We are the surrogate mental hospitals now,” says Larry Chandler, warden at the Kentucky State Reformatory in La Grange, Ky. With the rising number of mentally ill, the reformatory was forced to rebuild a system that was designed for security. Never intended as mental health facility, treatment has quickly become one of their primary goals.
Unfortunately, this situation is not unique to Kentucky. The continuous withdrawal of mental health funding has turned jails and prisons across the US into the default mental health facilities.
A 2006 report by the U.S. Department of Justice shows that the number of Americans with mental illnesses incarcerated in the nation’s prisons and jails is disproportionately high. Almost 555,000 people with mental illness are incarcerated while fewer than 55,000 are being treated in designated mental health hospitals.
In Kentucky alone, it is estimated that almost 25 percent of all Kentucky prisoners are afflicted with a serious mental health problems such as schizophrenia and bipolar disorder.
The problem with the mental health system in our country did not spring up overnight.
“There was a shift in the way our society sees mental illness,” says psychologist Dr. Stephanie Roby. “We saw a fallout from the 60s when we were institutionalizing everyone. Society reacted by saying the community needs to be more responsible for these individuals.”
The goal was to reduce the number of mental health patients housed in government-operated institutions and to shift the care to local communities where programs would be created to handle their special needs.
“It was a great idea in theory,” says Dr. Roby. “Unfortunately, mentally ill people do a lot of inappropriate things, they are misunderstood, they commit crimes and then they end up in CPTU.”
Kentucky’s CPTU
To alleviate the strain in the state’s prisons and jails, the Kentucky Department of Corrections decided to concentrate its efforts in one location and created the Correctional Psychiatric Treatment Unit at the Kentucky State Reformatory in 1998.
What started out as a 13-bed special unit has grown to a 150-bed treatment unit for the state’s most severely mentally ill inmates. Staffed by licensed mental health professionals, the unit provides crisis intervention, stabilization and individual counseling.
“We are a mental hospital right here in prison and there is no difference other than the clients are incarcerated and they are called inmates,” says Kevin Pangburn, mental health director for the Kentucky Department of Corrections.
“As soon as you walk through the doors, you hear people screaming, kicking their doors and crying,” says Matthew Estepp, an inmate at Kentucky State Reformatory and an inmate watcher in CPTU. Although CPTU is located within a reformatory, “it’s like walking into a different world,” he says.
The goal in CPTU is “to stabilize people and get them in the least restrictive area as safely and as expediently as possible,” says Dr. Tanya Young, CPTU program director and psychologist.
The unit consists of three wings. The inmates placed in C wing are on 23-hour lockdown and evaluated for the purpose of stabilization and receive the most intense supervision. The other two wings in CPTU, A and B, are for those who have been stabilized in CPTU but the doctors believe need more monitoring and structure but don’t need to be locked down for 23-24 hours a day.
The hope is to move the inmate out of lockdown and isolation as quickly as possible and into A or B wings. Once they are stabilized in CPTU, the aim is to send them back into general population in the prison system or society depending on the length of their sentence.
“If they can’t mainstream in this population, surely they can’t exist outside of here when all of this support is pulled,” says the warden. To view more of more of Jenn's photos and videos click here:http://www.jennackerman.com/trapped/feature/
Julia Lish, a correctional officer, comforts an inmate during one his psychotic episodes. "Its going to be OK," she repeats as he cries and yells to the voices in his head. "They are rejects of society and warehousing them in prison isn't the way to go. Most of them don't have life sentences - they will get out some day." says psychologist Dr. Tanya Young. Locked down for 24 hours a day, many inmates spend their day staring out the window of their cell. "What do they do when they get out? There needs to be something else to absorb them or take them in," she adds. 
one good thing is that forced antipsychotics have to be court ordered in kentucky! I have been off of neuroleptic(antipsychotics) a year and I feel well! No adverse events other than with drawals at first-that is hard.
ReplyDeletePeople should have the right to choose especially when they are mentally fit to do so!
I find it irritating to say the least that people would be forced to take antipsychotic injections that make them sick-Antipsychotics kill people an average of 25 year earlier than they would normally die, I was suffering health issues being on them 17 years-increased triglycerides, high ast alt, decreased bone mass, b-vitamin anemia, lowered platelets, high mch, mcv etc.
Anonymous, I understand your view point, since the SPMIs in my own family also were alleviated by medical, rather than psychiatric treatments (although psych meds at least kept them alive until we could figure out what could help them better - See "It's Not Mental").
DeleteNote however - they had insight. They could choose to do what was necessary to get better. The ones who end up in jail, or on the streets are not "choosing" to be in jail or homeless, freezing, filthy and starving on the streets. In fact, my kids were afraid of such a thing, and the way laws are currently written, they could not even protect themselves from such a possibility had they lost insight.
Psychiatric medications can be a good "emergency" tactic, but my family agrees it should only be a FIRST STEP until better medical care - comprehensive, collaborative, integrative, medical, psychological, etc. care - can perhaps helps better.
But in the meantime, many people get NO CARE - they just get jail time and abandonment - abuse, neglect and death.
To at least say, "We can do better" and give them CARE is a first step.
The first antipsychotic/neuroleptic was discovered in the 1950's to alleviate symptoms of schizophrenia-it was accidently discovered I am glad it was found but it does have several adverse affects! The first antipsychotic was an antihistamine, Check the side effects of the meds they can cause infertility, bone mass reduction etc like stated above, after someone is inilitialized on meds it then should become their choice if they will stay on the meds or not! Especially if they are not violent in nature and can function without meds. Antipsychotics kill people up to 25 year earlier than the average population!
ReplyDeleteDear Anonymous ~ it is sad that some who take antipsychotic/neuroleptic medications become obese, which can cause a person to die years earlier than their peers. Also, many people with SMI, (who choose to treat with meds or not) smoke, and this behavior can result in cardiovascular disease, emphysema or cancer ~ which can lead to an early death.
ReplyDeleteHowever, your comment about antipsychotics is contrary to the fact. "People with severe mental illness die on average 25 years earlier than the general population", and there is no research that support this is due to anti-psychotic medications. Often times, overall health problems from living a rough life on the streets in homeless and harsh conditions can lead to early deaths. Many who choose to NOT be in treatment often live a life of self-medicating with extreme drug and alcohol abuse ~ often resulting in early deaths.
The leading cause of death of people with SMI is not 'treatment' but the "lack of treatment" and too often ends in suicide.
More than 90 percent of people who die by suicide have a history of mental illness. Nearly a decade from the onset of symptoms until the first contact with the treatment system, and that delay increases the likelihood of disability and negative social outcomes. Untreated mental illnesses also lead to greater frequency of symptoms and episodes.
Also, if a person is not a threat to themselves or others ... they would not be subjected to AOT in KY or any other state. AOT is needed to save lives, not shorten a life span of a person that doesn't understand they have an illness.