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The Capital Times (Madison, Wisc.)

Prison Is Revolving Door for Mentally Ill, Who Don't Get Needed Meds

Jessica VanEgeren

It was 3 o'clock in the morning when the bad guy showed up, talking real loud and fast, like an auctioneer.

"Are you OK, my son?" Ellen Hanson asked as her son headed up the stairs. The look in his eyes when he turned to face her was like nothing she had ever seen before. It sent chills down her spine.

"I'm not your son," was his rapid reply.

That was eight years ago. She's seen those eyes and heard that voice many more times since then. Dubbed by the family as "the bad guy" to describe the manic side of their son's bipolar disease, it comes out three or four times a year and always accompanies his release from jail or prison, the result of fluctuating medications and lingering effects from time spent in segregation.

She's bracing to hear the voice again on June 21 when her son, 31-year-old Jarrod Hanson, is released from the Racine County Jail after serving nine months for his fourth drunken driving conviction.

Half of Jarrod's adult life has been spent in prisons and jails across the state for charges ranging from drunken driving to assault and battery. He is an MH-2 inmate, the prison system's classification for an inmate who suffers from a serious mental illness such as a psychotic disorder, major depression, bipolar disease or dementia.

Jarrod is one of the state's nearly 7,000 inmates with mental illnesses; a group that, as of June 2008, accounted for one-third of the total prison population of roughly 23,000. In the last few decades, since mental institutions have been shut down in favor of community-based care, prison has become a revolving door for Jarrod and others with mental illnesses. These inmates rarely get needed medications and treatment on either side of prison walls. It is not a phenomenon unique to Wisconsin, but rather a growing problem plaguing prisons across the country.

Now, because of a recent state audit and two lawsuits against the state, the treatment of Wisconsin's mentally ill inmates is in the spotlight. The state is under a fast-approaching deadline to upgrade conditions for mentally ill inmates at Taycheedah, the state's only female prison, in Fond du Lac. Among other things, correctional officers will no longer be allowed to hand out medication, a change that may well put pressure on the state to discontinue that practice in its male prisons as well.

The audit, which Rep. Joe Parisi requested two years ago after a federal agency issued a scathing report about conditions at Taycheedah, reveals such problems are system-wide: Mentally ill inmates receive inadequate treatment and therapy, which leads to self-destructive behavior, violent behavior toward guards and, ultimately, a high recidivism rate.

"The way we are doing this now isn't working," says Parisi, D-Madison, who is chair of the Assembly Committee on Corrections and Courts. "Our job is to protect the public and to look out for the most vulnerable citizens among us. When one-third of those incarcerated are mentally ill, we are failing."

In just over a week, one of the state's more dangerous and controversial mental health practices inside its prisons will cease at Taycheedah when licensed nurse practitioners, instead of correctional officers, will for the first time distribute medication to all inmates. Those interviewed for this article know of no other state that allows its guards to dispense medication.

The huge shift in policy is the direct result of two dueling wake-up calls the state received in May 2006.

A U.S. Department of Justice report and a lawsuit from the American Civil Liberties Union of Wisconsin both charged that the Eighth Amendment rights of inmates were being violated because of inadequate overall health care and mental health care. While the federal government agreed to give the state until September 2012 to comply with a lengthy list of improvements, the ACLU did not.

On April 24, a preliminary injunction was granted in federal court that stated medical professionals with the qualifications of a licensed nurse practitioner or higher must begin to distribute medicine at Taycheedah by June 24. It appears the state is complying. In a court filing last week, the state indicated it had hired six limited-term employment registered nurses and 10 licensed nurse practitioners. At a time when the state is facing a multibillion-dollar budget deficit, the state will spend close to $6 million on additional staff and space for therapy and programming to reach some aspects of its settlement agreement with the federal government.

John Dipko, a Department of Corrections spokesman, says the first day of work for the new nurses will be June 22, two days shy of the deadline. When asked if correctional officers will stop distributing medication in the male prisons, Dipko says the department's focus is on meeting compliance standards at Taycheedah.

"Anything more would be speculative at this point," he says.

As of June 2008, 77.3 percent, or 528, of Taycheedah's 683 inmates had a mental illness. This includes alcohol or drug dependency.

Allowing correctional officers to distribute psychotropic medication to such a high percentage of inmates is not only extremely rare, but dangerous, say inmate advocates. Because officers receive no formal medical training, they do not know how to distinguish between a side effect and bad behavior.

As noted in the federal findings letter, initial doses of anti-psychotic medications can result in an oculogyric crisis. When such a crisis occurs, the "patient's eyes roll back in her head and are stuck there." If the patient does not receive immediate treatment, the paralysis can progress down the airway and lead to suffocation.

"Everybody from the (Corrections) secretary on down knows correctional officers should not be handing out meds," says Marty Beil, executive director of the Wisconsin State Employees Union, who started working as a corrections officer in 1969. "I've been telling legislators for years that we didn't want to be handing out meds. But nobody wanted to do anything about it."

It turns out little has been done by the state to address other system-wide red flags at Taycheedah or elsewhere, according to the state audit released in March. Parisi calls the audit "a roadway to lawsuit prevention."

In a state that first started screening inmates for mental illnesses five years ago and still does not screen for developmentally disabled inmates, the audit illustrates how a lack of resources has contributed to a prison setting in which one-third of the population is causing an overwhelming majority of the violence.

Although mental health staffing ratios have improved at Taycheedah as a result of the federal investigation -- one psychologist per every 57 inmates -- numbers in the rest of the system are still deficient.

Currently, 89 psychologists and 11 psychiatrists are working full time in the male prison system, which includes some 21,000 inmates. To meet minimum professional standards set by the American Association of Correctional Psychology, the Department of Corrections would need to fill 40 additional psychology positions and hire 11 more psychiatrists.

Staff shortages consequently lead to substandard care. For example, the minimum professional standards require psychology staff to monitor inmates with serious mental illnesses at least once a month. In Wisconsin, such inmates are monitored once every four months.

Of the 190 inmates in special management units -- the areas designed to treat those with mental illnesses -- staff shortages prevent inmates from receiving the standard 11 hours of mental health treatment a week. In Wisconsin, inmates receive one hour and 10 minutes.

"While they are in custody, there is a constitutional right to mental health care," says Dr. Fred Osher with the Council of State Governments Justice Center, who recently studied the mental health side of Wisconsin's prison system as part of a report requested by the state. "That includes medications, individual and group therapy."

Unlike the staff requests made for Taycheedah, requests by the Department of Corrections for additional staff at its male institutions are not in the current budget winding its way through the Legislature.

With too many in need and not enough staff to offer treatment or therapy sessions, violent outbursts are commonplace. Between June 2007 and June 2008, mentally ill inmates were involved in 90 percent of incidents in which inmates harmed themselves and nearly 80 percent of the assaults on staff, according to the state audit.

Additionally, from 2003 to 2008, 16 of the 29 inmates who committed suicide had a mental illness. A suicide prevention policy was instituted system-wide in May 2007 to curb the deaths, but Wisconsin's numbers remain higher than those of neighboring states and the national average.

On Jan. 10, confessed murderer Adam Peterson hung himself with a bed sheet in his cell at the Dodge Correctional Institution. Peterson, 20, had been diagnosed with schizophrenia and psychosis after being arrested last summer for the murder of Madison resident Joel Marino. It was reported Peterson had stopped taking his medication. Despite the fact that Peterson had attempted to kill himself twice in the Dane County Jail while awaiting his court appearance, he was deemed mentally fit to live among the general population once admitted to the state's prison system. Todd Winstrom of Disability Rights Wisconsin says he is investigating Peterson's death for possible legal action.

Too much or too little medication is also prompting violent outbursts that are increasingly directed at correctional officers and staff. And the state is finding it is paying more in worker compensation claims as a result.

Last year, an inmate at the Fox Lake Correctional Institution stopped taking his medication. After a week, an officer reported troubling behavior to health care staff. Before anything was done to remedy the situation, the inmate grabbed a claw hammer and violently beat two officers. One had to have brain surgery to relieve the pressure in his head. Neither has returned to work.

"These people (mentally ill inmates) ended up in a different kind of institution that was not prepared to handle their heads," Beil says. "They become high-profile inmates and are often ticking time bombs."

The incident was one of 231 attacks on correctional officers caused by a mentally ill inmate in the 2007-2008 fiscal year. Over the broader three-year period ending in 2008, close to $1 million was spent by the state on worker's compensation claims because of attacks on staff by mentally ill inmates.


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Despite the violence, Beil gives the department credit for moving away from using medications to sedate inmates to providing more psychiatric care.

"We are going in the right direction, but there hasn't been enough resources put into the mix and that has been the problem all along," Beil says.

The common punishment for inmates who attack is segregation, a tactic that has gotten the state in hot water in recent years.

In 2002, a settlement agreement was reached as the result of a class-action lawsuit involving a number of inmates serving time in segregation at the Wisconsin Secure Program Facility in Boscobel, formerly known as Supermax.

As a result of the settlement, seriously mentally ill inmates can no longer be sent to serve their prison time in Boscobel. Changes at the Boscobel prison, however, did not translate to improvements in the state's other prisons. Seriously mentally ill inmates still can be sent to a segregation cell at the state's other maximum security prisons. And they are being sent on a more frequent basis. Between June 2007 and June 2008, mentally ill inmates in segregation accounted for 76 percent of those in segregation at Taycheedah, nearly 73 percent in the Columbia Correctional Institution and 55 percent in the Green Bay Correctional Institution, according to the audit.

"If you want to know where they are all being kept," says Winstrom, "they're down in the hole."

A request by The Capital Times for a tour of Taycheedah, including the Monarch unit where mentally ill inmates are treated, was denied by the DOC, citing the ongoing legal matters.

A glimpse of how things were three years ago, however, can be found in the Department of Justice findings letter. One inmate, who exhibited a clear sign of psychosis by punching herself in the eye, was put in segregation. Saying "I see more gods when I take Haldol," and "I get upset over the melody that plays in my head," the inmate was described by correctional officers as "crazy." According to the report, she had been placed in segregation four or five times in four years for "disrespect." This included soliciting sex from male and female officers.

Another time, a 15-year-old girl wearing a mask to prevent spitting was kept in long-term segregation. She was halfway through an 18-month stay in segregation and felt she would never get out. Although diagnosed with attention deficit disorder and intermittent explosive disorder, she was not receiving medicine because her mother would not consent.

After visiting the teen, Justice Department staff wrote: "Placing an unmedicated, mentally ill teenager in segregation, with little or no stimulation and no education services, causes psychological damage that may be irreversible."

In 2003, Dr. Kevin Kallas, the mental health director for the Department of Corrections, convened a group of staff from his department, the Department of Health Services and Disability Rights Wisconsin to address the treatment of mentally ill inmates in segregation settings. Two years later it released a report.

The report recommended psychological service staff provide "formal input" into the discipline of mentally ill inmates. Before seriously mentally ill and developmentally disabled inmates could be disciplined, the committee suggested a form be filled out.

Today, DOC policy does not require use of the form because "it is too time-consuming to complete," according to the audit. Since the beginning of this year, however, maximum-security male institutions have used the form on a trial basis for self-harm inmate behavior, Dipko says.

The audit also states that mentally ill inmates receiving treatment in special units should receive several warnings before they are sent to segregation. But staff at two institutions say that an inmate's mental health has little or no impact on the disciplinary process.

Kallas says a challenge for staff has been discerning when an inmate's misbehavior is the result of a mental illness.

"We are now bolstering our input from mental health clinicians," Kallas says. "We want to give inmates the benefit of the doubt."

On a recent spring day, during a hearing before the state Legislative Audit Committee, Ellen Hanson's story of her family's struggle to diagnose, understand and treat her son's mental illness proved to be jarring testimony among the facts and figures offered by mental health practitioners and advocates.

Years ago, Ellen told the crowd, Jarrod had begun self-medicating by drinking heavily, smoking pot and using cocaine, a lifestyle that got him mixed up with the wrong crowd. When he was 25, he returned home one night, unable to remember much that had happened. All he kept saying was that he thought he had hurt someone.

The family knew then that he was in trouble, and not just with the law. His manic highs had become too strong, causing him to have little or no control over his actions and vague memories of what those actions were.

Ellen says the family spent $30,000 for Jarrod to spend a month at a treatment center in Minnesota. It was then that his bipolar disorder was first diagnosed.

Committed to their son's chance at a stable life, Jarrod's parents then spent $110 for weekly psychiatric visits and $350 a month for his medication. By the time he was beginning to live his life cleanly and mentally stable, it was time for him to stand trial for the assault and battery charge, the incident he remembered only vaguely.

Jarrod's psychologist and a mediator testified that prison would not benefit him as much as the mental health treatment he'd been receiving. Jarrod's attorney recommended community service and continued treatment.

But the judge found him guilty and sentenced him to prison. The cycle between freedom and prison began. Ellen feared Jarrod's mood would begin to cycle in prison because of the lack of treatment and inconsistent doses of his medication. Her suspicions were correct.

During a short stay at a facility in Appleton, Jarrod was given no medication, Ellen says. She adds he continuously had his prescription "messed with" while serving the remainder of his 18-month sentence at the Jackson Correctional Institution, a medium security prison in Black River Falls.

Furious, Ellen contacted the prison and offered to pay for the medication she knew her son needed to keep him stable. She was told this was not allowed. Dipko confirmed such a practice is against department policy.

When released from prison, Jarrod, like all other inmates, was given a two-week supply of his medications and a 30-day prescription.

While this helps, treatment centers, visits to psychiatrists and prescription costs are only partially, if at all, covered by health insurance plans. While the state is trying to provide additional help to inmates in the form of applying for Medicaid or other programs, many are still slipping through the cracks.

"A common myth is that mentally ill people are more violent, and that is simply not the case," Osher says. "But bad things will happen when people with mental illnesses run out their meds."

Consequently, the likelihood that seriously mentally ill inmates like Jarrod will re-offend within two years of their release is 46 percent, compared to 39 percent of inmates without a mental illness, according to the Council of State Governments Justice Center study of Wisconsin's prison population.

After being released from prison it took awhile for Jarrod to stabilize, says his mom. Eighteen months after his release, he was in trouble again, this time for drinking and driving. He was so distraught over the thought of going back behind bars that he tried to kill himself. He was sent to the Racine County Jail, where staff initially dropped Jarrod's medication to a lower dosage, believing the dose he was on was too high. He proceeded to get in a fight with another inmate and recently spent 10 days in segregation. Shortly after his release from the hole, his medication was increased, Ellen says.

The financial and emotional drain on the family of a mentally ill inmate is great, Ellen says. She sees many parents throw in the towel, but says she'll never do that to her son.

"Everybody keeps telling me that I can't make a difference," she says. "But this is my son. I can't imagine how many more people like him are locked up without advocates."

More advocates may be stepping forward at the Capitol.

Parisi already has requested a second audit that will look at how the mentally ill initially find their way into the prison system. He has also asked the Department of Corrections to report back to the Joint Finance Committee by Jan. 4 with feasibility and cost analysis reports on what would be required by the state if it: provided correctional officers with a minimum of 16 hours of training in managing mentally ill inmates; screened for developmentally disabled inmates; offered support services for the developmentally disabled; and had nurses dispense medicine in all state prisons.

"As a society we have to ask ourselves, 'Should we be locking them all up in our prisons?'" Parisi says. "Because that's what we are doing."

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