Mental health care in state prison ‘insufficient and nearly non-existent’, expert testifies in federal civil rights lawsuit
Mental health care — from screening to staffing levels to suicide monitoring — in the restrictive housing unit of a Louisiana state prison is virtually non-existent, the former psychiatrist said in chief of the Ohio state prison system this week in a federal class-legal action against the state Department of Public Safety and Corrections.
Dr Kathryn Burns was called as an expert witness by civil rights attorneys for people being held in solitary confinement at David Wade Correctional Facility, a state prison in Claiborne Parish, who allege the conditions of their detention are unconstitutional. A four-week trial in the lawsuit, which was filed in 2018, began last week. It covers conditions at the prison until March 2020.
In the first week of the trial, several people who were previously held in restrictive accommodation at David Wade testified to conditions at the facility, saying they were held in often filthy cells for up to 23 hours a day with little social interaction other than incessant taunts and humiliations from prison staff. They also said those detained with obvious signs of mental illness received little or no treatment.
On Tuesday and Wednesday, Burns corroborated much of that testimony. During the pre-trial discovery period, Burns visited the prison twice – in 2018 and 2019 – during which she interviewed more than 30 people held in solitary confinement. She also reviewed the medical and mental health records of prisoner and prison policies.
Burns said Wednesday his overall impression from the visits and examination was that mental health care for those in restrictive housing at David Wade was “insufficient and almost non-existent, with the exception of medication.” And even the drugs, she said, “were not properly administered, documented, or supervised.”
Lack of care, she said, starts a cycle in which prolonged stays in solitary confinement — sometimes for years — exacerbate mental health issues among inmates. Then the symptoms of deteriorating mental state of prisoners are treated as disciplinary infractions, leading to criticism and more time in solitary confinement. The cycle has the potential to end with prisoners injuring themselves or others, or leading guards to use force against them.
Dr. Gregory Seal, the prison’s only contract psychiatrist, also testified on Tuesday. He said he visited the prison twice a month for about six hours each time, during which he met people for about 3-5 minutes each, and was mainly responsible for diagnosing patients and prescribing medication. . (If this were a new patient, Seal said those visits would be closer to 10 minutes, on average.)
Seal also said he was not aware of any mental health risks associated with prisoners with mental illness placed in restrictive housing, despite the American Psychiatric Association warning against the use of restrictive accommodation for prisoners with mental illness.
Lawyers for the Louisiana Department of Public Safety and Corrections argued that no one with a serious mental illness who is not stable or in remission is being held at David Wade in the first place, and that those detained there in restrictive accommodation receive sufficient treatment in the form of medication.
Even before the trial began, the state paid nearly three million dollars to private attorneys to defend the case over the past few years, according to information from the Louisiana Illuminator. These contracts are overseen by Attorney General Jeff Landry.
The plaintiffs seek changes in the administration of mental health care and restrictive living conditions at David Wade, not damages.
Louisiana Solicitor General Liz Murill told the Illuminator that Landry opposes settlements where the state might lose control of its budget and would prefer to take them to court so the state can eventually appeal a decision for complainants.
Monitoring and treatment
Burns’ main criticism of David Wade’s care was that regular mental health assessments – conducted 30 days after a person is first placed in solitary confinement, and every 90 days after that – were generally brief and superficial. (As of March 2020, these ratings have been increased to every 30 days, according to Burns.)
Moreover, the sessions were not private. Instead, they were made “in front of the cell”, meaning they were not confidential and could be overheard by other prisoners housed nearby, as well as prison staff.
The documentation produced by mental health staff for interviews consists mainly of a checklist of mental health indicators and very few individual details. She said most of the prisoners she spoke to didn’t even know they had taken part in a mental health assessment.
Without adequate and confidential monitoring of the mental state of prisoners while in solitary confinement, Burns said, new problems will not come to the attention of the prison psychiatrist for treatment, and a prisoner may deteriorate without receiving the treatment. necessary.
She also said the “individualized” mental health treatment plans she reviewed for prisoners were all exactly the same and did not change as a person’s condition changed.
Burns expanded on the plans in a January report filed in the lawsuit. Each treatment plan contains both long-term and short-term goals for each inmate — things like “maintaining compliance with all rules and regulations of the facility.” The objectives identified in the files she reviewed were all identical.
On Tuesday, she questioned whether they could even be considered mental health treatment plans and said they were of no practical use.
She also criticized the fact that none of the prisoners were offered individual or group therapy for their mental illness.
“I saw places where inmates were asking for advice,” Burns said. “I didn’t see it provided.”
Despite potential security concerns, Burns said it was possible to provide confidential mental health counseling and interviews with prisoners in prolonged detention, given the appropriate infrastructure and staff. She said soundproof rooms with windows could provide aural privacy while allowing security to monitor what’s going on, and that some restraints – which she called “high-security furniture” – can be used during breaks. therapy sessions to ensure the safety of everyone involved. .
Rather than receiving counselling, inmates with mental illness were treated solely with medication. But even the drug treatment was not done properly, Burns said. Jail records showed that medication was not regularly delivered to patients in extended confinement and she saw instances where there were ‘days, and sometimes weeks of medication missing for people’.
Dr Gregory Seal, the prison psychiatrist, said he had met prisoners held in restrictive accommodation who he felt could have benefited from psychotherapy, and told mental health staff. But he said he could not recall any instance in which psychotherapy had been incorporated into a treatment plan for someone held in restrictive accommodation.
“I may have said they could benefit from therapy, but I didn’t write it down anywhere,” Seal said.
He also said he was not involved in deciding whether a person with mental illness was placed in restrictive housing and was unaware of the confinement conditions on restrictive housing levels – like the time spent outside the cell a person receives, whether or not they are authorized to receive telephone calls or visits.
Burns testified that one of the main problems preventing David Wade from providing adequate mental health care to people in prolonged confinement is the lack of mental health staff – and insufficiently trained ones.
Seal, the prison’s only psychiatrist, is there on a contract basis. And he only works part-time. His contract provides for 18 hours per month, which he spreads over two days. His travel time is counted in his working hours under the contract. He spends six of his monthly 18 hours commuting from Shreveport.
“People can’t see Dr. Seal in a timely manner because he’s only there one day, every two weeks,” Burns said. “So if they’re not taking their meds or they need a change of meds, or the person is decompensating, it could be two weeks before they can see someone. It could take two months.
She testified that for a facility the size of David Wade – which has a prison population of around 1,000 – should have at least one full-time, full-time psychiatrist.
She also said the prison should have more trained mental health staff. As of March 2020, in addition to Seal, three members of David Wade’s mental health staff were providing direct services to inmates. But Burns said it was ‘clear from records that some mental health staff at the time were unaware of psychiatric signs and symptoms, did not necessarily recognize them, did not document them’ .