spotlight since Tropical Storm Irene irreparably damaged the State Hospital in Waterbury. We've considered acute care and designated agencies. Today we go inside the Vermont correctional system, which is bearing a significant responsibility for housing and treating people with mental illness. Southern State Correctional Facility is just off the highway in Springfield, Vermont. A nondescript road winds up a steep hillside and the blocky prison sits on top. One of Vermont's seven prisons, it deals with the largest percentage of inmates with serious mental health concerns. Mark Potanas is the superintendent at the prison. On a tour of the facility, he points out a couple of specialized units that house inmates with severe mental health issues. 'Today, as of about 8am," he says, 'we have 356 inmates lodged. That includes people waiting to go to court, who were recently arrested. Of that population we have somewhere around 200 of them are on the mental health caseload." All 200 of those inmates on the mental health caseload get counseling from just three clinicians on staff at the prison. Dr. Dolores Burroughs-Biron is the Director of Health Services for the Department of Corrections. She says inmates with serious mental health issues can exacerbate existing difficulties in a prison setting. 'When you have an individual who is acutely psychotic or delusional, it's like having five regular inmates. It requires quite a bit of staff resources on the custody side. And it requires quite a bit of resources from our mental health staff and providers." Vermont has about 1600 in-state prisoners on any given day. Nearly a third of them are dealing with diagnosed mental health issues. That is a huge number, disproportionate to the general population. But mental health practitioners caution against associating mental illness with an increased risk of criminal behavior. 'It does a great disservice to people with mental health conditions generally to imagine that they are somehow more criminally inclined." Meredith Larson is the chief of mental health services for the Department of Corrections. 'What we have here are people who have criminal profiles as well as mental health conditions and concerns of one sort or another." Neil Metzner, Director of Behavioral Health Services at Southern State, agrees. 'I don't think it's the mental illness. I think it's the lack of treatment and the resulting instability." Dr. Burroughs-Biron says some Vermont inmates might not be in prison in the first place if they had access to appropriate treatment in the community. 'Their ability to inhibit certain behaviors are, by definition, for some of them, not going to be what yours or mine are. Then if you remove the community supports where perhaps they were going to touch base, maybe to be fed, to have medication given to them, even for someone to say ‘have you seen your doctor lately?' So that individual who was maybe kind of tottering on ‘maybe I need to have something and I see it and I want it and so I take it.' And so off they go to corrections, or in they come." Burroughs-Biron says over the years, as institutionalization fell out of favor, not enough money was put into community supports. And when the recent recession hit, nonprofits and other community programs suffered—and so did people with mental illness. Some of them ended up in prison. Treatment Differs in Prison Adding to the problem, mental health treatment is different in prison than it might be in an in-patient hospital or outpatient treatment group. At the Springfield prison, there is a dedicated mental health unit for inmates with significant difficulties. They engage in group therapy and individual treatment. But the psychologists, like Neil Metzner, readily admit, it's not the same. 'Our mission in Corrections is really one of the here and now," he explains. 'We don't really delve into past traumas or issues that might trigger other emotional difficulties. What we deal with is the frustration of corrections, of being incarcerated, of the boredom of incarceration…and probably working with them a little more quickly and less in-depth than you would see in the community." Metzner and other clinicians say they don't have the luxury, in a prison setting, of dealing with the underlying problems related to a patient's mental illness, though the therapy does sometimes have beneficial results. They are in a prison, not a hospital. And their main focus is to make sure inmates learn to regulate behavior and conform to the confines of incarceration. Anne Donahue, a state representative who serves on the Mental Health Oversight Committee, thinks they're doing the best they can with the resources that are available. But 'I don't think anyone in corrections would try to tell you that even the special units in corrections that deal with mental health are in any way equivalent to an intensive residential program," she says. 'And that's the biggest missing piece of care that people with the same degree of illness in corrections need." No Designated Forensic Hospital Representative Donahue says people in prison aren't getting the mental healthcare they need because the state doesn't have a specialized forensic hospital for dealing with people who have committed crimes and have mental illness. 'Most states have a separate hospital system for the correctional system, a forensic hospital. We don't do that." In Massachusetts, for example, Bridgewater State Hospital serves as a psychiatric facility for detainees awaiting trial as well as those convicted of crimes but deemed criminally insane. Vermont has no such a facility. Inmates, even those with severe mental illnesses, serve out their sentences in one of Vermont's seven standard correctional facilities. The head of health services for Vermont prisons, Dr. Burroughs-Biron says having a dedicated forensic unit would make a huge difference. It would allow seriously mentally ill people to get focused treatment that they just can't get in Vermont's current prison system, even at Southern State, where there are specialized mental health units. 'They're not acute psychiatric facilities," Burroughs-Biron explains. 'They're units in a correctional facility in which mental health treatment is given or the attempt is made to deliver some sort of treatment, whether it's stabilization of the individual, behavioral planning around how to best respond to them. But it is not a forensic unit." For people who have been charged but not yet convicted of a crime, Vermont does have hospitals that are supposed to take them in and treat them. These are people who have been court-ordered to undergo psychiatric evaluation. Many of these detainees used to go to the Vermont State Hospital. Right now, the Brattleboro Retreat takes that population. But frequently, they're not going to the Brattleboro Retreat because the Retreat is full. So they're stuck in jail instead. And Dr. Burroughs-Biron says she doesn't see that changing, even when the state completes a new psychiatric hospital in Berlin. 'Our population is often the population that is triaged to the bottom of the list when it comes to being transferred into one of those beds." She says the state looks at a system that includes people in crisis waiting in an emergency room for treatment and determines that the prison population is not their top priority. 'When you look at our system from the perspective of ‘I have someone who is in corrections. They're safe, they're not harming anyone. And I have someone in an ER who is potentially unsafe and potentially at risk—of the community is—of harm, or I have them in the court room, who should I triage, who should I place first on my triage list of getting that bed?'" Dr. Burroughs-Biron says the Corrections Department alone could use 25 beds at any given time. Beds they're not likely to see in the near future. Corrections Commissioner Andy Pallito says there's no plan to ask the state for a dedicated forensic hospital to jail and treat mentally ill criminals. So Vermont's mentally ill will continue to be disproportionately represented in our prison system. Dr. Burroughs-Biron says the mental health staff in Vermont prisons do what they can to help people have the best lives they can, but, 'it's kind of sad in a way when you think that people are maximizing their potential within corrections." And when they get out? They're released back into the community, still battling the mental demons that may have contributed to their incarceration in the first place