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As described below, P&As and their partners have successfully advocated to limit or end the segregation of inmates with mental illness in various state and federal systems. These examples demonstrate the critical role P&As have played in providing independent external monitoring and advocacy in our nation’s prisons while also making clear that much still needs to be done to advance and protect the rights of inmates with mental illness in segregation.
➢ In 2014, Disability Law Colorado, the Colorado P&A, teamed up with the American Civil Liberties Union (ACLU) of Colorado to investigate the mental health treatment and isolation of inmates in administrative segregation as well as the conditions in the residential treatment programs for inmates with mental illness within the Colorado prison system. Disability Law Colorado’s concerns included the prolonged segregation of inmates with serious mental illness; the failure to provide adequate mental health care and medication management; the failure to maintain adequate numbers of appropriately trained mental health, clinical, and correctional staff; and the failure to provide meaningful out-of-cell time for recreation, therapy, and socialization. Soon after the investigation began, the prison made policy changes that instituted a minimum of 10 hours of out-of-cell therapeutic and 10 hours of out-of-cell non-therapeutic recreation per week, depending on an inmate’s custody level. Monitoring and investigation are ongoing to ensure compliance with the policy changes.
➢ In 2015, to address concerns that inmates in segregation were routinely denied access to mental health services, including medication, Connecticut Office of Protection and Advocacy for Persons with Disabilities met with the Commissioner of the Department of Corrections and various other prison personnel, including clinical staff, to discuss inmate access to mental health treatment at the State’s supermax facility. After meeting, it was agreed that inmates with mental illness and a P&A advocate would participate in treatment decisions with prison clinical staff.
➢ In 2015, Disability Rights Iowa selected one men’s facility and one women’s facility to investigate the use of segregation of inmates with mental illness as a punishment for violations of institutional rules, including the number of occurrences, duration of segregation, and consideration of mental illness in disciplinary proceedings. The Department of Corrections has been supportive of the effort, has allowed the P&A an unprecedented level of access to complete its investigation, and has requested recommendations on how to improve the Department’s policies concerning segregation of inmates with mental illness. In the past, Disability Rights Iowa successfully worked with the Department to improve its restraint policies and its training about inmates with mental illness for correctional officers.
➢ Kentucky Protection and Advocacy made it an organizational priority to investigate reports of abuse or neglect and deaths of inmates with mental illness in segregation in 2016. To carry out this priority, the P&A plans to complete monitoring in all 14 state prisons before the end of September 2016 and has opened several individual cases involving prison inmates with serious mental illness over the last year.
Kentucky Protection and Advocacy also requested records and compiled data about the mental health treatment available to inmates in state prisons, including the reasons for placement in segregation and the length of time inmates remain in segregation. Following the P&A’s records requests, the Department of Corrections implemented a new data tracking and classification system to document the number of inmates with serious mental illness, intellectual disabilities, and brain injuries in prisons throughout Kentucky.
The P&A has also provided public comments to the Department of Corrections on amendments to policies and procedures, including policies regarding special management inmates (inmates who spend 23 hours per day in cell) and mental health services. In light of the P&A’s comments, the Department decreased the duration of inmates’ initial administrative segregation stay from a maximum of 60 days to a maximum of 30 days. The Department also secured an expert for consultation on further segregation reform. The P&A has also reviewed four incidents of alleged inappropriate restraint. When a review of the Department’s secure restraint policies is complete, the P&A will provide additional comments to ensure inmates with mental illness are not being inappropriately restrained. The P&A will continue to monitor and review amendments to Department regulations, policies, and procedures that impact inmates with mental illness into the next legislative session.
Kentucky Protection and Advocacy also advocates for the approximately 300 inmates with serious mental illness in segregation statewide by handing out awareness buttons. The button with the number 23 signifies the number of hours per day that inmates with mental illness spend in their cell. On the 23rd day of each month, the P&A posts disability-related criminal justice reform information on its Facebook page and P&A staff wear the buttons.
➢ In 2014, to explore the criminalization of mental illness and the impact of segregation on mental health, Disability Rights Nebraska released a report highlighting the psychological and physical harms of segregation on inmates with mental illness, and shared its findings with the Nebraska Department of Corrections and state senators. The findings included: a connection among segregation, serious mental illness, and self-harm and suicide attempts; limited access to mental health treatment and programs in segregation and an underfunded mental health services budget for inmates in segregation; unique barriers to reentry for inmates with mental illness; and the need for systemic community mental health reform.
As a result, legislation was proposed and the P&A was consulted to provide language related to issues raised and recommendations made in its report, which included data collection on the use of segregation, developing a long-term plan to decrease the use of segregated housing, and implementing Department rules and regulations to ensure that inmates in segregation are housed under the least restrictive conditions. Disability Rights Nebraska supported these bills throughout the legislative process, and the following session legislation was passed to limit the use of segregation and improve the treatment of inmates with mental illness. A special investigative committee was also formed to further examine prison issues, specifically inmates with mental illness and segregation. Disability Rights Nebraska has continued to educate state legislators about the need for segregation reform and participates in a workgroup with state corrections stakeholders aimed at reducing the use of segregation in Nebraska prisons. The P&A has also convened its own multi-disciplinary workgroup focused on achieving systemic improvements for inmates with mental illness. The committee and workgroups are ongoing.
➢ In 2000, a coalition including Disability Advocates, Inc.,52 began actively pursuing a legislative solution to the problems facing inmates with mental illness in segregation in response to New York’s increased use of cell confinement sanctions and building of segregation units called Special Housing Units (SHUs). After three years of this pursuit, legislation was introduced to provide treatment to inmates with mental illness and limit the use of SHUs. Disability Advocates, Inc. remained active in this legislative advocacy until it instead focused its efforts on a lawsuit against the Department of Corrections and Community Supervision, the state Office of Mental Health responsible for providing mental health services in the prison system, as well as individual superintendents and Mental Health officials to address the deliberate indifference to inmates with serious mental health needs by failing to provide adequate mental health services and imposing punishments that exacerbate mental illness. Meanwhile, the coalition continued its legislative work, but the bill was vetoed.
However, in 2007, after a litigation settlement was reached, a bill passed that incorporated and improved upon the litigation settlement’s terms. With some exceptions, treatment for inmates with mental illness carrying SHU sanctions increased to four rather two hours of out-of-cell treatment and was to take place in residential mental health treatment programs. In addition, the bill contained a presumption against added SHU sanctions for inmates in the residential mental health treatment programs. What is now knows as the “SHU Exclusion Law” went into effect in 2011 following the sunset of the lawsuit’s settlement agreement.
Since the law’s passage, Disability Rights New York testified against a proposed delay in the bill’s effective date, and twice testified by invitation before the joint Assembly and Senate hearings on mental health treatment in the state prison system. The P&A also testified in favor of expanding the law’s exclusionary criteria to reach all inmates with mental illness. Disability Rights New York continues to monitor segregation in state prisons and investigate allegations of abuse and neglect of prisoners with mental illness in segregation.
Disability Advocates, Inc. (DAI), now Disability Rights New York, was a regional protection and advocacy office with the New York P&A system.
➢ Disability Rights North Carolina conducted an investigation into the segregation practices of the North Carolina Department of Corrections after learning about two inmate deaths from public reports in 2011 and 2014. The P&A’s subsequent investigation revealed serious harm resulting from segregation as well as inadequate care and treatment for inmates with mental illness. In response, Disability Rights North Carolina employed a multitude of advocacy strategies to advance the rights of inmates with mental illness in segregation, including: monitoring prisons with a Centers for Medicare and Medicaid Services psychiatric nurse surveyor; conducting abuse investigations; issuing reports; making public recommendations; forming coalitions with other advocacy groups and prison leadership; and participating in forums to increase public awareness about the need for segregation reform. As a result of this advocacy, a national expert has twice provided consultation regarding the treatment of inmates with mental illness in segregation, prison Crisis Intervention Team training was initiated, and treatment chairs and tables were installed to facilitate out-of-cell treatment. In 2016, the Legislature provided funding to develop eight Therapeutic Diversion Units for inmates on control status with mental illness, and prison policies were updated to require prompt mental health screening of segregated inmates and limit the segregation of inmates with mental illness to no more than 30 days per year.
➢ After an inmate with mental illness died of dehydration in segregation, Disability Rights North Carolina conducted an investigation and issued a report with recommendations. In response, the North Carolina Department of Corrections convened a taskforce on mental health in prison. Disability Rights North Carolina and other advocacy groups provided input to the task force, which resulted in a 2015 report with 90 far-reaching recommendations, including improved and more frequent screening for disabilities, elimination of segregation for inmates under 21 years of age, out-of-cell treatment for inmates with a mental health designation, suicide prevention training, and clinical input in the disciplinary process.
➢ In March 2015, Disability Rights North Carolina conducted monitoring of the prison confining inmates under 18 years of age. The P&A discovered that as much as 38% of the youth were in segregated confinement under the same terms and conditions as segregated adults. Disability Rights North Carolina issued a report to the Director of Prisons, and continued monitoring and advocating for the elimination of segregation for youth. In June 2016, a new Youthful Offender Program was announced that eliminates the use of solitary confinement for inmates under age 18 and requires enhanced education services, behavioral health treatment, life skills development, and family and community reunification services.
➢ Since 2012, Disability Rights North Carolina’s monitoring and advocacy has resulted in concrete improvements to the conditions of confinement for inmates with disabilities, including: removal of thick metal-mesh screens from cell door windows in segregation blocks; issuing mattresses to every inmate placed in a suicide watch cell and upon admission to the acute mental health service unit; issuing a suicide smock and blanket instead of one or the other; and enforcing the out-of-cell exercise policy.
➢ Disability Rights Ohio began receiving an above average number of complaints from Ohio’s maximum security prisons, where most of the inmates are placed in segregation for extended periods of time. The first complaints were from inmates placed on suicide watch or crisis watch. They indicated that segregation was making their mental health symptoms worse and the prisons were offering little to no effective mental health care to address them. Some inmates even reported that prison officers were encouraging them to go ahead with their suicidal ideations, or chiding them not to commit suicide during their shift so they could avoid the paperwork. Throughout late 2015, the P&A investigated further by visiting three Ohio prisons with the largest populations in segregation. The P&A took pictures of the cells, recreation cages, and other areas used by inmates, and went cell-to-cell in selected units, speaking to over 110 individuals in segregation, over 75 of whom had a documented mental illness. These conversations revealed a number of other problems that resulted in further advocacy and follow up, including claims of excessive use of force, inadequate medical care, retaliation, and prolonged periods of 24-hour confinement. Finally, the P&A recorded extended interviews of 22 individuals who wanted to share their story with the public. Disability Rights Ohio then teamed up with the ACLU of Ohio to publish a public report in May 2016, Shining a Light on Solitary Confinement: Why Ohio Needs Reform. The report detailed findings from the investigation, outlined research into the problems of long-term solitary confinement, and listed specific reforms for the Department of Rehabilitation and Corrections to drastically reduce its use of solitary confinement and provide more rehabilitation, programming, and out-of-cell time to every inmate in segregation. The P&A and the ACLU of Ohio held a joint press conference and multiple interviews to publicize the report on Ohio television and radio programs. The Department of Rehabilitation and Corrections has stated that they will work to reduce solitary confinement, particularly for individuals with mental illness, and that new reforms will be announced in late 2016.
➢ Disability Rights Oregon conducted an investigation into the Oregon State Penitentiary’s Behavioral Health Unit (BHU), an intensive behavioral management and skills training unit for inmates with serious mental illness who have committed violent acts or disruptive behavior. Disability Rights Oregon released an investigation report, which concluded that inmates in the BHU were routinely isolated in their cells for 23 hours a day without timely access to mental health care and that mental-health related behaviors were often dealt with using force. While the Oregon Department of Corrections did not agree with all of the findings and conclusions in the P&A’s report, the Department agreed to improve treatment in the BHU and conducted a comprehensive review of the BHU that included consultation with a nationally-recognized expert. Following that review, the prison and the P&A entered into a Memorandum of Understanding that reflects the parties’ commitment to changes that include: allowing BHU inmates an average of 20 hours per week out-of-cell time, including 10 structured programing hours and 10 unstructured hours; enhanced access to mental health services with greater consideration of individual treatment needs; quarterly reports to the P&A for four years; and to pay for ongoing guidance from the expert. The required improvements will involve architectural, operational, and staffing changes. Following a joint funding request by the P&A and the Department, the Oregon Legislature allocated more than 8 million dollars that will be used by the Department to comply with the terms of the Memorandum of Understanding.
➢ Disability Rights Tennessee received a report in June 2015 that an inmate with mental illness was denied medical treatment by prison staff. Upon investigation, the P&A learned that the inmate requested pain medication after an assault and engaged in self-harm when the medication was denied. As a result of the self-harm behavior, the inmate was moved to a mental health segregation unit where he continued to self-harm, was placed on 24-hour watch, and was ultimately put in six-point restraints. The P&A’s investigation further revealed that the inmate remained restrained and in segregation for three months, during which time a feeding tube, and intravenous fluids and medications were required. Disability Rights Tennessee initiated discussions with the Department of Corrections medical and mental health directors who agreed to develop a treatment plan for the inmate that included regular individual therapy, clear guidelines for the inmate’s personal care, incentives to refrain from self-harm, and weekly treatment team meetings with the inmate’s mother and medical conservator. Though Disability Rights Tennessee continues to investigate this report, the P&A’s intervention has produced a treatment plan for the inmate that has removed him from restraints and allowed him to be moved to as less restrictive setting within the prison.
➢ In September 2014, Disability Rights Washington opened a systemic investigation into the Washington State Department of Corrections’ treatment of inmates with personality disorders. The investigation focused on the use of segregation for these inmates, the use of restraints and force in response to incidents of self-harm, and inmate access to mental health and programming while in segregation. DRW determined that additional expertise was required in order to address the issues raised by this population and presented a proposal to the prison system to jointly hire an expert. In March 2015, the expert did a tour of two prisons where inmates with personality disorders are often concentrated, reviewed policies, and interviewed inmates, staff, mental health providers, prison administrators, and P&A staff. The expert then produced a report, identifying areas of concern and making recommendations for change. The recommendations included, among other things, modifications to the prison’s restraint policy, shorter time periods before inmates get privileges in segregation, more out-of-cell time, more programming, better yards, and private mental health appointments for inmates on the mental health units. In response to the report, the prison system has drafted a plan of corrective action. Disability Rights Washington is currently monitoring the implementation of that corrective action plan.
➢ As a result of its ongoing monitoring and advocacy related to the needs of inmates with mental illness, developmental disabilities, and traumatic brain injuries, Disability Rights Washington noted that many of these inmates were placed in segregated units for prolonged periods of times, sometimes as long as several years. In 2013, Disability Rights Washington and the Department of Corrections established an ongoing relationship in which the P&A and the prison system work collaboratively to identify and develop plans to address the needs of inmates with disabilities. As a result, the prison system developed a specialized unit for inmates with developmental disabilities and traumatic brain injuries and works closely with the P&A on individual cases where actions related to a person’s disability results in the inmate being held in more restrictive settings than necessary.
➢ After learning that Washington State Department of Corrections punished individuals for self-harm and attempted suicide, Disability Rights Washington sent a letter to the prison system asking for this practice to stop, citing a case based on similar facts brought by Disability Rights Vermont. In 2013, Washington State Department of Corrections formed a workgroup comprised of prison clinical and corrections staff, as well as a Disability Rights Washington attorney. As a result of this workgroup, the prison system agreed to stop infracting people for self-harm behavior and to restore good time lost due to infractions related solely to self-harm behavior.
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The AVID Prison Project is a collaboration between The Arizona Center for Disability Law, Disability Law Colorado, The Advocacy Center of Louisiana, Disability Rights New York, Protection and Advocacy for People with Disabilities of South Carolina, Disability Rights Texas, Disability Rights Washington and The National Disability Rights Network.