In a scathing report to N.C. lawmakers, a retired prison psychologist contends that the state’s efforts to reform mental health for inmates has instead squandered millions of tax dollars while endangering inmates and prison workers.
The psychologist, John Schwade, maintains that money allocated for mental health reform in 2015 “has not been spent as promised.” What’s more, Schwade says, many of the inmates who most desperately need treatment aren’t getting it.
State prison leaders sharply disputed Schwade’s conclusions, saying they have done much to improve care for those with mental illness.
“His allegations and conclusions are based largely on conjecture, opinion and untruths,” Gary Junker, director of behavioral health for the prison system, wrote in a letter to legislators Wednesday.
Others who advocate for inmates say that while prison leaders have improved mental health care, far more action is needed.
Elizabeth Forbes, who heads the criminal justice reform group NC CURE, said that over the past three years, her organization has received almost 300 letters from mentally ill inmates who complained of problems with their treatment. Some have had to wait months to see a psychologist, she said, while many others have lost access to the medications they need.
“Mentally ill inmates are still going undocumented and untreated,” Forbes said. “(The prisons) continue to release these people into the community without an adequate support mechanism. … So where do you think they’re going to end up? … They’re going to be back in our prison system. They’re going to be back on our streets.”
Jails and prisons have become the nation’s largest providers of mental health care in recent years as funding for treatment in the community drops.
State prisons leaders announced plans to reform mental health care following the 2014 death of Michael Kerr, a mentally ill inmate at Alexander Correctional Institution in Taylorsville who died of thirst after spending days lying unresponsive in his cell.
In 2015, Gov. Pat McCrory asked the legislature for $24 million over two years to improve the care of prisoners with mental illness. Lawmakers provided half that.
Most of the money was to set up new “therapeutic diversion units,” where inmates with mental illness would receive intensive treatment as an alternative to solitary confinement.
There are helpless people who are not getting the help they need. And the public’s goodwill and money are being wasted.
Retired N.C. prison psychologist John Schwade
Schwade, 63, retired in December after working for more than 16 years as a psychologist at Polk Correctional Institution in Butner.
In his 18-page report to co-chairs of the Joint Legislative Oversight Committee on Justice and Public Safety, which oversees the prisons, Schwade contended that “every supposed reform has been harmful to the mental and behavioral health of inmates, and has endangered inmates, prison workers, and the public.”
Are illnesses overlooked?
Among Schwade’s allegations:
▪ The mental health screening of newly arriving inmates is inadequate. It’s not done by licensed mental health professionals, but instead relies largely on self-reporting by inmates.
Junker disputed the assertion that large numbers of inmates are going untreated, calling it “grossly overstated.” He said that inmate screening is done by nurses and trained behavioral specialists.
▪ Prisons have been unable to recruit and retain enough psychologists and psychiatrists. Prison leaders say they’ve filled some positions. But about 23 percent of psychologist positions are vacant, state figures show.
▪ The prison system’s new suicide prevention plan is “no such thing,” Schwade wrote. Last June, as authorities investigated a flurry of inmate suicides, the prison system rolled out a plan to prevent more inmates from taking their own lives. But Schwade says that plan doesn’t include tools that effectively identify those who are most likely to kill themselves.
Junker says the prisons’ tool for assessing the risk of suicide is used nationwide and is endorsed by many professional groups.
▪ The new therapeutic diversion units are not helping the inmates who state prison leaders promised would be treated when they asked the legislature for money.
Schwade said that of the first 22 inmates he saw at Polk’s new TDU, only one or two appeared to qualify under the criteria laid out by prison mental health leaders.
Junker said Schwade’s definition of mental illness is too narrow and “does not conform to contemporary practice.” Schwade, however, says he used the definition that Junker himself wrote in an operational manual for the TDU’s.
Mentally ill inmates are still going undocumented and untreated. ... So where do you think they’re going to end up? They’re going to be back in our prison system. They’re going to be back on our streets.
Elizabeth Forbes, director of the criminal justice reform group NC CURE
Dangerous gang members have been among those assigned to the TDU’s, and those prisoners can prey on inmates who are mentally ill, Schwade said.
Schwade also described the struggles of several seriously ill inmates who he believes did not get the care they needed.
One was a schizophrenic man who refused to shower and at times didn’t know where he was. Schwade said the inmate left the prison so sick that “he could not function on the outside, even for a day.” He soon returned to prison.
Another inmate, he said, was so psychotic that he pulled out clumps of his hair. But when a psychologist tried to get him transferred to Central Prison’s mental health unit, his request was denied. Suffering from severe schizophrenia, the inmate remained housed in the state’s most restrictive prison unit for months before he was moved out.
‘Lives hang in the balance’
Jack Register, executive director of NAMI-NC, a mental health advocacy group, said he was disturbed – but not surprised – by Schwade’s conclusions.
“(Mental health reform) is not happening at the speed we would like,” Register said. “There are pearls of goodness. We just know it needs to be more robust and more pro-active.”
Vicki Smith, executive director of Disability Rights North Carolina, a nonprofit advocacy group, said that while the prisons are “moving in the right direction” on mental health reform, they need more resources, staff and expertise.
Chris Brook, legal director of the N.C. ACLU, agrees.“It’s clear that more is needed, and too many lives hang in the balance for officials to not take further action,” Brook said.
Schwade recommended that lawmakers subpoena psychologists who work for the state prison system to testify in closed-door hearings.
He said he waited until retirement to file his report “because it is not possible for a current employee of a North Carolina prison to report a problem without facing severe retaliation.”
Junker took issue with that, saying he has encouraged “open dialogue and staff input.”
Schwade says it took more than a year to compile information for his report. Asked why he has put so much time into it, he said:
“There are helpless people who are not getting the help they need. And the public’s goodwill and money are being wasted.”