- Associated Press - Saturday, November 14, 2015

HARRISBURG, Pa. (AP) - Owing to damage to his frontal lobe when he was born, Jeremy Anthony, 38, has virtually no control over his sexual impulses.

As a result, since his imprisonment in 1997 for the attempted rape of a Pittsburgh woman, Anthony has violated the rules of Pennsylvania’s state prison system 77 times, almost entirely for compulsive masturbation.

His punishment inside the system, more often than not, has consisted of solitary confinement. Marcia Franklin, his mother, calculates that Anthony has spent more than 10 of his 18 years of incarceration in isolation and she believes it not only exacerbated his compulsive behavior but led to new mental health issues - like hearing imaginary voices.

“If you yourself were thrown in solitary confinement for a year, how would you react?” Franklin said. “A normal person would have problems.”

It was stories of punitive isolation against seriously mentally ill and intellectually disabled inmates that spurred the U.S. Department of Justice to investigate Pennsylvania’s state prison system in 2011. Pennsylvania’s jails and prisons, like those in other states, have experienced a surge in mentally ill inmates in recent decades, which has brought new scrutiny of how it handles those individuals.

In the case of Pennsylvania’s state prison system, the Department of Justice concluded in 2014 that mentally ill or intellectually disabled inmates like Anthony were twice as likely to be isolated than other prisoners in the system. The department described the practice as “the mental equivalent of putting an asthmatic in a place with little air to breathe.”

The investigation - and a concurrent lawsuit filed by the Disability Rights Network of Pennsylvania - led the Department of Corrections to pledge to transform care for mentally ill inmates: from new disciplinary procedures to expanded mental health treatment.

Now, more than four years after the Department of Justice began its investigation, opinions remain divided over how effective those reforms have been.

For his part, John Wetzel, secretary of the Department of Corrections, said he’s proud of what his department has accomplished.

“Every day we get a little better,” Wetzel said. “We are eons ahead of where we were four years ago.”

Among some inmates and their families, however, there are concerns that the Department has fallen short of its promises.

“He’s not getting any help,” said Franklin, referring to her son. “And he’s not going to get any until he gets out.”

Transforming care

Over the brick walls and coils of barbed wire, “O block” at SCI Camp Hill is barely distinguishable from its sister cellblocks - a towering beige building with slit-like windows.

But inside, it’s clear that “O block” is different from its peers. The first sight that greets a visitor, of all things, is a mural. It features a coil of blue and purple paint with bold, yellow letters that reads: “obstacles are opportunities in disguise.”

The mural, and several others spaced between the building’s gray walls and hard steel doors, are new additions to “O Block”, which serves as the prison’s treatment unit for seriously mentally ill inmates. They are one of the more obvious changes the Department of Corrections has made to its mental health facilities.

Standing near “O Block’s” entrance earlier this year, Debra Rich, the unit’s manager (Rich has since been promoted to a different position in the Department of Corrections) said the murals were intended to foster a more therapeutic environment while providing those inmates with a therapeutic outlet too.

“We have some really talented artists here,” Rich said, beaming.

Corrections officials insist however that the changes go beyond just murals. Rich said that SCI Camp Hill, like other facilities that handle mentally ill inmates, has expanded educational programming and music classes for the mentally ill. It has also hired a social worker to help mentally ill inmates transition to the outside world.

Rich said the system was ultimately trying to cultivate a different culture in its mental health facilities.

“Living on ‘O block’ is kind of a privilege,” Rich said. “It’s quiet and clean. It’s kind of a community. It’s not just a cellblock or housing unit - it’s a place where people really look out for each other.”

Beyond changes to the units themselves, the Department of Corrections has overhauled how it determines which inmates should be placed in them.

Pennsylvania’s state prison system receives nearly all of its inmates from county prisons, where most defendants are held when they’re awaiting trial. The system is now better at flagging inmates who have been diagnosed with mental illnesses in those facilities, even if they arrive in the state prison system in a stable condition.

Officials also say the system is better at flagging and diagnosing existing inmates who had never previously been diagnosed with a mental illness.

Likely as a testament to those changes, the department’s internal statistics show a sharp rise in the proportion of state prison inmates who are classified as having either a mental illness or a serious mental illness. In 2014, the percentage of inmates in the latter category jumped from 2 percent to 8 percent in the past two years - which puts the system’s rate more in line with those observed in other state prison systems.

New disciplinary procedures

However, perhaps the most crucial change the Department of Corrections has made is to how it handles punishment for mentally ill inmates.

Under the department’s new policy, reinforced by a settlement agreement with the Disability Rights Network of Pennsylvania in January, when a seriously mentally ill inmate breaks a rule he or she is barred from placement in solitary confinement - known as a “restrictive housing unit” in correctional parlance.

Instead, when an inmate with a serious mental illness commits an infraction, that inmate is now referred to a prison psychologist who determines whether his or her behavior was due to a mental health episode or whether it was a deliberate decision to break the rules.

If the former is determined, clinicians will work to address the inmate’s mental health needs and the inmate won’t be penalized. If the latter is determined, that inmate is now placed in what the department calls a “diversionary treatment unit,” which is designed to strike a balance between holding an inmate accountable for bad behavior but not aggravating their mental illness.

An inmate in a diversionary treatment unit is guaranteed at least 20 hours out of his or her cell each week, including therapy and other programming. By comparison, inmates placed in solitary confinement are confined for a minimum of 23 hours per day.

Wetzel said he was very pleased with the new approach. As evidence of its effectiveness, he said that since the department had made the change it had discovered that about 10 percent of inmates who garnered misconducts required commitment to the system’s inpatient psychiatric beds.

“What would happen in the old system, we wouldn’t have asked the follow-up question to find out what the driver of the behavior was and that was what really got us into trouble,” Wetzel said.

Concerns linger

But amid those changes, concerns still linger about care for mentally ill inmates inside Pennsylvania’s state prison system.

An inmate with a diagnosed mental illness told PennLive that while he was impressed with many of the changes the department had made he still felt there were ongoing problems.

The inmate, who declined to be named for fear of retaliation by correctional officers, alleged that that the department was continuing to excessively restrain seriously mentally ill and intellectual disabled inmates - a practice that the Department of Justice had criticized in its investigation.

In addition, the inmate said, “therapy” within the prison system still consisted of little more than heavy use of psychiatric medication.

“When an inmate requests talk therapy, his requests are often ignored,” the inmate wrote in correspondence with a PennLive reporter. “If he does see a psychologist, he is rushed through a 15-minute “session” and then referred to a (nurse practitioner) for medication.”

The inmate’s harshest allegation, however, is that the Department of Corrections is intentionally misclassifying seriously mentally ill and intellectually disabled inmates.

The inmate said he believed that the prison system was misclassifying inmates both to reduce demand on its revamped mental health units and because it allowed certain staff and correctional officers to punish inmates without fear of reprisal. He said the view among some officers was that mental health treatment was the equivalent of “coddling” inmates.

“They feel that if we were ‘insane’ we would have been found not guilty,” the inmate wrote. “Therefore, as long as we are in prison, we will be treated accordingly.”

Marcia Franklin said she believes her son, Jeremy Anthony, has been a victim of that alleged policy.

Franklin said, for as long a she could remember over her son’s 18-year incarceration, he had been on “D roster” status - a classification for inmates with serious mental illnesses or intellectual disabilities.

But she said, out of the blue, her son’s status was downgraded last year to C roster status for inmates with mental illnesses, not serious mental illnesses.

As a result, this February, when her son garnered another misconduct for compulsive masturbation, he didn’t have the protections that are afforded to D roster inmates. He was consequently placed in solitary confinement.

After Franklin complained to the department, Anthony was removed from isolation and his D roster status was reinstated. But a few months later, Franklin said, he would again lose and then regain his D roster status.

Franklin said she feared it was only a matter of time before he would lose his D roster status again and be placed in solitary confinement.

“My son has been sitting in prison for 18 years with no help,” Franklin said. “All he gets is abuse. They are supposed to re-train them, but all they have done the entire time he has been there is to throw him in the hole for a problem he can’t control.”

Ann Schwartzman, executive director of the Pennsylvania Prison Society, which advocates for the welfare of inmates, said hadn’t heard concerns about inmates who were losing D roster status.

In general, however, Schwartzman said she was concerned that the changes the department was making, while welcome, were not happening quickly enough.

Schwartzman said that while she knew the department had expanded mental health training for correctional officers, her organization still heard too many stories of officers who weren’t handling mentally ill inmates appropriately.

“There just doesn’t seem to be the recognition of mental health issues and the action that’s required,” Schwartzman said.

Department disputes those claims

Officials for the Department of Corrections vigorously dispute those claims.

In response to Schwartzman, Wetzel said all 15,000 of the department’s employees, including himself, now had a mandatory eight hours of mental health first-aid training, an internationally-developed program that teaches people how to recognize mental health and how to respond.

“We are literally going to be the only system, probably in the world, certainly in the country, which has trained all its staff in mental health first aid,” Wetzel said.

He said an additional 850 employees had received 32 hours of crisis intervention training, a more advanced program to understand and respond to inmates in the midst of a psychotic episode.

Wetzel also disputed the claim that the department overused restraints on mentally ill inmates.

“If you had made that argument before we went through all the changes, I wouldn’t argue that,” Wetzel said. “That’s not the world we live in today.”

Statistics supplied by Wetzel’s department show that the number of inmates who were placed in restraint chairs in its facilities fell from 153 in the first half of last year to 76 in the first half of this year.

Meanwhile, Lynn Patrone, who serves as the department’s mental health advocate, a newly created position intended to monitor the welfare of mentally illl inmates, said she disputed the claim that the department didn’t provide enough talk therapy.

“I think we have the tools in place,” Patrone said. “What I see, more often than not, is inmates may not be taking advantage of it.”

Both Patrone and Wetzel also strongly disputed that the department was intentionally misclassifying inmates.

Wetzel said that decisions about how inmates were classified were in the hands of clinicians, not correctional officers. He said while there may be cases where it may be difficult to determine the best classification for an inmate, the department’s staff did the best it could.

“I don’t think we bat a thousand but I think we’re pretty frigging close,” Wetzel said. “Those decisions are made by clinical people who have no dog in the fight.”

Patrone, who regularly visits prisons and talks with mentally ill inmates, also said she hadn’t seen any intentional misclassification, although she believed there were inmates who were not always happy with their classification.

“It goes both ways,” Patrone said. “Somebody wants to be on D roster to enjoy what they see, I guess, as privileges and perks. And then there’s others who are on the C roster who are ‘I’m fine, where I am’ and I think, ‘maybe they need to be on D roster?’ So the clinicians really make that determination.”

Firm answers may be forthcoming

If the department is misclassifying inmates, there is no clear evidence of that in the department’s figures on inmates’ roster statuses.

The proportion of D roster inmates sharply increased in 2013 after the department revamped how it flags inmates for mental illnesses and serious mental illnesses. But that increase has largely plateaued at 8 percent of the department’s 49,000 prisoners. There is no clear drop of D roster inmates since 2013, nor a corresponding increase in inmates on C roster.

That doesn’t preclude the possibility of misclassification of D roster inmates, but there are no tell-tale signs in the data.

Robert Meek, managing attorney for the Philadelphia office of the Disability Rights Network of Pennsylvania, said he was familiar with inmate complaints about classification.

Meek said he had received hundreds of letters from inmates on the matter but it would require a review of clinical records to determine their credibility.

“Whether they are accurate or not is yet to be determined,” he said.

Meek said that determination, and an assessment of how well the department is doing in general to improve care, rested with an independent, two-person team that is inspecting Pennsylvania’s state prisons.

As part of the settlement agreement that Meek’s organization reached with the Department of Corrections, that team was established to monitor compliance with the agreement. It’s tasked with visiting eight of the state’s 16 prisons that have D roster inmates each year.

That compliance monitoring first began in July and, after visiting four prisons over the past few months, the team will release its first report in December.

Wetzel said he’s confident the report will show the progress that the department has made.

“I’m very happy with the level of mental health services that we have here,” he said. “I’m still not happy with the amount of mentally ill offenders that end up in state prison - I think we still have some work to do around that as a society.”

While the department’s critics, like Schwartzman, might have lingering concerns about the quality of mental health care that the department is providing, there is at least little disagreement on that latter point.

“The Department of Corrections and many county facilities have picked up a problem, a burden, that they are not designed for,” Schwartzman said. “We have a mental health system that has been virtually disassembled and people end up in prison because there’s no other place to go.”





Information from: Pennlive.com, https://www.pennlive.com

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