Special Report: An inmate took his life after mental illness treatment needs went unmet

At 7:38 p.m. on April 23, an employee at Southern State Correctional Facility sent an email blast from her phone. A 10-33, code for emergency, was called for an inmate who tried to commit suicide.
http://vtdigger.org/2015/06/28/special-report-an-inmates-suicide-patrick-fennesseys-mental-illness-treatment-needs-were-unmet-in-prison-and-out/

SPECIAL REPORT: AN INMATE TOOK HIS LIFE AFTER MENTAL ILLNESS TREATMENT NEEDS WENT UNMET ELIZABETH HEWITT JUN. 28 2015, 3:12 PM 1 COMMENT Share on facebookShare on twitterShare on redditShare on google_plusone_shareShare on printShare on email Southern State Correctional Facility in Springfield, Vt. Photo by Elizabeth Hewitt/VTDigger Southern State Correctional Facility in Springfield, Vt. Photo by Elizabeth Hewitt/VTDigger At 7:38 p.m. on April 23, an employee at Southern State Correctional Facility sent an email blast from her phone. A 10-33, code for emergency, was called for an inmate who tried to commit suicide. An ambulance rushed Patrick Fennessey to the Springfield Hospital, where a medical helicopter transferred him to Dartmouth-Hitchcock Medical Center. But efforts to resuscitate the 34-year-old were unsuccessful. Two days later, early on a Saturday evening, Fennessey died as a result of injuries from his attempt to hang himself. Patrick Fennessey. Patrick Fennessey. Fennessey had completed his sentence and was eligible to leave prison, but he was returned to a cell several times because the state and community mental health partners could not coordinate what they deemed a suitable re-entry plan before he took his own life. At the time of his death, Fennessey was part way through the process of challenging the 2007 conviction that put him in prison in the first place. Fennessey’s situation is not unusual. Inmates with acute mental illness often languish in prison because the state’s decentralized mental health system lacks the capacity to fully meet their needs. INSIDE PRISON WALLS Of average build, with bright, dark eyes, Fennessey was not an imposing figure. He stood just shy of 6 feet tall with a “very sweet smile,” recalls Deborah Olson, Fennessey’s mentor who first began working with him more than half a decade ago. Olson remembers Fennessey, whom she counted as a close friend, for his charisma and humility. “He wouldn’t break a rule,” Olson said. “He wouldn’t litter, he wouldn’t smoke where he wasn’t supposed to.” James Fennessey, four years Patrick’s senior, described his brother as sharp, smart and fiercely loyal to friends. He enjoyed chess, and he volunteered with the local Democratic Party. The brothers liked to fish on the Connecticut River. But Patrick Fennessey had demons. James Fennessey does not put much stock in psychiatrists, but he said that Patrick may have had a medical diagnosis of bipolar disorder. Mental illness runs in his family, he said. At the time of Fennessey’s death, he was in Southern State Correctional Facility (SSCF) serving time on a 2007 conviction for trespass and burglary. He was sentenced to two to 10 years. Fennessey had served his minimum sentence, but he battled mental illness and struggled to comply with the rules for his life on the outside — a proclivity that landed him back behind bars several times. People who knew Patrick Fennessey, including Olson, say that he attempted suicide many times in and outside of prison. Email correspondence among state Department of Corrections staff obtained by VTDigger point to a string of incidents over the past three years involving self-harm. Fennessey was officially being watched for self-harm on several occasions, including in June 2013 and December 2014. As recently as January, Fennessey was in Alpha, a SSCF unit designated for inmates with mental health issues, after he had received medical treatment from an unspecified injury he sustained by climbing atop and jumping from his sink. Upon his return to a cell, he jumped again. At times, Fennessey seemed to favor the solitude of Foxtrot, the SSCF’s maximum security unit, where prisoners are only permitted out of their cells for one or two hours a day, and do not leave the unit unless they are in “hardware,” such as handcuffs or other restraints. An email from Kevin Jenkins, a corrections employee in Springfield, documents that Fennessey was transferred into Foxtrot for discipline in February 2013 when he refused to lock in at one point during the day. Jenkins wrote that Fennessey packed his personal property himself without incident. SFI: SERIOUSLY FUNCTIONALLY IMPAIRED Ask Dr. Dee Burroughs-Biron, health services director for the Department of Corrections, about health services in prison and she’ll tell you that across the state’s seven prisons, DOC runs a full-blown hospital, from on-site dialysis to psychiatric services. Southeast State Correctional Facility The Southeast State Correctional Facility in Windsor. Department of Corrections photo “We have become one of the largest mental health providers,” Burroughs-Biron said. According to DOC data, 44 percent of incarcerated men, and 70 percent of incarcerated women, in the state of Vermont received mental health treatment while in prison in fiscal year 2014. Meanwhile, over the past seven years, self-harm incidents have been on the rise. There were 634 recorded instances in fiscal year 2014, up from 408 in fiscal year 2008. Fennessey is the third Vermont inmate to die by suicide in the last two years. Fennessey was designated as seriously functionally impaired, or SFI, a classification that exists exclusively in the corrections system. The Department of Corrections adopted the SFI designation about a half-decade ago under direction from the Legislature, according to Burroughs-Biron. The statutory definition broadens beyond the scope of the previous designation (serious and persistent mental illness) to include someone with a traumatic brain injury, severe PTSD, dementia or a host of other impairments. According to department data, on an average day in June 2014, there were 124 people inmates with a seriously functionally impaired designation in Vermont. That year, the incarcerated population was about 2,100. Andy Pallito Department of Corrections Commissioner Andy Pallito testifies before the Senate Education Committee. Photo by Amy Ash Nixon/VTDigger However, Burroughs-Biron pointed out, SFI is not a diagnosis and the designation does not carry any meaning outside of prison walls. There is no money set aside to provide support for inmates who are seriously functionally impaired when they get out. In order to qualify for mental health, disability or other services, they need to fit the criteria for programs. For individuals with extraordinarily complex needs, a team of people from across the Agency of Human Services, including the departments of Health, Mental Health and Disabilities, Aging and Independent Living, meet with local community justice partners and service providers to design an individualized plan to help the inmates live in the community. In Fennessey’s case, getting out of prison was no simple matter. He had been through the process a few times. According to email correspondence, an effort to partner Fennessey with a couple in 2010 failed when the couple became concerned that his needs were too acute. Fennessey had been out on probation in 2011, but returned to prison in January 2012. Deborah Olson, Fennessey’s mentor, recalls that he may have returned on a violation related to drugs or alcohol. Emails from mid-2012 show that the DOC had started working with a Springfield-based designated agency, Health Care and Rehabilitative Services, during that summer on a plan to coordinate various mental health and disability services that would allow Fennessey to live in the community. In email exchanges among DOC staff, officials expressed concern that the plan that HCRS put together was too expensive to gain approval. With an estimated $250,000 price tag, the plan included a full-time monitor. By November 2012, the release plan had not advanced, so Fennessey remained in Southern State Correctional Facility. Meredith Larson, the mental health services chief at the time, wrote in an email that Fennessey required a complex plan — one that included psychiatry, behavioral services and facility management. “This is not something that can be postponed,” Larson wrote, referencing one previous “very nearly lethal hanging attempt,” though it is unclear from correspondence when that occurred. Fennessey was still in Southern State the evening of Feb. 22, 2013, when a member of the prison’s medical staff sent out an email that Fennessey was found unconscious in his cell after he attempted to hang himself. Three hours later, Larson wrote to Burroughs-Biron that Fennessey “should have been out many months ago, but HCRS decided that he was so ‘likely to reoffend’ that they designed an impossibly expensive wrap around plan, the result of which is that he remains incarcerated.” State officials from three separate departments that have jurisdiction over corrections, disabilities and mental health services would not speak specifically about Fennessey’s case, but they said that a plan would not be vetoed purely because of a price tag. Monica Hutt, commissioner of DAIL, said that cost would not be the only factor a plan was turned down. However, she said, “There is the need to be efficient with the dollars we’re spending.” George Karabakakis, director of HCRS, said that cost is not “as big as an issue as making sure we have the right plan.” However, Wendi Lashua Germaine, executive director of the Springfield Restorative Justice Center, said that she “definitely” thinks that money plays a role in the approval of release plans that coordinate multiple services. Fennessey was not hospitalized following the suicide attempt. According to records, however, he was on medical furlough three more times during the year before an adequate plan was finalized, allowing his release in December 2013. Germaine worked with Fennessey and recalled recently that the plan that won final approval that year involved less contact with community support staff than the original proposal. In mid-December 2013, Fennessey was released. Larson sent an email following a pre-release meeting with him, during which he told her that he had more confidence in his release plan than the previous one, she wrote. “We both hope that we won’t have an occasion to meet again except perhaps by accident in a grocery store,” Larson wrote. Fennessey was back in Southern State nine months later. MORE THAN A ROOF AND A BED Germaine had worked with Fennessey for six or seven years, first as a teacher at the correctional facility in Woodstock, then in her current role at the Springfield Restorative Justice Center. She described Fennessey as “wicked smart.” “I think sometimes he struggled to find people who were at his level of intellect,” Germaine said. According to Olson, Fennessey had difficulties with his mental health while he was in the community in 2014. She recalls celebrating his 34th birthday with him July 1 of last year, while he was receiving treatment for mental illness at the Brattleboro Retreat. Later in the summer of 2014, Fennessey was living with a roommate in an apartment in Springfield, according to Olson and Germaine. Germaine said many people, including herself, were concerned about Fennessey’s safety at that time. He needed much more than a roof and a bed, she said; he required someplace where he could be treated. But many facilities refused to take him on, saying his needs were too “acute,” Germaine recalled. Olson recalls that Fennessey was feeling suicidal and called a suicide hotline shortly before he returned to Southern State on Aug. 22, 2014. Pallito confirmed that Fennessey was reincarcerated because his housing situation was determined to be insufficient to meet the terms of his release. Inadequate housing is a barrier that keeps hundreds of prisoners in correctional facilities each year. Fennessey needed a higher level of supervision, Pallito said, and would require more care than basic housing. Germaine said that she and other community partners who worked with Fennessey continued to scour Vermont and the country for a place he could live that would be able to accommodate his mental health needs. Fennessey chipped in, searching for places from prison and sending suggestions in letters to Germaine. “There just wasn’t anywhere,” she said. SERVICE AND SUPERVISION IN COMMUNITY-BASED MENTAL HEALTH TREATMENT By the time floodwaters from Tropical Storm Irene washed through the state hospital in Waterbury that had housed Vermont’s seriously mentally ill for the last century, the state had long since begun the process of shifting to a community-based system for mental health treatment. According to Dr. Burroughs-Biron, the director of health services at the Department of Corrections, the closure of the state hospital in Waterbury and the shift to community-based mental health care left a shortage of locations for inmates with severe mental illness to go. “People didn’t stop having acute or chronic mental illnesses,” Burroughs-Biron said. “There were just fewer beds for them.” The community-based mental health system is unable to provide all the various services that an individual may require in one location — a prison, however, does coordinate a range of mental health services, Burroughs-Biron said. “There’s just no other setting like corrections,” Burroughs-Biron said. “That does not, however, mean that that is where we can continue to place people.” Seth Lipschutz, of the prisoners’ rights office under the Vermont Defender General, sees it as a swap. The Department of Corrections has picked up some of the roles that Vermont’s centralized institutions used to play, he said. “When we institutionalize people now, technically we institutionalize them for the commission of criminal offenses,” Lipschutz said. Hutt, of the Department of Disabilities, Aging, and Independent Living said the community-based treatment system is still young and there are “growing pains.” The state needs to find a balance between treatment for individuals and security for the community, Hutt said. When it comes to treating seriously mentally ill Vermonters who are coming out of prison, the community-based mental health system may need more work, she said. “Should we have more locked treatment facilities? Maybe,” Hutt said. As the criminal justice system currently functions, the corrections system is a sort of catchall for people with mental illness, drug addiction and others, according to Pallito. “The DOC becomes the de facto housing for a lot of populations,” Pallito said. Pallito said that in looking ahead at the next 10 years, Vermont needs to undertake a fundamental evaluation of who comes into the criminal justice system. CONTESTING HIS CONVICTION Late in 2014, Fennessey initiated a process to challenge the 2007 conviction that had put him in prison. As per statute, Fennessey was linked up with a public defender who took up his case. Emily Tredeau, a lawyer in the Prisoner’s Rights Office of the Defender General’s office, began working on Fennessey’s case early in 2015, and spoke with him over the phone. Southern State Correctional Facility in Springfield, Vt. Photo by Elizabeth Hewitt/VTDigger Southern State Correctional Facility in Springfield, Vt. Photo by Elizabeth Hewitt/VTDigger According to a transcript of his court hearing on charges of burglary and trespass in 2007, in which Fennessey pleaded guilty, the judge asked Fennessey if he understood the charges against him. But the judge never asked Fennessey if he admitted to the facts. Tredeau said that it is an error that occurs with some regularity; the prisoner’s rights office often takes up similar petitions to challenge convictions. “Based on the law and how the courts have ruled on similar cases, I think it’s likely his conviction would have been overturned,” Tredeau said. The documents were filed in the civil division of the Windham County Superior Court on April 23, 2015 — the same day Fennessey hanged himself. ‘IT’S LIKE THERE’S A FIRE IN YOUR KITCHEN AND YOU JUST SAY EVERYTHING ELSE IS OK’ According to Pallito, in the period before his death, Fennessey’s mental health seemed to be improving. He had recently been moved from Southern State’s unit for mental health treatment to India, a general population unit. Fennessey had a roommate, Pallito said, though he was not in the room when Fennessey attempted to take his life. Fennessey had at times in the past been subject to checks every 15 minutes, a common practice for prisoners considered at risk of suicide. Pallito said he was not on checks at that time. It was because of this apparent improvement that the news of Fennessey’s death took Germaine, of the Springfield Restorative Justice Center, by surprise. Just a few weeks earlier Fennessey had sent Germaine a letter with more suggestions for residential places he might be able to live, signing off with his customary farewell: “Peace out, girl scout.” “I think a lot of people had let down their worry, their guard,” Germaine said. In Germaine’s view, Fennessey should not have been in prison. She thinks that he belonged someplace that could provide him with treatment and care. Olson said that Fennessey’s story has shaken her trust in the criminal justice system. She said that the last time he returned to prison in August 2014, he had not committed a crime, and that, in her view, he belonged where he could be treated for mental health. “I want Patrick’s life and death to mean something,” Olson said. For James Fennessey, his brother’s cycle of incarceration and eventual death is a sign of a wider problem. James Fennessey said that Patrick should not have been in prison and that he should have been somewhere he could be properly treated. It is indicative of a wider problem in Vermont, he said. “It’s like there’s a fire in your kitchen and you just say everything else is OK,” James Fennessey said.