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Appel: Mental Health In Prison

Remember Police Captain Claude Rains’ Casablanca line, “I’m shocked. Gambling taking place here in Rick’s. Just shocked.” This discussion has been going on for at least 20 years. The 1993 asphyxiation death of an inmate with severe mental illness who choked on his own vomit while in four point restraints, left face down and unobserved by correction staff, was the catalyst for the first Corrections Oversight Committee. That committee, spurred by many advocates, has been successful in urging the Legislature to enact minor reforms to provide somewhat more  humane treatment of mentally ill inmates. However, the situation continues to worsen.

As a state official  for twenty years involved with mental health and criminal justice policy, I participated in countless studies about treating mentally ill persons in Correctional facilities. This is like trying to shove a square peg into a round hole. Inmates with serious mental illness simply do not fit in that milieu. In fact, they are much more likely to decompensate and regress in prison. In addition, their presence makes the difficult job done by our correctional staff far more stressful as they are trained to provide security - not mental health treatment. In Vermont prisons, more than one-third of men and 60 percent of women have been diagnosed with SERIOUS mental illness. Very few are true psychopaths or pose significant threats of violence.

Vermont fails to provide effective and accessible community-based mental health services. The new state psychiatric hospital cannot fill all of its beds due to staff shortages for this most challenging work. Presently, persons needing acute mental health intervention are often housed in hospitals’ emergency rooms with little, if any, mental health treatment. Two sheriffs are paid 24/7 to babysit persons in state custody. An E-R is no place to be lodged while in the midst of an acute mental health crisis. This was a factor in the tragic death of law professor and public commentator, Cheryl Hanna.

Vermont needs an acute psychiatric care facility for inmates. The Legislature passed a law years ago that “[T]he Department shall provide health care for inmates in accordance with prevailing medical standards.” Mental health is a key component of overall health care, evidenced by Vermont’s mental health parity law requiring insurers not to discriminate between physical and behavioral health.

Until Vermont commits to an effective community-based treatment with services on demand and the DoC creates a true acute psychiatric care unit, unfortunately, we will continue to read about these tragic inmate deaths.

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