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July|August 2005
What Would Allah Do? By Nadya Labi
The Dread Pirate Bin Laden By Douglas R. Burgess Jr.
On Notice By Sasha Issenberg
Boss of the Bosses By Len Costa
Changing of the Guards By Mary Beth Pfeiffer

Changing of the Guards

A prison breaks from convention in treating the mentally ill.

By Mary Beth Pfeiffer

TIMOTHY PERRY WAS 21 YEARS OLD AND MENTALLY ILL when he made his first and final trip to a Connecticut prison in April 1999. He had spent most of the preceding three years at state-run psychiatric hospitals and told doctors that he was afraid of jail. In his 12th day at Hartford Correctional Center, he erupted in a day room while waiting for a nurse. He paced wildly, banged on windows, and stood on a table. He refused repeated orders to return to his cell and charged a member of the staff.

Though he was only 5 feet 4 inches and 167 pounds, at least six guards took 10 minutes to wrestle Perry to the floor. They held him facedown, cuffed his hands behind him, and placed a towel over his face. By the time they carried Perry to the green plastic mattress in his dingy cell, he was motionless.

But the officers kept going. They administered what prison regulations call "pain compliance techniques"—a wrist bent this way, a leg bent that way. Perry's feet flopped at 45-degree angles. He did not flinch as sedative-filled syringes were injected into his buttocks. He did not fight as his clothes were torn off and restraints applied.

Perry was left alone for two hours before anyone realized that he was dead—from "sudden death during restraint."

In a broader sense, he died because the prison was ill-prepared for an increasingly common event: the outburst of a mentally ill inmate. As with similar incidents involving mentally ill prisoners across America, Perry's death prompted the suspension or reprimand of the guards who had restrained him and the filing of a federal civil rights lawsuit that resulted in Connecticut's paying his family $2.9 million.

Fifty years ago, a man like Perry might have spent much of his life in one of hundreds of public psychiatric hospitals that dotted the American landscape—sprawling campuses with thousands of patients who were often kept too long and without good cause. Then came drug treatments that allowed mentally ill people to function in society and a series of landmark court rulings that granted them the right to be released. Most state-run hospitals closed, and, for people who might have been patients and were too poor or ill to stay out of trouble, the alternative often ended up being prison. At the close of 2004, there were about 3,100 people with mental illnesses in Connecticut's prisons, about 17 percent of the state's inmates.

Like Perry, few inmates identified as mentally ill received proper care. In 2003, a year after Perry's case settled, a suit was filed on their behalf. It accused the Connecticut Department of Corrections of failing to treat mentally ill prisoners and of routinely punishing them for acts related to their ailments. Under a new commissioner, Theresa C. Lantz, the department began to make changes even before the case was settled in March 2004. Mental health workers were hired to counsel prisoners. Officers were trained to manage the mentally ill. Policies were adopted to avoid the needless punishment of inmates. Care of mentally ill prisoners was consolidated at Garner Correctional Institution, a maximum-security prison in Fairfield County that once housed gang members. Today it is an intensive treatment center for inmates with the most serious cases of mental disease.

Connecticut is doing what many reformers recommend to help people behind bars with mental illness. But the state's recent experience shows only limited success. Three inmates died in the months following the settlement. One of them, like Perry, was killed while being restrained by guards at Garner. Two others hung themselves, one at Garner and the second after being returned to another prison from Garner. The guards feel unprepared to manage inmates with a host of serious mental illnesses, including bipolar disorder and schizophrenia. They complain of having to cede their disciplinary power over inmates to mental health clinicians.

To prison authorities, these are the growing pains of a system in transition. "What you are seeing," insists the corrections department's Lantz, "is a work in progress." With Garner's transformation, however, Connecticut has drawn national attention from corrections officials and psychiatric experts. Although forensic hospitals have for decades housed convicted criminals with mental problems, Garner tries to incorporate mental health care into a prison, an experiment whose outcome is uncertain to even the strongest supporters of the institution.

FROM THE START, PERRY'S LIFE WAS BLEAK. His mother repeatedly told social workers of her having been raped and sexually abused, once by strangers, other times by family friends. She became pregnant at 14 and gave birth to Perry at 15. His father was in his 50s, and nothing more is known about the man. Court records say Perry's mother suffered frequent hallucinations and was diagnosed as "retarded and paranoid schizophrenic." In an 18-month period before Perry was 3, he lived in 13 different places. He was reported by child welfare officials to be "emaciated. . . . [and] in the care of drunken men for long periods of time."

When he turned 3, his mother, then 18, threw herself down a flight of stairs and sprained an ankle. Then she took the toddler to the roof of a nearby building in Hartford and, with Perry in tow, threatened to jump. A passing cabbie talked her down.

Two months later, Perry's mother lost her parental rights. "I believe that [she] is likely to kill herself and Timothy if left in her care," wrote a social worker in July 1981. Perry was soon adopted by a family in Middletown, Conn., but he was aggressive and, at 10, was kicked out of school. At 11, Perry was removed from the home of his adoptive parents after he complained that they had abused him, though no charges were filed. Doctors diagnosed Perry with schizoaffective disorder, a condition marked by mood swings and distorted thinking, and he was placed in Cedarcrest Hospital in Newington, one of two state-run hospitals for mentally ill adults in Connecticut.

The state has been helping people with mental illness since 1656, when it first required towns to provide the "insane" with financial assistance. By the 1950s, when the state's population was 3.5 million, or half what it is today, Connecticut had three public mental hospitals, together housing 9,000 people. Historically, such institutions devalued individuals, stigmatized groups, and denied patients and staff adequate resources, according to Ira Burnim, the legal director for the Judge David L. Bazelon Center for Mental Health Law.

Then came the discovery of drugs that made it possible for many patients to be stabilized and to leave the hospitals. In the 1980s, courts granted the mentally ill a right to live in the "least-restrictive setting," prompting the release of even more people to halfway houses or, most often, unsupervised homes. In the 1990s, Connecticut closed two of the four public mental hospitals, and, in 2003, more than 11 percent of the state's mental health staff was cut. Today, Connecticut has just 665 beds in public mental institutions.

For about 30 of his final 36 months, Perry occupied one of those beds at Cedarcrest. He was considered sweet and immature, a young man who sang in the Christmas pageant, earned his high school degree, and wanted a family of his own. He "had the mind of an 11-year-old," said Deborah Washington, his aunt. Perry was also volatile. He had to be restrained 15 times in one three-month hospitalization and had been accused several times of inappropriately touching women. In April 1999, when he assaulted two staff members, Cedarcrest officials gave up. To teach him a lesson, they pressed charges, and he was sent to Hartford Correctional Center.

While Connecticut was cutting care for mentally ill people like Perry, it was engaging in a prison boom. During the 1990s, the state spent about $1 billion to expand its jails and prisons, and the correctional system's operating budget doubled to more than $500 million. Meanwhile, the number of mentally ill prisoners grew almost sixfold.

Other states also lavished money on prisons while stinting on mental health care. Nationwide, prison capacity quadrupled in the final two decades of the 20th century, while inflation-adjusted dollars allocated to state mental health care decreased by 7 percent. Corrections departments spent a large portion of their expanded budgets on "supermax" prisons, high-security fortresses designed to house the most violent inmates. Connecticut was late to make the commitment, but in 1996 it became one of 34 states to build a supermax, Northern Correctional Institution in Somers, near Massachusetts. Like other supermaxes, the facility was an asylum without care. It was a warehouse for murderers, rapists, and other violent criminals but also for mentally ill people who could not be managed in the general prison population or who became ill from the prolonged isolation that was standard in a supermax. In 2003, civil liberties and prisoner advocates filed a lawsuit claiming that Northern Correctional inmates were "subjected to social isolation and sensory deprivation that approach the limits of human endurance."

Today, as a result of a settlement, inmates with the most serious mental illnesses are banned from the supermax and are cared for at Garner. The facility has 82 psychiatric social workers and other mental health workers and 570 beds for mentally ill prisoners. Inmates receive at least three hours of therapy a day, and corrections officers assigned to Garner get 16 hours of training on topics ranging from suicide prevention to mental disorders. The purpose of the training is to forge a "treatment team" of mental health professionals and correction officers who will cooperate in caring for mentally ill patients. If it works, Garner will be one of the nation's most sophisticated mental health facilities within a correctional system.

After spending two months in a prison hospital in early 2004, inmate Dennis Kinsman, 47, was returned to Garner. He had been there six weeks when he began to shout during a therapy session on stress and anger management. When asked to leave the group, he grabbed a therapist's arm. A "code orange" was called, indicating that a staff member was being assaulted. Kinsman, yelling and flailing wildly, was set upon by at least five officers.

"All officers were giving verbal commands to Inmate Kinsman to stop resisting," an official report of the incident said. The officers held Kinsman facedown, with his arms behind his back, and within moments, his face turned blue. He died an hour later.

Kinsman's death may have been unavoidable. But, as in Perry's case, it may also have been a byproduct of a culture of custody and control, one that responded in all the wrong ways to a man who had been diagnosed as schizophrenic.

Converting a prison like Garner into a treatment facility meant reversing the basic rules by which guards operate. At prisons, officers use disciplinary measures to keep order and protect themselves. At Garner, clinicians are supposed to determine whether discipline is appropriate and to avoid the punishment of behavior that is illness-related. In prison, correctional staff members do not normally negotiate with inmates to get them to cooperate. At Garner, guards are supposed to do that and more by asking a counselor to speak with an agitated inmate before they use force against the prisoner, for example.

Such measures are long overdue at institutions where the sudden movements and scene-making disturbances of mental illness are often misinterpreted and provoke punishment. But corrections officers typically see inmates as manipulative and their outbursts as intentional. "We don't have much faith in the mental health people over here," said Tom Caparole, a Garner guard for 12 years. "[Inmates] just play these people like you can't imagine."

The gap between guards and mental health professionals is a major challenge for Garner. Kinsman died because "custody people are not designed to handle people with mental illness; it's not our mission," said Catherine Osten, the president of the correctional system's union of lieutenants. Osten hopes to persuade Connecticut that Garner should be run by the mental health department rather than the correctional system. "If we need a 600-bed facility for people who are mentally ill," she said, "we should turn it over to the people who are well-trained to handle them."

The nation has only one prison run by a state agency other than a corrections department. It is the Wisconsin Resource Center near Oshkosh, which the Wisconsin Department of Health and Family Services operates for up to 400 mentally ill inmates. The prison's administrators say it has at least two advantages over an institution like Garner. It can recruit mental health workers more easily, because it does not carry the stigma of a prison. It also does not compete for funds with other prisons, because it is not part of a corrections department budget. "Our closeness to the mental health system enables us to maintain currency and focus on mental health care," said director Byran Bartow. But "legally," he went on, "we are a prison."

Short of turning Garner over to the mental health department, Osten advocates giving more rights to inmates, and she is promoting legislation that would apply the state patient's bill of rights to mentally ill prisoners. Inmates would have the right to wear their own clothes, make phone calls, and send letters that are uncensored. Osten believes the legislation would transform Garner into an institution resembling the Whiting Forensic Institute, which is run by the Connecticut mental health department. It has 100 maximum security beds, but only a tiny portion are used by state inmates. The rest are for people who are undergoing court-ordered competency evaluations or who have been found either incompetent to stand trial or not guilty by reason of insanity. At Whiting, patients can't be put into solitary confinement or denied privileges for disciplinary reasons, and they can't be restrained without a clinical reason. As at the Wisconsin facility, they are patients first and prisoners second.

GARNER WARDEN GIOVANNY GOMEZ, a 20-year corrections department veteran, led a tour through the facility on a hot day last summer. The floors of the 13-year-old prison shined, air conditioners whirred, and inmates moved from place to place in orderly rows. A serious, slightly balding man with a closely trimmed salt-and-pepper goatee, Gomez is a firm believer in his work—and he knows what he is up against. He uses words like "sense of disempowerment" and "set in our ways" to describe the mindset that officers will need to overcome in the new world of Garner.

Earlier that day, an inmate known to assault staff refused his medication. He became abusive, cursing at officers—a disciplinary violation under any other circumstance. But working with mental health staff, officers calmed the inmate and talked him through it. If Timothy Perry had been at Garner Correctional Institution in 2005, with its menu of therapies and ethic of care, he might have been assigned to a mood or impulsive-control disorders unit. There he would have attended sessions focused on such topics as social skills, self-esteem, and problem solving. These services may not have saved Perry's life: Dennis Kinsman's death, as well as other problems at Garner, raise doubts about that. Still, with the focus shifting from punishment to care, there would have been reason to hope.

Mary Beth Pfeiffer is a Soros Justice Media Fellow who writes about prison conditions and the treatment of mentally ill inmates.

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