California to seek return of sole control over mental health care at prisons (Photos)

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On Wednesday, California will ask a federal judge to end his oversight of the mental health care system in state prisons. Since the judge appointed a special master more than a decade ago,  California has spent billions of dollars to improve psychiatric care for inmates. But the state's failure to lower the inmate suicide rate will complicate its effort.

Experts hired by the state and by the court say there are fundamental problems with how the Department of Corrections and Rehabilitation handles suicidal prisoners.

The experts say things go wrong as soon as an inmate is labeled suicidal. While waiting for a psych assessment, the prisoner is placed in a holding cell the size of a telephone booth.

"They’re often times first stripped, and left just in their boxers," said Jane Kahn, a lawyer who represent inmates in lawsuits against the prison system. She points to the report of Lindsay Hayes, an expert hired by the state. Hayes called this holding cell procedure “punitive” and “anti-therapeutic.”

"The biggest concern is that prisoners will not report that they’re feeling suicidal if they’re held in these kind of settings. We think it’s one of the many factors that explains this high rate of suicide within our system," said Kahn.

The suicide rate in California’s prisons has gone up in recent years, and over the past 14 years an average of 31 prisoners a year have killed themselves – a rate higher than the national averages for state and federal prisons.

Lindsay Hayes declined to be interviewed because he has been deposed as part of the case before the federal judge. Jane Kahn thought that his report, and reports from an expert hired by the court, speak volumes.

"The rate is high, but what’s more shocking is that these suicides show us how bad the care is," said Kahn. 

The court’s expert, Raymond Patterson, found the treatment of suicidal prisoners to be routinely deficient. Patterson said that in nearly half of the suicides last year, prison staff failed to assess the inmates for suicide risk, or assessed them incorrectly.  

In at least one case, bureaucratic bungling contributed to a suicide, according to Dr. Alan Abrams, recently retired from his job as chief psychiatrist at the California Medical Facility in Vacaville. 

"We had a patient who had every reason for suicide, severely depressed," said Abrams. 

Abrams said staff sent the inmate to the acute care facility at the prison. The staff there said the inmate "was malingering," said Abrams, adding that they "kicked him out without telling us, and he [hanged] himself within three hours."

In a court filing, the corrections department said its system saves thousands of lives every year, and that focusing on the handful of suicides distorts the picture. It accused Patterson of “second guessing and conjecture.”

Corrections Secretary Jeff Beard says it’s time for the federal court to bow out.
 
"I’ve been around this system and visited over 20 institutions and I can assure you there is not a deliberate indifference to the needs," said Beard. "People are being identified, people are being properly placed and people are given the level of care that they need."

As part of its effort to improve care, the state last month opened the California Medical Facility in Vacaville. The $24 million, 44,000 square-foot treatment center includes rooms where inmates will undergo individual, group and recreational outpatient therapy. It will be used to treat inmates who are seriously mentally ill but are able to function without around-the-clock care.

But the state still faces the question of why the rate of suicide in state prisons has not fallen. 

Forensic psychiatrist Terry Kupers is a prison consultant who believes California policies have contributed to the problem. He notes that the state gutted rehabilitation and education programs for inmates in recent years, and resorted to more lockdowns and long-term segregation to deal with overcrowding and violence. All of that, says Kupers, leads to despair.
 
"In fact a lot of the suicides that I’m asked to investigate will be of someone housed in solitary confinement," said Kupers, adding that the record typically shows that the inmate will have been "to  the observation area three or four times and they return to their cell and that’s where they kill themselves."
 
But former chief prison psychiatrist Alan Abrams says even if the state restored its education and rehabilitation programs, and had the best psychiatric care available, some prisoners would still kill themselves. Because, he says, not all suicidal inmates are mentally ill.

"You know, people finally understanding that they’re going to spend the rest of their lives in prison, who's to say that it isn’t an acceptable solution to a failed life?”
 
After the state makes its case Wednesday, the federal judge is expected to rule within two weeks whether California is ready to once again assume sole control over mental health care in its prisons. 

About This Chart: This chart shows the rate of suicide in California Department of Corrections and Rehabilitation prisons per 100,000 inmates between the years of 1999 and 2012.

Year Number of Suicides Prison Population Suicides per 100,000 inmates
1999 25 159,866 15.6
2000 15 160,855 9.3
2001 30 155,365 19.3
2002 22 158,099 13.9
2003 36 155,722 23.1
2004 26 163,346 15.9
2005 43 164,179 26.2
2006 43 171,340 25.1
2007 34 172,535 19.7
2008 37 165,790 22.3
2009 25 159,084 15.7
2010 35 165,747 21.1
2011 34 161,818 21
2012 32 134,901 23.72
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