The Real Cost of Prisons Weblog

The inmate had tried suicide several times before and was experiencing delusions and hallucinations - clear signs of mental illness - but this did not affect how his keepers viewed him: as a "malingerer," according to court documents, who deserved round-the-clock lockup in a veritable closet for his prison misdeeds. Nor did it matter that the prison was operating under the watchful eye of a federal court that had sought to avoid this kind of outcome.

Now, nine years later, such abusive long-term isolated confinement of mentally ill inmates is at the center of another, more far-reaching federal lawsuit recently settled by New York State, alleging dismal inmate mental health care across its 71 prisons. With the state's pledge to add 400 treatment beds and curbs on how mentally ill inmates are disciplined, the settlement has the potential to lift hundreds of prisoners out of miserably punitive conditions. Nonetheless, caution is advised.

One need only look at Inmate A and others who died long after the state had agreed to improve their lot - even as court monitors kept a regular vigil - to know the limits of judicial reach. The settlement is a good development, to be sure, but it fails to go far enough.

The court reports that tell the checkered history of settlements of class-action prison lawsuits - those, for example, that revealed the fate of Inmate A - will not, under this new settlement, be made public. So who will know if the state reneges?

It's an urgent question, as New York's prisons, like those in other states, have become de facto mental institutions in an era of shuttered mental hospitals and inadequate community care. While the prison population has expanded by about 9 percent since 1991, the number of inmates with mental illness - currently estimated at 8,400 - has nearly doubled. The system has its own 189-bed psychiatric hospital and specialized units for mentally ill inmates, but its resources are dwarfed by the need.

Unable to conform and offered few treatment alternatives, mentally ill inmates often are isolated in cells as small as 50 square feet for an average of three years. The most recalcitrant are fed cold loaves of flour, milk, potato and carrot - with a side of raw cabbage - a punitive practice frowned upon by the accrediting American Correctional Association.

The lawsuit settlement places limits on use of the "loaf" and on punishment of mentally ill inmates who hurt themselves in violation of prison rules. It also provides two hours of therapy a week for inmates in isolation. What it will not do, however, is exclude schizophrenic and other intensely ill inmates from the dehumanizing, psychologically battering rigors of isolated confinement.

Prisons in at least seven other states now ban isolated confinement for inmates with serious mental illness. Under a bill pending in the State Legislature - vetoed last August by then-Gov. George Pataki but reintroduced and now in committee - New York would follow suit. Crucially, the bill would let a state commission monitor mental health care behind prison walls, providing badly needed, and permanent, oversight.

Settlements in federal lawsuits undoubtedly have improved prison conditions. But the path to change has been tortuous and long. After a settlement involving the Green Haven Correctional Facility in Dutchess County, a frustrated court monitor wrote 13 reports from 1992 to 2000 in which he described care as "wretched," "callous" and "dangerous." Five inmates died needlessly, including one from a staph infection that wasn't treated for six months; others were transferred under the monitor's nose to prisons not covered by the settlement.

In 1999, after the suicide of another Attica inmate under conditions almost identical to those involving Inmate A, a court expert reported that "no substantively meaningful improvement" had occurred. This was about 19 years after the filing of the suit pertaining to inmate care at Attica. By 2002, when advocates decided to take their case against corrections officials systemwide, half of prison suicides were occurring in isolated confinement - and Attica's count was among the highest.

Given a cooperative state bureaucracy with an enlightened view of mental health care, advocates believe that the outcome in the most recent case - Disability Advocates Inc. v. Office of Mental Health - will be different from the outcome in other cases. Maybe. Maybe not. The track record isn't good.

Without legislation, I fear that someone else may be writing this very article in a decade or two. Or - denied progress reports under a confidentiality clause that keeps them under wraps - maybe she won't.

Copyright 2007 Newsday Inc.
http://www.newsday.com/news/opinion/ny-oppfe065201084may06,0,3547153,print.story