By Gretchen Gavett

Mental illness is a growing challenge in correctional settings nationwide, and Massachusetts prisons are no exception. The relationship between the clinical needs of prisoners with mental illness and correctional responses to the behavior of such prisoners is complex and unique to each prison. The Mental Health Care Subgroup was formed by the Department of Correction Advisory Council’s Medical Review Panel and charged with the substantial task of reviewing mental health services in the DOC. The subgroup reviewed documents, toured facilities, and interviewed groups and individuals over a three-month period to gain a comprehensive view of mental health care needs and service delivery in each facility. The following is an overview of the subgroup's findings and recommendations in ten areas.¹

Residential Treatments

Department of Corrections policies require that an inmate who "displays a pattern of behavior which makes it difficult for them to function in general population" due to mental illness should be a candidate for placement in a residential treatment unit (RTU).² Currently, there is only one RTU, which is located at the Old Colony Correctional Center and available for level 5 inmates only.³ According to staff and prisoners, this RTU is highly successful, though it is often underutilized as a treatment facility. Beds are commonly left open, or they are filled by prisoners who are not candidates for RTU treatment when there is no space for them elsewhere. RTUs are considered a better option than segregation for inmates with mental health problems, but there are not enough facilities or staff to provide RTUs as an alternative for prisoners at all security levels.

Recommendations

• The planned level 4 Residential Treatment Unit (RTU) should be implemented at NCCI-Gardner
• A level 6 RTU needs to be established in a manner guided by a treatment model consistent with the high security needs of the population
• Classification procedures need to be modified in order to accommodate the mental health recommendations of each inmate
• An independent study should take place in order to determine the need for RTUs. The study should survey existing RTU models to determine which work best and are most appropriate for the various security levels in Massachusetts state prisons

Correctional Staff Training and Selection

Correctional officers often encounter prisoners with mental illness, but they are not adequately trained to recognize the effects of the illness or to respond to the behavior appropriately. Currently, officers receive eight hours of mental health instruction at the Training Academy and two hours of suicide prevention instruction at annual in-service trainings, though the instruction is delivered via computer. In addition to negatively affecting mentally ill prisoners, instances of correctional officers' impatience with the mentally ill can lead to animosity between correctional officers and clinicians.

Recommendations

• Increase mental health training for correctional officers and administration
• It may be helpful to have trainings conducted by prison mental health staff to develop relationships and camaraderie
• Ensure that posts demanding the most frequent or intense interactions with mentally ill prisoners are staffed with the most appropriate personnel available

Use of Mental Health Watches

Mental health watches are used to ensure the immediate safety, containment, and well-being of inmates who are experiencing a mental health crisis. These watches are often described as humiliating by inmates, and the cells in which these watches take place are often dangerous and allow for little visibility.

Recommendations

• Cells used in mental health watches should be reviewed and any deficiencies should be remedied
• Correctional and mental health staff should be trained on how to minimize the negative emotional consequences of mental health watches
• Mental health watches should be studied systematically by a Continuous Quality Improvement project.

Mental Health Staffing

Staffing shortages and prison operations interfere with adequate prisoner mental health care. While caseloads for primary care clinicians average forty inmates per full-time equivalent (FTE) clinician, caseloads for psychiatrists average 165 open cases per FTE psychiatrist. Lack of administrative support forces already overloaded psychiatrists to spend precious time tracking appointments and retrieving medical information. The remaining time for appointments is often lost to slow inmate movement (resulting from prisoner counts, emergency freezes, etc.) and limited space for appointments. Group and alternative therapies and multilingual staff are often unavailable. Consequently, inmates may wait four weeks or more for an appointment. The lack of nursing staff to distribute medication at minimum-security facilities further hampers delivery of mental health care services.

Recommendations

• A staffing review should be performed by an outside agency or consultant to determine the mental health needs of each facility
• Internal and external inefficiencies that impede treatment should be reduced. These include reviewing mental health caseloads, allowing clinicians and psychiatrists to make decisions on the handling of cases, and requiring correctional staff and administration to address disruptions in inmate movement
• Multilingual staff should be increased
• Nursing coverage should be increased in minimum security prisons
• Support should be increased for group treatments

Communication and Collaboration between Mental Health and Correctional Staff

In several corners of the prison system, a culture persists that places correctional staff at odds with mental health staff. This impedes treatment by making mental health staff feel like unwelcome visitors rather than participants in the DOC’s mission.

Recommendations

• Formal channels of communication should be established to encourage input by mental health care providers regarding decisions involving their patients
• Correctional culture needs to be developed and strengthened in order to support mental health services and the providers of these services

Integration of Mental Health and Substance Abuse Services

In a recent study, nearly 70% of mentally ill prisoners involved in Massachusetts prisons screened positive for substance abuse problems. However, treatment for co-occurring mental health and substance abuse problems is not consistently coordinated.

Recommendations

• Substance abuse and mental health services should be contracted to the same vendor in order to ensure similar goals and approaches in quality service delivery
• Care should be taken in providing continued comprehensive care upon inmates reentry into the community

Medications

Current practices sometimes prevent proper medications from being distributed to the prisoners who need them. Many prisoners find the side effects of older antidepressants so unpleasant that they discontinue taking the medications. Because of cost, newer psychotropic medications that are less likely to cause side effects are not administered. In addition, attention-deficit hyperactivity disorder (ADHD) often goes untreated, because current policy requires proof of the condition before the age of twelve in order for proper medication to be administered.

Recommendations

• Newer psychotropic medications with fewer side effects should be available for prescription
• The current ADHD policy should be reviewed

Treatment of Axis II Disorders

The behavior of individuals diagnosed with Axis II disorders (such as obsessive-compulsive disorder and borderline personality disorder) often perplexes those charged with their care. Persons with these disorders are often regarded, explicitly or implicitly, as untreatable. New treatments, such as Dialectical Behavioral Therapy (DBT), have been found to be helpful, though few, if any, are used or adapted to prison settings.

Recommendations

• The DOC should establish a goal of developing a comprehensive approach to the treatment of Axis II Personality Disorders

Discharge Planning and Reentry

Difficulties exist in arranging for continuity of mental health care services upon reentry to the community.

Recommendations

• Mental health staff must overcome a lack of coordination and collaboration with the correctional system itself
• The DOC needs considerably more support from other agencies and the community to design effective and clinically sound reentry plans
• Level 6 inmates and those on mental health watch should not be released directly from these locations. Improvements in classification and mental health watches should aid in this process.
• The DOC should make efforts to “step down” prisoners, particularly those with mental health disorders, in Level 6 facilities, segregation, or on mental health watch

Communication with Counties

The movement of incarcerated individuals with mental health disorders from the county jail to the state prison system presents significant challenges to the continuity and quality of care available to this vulnerable population. Communication between counties and the state is often lacking.

Recommendations

• Inmate transitions from county to state facilities should be smooth and efficient, especially regarding the transfer of health information

_{¹ Governor's Commission on Correction Reform, Department of Correction Medical Review Panel, Report of Mental Health Services Subgroup, August 24, 2005.
²Department of Correction, “Mental Health Services"(policy document 650), Section 12.
³Level 5 is the second-highest security level, employing "maximum external and internal control." Descriptions of the six security levels are available here.}

On March 20, 2006, the Joint Committee on Mental Health and Substance Abuse held a hearing on Correctional Behavioral Health and Substance Abuse. Below is the testimony of Leslie Walker, Executive Director of Massachusetts Correctional Legal Services. The views are the author's and present facts that CJPC has not independently verified.

The Story of Nelson Rodriguez

Nelson Rodriguez killed himself on December 20, 2005. Nelson was a 26-year-old Springfield native, who was serving a 4 to 7 year sentence for assault and battery with a dangerous weapon. He was mentally ill, and mentally retarded. On December 20, he was found hanging in his cell in the West Wing Segregation Unit, also known as 10 Block, at MCI-Cedar Junction in Walpole - one of the most restrictive units in one of the most restrictive prisons in the Commonwealth.

Nelson had been in 10 Block for about a week. He was there awaiting disciplinary action. His disciplinary infraction had occurred when Nelson was being taken to the infirmary because he had "cut up," i.e., he had purposely self-mutilated while in his cell. Nelson stayed in the infirmary while his cuts were treated and his mental status was assessed. At some point he was sent to 10 Block.

In the week that Nelson was held in segregation, he did not receive his personal property. This would include books, letters, photographs, and possibly a radio or television. Nelson liked to draw and had some artistic ability, but he did not have pencil and paper. He requested his property several times, but never received it. Without his personal belongings, Nelson was left alone with his thoughts, for 23 hours a day or more, in his 10 Block cell. The windowless cell is 6 feet wide by 9 feet long. A tall man can easily touch both sides. There is almost no room to pace.

On December 19, an attorney and a paralegal from Massachusetts Correctional Legal Services (MCLS) visited Nelson to talk to him about how he was doing in segregation. Nelson appeared disoriented, scattered, and incoherent. He could not follow many of the questions that he was asked since he had trouble staying focused. Nelson told the MCLS staff members that he cuts his neck and arms when he gets angry and frustrated. In fact, they observed cuts all over his arms. He told them he keeps his hands in his pockets: he knew he was impulsive and didn’t trust himself. He also told them he wanted to die because he was extremely depressed and “sick of living like this.” Nelson reported that a mental health worker had visited him only once in the previous week, and that mental health workers were not as available as needed.

The next morning, on December 20, Nelson asked to see a mental health clinician. He was told that mental health had previously made its rounds on his tier and would not be returning. Nelson protested that he needed to see mental health, to no avail. He pushed his plastic lunch tray, which was passed to him through a slot in the grill door, back out through the slot onto the floor. Prison staff responded by putting Nelson “behind the door.” That means they slammed shut a second door to his cell, a solid steel door.

The solid door has a tiny window, about the size of a car’s rear view mirror. Otherwise, the door lets in no light. The confined prisoner can control only a dim light. The solid door does not allow air to circulate in the cell. In the winter, hot air is being pumped through a vent into the cell, and the temperature rises quickly. The water to the cell is typically shut off. To say that it is claustrophobic is an understatement.

Nelson could not tolerate this extreme sensory deprivation, on top of his days of isolation. He continued to yell for mental health. He warned the guards that he would kill himself if they kept him behind the door. For hours he called for mental health to see him. Other prisoners on that tier, who knew that Nelson was mentally ill and vulnerable, also shouted to staff to bring mental health to see Nelson. No one came. A guard came by at about 4:20 p.m., to find that Nelson had hanged himself.

Prison Mental Health Issues

Nelson’s death, while tragic, was not an isolated event. His was the fourth suicide of a prisoner in Department of Correction custody in 2005. Along with the testimony you will hear about Nelson later today, you will hear from the family of Andrew Armstrong, a 22-year-old man who hanged himself last October - also after self-mutilating, also while in a segregation unit, and also after warning staff that he would kill himself. The year 2004 was no exception. On Thanksgiving Day in 2004, Richard Street killed himself by hanging in 10 Block, just as Nelson did.

These suicides are only the most tragic examples of a problem that plagues the correctional system. They are only the tip of the iceberg. In Massachusetts and nationwide, it is an accepted truth that our prisons have been pressed into service as de facto mental hospitals. An estimated 25% of all prisoners are mentally ill, with 12-15% of prisoners suffering from a serious mental illness, such as schizophrenia or psychosis.

The prison system was not designed with these people in mind. Many mentally ill prisoners cannot conform to prison rules. They get into trouble with staff and are targeted by other prisoners. Altercations and other rule violations lead to placement in higher security prisons, and ultimately in the segregation and isolation units of those prisons, where conditions are at their most austere. In these units, things really fall apart for these prisoners. The mentally ill decompensate; as their condition worsens, they violate more rules, thus ensuring more time in solitary confinement. A few succeed in killing themselves, while many more try to do so, and others “cut up”, or otherwise mutilate themselves. You will hear today from the family of one such prisoner, a chronic self-mutilator.

Self-mutilation or an attempted suicide may result in a trip to an outside hospital, or to Bridgewater State Hospital. There, prisoners are patched up, deemed fit to return, and are brought back to their segregation cell, where this vicious cycle starts again.

The tragedies you are hearing about today describe a clearly malfunctioning system and raise two fundamental questions: 1) why do we find ourselves in this appalling and unacceptable situation, and 2) what can we do about it? There are a multitude of reasons why we are confronted with stories like Nelson’s and others you’ll hear today that seem lifted straight out of Dickens. But there are four primary causes underlying the creation of the various circles of hell that our mentally ill prisoners find themselves in day after day after day.

The Need for Residential Treatment Units

A primary cause of Massachusetts’ prison mental health crisis is a lack of specialized housing units for mentally ill and mentally compromised prisoners, known as residential treatment units or RTUs. RTUs are life-saving alternatives for this vulnerable population that provide specialized programming and care and which are needed at every security level. Second is the almost complete lack of training of correctional staff in dealing appropriately and effectively with this population and the attendant behavioral challenges. In addition, staff positions that require sustained contact with mentally ill prisoners are rarely filled with officers who possess the appropriate skills, training, and temperament. Third, the understaffing of mental health workers at virtually every facility creates unreasonably high caseloads that result in systemic inefficiencies and inadequate treatment. Fourth is the inefficient and ultimately unjust lack of coordination between the treatment needs of this population and the deemed security needs of confining institutions. Nelson Rodriguez’s suicide is illustrative of all four of these problems.

Currently, the Department of Correction (DOC) does not have an RTU or other specialized housing unit for prisoners like Nelson Rodriguez, Richard Street, Andrew Armstrong and others in maximum-security facilities whose photos you see here today, or from whose families you will soon hear. Only one 56-bed residential treatment unit is available for a male prison population of almost 9,000. This facility is available only to level 5 prisoners, who make up about 7% of the population. There are no RTUs for prisoners at level 4, where 60% of the population reside, or at level 6, with 20% of the male prisoner population and where a disproportionate 27% of prisoners receive mental health services. And even the DOC’s existing and highly successful RTU at Old Colony is rarely filled, in large measure because the exact criteria for admittance remain a mystery to both correctional and mental health staff. When the panel looking at the delivery of mental health services by DOC visited the RTU last summer, only 41 of the 56 beds were filled. This is unconscionable given the obvious need for such beds.

The behavior that results from untreated or inadequately treated mental illness is almost certainly keeping at least some prisoners at higher security levels than necessary since the mentally ill are disproportionately represented in maximum security facilities. As I just mentioned, over 27 percent of Level 6 prisoners have open mental health cases. In contrast, at Level 4 prisoners with open mental health cases comprise approximately 17% of the population, while at minimum security levels they represent between 4 and 16 percent of the population.

A critical first-step solution to the untenable and often unbearable situation that mentally ill prisoners currently face is the creation of at least one RTU at the highest security level where prisoners are clearly in the worst shape yet have access to few programs and only limited treatment. Although level 6 prisoners with mental illness may be sent to Bridgewater when they are in crisis, they are often returned to prison because evaluators consider them to have personality disorders that do not meet the statutory definition of “mental illness.” Inadequately trained correctional staff have difficulty managing these prisoners and as a result the DOC spends a disproportionate share of correctional resources managing the ensuing crises rather than providing appropriate therapy and treatment. The creation of an RTU at level six would be a major step forward, using DOC funds more effectively and more efficiently given the high success rate of RTUs, including the unit at Old Colony.

Unfortunately, however, one size does not fit all. The Commonwealth will have to investigate and assess the different needs of various mentally compromised prisoner populations, including an ever-growing number of aging prisoners with dementia, and create appropriate treatment units. You will hear shortly from Hal Smith, an expert on the treatment and needs of prisoners with mental health problems, who will talk about the different types of RTUs found in prisons in New York State. New York’s RTUs are designed to accommodate a variety of mentally ill prisoners and their special needs, including those diagnosed with personality and other Axis II disorders who are rejected from commitment to Bridgewater.

Correctional Staff Selection and Training

Proper training and selection of correctional staff is the second critical mental health need the DOC faces. Currently, correctional staff receive less than two hours per year of training to deal with mentally ill prisoners, and that is focused exclusively on suicide prevention. That this is unacceptable is apparent not only to mental health professionals. Many of the correction officers I interviewed as part of the mental health review panel last year wanted in-depth training not just on suicide prevention but on recognizing symptoms and the behavioral effects of mental illness, how best to address problems before they escalate to a point where clinical or disciplinary intervention is needed, and medications and their side effects. More training for prison administrators is also needed, to heighten their sensitivity to and understanding of mental health issues that pertain to administrative and disciplinary decisions. The superintendent at Walpole told me that because an extremely ill prisoner could sometimes be cooperative, he “can do time well when he wants to.” This widely shared but inaccurate, uneducated and outdated viewpoint significantly exacerbates the problem.

Certain staff positions require more intense and regular interactions with prisoners with mental illness. Officers assigned to segregation units, for example, particularly those working at higher security levels, must be carefully selected precisely because of the disproportionate placement of mentally ill prisoners in such units. Recent reviews of these units reveal that approximately 50% of the prisoners have open mental health cases. The presence of seriously mentally ill prisoners in segregation, a place these men and women clearly do not belong, raises consistently challenging management issues. Staff assigned to these areas should not only have the requisite mental health training but should also be evaluated and screened up front so that only those officers with the appropriate temperament for working with this population are assigned to these more volatile units.

New recruits cannot be assigned to work with the Nelson Rodriguezes and Richard Streets of the system. New officers are too often scared or insecure in their new roles and often react in punitive or mocking ways that only escalate problems. For example, let’s say a frustrated, mentally ill prisoner like Nelson acts up, and throws his food tray on the floor. A well-trained, carefully screened officer will understand that punishment is often counterproductive with a seriously mentally ill prisoner, and will know that punishment can often initiate an ever-increasing spiral of recalcitrant, defiant, even self-injurious behavior. Such an officer will not shut off family telephone calls and visits for six months since he will recognize that these are critical lifelines for the mentally ill. And he certainly will not lock a mentally ill prisoner in a steel tomb in an attempt to punish him or to show him who’s boss. He’ll get the prisoner what he really needs: proper treatment.

Mental Health Staffing

This leads to the third critical lack that is contributing to this unacceptable situation. Even if a properly trained CO sought appropriate treatment for a de-compensating prisoner with mental illness, inadequate mental health staffing levels mean that there is no guarantee a clinician will be available when needed.

Significantly increased mental health staffing is therefore an absolute necessity. Very high caseloads for all mental health professionals, when coupled with other systemic problems including lack of support personnel and inadequate and inappropriate working and treatment space, make the delivery of high quality, efficient and cost effective mental health services almost impossible. Understaffing not only minimizes the time and frequency that any given client can be seen, it also impacts the variety of mental health treatment that staff can offer. DOC does not offer group therapy, day treatment, individual counseling, neuro-psychiatric services, partial hospitalization, or other treatment modalities commonly found on the street.

Choices for treatment of mentally ill prisoners are quite limited, with basically two options. Seriously mentally ill prisoners can be committed to Bridgewater State Hospital, though prisoners diagnosed with Axis II disorders are rejected as non-mentally ill. That means that this highly volatile and vulnerable segment of the population is simply recycled back to disciplinary segregation where it ís only a matter of time before they act out again due to the lack of appropriate treatment. The other treatment option is 15 minutes of counseling every two weeks, often at the cell door within hearing of other prisoners on the block as well as correctional officers. The mental health review panel generally heard positive comments from inmates about mental health staff, with the most pointed complaints coming from mentally ill prisoners in segregation and others at MCI-Cedar Junction. At virtually all DOC facilities it was clear from correctional and mental health staff as well as prisoners that the mental health professionals must carry enormous caseloads, forcing them to spread themselves dangerously thin, greatly reducing their effectiveness with patients. While we understand the need for a comprehensive mental health staffing review as recommended by the DOC mental health review panel, we urge DOC and University of Massachusetts Correctional Health to increase the number of mental health clinicians at the most vulnerable sites, including MCI-Cedar Junction.

Coordination Between Correctional and Mental Health Staff

The final area calling out for urgent action involves the coordination of efforts between mental health and correctional staff. Too often, critical custodial decisions concerning mentally ill prisoners are made without the involvement of mental health professionals. Decisions affecting the classification, placement, and discipline of mentally ill prisoners clearly play a significant part in shaping a prisoner’s mental health. And such decisions therefore must incorporate the valuable input that only mental health clinicians can offer. Current policies governing the relationship of mental health and correctional staff and the input of mental health staff into custodial decisions must be strengthened and given teeth. At present these policies, found at 103 DOC 650 and commonly called “the 650s,” only require that mental health and correctional staff communicate. Mental health professionals are given no authority to make or affect critical decisions that directly affect their patients and impact their care and treatment. As a result, certain institutions have made some progress in this area, with mental health professionals reporting that their opinions are respected and actively considered in the decision-making process. At others, these professionals note that they are merely guests at the decision-making table. Mental health staff must be given a decisive voice in the care and custody of patients under their care, particularly in decisions affecting classification, discipline, housing placements, and roommate assignment. Each of these decisions shapes how mentally ill prisoners will interact with the prison system and has a direct impact on their ability to function within the system.

Steps Forward

MCLS recommends the introduction of legislation that would ban the use of segregation for prisoners diagnosed with mental illness, mental retardation, and other mental disfunctions, and increase the number of RTUs that are available to properly treat these prisoners. We urge the DOC to proceed with a study to examine and make recommendations concerning the mental health staffing at all its institutions, as recommended by the DOC mental health review panel. The DOC must improve the training of correctional staff with respect to interacting with and managing mentally ill prisoners. DOC must also initiate a screening process to ensure that only properly trained and temperamentally appropriate correction officers are selected for posts that require sustained interaction with the mentally ill. Finally, we request that the DOC come up with improved regulations that mandate the participation of mental health professionals in decision making processes that directly affect their clients.

On behalf of all mentally ill prisoners in the system and my staff, I thank you for your time and consideration.

Recent legislative activity has addressed some of the problems highlighted by the Mental Health Care Subgroup. Common themes include the tension between correctional and clinical staffs, the tendency to react punitively to mental illness and suicidal behavior, and the lack of proper training of correctional staff. Three bills, at various stages in the legislative process, are summarized below.

“An Act Relative to Confinement Conditions and Treatment of Prisoners With Mental Illness”

Massachusetts Correctional Legal Services has drafted a bill that addresses the problem of placing psychologically vulnerable prisoners in segregation.

Current law requires that prisoners placed in segregation "shall be given periodic medical and psychiatric examinations, and shall receive such medical and psychiatric treatment as may be indicated."¹ Still, as Leslie Walker's testimony reveals, these mental health evaluations can be delayed, infrequent, and inconsistent, leaving mentally ill prisoners to suffer in isolation. Moreover, current law does not make clear how the outcomes of mental health evaluations affect a prisoner's placement in a segregated unit. These decisions lie with the commissioner.

The draft bill specifies the promptness and frequency of mental health evaluations and makes it clear when the results require that prisoners be removed from segregation for mental health reasons:

• Within twenty-four hours of being confined to a segregated unit, a prisoner would be assessed by a mental health professional who would also review the prisoner’s mental health record.
• Any person placed in confinement would receive a confidential mental health evaluation at least every three days.
• Any segregated prisoner found to be at risk for committing suicide would be removed from segregation.
• Any segregated prisoner found to be suffering from any of several, specific psychiatric conditions, forms of cognitive impairment, or signs of substantial mental or emotional deterioration would be removed from segregation.
• Prisoners removed from segregation for mental health reasons either would be returned to the general inmate population to receive clinical treatment or would be moved to a residential facility operated by the Department of Health. These units would be specifically designed to treat mentally ill prisoners.

The draft bill would also mandate special screening and training for all correctional staff, including guards, who work in these treatment units. In addition, the bill would require that all correction officers receive at least one day of mental health training per year, including information about types and symptoms of mental illness, training in effective and safe management of prisoners with mental illness, and related matters. There is no current requirement for such training under existing law.

H. 1616, “An Act Relative to Mental Health”
Chief Sponsor: Rep. Kay Khan

H. 1616 addresses mental health care as a whole in county and state facilities. The bill relies on guidelines developed by the American Psychiatric Association's Task Force on Psychiatric Services in Jails and Prisons (1988) to establish the basic, general standard of psychiatric care in correctional facilities. The guidelines call for psychiatrists working in prisons to be accorded the authority to create effective therapeutic environments that will ensure the same standard of individualized care inside prisons as outside them. This standard requires timely treatment, adequate staffing, and the non-discriminatory treatment of prisoners. Mental health evaluations, including suicide and substance abuse screenings, would be made upon admission or transfer to a facility.

Mental health evaluations would be make periodically throughout incarceration, and at any point of urgency. The facility’s staff also would be responsible for arranging transitional psychiatric care and access to medication following release.

H. 1616 would require the Department of Mental Health to inspect county and state correctional facilities for compliance with these guidelines. The DMH commissioner would report its findings from each facility to sheriffs or to the DOC commissioner, as well as other state offices. The DMH would also work with sheriffs and the DOC to develop protocols for regularly training country correctional and state prison staff to work with mentally ill and suicidal individuals.

H. 1616 was favorably reported out by the Mental Health and Substance Abuse committee Health Care Finance Committee. It was referred to the Committee on House Ways and Means in April, 2006.

H. 1846, “An Act Relative to the Treatment of Prisoners”
Chief Sponsor: Rep. Byron Rushing

H. 1846 focuses on making prison staffs’ responses to self-mutilation and suicide attempts therapeutic instead of punitive. The bill prohibits the punishment and segregation of prisoners who attempt suicide, allowing only for such isolation as is deemed medically necessary. Prison staff would be trained to respond quickly and appropriately, and a licensed psychiatrist would evaluate the prisoner within twelve hours of the incident. This psychiatric interview would become part of the prisoner’s medical record and would be recorded in the log of the block in which the incident took place.

Rushing’s office cites findings that affirm that written policies and proper training can make lower suicide rates in prisons.²

_{¹M.G.L. Chapter 127, Section 39.
²Lindsay Hayes, National Study of Jail Suicides: Seven Years Later (Mansfield, Massachusetts: The National Center on Institutions and Alternatives, 1998), 47.}

The National Alliance for the Mentally Ill (NAMI) has launched CIT IN ACTION, an electronic newsletter focused on police crisis intervention team (CIT) programs and other jail diversion initiatives. The newsletter is produced by the NAMI CIT Technical Assistance Resource Center, which has been established as a repository of information about CIT and related pre-booking diversion initiatives and as a catalyst for the development of these programs across the country.

CIT IN ACTION will appear on a periodic basis and will feature news and information about CIT programs as well as other information on jail diversion, community reentry, and related decriminalization initiatives. You also can request to be added to the list for future issues of CIT IN ACTION by emailing your request to [email protected].

Recent links from CIT IN ACTION:

The National Gains Center:
http://gainscenter.samhsa.gov/html/default.asp

Focused on expanding access to community based services for adult's
diagnosed with co-occurring mental illness and substance use disorders
at all points of contact with the justice system.

The Criminal Justice/Mental Health Consensus Project: http://www.consensusproject.org/

A repository of information about all aspects of jail diversion, reentry,
and enhanced treatment for offenders with mental illness.