In a report sent to N.C. lawmakers on Feb. 17, retired prison psychologist John Schwade said many of the state’s efforts to reform mental health for inmates have done more harm that good. Here is the report that Schwade sent to co-chairs of the Joint Legislative Oversight Committee on Justice and Public Safety:
Recently I retired as a prison psychologist, stationed at Polk Correctional Institution in Butner, the location of one of the four “therapeutic diversion units” opened in 2016. These “therapeutic diversion units” were to be the cornerstone of planned prison mental health reform, for which the legislature allocated an additional $12 million in 2015.
The $12 million allocated for mental health reform has not been spent as promised.
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Every supposed reform has been harmful to the mental and behavioral health of inmates, and has endangered inmates, prison workers, and the public. Moreover, many of the inmates with the most serious mental disorders, including schizophrenia and intellectual disorder (formerly called “mental retardation”), are not provided with the treatment they need.
The focus on therapeutic diversion units in reports to the Joint Legislative Oversight Committee on Justice and Public Safety, self-described “advocates” for inmates, the public, and the news media has diverted attention from the full extent of the scandal of “mental health reform,” which will outrage every one of your constituents when the details are revealed. In simple terms, those who lean toward the political left will be outraged to learn that the state of mental health treatment has declined as “reform” is ballyhooed. Those who lean toward the political right will be outraged to learn how mental health “reform” enables the gangs who have taken over some prisons to operate without fear of consequences. And every voter will be outraged when they learn that the $12 million allocated for mental health reform has not been spent as promised, yet the prisons and advocates are demanding more money from the taxpayers.
I have waited until retirement to make this report because it is not possible for a current employee of a North Carolina prison to report a problem without facing severe retaliation. In fact, this was my experience after I contacted the late Rep. Paul Luebke three years ago today to report that the public was threatened by the breakdown in security at Polk Correctional Institution, including the smuggling of cell phones, which just two months later resulted in the kidnapping of the father of a Wake County assistant district attorney. Seven months later the since discredited and disbanded “Office of Professional Standards” (see Youron vs. NC DPS, attached) was enlisted in an unsuccessful attempt to terminate me. Since then, psychologists have been admonished not to report any problems via email, have been “shushed” in person and told they cannot report serious problems, and been made scapegoats for the egregious actions of psychiatrists.
Hence, although I am taking advantage of my newfound freedom to make this report to you, I must notify you that it is not a full report because I have to protect my sources, all of whom are terrified that when the reality of “mental health reform” is revealed they may be selected for retaliation. As they say in prison, “snitches get stitches.”
This report will address the following:
- The September 15, 2016 “Behavioral Health Update” to the Joint Legislative Oversight Committee on Justice and Public Safety (posted on the Committee web site; see attachment).
- “Reforms” and inaction not reported to the Joint Legislative Oversight Committee on Justice and Public Safety, including the misguided “Suicide Prevention Program” implemented September 1, 2016 and the failure to operate the $150 million hospital at Central Prison as a hospital, emergency room, or even an urgent care center.
- Recommendations to the Joint Legislative Oversight Committee on Justice and Public Safety and other members of the North Carolina legislature.
Behavioral Health Update of September 15, 2016
The Behavioral Health Update of September 15, 2016 begins with the presentation of data indicating that the percentage of inmates “receiving Behavioral Health Services” increased from 9.8% in 2008 to 15.15% (5,499 of 36,297) in 2016.
A bar graph shows that as of September 6, 2016, 4,389 inmates were classified as “M3,” meaning only that psychiatric medications were prescribed for them (they keep the classification even if they refuse to take the medication), and another 832 inmates were classified as “M2,” meaning only that psychiatric medications were not prescribed for them but they are “on the mental health caseload,” which does not mean they are participating in therapy or even talking to a therapist. For example, an inmate suffering from schizophrenia who refuses to either take prescribed medication or speak with a psychologist may be classified as “M2” to give the impression that he is being “followed” by behavioral health staff members. Once, when an “M2” inmate refused to speak with a social worker, this note was entered into the medical record: “I did observe that the inmate was breathing.” That’s not treatment, but to those concerned only with the number of inmates designated as M3 or M2, it counts as treatment.
The bar graph reveals the emphasis on increasing the number of inmates who are provided with prescriptions for psychiatric medications. The percentage of inmates “receiving Behavioral Health services” who are provided with prescriptions for psychiatric medications has increased from 61% (2,182 of 3, 549) in 2008 to 84% (4,389 of 5,221) as of September 6, 2016. At the same time, the number of inmates provided with valuable non-drug treatments provided by psychologists and social workers has decreased from 1,499 in 2010 to 832 by September 6, 2016. The percentage of Behavioral Health patients receiving non-drug treatments decreased from 39% in 2008 to 16% on September 6, 2016. Thus, the reported increase in the number of an percentage of inmates “receiving Behavioral Health services” reflects only an increase in the number of inmates who have prescriptions for psychiatric medications (“M3” inmates). The number of inmates receiving non-drug treatments (“M2” inmates) has decreased drastically.
Of course, the fact that more inmates are receiving prescriptions for psychiatric medications does not mean that either (a) those inmates most in need of treatment are receiving it or (b) those receiving treatment are receiving appropriate treatment, or even need treatment.
It is impossible to conceive of another area of medicine where the number of patients receiving a type of treatment would be construed as a measure of success without regard for whether patients receiving that treatment actually needed it or whether all of those who needed that treatment were receiving it. Indeed, this is a hallmark of fraud, as in the recent case of a Palm Beach dermatologist who falsely diagnosed skin cancers in hundreds of patients and subjected them to unnecessary and very profitable treatments. (See http://www.palmbeachpost.com/news/crime--law/palm-beach-doctor-agrees-pay-18m-settle-medicare-suit/i9UkrbaaP9Bbz2h261yA3K/ .)
Although the authors of the Behavioral Health Update attributed the increased percentage of inmates “receiving Behavioral Health Services” to “enhancing awareness and improved screening,” that attribution is subterfuge employed to cover up the facts that there have been no improvements in awareness or screening, and the increase is actually the result of corrupted diagnosing.
W. David Guice, Commissioner of Adult Correction and Juvenile Justice, told WRAL on August 23, 2015 that getting an extra $12 million for mental health treatment would enable the prisons to more accurately identify mental illness in inmates entering the prisons. By February 10, 2016 the prisons had received that money, and Guice told the U.S. Senate Judiciary Committee that “The North Carolina correctional system identifies the physical health, mental health, educational level and criminogenic needs of inmates to determine suitable housing assignments…. placement is based on the results of an extensive screening process. Those inmates in need of acute mental health services will begin receiving treatment services immediately, while still in-processing, and, once stabilized, will be transferred to a facility with the appropriate clinical and nursing staff to address their mental health issues.” (See attached record of Guice’s testimony.)
Polk Correctional Institution in Butner, where I was a staff psychologist for 17 years, is what has been variously called a processing or intake center. It is the point of entry into the North Carolina prison system for hundreds of inmates each month. Therefore I can attest to the following facts:
- There have been no improvements in the screening process since the addition of one question in 2014.
- The screening process is not extensive; it is substandard.
- Inmates in need of acute mental health services do not begin receiving treatment services immediately.
- Once stabilized, inmates are rarely transferred to a facility with the appropriate clinical and nursing staff to address their mental health issues.
Screening Process and Awareness
The major flaws in the screening process are that it relies on an inmate’s self-report and that licensed mental health professionals are not involved.
On the day an inmate is admitted to Polk CI a member of the Nursing staff asks him a series of yes-or-no questions about his mental health history and current status. Nurses have the opportunity to record any pertinent observations about the inmate’s behavior and mental status, but rarely do so. Few members of the Nursing staff have any training in identifying the symptoms of mental illness. The same is true for the screening done within a few days of admission by a member of the Diagnostic staff, who asks each inmate a series of 14 questions called the Mental Health Screening Inventory.
By the way, the only change to the “extensive” screening process in the last 10 years was the addition of the question, “Have you ever heard things other people don’t seem to hear or seen things that other people said weren’t there?” to the Mental Health Screening Inventory in October 2014.
This is entirely inadequate and sub-standard. Not surprisingly, many inmates with a serious mental illness—perhaps most inmates with a serious mental illness—slip past this “screening” by simply denying that they have any current or past mental health problems or are receiving or have received treatment. The sickest inmates often lack insight into the extent of their illness and, if their delusions or hallucinations are real to them, do not report these symptoms.
Every newly admitted inmate should be interviewed and observed by a psychologist or other licensed mental health professional. This is the standard at the Federal Correctional Institution in Butner, where Gary Junker, director of behavioral health for North Carolina prisons, was once the director of mental health. A professional is needed to detect symptoms of the most serious mental illness, schizophrenia, particularly the “negative” symptoms, which include the absence of emotional expression (“flat affect”) and a lack of energy and motivation (“avolition”), and the most prominent signs of emerging schizophrenia, confusion and suspiciousness. It takes a mental health professional to distinguish between the natural, expected reactions to being admitted to a prison and pathological confusion, suspiciousness, and sadness. Likewise, it takes a professional to distinguish between the grandiosity of a psychopath and the grandiosity of a man in a manic phase of bipolar disorder. A series of yes-and-no questions is no substitute for a screening done by a psychologist or other licensed mental health professional.
Recognizing this, in September of 2014 I began to interview every inmate who got off the bus at Polk CI on Wednesday and Friday nights, when at least 90% of inmates are admitted. I continued this until the end of October 2014, when the head of the Diagnostics department in Raleigh informed me that prison policy forbade a psychologist from asking the questions on the Mental Health Screening Inventory, a policy that remains in effect. So, while Commissioner Guice boasted to United States senators of an “extensive screening process,” the truth is that psychologists are not allowed to speak with newly admitted inmates until they have been “screened,” using substandard measures that rely on an inmate’s self-report, by employees who are not licensed mental health professionals, which results in inmates with severe mental illnesses being overlooked.
Fortunately, during my 17 years at Polk CI the uniformed “custody” staff—corrections officers, sergeants, lieutenants, and captains—were astute detectors and reliable reporters of symptoms of severe mental illness displayed by inmates. While the authors of the Behavioral Health Update of September 15, 2016 claimed credit for “enhancing awareness” of mental illness among staff members, this appears to be merely an attempt to justify the time and money spent on Crisis Intervention Team (CIT) training, a largely irrelevant three-day program bereft of practical advice for custody staff members, in which a few tricks that appeared to calm down angry inmates are repeated. (See attached “On the Scene,” which reports on giving an inmate stickers and singing a gospel song with an inmate.) DPS also has a need to justify paying outsiders to provide training in “Mental Health First Aid,” the H.O.P.E. program, and others, all selected without any input from people who work inside North Carolina prisons.
Acute Mental Health Services and Transfers to Treatment Units
Guice’s claim to the U.S. Senate Judiciary Committee that inmates who are admitted with an acute mental health problem “begin receiving treatment services immediately” is a falsehood. Polk CI and other so-called “processing centers” are not hospitals. No psychiatrist ever visits Polk CI; there is a “psychiatry clinic,” usually weekly, but that consists of “tele-psychiatry,” with the inmate speaking to the “doctor on the television” over an Internet linkup. The limited view of an inmate leads to the psychiatrist overlooking prominent symptoms, including the smell of a schizophrenic inmate who would not bathe. Also, there are limitations on the minimum and maximum number of patients the tele-psychiatrist at Polk CI is willing to see weekly. If there are too few, the tele-psychiatrist cancels the “clinic” because “It’s not worth my time,” no matter how acute the treatment needs of the patients scheduled to be seen at that clinic. If there are too many, the tele-psychiatist will not see all of those on the schedule, regardless of the need.
Guice also told the U.S. Senate Judiciary Committee that “once stabilized” an inmate “will be transferred to a facility with the appropriate clinical and nursing staff to address their mental health issues.” I wish it were so. In my experience, even when a newly admitted inmate (or safe keeper) was in grave danger of suicide or self-mutilation, there was no guarantee that the hospital at Central Prison would allow him to be transferred there, even in cases where an inmate had actually attempted suicide by hanging, or was actively cutting himself.
This is due in part to the failure of those admitting inmates to the Mental Health unit at the Central Prison Healthcare Complex to prioritize cases, in violation of the North Carolina Administrative Code (10A NCAC 26d .0804, WAITING LISTS). A psychiatrist there recently admitted that they still admit cases on a “first-come, first-served” basis.
The increase in the percentage of inmates “receiving Behavioral Health Services” is not the result of “enhancing awareness and improved screening,” it is actually the result of corrupted diagnosing, which began with the imposition of a de facto medication prescribing quota and was enforced with a prohibition on psychologists reporting that an inmate had no mental illness or was faking a mental illness for some tangible gain (e.g., prescription drugs to sell for his gang).
In 2012 consultants Jeffrey Metzner and Dean Aufderhiede pointed out that the percentage of inmates in North Carolina prisons receiving psychiatric medications, 9%, was about half of the average for prisons around the USA, 18%, and while well within the range of other states, was “at the low end.” The consultants admitted that they had not examined a single inmate, and could not point to a single case of an undiagnosed mental illness; they simply suggested that the 9% figure might indicate that mental illness was under-diagnosed in North Carolina prisons. The consultants did not consider the we were at the “low end” because our diagnosing was not corrupted and because we did not believe that the scandalous overprescribing drugs to minority and poor children became less scandalous once those kids became, at age 16, old enough to be sent to prison.
De Facto Medication Prescribing Quota
However, after the 2014 dehydration death of inmate Michael Kerr at Alexander Correctional Institution brought increased scrutiny of prison mental health and the dismissal of then-director John Carbone, the 18% figure was adopted as a de facto quota, and as the increased percentage of inmates receiving psychiatric medications was promoted as the primary measure of improved mental health care for inmates, as you see in the Behavioral Health Update of September 15, 2016.
Evidence of the corrupting influence of a de facto medication quota can be found throughout the medical records in cases where medication is prescribed to inmates who are faking a mental illness and to those who do not even claim to suffer from a mental disorder but merely demand medication. It is also evident in the ruses psychiatrists use to justify prescribing medication.
For example, an inmate was admitted to Polk from a county jail, where he was receiving an anti-depressant that is commonly used and abused by inmates who want to sleep away their sentence. I did a thorough mental health evaluation and concluded there was not a shred of evidence that the inmate ever was depressed. The psychiatrist, however, prescribed that medication, offering this nonsensical written justification: “This medication has been effective for his depression, if he ever had depression.” IF HE EVER HAD DEPRESSION! I told my personal physician, who was appalled by this story, that she could write the same about the 81 milligram aspirin pills she told me to take and my nonexistent brain tumors: “Aspirin has been effective for his brain tumors, if he ever had brain tumors.”
I watched on numerous occasions as the tele-psychiatrist at Polk CI shaped an inmate’s complaints, even ludicrous complaints, to allow him to prescribe that same anti-depressant for sleep, although prescribing medication only to help an inmate sleep is contrary to policy. One inmate seeking that anti-depressant made the absurd complaint that, “I wake up six times a night and I can’t go back to sleep!” (Of course, if the problem is that you wake up and can’t go back to sleep, that can only happen one time each night, not six times.) The tele-psychiatrist informed the inmate that he could not prescribe that medication for sleep but said, “You might be depressed” before asking a series of questions that made the path to that medication, prescribed for “depression,” very clear to the inmate.
When a psychiatrist is unable to get an inmate’s complaints to conform to a standard diagnosis, they sometimes just make up a diagnosis. The N.C. Administrative Code requires that a psychiatric diagnosis be made in the terms of, and in accordance with the diagnostic criteria in the latest version of the Diagnostic and Statistical Manual of the American Psychiatric Association (the latest version is DSM-5). Often a diagnosis is given that cannot be found in DSM-5 or its predecessors.
Even when a DSM-5 diagnosis is given, it is often based upon an inmate’s description of a single symptom. Thus, an inmate who claims, “I’m hearing voices” will almost always receive a diagnosis of schizophrenia or “schizophrenia spectrum disorder,” even though other symptoms needed to make that diagnosis are not described.
Diagnosis of Malingering Prohibited
For prison inmates there are numerous advantages to being “on the mental health caseload.” Thus it is common for inmates who are not mentally ill to attempt to fake symptoms of a mental illness so that they can: obtain drugs to abuse or sell; compel the personal attention of a woman psychologist; spend time in a community hospital, where they are treated as a patient rather than as an inmate; or avoid the penalty for crimes committed while incarcerated. It should not be surprising that studies have determined that in forensic settings 18% of encounters with mental health professionals involve malingering, the fabrication or exaggeration of symptoms in an attempt to obtain a tangible benefit such as those listed above.
Identifying malingering and making the appropriate DSM-5 diagnosis (V65.2) is crucial with prison inmates. To fail to do so rewards the inmate for being deceptive, which is certainly not therapeutic, it subjects that inmate to the potentially destructive side effects of the medication that will be prescribed to “treat” his contrived symptoms, and it diverts time from the essential functions of mental health professionals inside prisons, identifying and treating inmates with an actual mental illness.
Nevertheless, in March 2015, my colleagues and I were forbidden from making a diagnosis of malingering under any circumstances. That prohibition was issued after I interfered with a corrupt community psychiatrist’s attempt to make a profit by acting as a forensic “expert” in the case of a Polk CI inmate charged with murder. The corrupt psychiatrist claimed he had treated the murder defendant in the community, but having obtained the medical records from his practice, I had written in my notes that he had never spoken with the defendant. My notes included overwhelming evidence that the defendant, who asked each time he saw me, “Can you tell the judge I’m mental so he’ll drop my charges?” was malingering, which was the diagnosis made by three prison psychiatrists. The prohibition against psychologists at Polk CI saying or writing that an inmate was malingering was never rescinded.
The diagnosis of malingering is not made without overwhelming evidence that an inmate is faking a mental illness in an attempt to obtain some tangible, identifiable benefit. When an inmate’s complaints, stories, and demands made me suspicious that an inmate was attempting to fake a mental illness I employed a variety of tests specifically designed to detect malingering. I also reviewed treatment records from the community and other available information, including interviews with family members and even the inmate’s public Facebook page. In every case where an inmate wanted medication, even when my in-depth assessment indicated he was malingering, I scheduled an appointment with the tele-psychiatrist.
Two examples of malingering show how indulging inmates who are faking a mental illness can hurt the inmate and subject staff members to terrible harassment.
I met the inmate I’ll call “Strawberry Cheesecake” when I was notified he was pounding his head against a concrete floor. I assisted the custody staff, kneeling down and holding the inmate’s head off the floor, before transferring him to the hospital at Central Prison.
While there, he told psychiatrists and psychologists that he had “flipped out” because he has PTSD and experienced “flashbacks” of his two-year-old son being shot in the head right in front of him. When he was returned to Polk CI he repeated that story for me, claiming they were walking back from the store, where they both got “strawberry cheesecake” ice cream—a trivial detail included in an attempt to add credibility to his story—when they were caught in a shootout between two Charlotte gangs. He said he son was shot through the head and died immediately, right in front of him.
When I checked with a detective from the Charlotte-Mecklenburg Police Department homicide unit, she told me no such crime had occurred. Upon hearing this, “Strawberry Cheesecake” offered a ridiculous defense of his tall tale: “I can’t believe they didn’t write it down!”
The truth was that “Strawberry Cheesecake” suddenly developed “PTSD” and “flipped out” when he was about to appear before the Disciplinary Hearing Officer, where he faced time in restrictive housing for crimes committed behind bars. He escaped that punishment by beating his head on the floor, which made that potentially fatal action more likely to occur the next time he needed to avoid the consequences of his illegal actions. He was also exposed to potentially disastrous side effects from the anti-psychotic drugs prescribed to treat his “PTSD.”
The inmate I’ll call “Eleven and a Half Inches” claimed he had a mental illness that could be treated only by a particular woman psychologist, to whom he wrote this letter:
Dear Ms. [Name deleted], Im writing you because I want you to know how I truly feel about you. In all the years I’ve existed I’ve never ever come across anyone as Beautiful and Elegant as yourself! You are thee most Gorgeous, Flawless, Sensual woman I have ever encountered. I love everything about you, Everything from your hair to your beautiful face to the way you walk to your sexy and delicious supermodel body. I also love your fashion sense. Im a pretty big fashionista myself. I also admire that you’re a hard working independent Black woman. I would love to know all about you, where your from, where you live, how you grew up, what you like to do, etc. Ms. [Name deleted] I want to know all about you. If you gave me a chance I would make it worth your while. I’ll give you roses, rub your feet, massage your body with warm oil, cook for you, clean for you, devour your pussy and anal hole, long stroke your kitty with my 11 ½ inches, etc. Baby I’ll even read you bedtime stories if you like. Every since I laid eyes on you you’ve tugged at my heartstrings. I want you, I need you, I desire you. I go home in 3 weeks and I figured I’d give it a shot at true love. I promise you’ll like me a lot more if you just told yourself “What the heck [Name deleted], go for it.” I will be your slave [he drew a smiley face icon here]. Im a mature young man who’s quite handsome and full of life, love & energy. Everything you like I love. I’ll surprise you with spontaneous things almost daily. Roses & rose petals, massages, toe curling sex, unlimited love & attention. I can be your knight in shining armor. I can envision us going out to classy upscale restaurants & jazz clubs, if that’s what you like baby. I hope you send me your information so I can get to know you outside of these walls. Im not a thug, I don’t sell drugs, I don’t use guns, Ms. [Name deleted] Im not what you think. Only reason im at Polk is because I’ve made a bad decision as a juvenile. I have nothing violent on my record. Im a lover, I want to give you all of me. I don’t know if you like music but when you get a chance look up this song “All Of Me” by “John Legend.” That’s how I feel about you my dear. I really want you. I need you. I promise you all the love I can conjure. I want to explore your body with my tounge, your whole body. Anyways, I just wanted to pour out my heart to you. I really hope you understand. Pleaseee give me a shot. Don’t think im a weirdo either. If loving you is wrong then I don’t want to be right.
[Signed] “Eleven and a Half Inches”
P.S. You look amazing in GREEN!
When I saw “Eleven and a Half Inches” he said he had no mental health problems and he was subsequently released from prison a week later. But when he was re-admitted three months later he again claimed he had a mental problem that only the target of his sexual harassment could treat. So I saw him again and administered a full battery of tests, all of which indicated he was malingering (which was obvious even without the tests). When I told “Eleven and a Half Inches” that he would not be allowed to speak with the woman he was harassing, he denied that he had any actual mental health problems.
That was a close call. One week later my colleagues and I were forbidden from saying that “Eleven and a Half Inches” or any other inmate was malingering. We were ordered to indulge them, to treat them as if they actually had a mental illness, and to endure any harassment.
In December 2015 some psychologists and psychiatrists were given permission to use the malingering diagnosis when appropriate, but this permission was never given to the psychologists at Polk CI. Even after others were given permission to report that an inmate was faking a mental illness, in the following year I saw no evidence that they were doing so. The pressure to increase the number of “M3” and “M2” inmates was simply too great.
Practically and ethically the biggest problem with the de facto medication quota is that it can be met by handing out pills to inmates who don’t need them, and would be harmed by those pills, while ignoring the treatment of inmates who need those pills. And this is exactly what has happened in North Carolina’s prisons, as administrators and “advocates” celebrate the rise in the percentage of inmates classified as “M3.”
Adequate Treatment Not Provided to Inmates in Greatest Need
Last year Polk CI housed an inmate with severe schizophrenia, just a few feet from the “therapeutic diversion unit,” who was twice released and re-admitted during the year of supposed “mental health reform.” The “treatment” of the inmate I’ll call “Les Malodorous” was shameful.
“Les” was admitted to prison and processed at Polk CI in March 2015. I made a diagnosis of schizophrenia and the former psychiatrist concurred and prescribed antipsychotic medication. After he completed processing at Polk CI he was transferred to Johnston CI where there is no psychiatrist available. In June 2015 he was apparently asymptomatic and convinced a nurse practitioner he did not need antipsychotic medication, so it was discontinued, as was mental health treatment. It is common for persons suffering from schizophrenia to lack insight into their condition and understanding of the need to continue to take antipsychotic medication.
He deteriorated rapidly and by the end of August 2015 he was seen by a psychologist at the request of corrections officers who could not stomach the smell of the inmate, who refused to shower, which is not uncommon among those with severe schizophrenia. That psychologist concluded that the inmate was just a thug and wrote that he was “just trying to piss off other inmates and staff” members.
“Les” was returned to Polk CI but refused to go to the “studio” to speak with the “tele-psychiatrist” (who replaced the last competent psychiatrist we had). Not being on-site, the “tele-psychiatrist” could not go to his cell to speak with the inmate or SMELL him. By the way, this was exactly what happened to the late Michael Kerr at Alexander CI; he refused to leave his cell and, having only a tele-psychiatrist available, he was not examined by a psychiatrist in his dying days. I was not able to transfer this inmate to the hospital at Central Prison until December 10, and there he was immediately put in isolation because he “refused” to answer the psychiatrist’s questions. He was not seen again by a psychiatrist for another 21 days.
The inmate made no progress in the hospital at Central Prison but was returned to Polk CI with a psychiatrist’s note that he was “less malodorous than when he was admitted” to the hospital. “Les” was “less malodorous” not because his symptoms had subsided, but only because forced showers, not permitted at Polk CI or elsewhere in “the field,” were used at CP. Forced showers do not constitute “mental health treatment,” or “mental health reform.”
I had to transfer “Les” back to the hospital at CP for a second time shortly after his return to Polk CI. During his second stay at CP forced medication—injectable antipsychotic medication—was used in addition to forced showers. Forced medication is also prohibited in “the field,” so when he returned to Polk CI antipsychotic pills were prescribed. He refused to take those pills and his condition deteriorated so I had to send him back to CP two weeks before his release from prison. Apparently not wanting to do the paperwork to have this severely ill inmate involuntarily committed, the psychiatrist at CP changed the diagnosis from schizophrenia to “depression” and sent him back to Polk CI five days before his release. I could not pursue involuntary commitment because his diagnosis had been changed to mere “depression” with no mention of psychotic symptoms. When “Les” was released from Polk CI for the first time I actually walked him to the transportation department where he would board a vehicle to take him to a bus station. Along the way it was clear he did not know where he was or where he was going.
“Les” was re-admitted to Polk CI, released, and re-admitted for a second time in 2016. After each release his probation officer asked a judge to send him back to prison on technical probation violations because “Les” could not function on the outside, even for a day. Indeed, after “Les’” second release his probation officer, going way beyond the call of duty, arranged for him to stay in a hotel beside the probation office so that transportation would not be an issue and he could check on “Les” daily. But “Les” could not function for even one night outside prison, and he was thus re-admitted to Polk CI for the second time.
Prior to retiring on December 1, 2016, one of my final initiatives was to observe the tele-psychiatrist for Polk CI conduct his “clinic,” so I was present when “Les” appeared “in studio” after his second re-admission. “Les” denied any symptoms, as always, and the “tele-psychiatrist” concluded, “So you’re doing pretty good,” a statement with which “Les” naturally agreed. When “Les” left the “studio” I implored the tele-psychiatrist to review the extensive, detailed mental health record of “Les,” and to understand that, never having entered Polk CI or any other prison, he had not observed “Les” staring at the wall or talking to himself and, being in Raleigh, he could not smell “Les.” The “tele-psychiatrist” dismissed my concerns with, “He’s a low IQ guy.” In fact, “Les” had an average IQ and the tele-psychiatrist, acting like a “low IQ guy,” made the same mistake that those faking a mental illness make, confusing symptoms of schizophrenia with signs of an intellectual disability.
Twice I was told by someone in Behavioral Health administration to “Stop making a big deal of it.” But the mistreatment of “Les” IS a big deal—just one of hundreds of big deals that are being obscured.
There is an inexplicable perversity in the determination of which inmates do and do not receive treatment. For example, last year an inmate in HCON—North Carolina’s “supermax” facility—was observed talking to himself and pulling out clumps of hair. He was obviously psychotic, yet when the HCON psychologist attempted to transfer him to the hospital at Central Prison he was shocked to find that his request denied. More shocking, at a time when Junker, the director of behavioral health, was emptying HCON (which now has only 25 inmates), the regional behavioral health assistant director was assigned to prevent the inmate’s transfer out of HCON.
The assistant director first ordered the HCON psychologist to do a full evaluation of the inmate, something that was unprecedented in the case of an inmate having a psychotic breakdown. When that evaluation was completed the assistant director ordered another psychologist at Polk CI (where HCON is located) to do another full evaluation of the inmate. As that evaluation was being completed the assistant director made a surprise visit to Polk CI to do her own evaluation of the inmate, and made an appearance at Polk’s multi-disciplinary meeting, where psychologists, custody staff members, and administrators provided abundant evidence that the inmate was psychotic. When the HCON unit manager reported hearing the inmate talking to himself, the assistant director suggested the inmate was malingering in an attempt to be transferred out of HCON, saying, “I’m sure he could hear you coming down the hall. He’s young. When I was young I had hearing like a bat.” The inmate was young—at the age when schizophrenia is most likely to emerge. The inmate suffered with symptoms of severe schizophrenia for months before he was finally moved out of the state’s highest security, most restrictive unit.
Medication Side Effects
Amidst the celebrations over the increase in inmates with an M3 classification and progress toward the quota, I have seen no mention of the concomitant increase in medication side effects, which are often devastating, and especially outrageous in cases where an inmate neither wants nor needs medication. I shall not provide a full list of potential side effects, which I assume members of the Joint Oversight Committee are somewhat familiar with. Here I’ll just say that it is distressing to inmates when they develop gynecomastia, or experience such a dramatic rise in prolactin levels that milk begins to seep from their (male) nipples, or gain 50 pounds in three months, or are unable to stay awake or engage in a conversation when their families visit.
Moreover, I have seen no regard for the requirement, stated in the North Carolina Administrative Code, that patient education regarding their medications, including potential side effects, is mandatory (1105). We did not see the “tele-psychiatrist” at Polk CI inform any inmates of the potential side effects of their medication. In fact, according to an email distributed on January 3, 2017, this task has been delegated to office staff (e.g., secretaries).
Decrease in Offenders in Restrictive Housing
The Behavioral Health Update of September 15, 2016 presents data showing the number of “Offenders in Restrictive Housing” has declined. You must understand that this is also partly the result of the corruption of diagnosis within the prisons.
According to a 2016 policy change, if an inmate is classified as “M2” or “M3” he cannot spend more than 30 out of 365 days in restrictive housing, no matter how serious his offense. Perhaps you have already figured out what the most dangerous inmates have figured out: if a diagnosis of “mental illness” (and medicine to enjoy or sell) is available for the asking, when they are caught assaulting another inmate or a staff member, smuggling drugs, or committing another crime inside prison, all they have to do is say something like, “I’m hearing voices” and after 30 days they will be free to resume assaulting others, selling drugs, and generally enjoying themselves for the next 365 days without consequence.
At some prisons the staff members no longer bother to write up an inmate even when he commits a serious infraction because it is a waste of their time, and risks making another potentially deadly enemy.
You should be aware that the 30-day “reform” facilitates organized crime in the form of the gang activity and staff corruption that has been, according to news reports, under investigation by the FBI and DEA.
The 30-day limit is arbitrary, and seems a tacit admission that many “M3” inmates are malingering. For inmates with severe schizophrenia that I discussed earlier, one day in “solitary confinement” is too much. On the other hand, the Vera Institute, which advocates safe alternatives to segregation, recognizes that under some conditions it is necessary to separate a dangerous inmate from potential victims, even if that separation exceeds 30 days or another arbitrary limit.
Therapeutic Diversion Units
An optimistic picture of the therapeutic diversion units is presented in the September 15, 2016 Behavioral Health Update. That is a deceit.
First and foremost, therapeutic diversion units are NOT treating the inmates that the legislature provided an extra $12 million to treat.
Gary Junker, director of behavioral health, specified in his “Therapeutic Diversion Unit Operational Manual” which offenders with mental illness would be the first admitted to TDUs.
During initial program implementation, the target mentally ill population will be those with a serious and persistent mental illness (such as Schizophrenia, Bipolar Disorder with psychotic features or severe manic episodes, or Major Depressive Disorder, Severe) in which they primarily receive infractions due to their mental illness rather than other factors, such as antisocial character traits.”
Junker specified further in his Manual:
Screening will be conducted in a stepwise fashion beginning with mentally ill offenders who are within one year of release.
Likewise, Junker told WRAL on March 12, 2016 that the new therapeutic diversion units “will focus first on the almost 70 mentally ill inmates currently in solitary confinement who are due for release within the year.”
According to Junker’s Manual:
The second level of screening will include mentally ill offenders who have resided in restrictive housing for greater than one year.
Some inmates pose a severe threat to other inmates, especially those with a serious and persistent mental illness who, according to the plan, would occupy the therapeutic diversion units, and some will not cooperate with treatment efforts. Junker’s Manual recognizes this implicitly.
Exclusion criteria to be considered will include history of assaultive behavior, severity of infraction resulting in current sanction, number of infractions over the past 12 months unrelated to a mental illness, history of sexually aggressive behavior, history of subverting or hoarding medication or other significant factors as determined by the screening panel.
Indeed, in two presentations at Polk Correctional Institution prior to the opening of a therapeutic diversion unit there, Junker repeatedly emphasized, “Safety first.”
TDU Referral List
Those were the promises. The reality can be seen in the TDU Referral List, which is confidential because it includes the names of inmates deemed to need mental health treatment in a therapeutic diversion unit. However, I can tell you that a psychologist (at another prison) broke down that list according to Junker’s admission criteria, revealing that relatively few—about one quarter—have a diagnosis of a serious and persistent mental illness, the primary admission criterion.
Before I retired I saw that of the first 22 inmates assigned to the TDU at Polk CI only one or two qualified according to the inclusion and exclusion criteria Junker specified.
Of the first “cohort” of six inmates admitted on September 12, 2016, when there was presumably an abundance of candidates who met the criteria, none qualified.
To begin with, although Junker’s Manual specified that the first inmates to be admitted to a TDU were those with a “serious and persistent mental illness,” two of the first six inmates assigned to the Polk TDU were not even taking psychiatric medication. Attempts to schedule an appointment with a psychiatrist who could prescribe such medication were delayed because the “half-time staff psychiatrist” that Junker promised would be available to each TDU never materialized.
While Junker said that the TDUs “will focus first on the almost 70 mentally ill inmates currently in solitary confinement who are due for release within the year,” of the first six inmates assigned to the Polk TDU, when there were fewer than 30 inmates in TDUs statewide, only two were scheduled for release within the next year; the release dates of the other four were 2018, 2020, 2028, and 2039.
Junker’s “second level of screening” was to include “mentally ill offenders who have resided in restrictive housing for greater than one year.” Of the two inmates scheduled for release within a year, neither had been in restrictive housing for close to a year. In fact, one had just been placed in restrictive housing just six days before he was transferred to the TDU, although when he was first admitted to prison he spent two months in restrictive housing for refusing to leave restrictive housing.
Exclusion Criteria Ignored
Because inmates have been assigned to TDUs without regard to the exclusion criteria in Junker’s Manual, a substantial portion have had to be dismissed before program completion. This is surprising only to those who do not understand the implications of assigning inmates who do NOT, in Junker’s terms, “primarily receive infractions due to their mental illness rather than other factors, such as antisocial character traits.” For example, dangerous gang members who have committed violence in prison when ordered to do so by their superiors, have been assigned to TDUs and populate the waiting list. Their violence is unpredictable and often seems “crazy” to people who have no clue as to the reality of prison. They commit violence not when they are “hallucinating” or “angry,” but when their gang master orders them to commit violence. Gang violence cannot be treated in a “therapeutic unit,” especially one in which there are vulnerable inmates who actually suffer from a serious and persistent mental illness upon which gang members may prey. The gang “program” uses far more effective consequences than the TDU or any other “therapeutic” program. When a gang member disobeys he may be stabbed, beaten into a coma, or otherwise savaged. There is no psychiatric “medication” powerful enough to overcome these consequences. (Nor, by the way, is there any psychiatric “medication” approved for the “treatment” of violence. In fact, tests of these medications exclude subjects with a history of violence or substance abuse—which describes most inmates.)
Number of Inmates Assigned to TDUs
Prison administrators did not come close to fulfilling their diminishing promises regarding the number of inmates who would be treated in TDUs during 2016.
On February 11, 2016 Junker told members of the Joint Oversight Committee that therapeutic diversion units would be “launching at Maury and Central Prison toward the end of the first quarter.” In fact, the Maury TDU was opened on July 1, 2016, the beginning of the third quarter, and the Central Prison TDU on June 1, 2016, two months later than promised. Junker also promised members of the Joint Oversight Committee, “In the second quarter we’ll be launching the programs at the Polk Correctional Institution and at the women’s facility.” In fact, the Polk CI TDU was opened at the end of the third quarter, on September 12, 2016 and NCCIW TDU was also opened in the third quarter, on August 14, 2016.
A month after making those promises to the Joint Oversight Committee Junker had changed his deadlines until December 31, 2016. He told WRAL (on March 12, 2016) that with the $12 million provided by the NC legislature “by the end of 2016 four therapeutic diversion units would be open, with space for 130 inmates, and that by the end of 2017 four more therapeutic diversion units will open, creating places for 100 more inmates.” Indeed he was so confident he told WRAL, "Quite frankly, within two to three years, we're going to see a dramatic reduction of mentally ill inmates in restrictive housing. We hope to work ourselves out of business and turn TDUs into a therapeutic environment."
By September 15, 2016 he had lowered his goal to having 75% of TDU slots filled by the end of the year. The Behavioral Health Update boasts, in red font, that 25% of TDU slots were filled, but that was accomplished only by opening the TDU at Polk CI three days earlier, before the paint on the walls was dry. In fact, on December 31, 2016 only 82 inmates were housed in TDUs, filling just 63% of the openings—and many of those inmates were crammed into TDUs in the last half of December 2016, without regard for Junker’s admission and exclusion criteria.
Promises Without Facts
Junker made promises without regard to the reality of the prisons. For example, during Junker’s testimony before the Joint Oversight Committee on February 11, 2016, the chairwoman, upon hearing that Polk CI in Butner was selected as a TDU location, said, “They have a lot of trouble getting people to work there. So why did they choose that location?” Junker answered that ”It’s for the younger inmates” at Polk, which holds inmates up to age 25.
Yet it was not until June 2016 that Junker asked one of his four regional assistant directors to find out how many “M3” inmates (meaning only that psychiatric medication had been prescribed) were in long-term restrictive housing at Polk CI. I informed him, through his “translator,” that the answer was zero, and that the number had never been more than two—hardly a justification for locating a TDU at Polk CI.
Likewise, although in October 2015 Junker told psychologists and administrators at Polk CI of his plan to use “modified housing” as a “step-down unit” for inmates who completed the TDU program, it was not until a year later that he asked, again through his regional assistant directors, which prisons actually had “modified housing,” as you can see in this email. It is noteworthy that when he finally got around to asking that question, he gave his subordinates only a few hours to provide him with answers.
From: Junker, Gary
Sent: Monday, October 24, 2016 8:26 AM
To: Monguillot, John; Yearick, Kenneth; Hahn, Patricia; Peiper, Lewis
Subject: Modified Housing
Please provide information about each facility in your region that offers modified housing. I need the facility name, total number of inmates currently in modified housing, the number that are M2-M5 and the amount of time out of cell offered on each unit. If possible, I need this information by today. thanks
Gary Junker, PhD, HSP-P
Director of Behavioral Health
NC Department of Public Safety
From: Hahn, Patricia
Sent: Monday, October 24, 2016 10:34 AM
Subject: Fw: Modified Housing
Please respond to me (not Dr. Junker -- he prefers for us to summarize) regarding the information below by 3:00. IF YOU DO NOT HAVE MODIFIED AT HOUSING AT YOUR FACILITIY/FACITLITIES PLEASE STILL RESPOND. Thank you! I am hoping it will not take too long, especially since most of you do not have it. --Tricia
Tricia Hahn, M.S.P.H., Ph.D., L.P.
Assistant Director, Behavioral Health, Triangle Region
North Carolina Department of Public Safety
TDUs Are More, Not Less, Restrictive
Inmates in therapeutic diversion units are not free from restrictive housing or extreme physical restrictions.
The keystone of the reforms intended to reduce the number of inmates with a psychiatric diagnosis in “solitary confinement” was the promised opening of eight “therapeutic diversion units,” the purpose of which was explained by Commissioner Guice in a July 8, 2016 Op-Ed appearing in the Raleigh News and Observer. Guice wrote, “Therapeutic Diversion Units for offenders with mental illness have been developed. These units, which will decrease the need for placement in secure housing, will use individually tailored treatment plans to assist offenders with coping and social skills development, emotional regulation and medication management.”
Indeed, on February 11, 2016 Gary Junker told members of the Joint Legislative Oversight Committee on Justice and Public Safety that the purpose of the TDUs was to avoid having inmates “in a locked or confined setting.”
Surely no member of the Joint Oversight Committee and none of Guice’s readers could imagine that, far from being out of a “locked or confined setting” or free from “secure housing,” inmates in the TDU at Polk CI are housed in the same cells that contained ICON (“intensive control”) and MCON (“maximum control”) inmates since Polk CI opened 20 years ago. Unlike other “restrictive housing” units around the state, the cells are walled off so that when inmates leave their cells they are confronted with a Lexan shield. Nor could members of the Joint Oversight Committee or Guice’s readers imagine that in December 2016 the TDU at North Carolina Correctional Institution for Women, which opened in a medical unit, was moved to a restrictive housing unit.
Moreover, these promises are absurd considering that in the initial stage of the TDU program inmates are secured to a steel table with shackles around their ankles while their hands are cuffed together in front of them.
No other inmates in North Carolina are subjected to these restrictions, which make them extremely vulnerable. At other prisons there have been cases of unrestrained inmates assaulting secured inmates, who had been rendered helpless to defend themselves. And in the TDU at Polk CI two inmates secured to a steel table fought one another, battering each other with their handcuffs and falling to the floor before corrections officers were able to stop the mayhem.
Violations of NC Administrative Code
The therapeutic diversion units are in blatant violation of the NC Administrative Code, especially:
Treatment areas must be separate from sleeping areas (0604). The TDU at Polk is in a "pod" with the treatment area directly below three tiers of cells. Among other problems, this arrangement provides no privacy for inmates. At NCCIW the TDU was moved from the medical are to a restrictive housing unit in December 2016, where there is no separate treatment area available.
Transfer to a treatment unit requires the informed compliance of the patient, and involuntary admissions require due process (1205, 1206, 1207). Junker has said that to fill TDU cells, inmates will be admitted involuntarily, without due process. Junker has designated treatment in a TDU as "outpatient" in an attempt to circumvent the informed consent and due process requirements. Remember that in the initial stages of Junker's TDU program inmates are handcuffed and shackled to steel tables. This is not an "outpatient" procedure. Nor do the limitations on the movement of TDU inmates, who are not allowed to leave the confines of the unit, meet the perverse "outpatient" designation within NC prisons.
Behavioral Health Update Omissions
“Suicide Prevention Procedure”
The most basic requirement of a suicide prevention plan is that inmates who are at enhanced risk for suicide be identified and appropriate interventions begun BEFORE the inmate attempts or completes a suicide. A plan that includes only reactions to self-injurious behavior, suicide attempts, or threats thereof is NOT a suicide prevention plan.
In 2012 consultants Jeffrey Metzner and Dean Aufderhiede noted that although the North Carolina prisons had a self-injurious behavior (SIB) policy prescribing reactions to SIB and threats of SIB or suicide, there was no specific plan to prevent suicides. Such a plan was promised in 2012 and again in October 2014. Junker did not deliver a nominal “suicide prevention program” until June 2016, and only after he was pressed by an investigative reporter for the Charlotte Observer, who was looking into the rash of suicides that occurred in April and May of 2016. Junker’s “program” did not go into effect until September 2016, 47 months after it had been promised and 12 months after Junker became the director of “behavioral health.” http://www.charlotteobserver.com/news/local/article81626502.html
Junker employed a ruse to attempt to cover up this delay. He wrote “SUPERCEDES DATE: January 15, 2015” at the top of his “Suicide Prevention Program,” just below “EFFECTIVE DATE: September 1, 2016.” This is clearly a duplicitous attempt by Junker to make it appear that there was a suicide prevention policy and program in place when he became the director of behavioral health on September 1, 2015 and to cover up the fact that it was not until a full year after that date that any such policy or program went into effect. However, he forgot to include the nonexistent suicide prevention plan of January 15, 2015 as the “current plan” on the DPS web site. [http://www.ncdps.gov/Adult-Corrections/Prisons/Policy-Procedure-Manual/Health-Care-Manual.]
Below is an excerpt from that web link. As you can see, there are links to both the old “Self Injurious Behavior” policy and the new “Self Injurious Behavior Intervention,” which also became effective on September 1. While there is a link to the “Suicide Prevention Program” that became effective on September 1 there is no link to the old suicide prevention program because, of course, there was no such program or policy prior to September 1, 2016.
Self Injurious Behavior (Current Policy)
Self Injurious Behavior Intervention (Effective 09/01/2016)
Suicide Prevention Program (Effective 09/01/2016)
Junker’s “Suicide Prevention Program” is no such thing. To begin with, it is still reactive rather than proactive. The screening procedures that supposedly would identify inmates at enhanced risk of suicide upon admission to a prison were, in fact, copied and pasted from existing policies describing the terribly inadequate existing screening procedures.
The existence of validated suicide prevention screening instruments, for example the Columbia Suicide Severity Rating Scale, which is efficiently used with large groups (the United States Marine Corps, for example), was overlooked. Instead, the only measure included in Junker’s “program,” the SAFE-T, was designated for use AFTER an inmate had already threatened or committed self-injurious behavior, or threatened or attempted suicide. And the SAFE-T does not have predictive validity, a “cut-off score” that indicates an enhanced likelihood of a suicide or attempt. It simply compiles a list of so-called “protective factors” and “risk factors,” which do not include risk factors specific to a prison.
By the way, completion of the SAFE-T in HERO (the acronym for electronic prison health and mental health records) entails another violation of the North Carolina Administrative Code, specifically the stipulation that entries in the mental health record can be altered only by the person who made the original entry (0703). The "Self-Injury Risk Assessment" (the designation for the SAFE-T in HERO) requires psychologists to respond to 46 separate questions. The first time I did this and hit the button to enter it into the inmate's mental health record, I was stunned to see that text, which was not visible on the form, had been inserted in such a way that it appeared to be my own words and my own interpretation of the results.
Junker’s “Suicide Prevention Program” stipulates that all prison staff members are required to complete online training. That training did not include a single risk factor for suicide or any other guidance to the frontline staff members who are most essential in preventing suicides. (This has been established by worldwide research.) The training did emphasize that Junker had done nothing more than copy and paste from existing policies, with a few quotes taken from the federal Bureau of Prisons suicide prevention policy; the training reiterated that all matters regarding staff training and program implementation were the responsibility of psychological program managers and prison superintendents. This includes such mundane matters as shopping for mattresses that met Junker’s demand that they be “tear resistant and plastic-covered.” Junker revealed at a meeting in May 2016 that he does not know where such mattresses can be purchased.
It is bewildering to me that Junker, who was the director of mental health at the federal prison in Butner, did not simply adopt the suicide prevention plan of the Federal Bureau of Prisons, which is the best I have seen. It is specific to prisons, including the inclusion of situational risk factors found only in prisons. Chief among these risk factors is that an inmate is in protective custody because he has been assaulted or fears being assaulted. In fact, among the North Carolina inmates who committed suicide in 2016 was an inmate who was in protective custody after having been assaulted.
The most perverse feature of Junker’s program is that when an inmate is assaulted the assailant(s) must be seen by a psychologist within 72 hours, while the victim remains unknown to the psychologist even though it is the victim who is at significantly increased risk for suicide while there is no increased risk for the assailant(s), even after 72 hours of “solitary confinement.”
Junker has added a crushing, yet unnecessary burden to his depleted staff with the requirement that every inmate who goes to restrictive housing must be seen by a psychologist, and the additional, senseless requirement that when an inmate is taken off suicide precautions as psychologist or social worker must see that inmate again within 24 hours. No psychologist or social worker in his or her right mind would discontinue suicide precautions if they thought that inmate needed to be seen again by a mental health professional within 24 hours.
This burden made it impossible to continue the suicide prevention procedures I initiated at Polk CI. For example, research has established that young inmates facing a long sentence are 7 times more likely to commit suicide than are their same-aged peers. Indeed, the only suicide committed at Polk CI, and the most dangerous attempt, were both done by safe keepers facing a sentence of life without parole for murder. Therefore, I arranged for case analysts to inform me immediately when an inmate with a pending murder charge was admitted to Polk CI so that I could speak with that inmate BEFORE he threatened or attempted suicide or committed self-injurious behavior. This initiative had to be abandoned as soon as Junker’s “suicide prevention program” went into effect.
Junker defiantly told the Charlotte Observer (June 3, 2016) that he wrote his “suicide prevention program” without regard for the severe staff shortage. In so doing, he revealed that he is not truly concerned with preventing suicides.
Central Prison Healthcare Complex (CPHC) not operating as promised
The $150 million Central Prison Healthcare Complex (CPHC) does not function as a hospital, emergency room, or even an urgent care. Although CPHC personnel answer the phone with, “Urgent care,” they do not even put in sutures. This poses a grave danger to the public. The North Carolina legislature recognized this danger when it allocated $150 million to build the CPHC.
The easiest way for an inmate to escape custody is to get a trip to a community hospital, as happened at Cape Fear Valley Medical Center in December.
Hence many inmates contrive ways to earn frequent trips to community hospitals. At Polk CI, one inmate learned that he could cause his lung to collapse by slamming his body against a door, while another learned he could produce rhabdomyolysis by exercising excessively in his cell (which causes muscle cells to break down and makes the urine dark brown). One of these inmates, a gang leader from Durham, admitted to the correctional officers guarding him at Duke Regional Hospital that he was looking for ways to escape. He taunted the officers by asking, “What are you gonna do if my boys show up with their AK’s?” In fact, his “family” learned of his location and did show up, requesting a “visit,” which was denied.
Another inmate cut himself while in a county jail, and when he was transported to a community hospital his mother was waiting for him with civilian clothes, a bolt cutter, and a gun in her car.
For the protection of the public and those inmates who now have a strong incentive to hurt themselves, the CPHC must be made to function as, at the very least, and emergency department.
“Behavioral Health” and Psychiatry staffing
The prisons are not able to recruit or retain adequate numbers of psychologists or psychiatrists. You need to be aware that the prisons employ a variety of ruses in an attempt to cover up the staff shortage, none more outrageous than that employed in January 2016, a few weeks before Guice and Junker traveled to Washington D.C. so the former could testify on mental health “reform” in North Carolina before the U.S. Senate Committee on the Judiciary.
At his “Behavioral Health Leadership Meeting” in the last week of January 2016 Junker made the stunning announcement that a number of staff psychologist positions had been eliminated from his depleted staff. Then he emphasized, “It’s important that you understand the reason we did this. It’s because we have not been able to fill those positions.”
By the way, within a year Junker was telling others of his plan to ask the legislature to provide funding that would allow him to double the size of his “behavioral health” staff, without saying why he suddenly thinks he can fill even more vacant positions.
Only later did I find that the real reason those positions were eliminated. On February 11, 2016 Junker and Guice drove to Washington D.C. where Guice presented a report to the Senate Judiciary Committee in which he boasted there were only 9 prison “psychologist” vacancies in the entire state, a 14% vacancy rate (9 of 64 “psychologist” positions). (See the attached record of Guice’s testimony.) The quickest, surest way to decrease the vacancy rate is to eliminate vacant positions.
Just three months later a prison spokesman reported these numbers, as of May 17, 2016.
Psychology Services Coordinator: 30 FTE 6 vacant
Psychology Program Coordinator: 5 FTE 0 vacant
Psychology Program Manager: 17 FTE 6 vacant
Senior Psychologist: 4 FTE 0 vacant
Staff Psychologist: 67 FTE 17 vacant
Psychiatrist: 17 FTE 7 vacant
It appears that in his report to the U.S. Senate Judiciary Committee, Guice reported only the vacancies for staff psychologist positions, from which vacant positions had been eliminated. In a short time the vacancy rate for staff psychologist positions climbed from 14% to 25%. In May 2016 the vacancy rate for other psychologists, in supervisory or management positions, was at 11%, while the vacancy rate for psychiatrists was 41%, a glaring shortage not reported to the U.S. Senate Judiciary Committee.
Since that time psychologists have left the prisons faster than they can be replaced. And we ask each other, if Junker cannot fill the positions he has, how can he fill more psychology positions?
I respectfully offer three recommendations.
1. Subpoena psychologists who actually work inside North Carolina prisons to testify in closed-door hearings.
Under provisions of the North Carolina Psychology Practice Act, a psychologist can reveal confidential information only with the informed consent of the patient, or under subpoena. The full extent of the scandal of mental health “reform” cannot be understood without revealing details of particular cases, and for a psychologist to reveal those details will require a subpoena in almost every case.
2. Enjoin prison administrators from retaliating against psychologists and other mental health staff members.
The friends and colleagues I left behind when I retired are justifiably afraid that they may be designated as a “snitch” and face unjustified punishment, including loss of their jobs, when prison administrators learn that I have contacted the Joint Oversight Committee.
3. Review the contract of the Disability Rights North Carolina law firm for conflicts of interest. A Disability Rights attorney has admitted to playing a major role in shaping the disastrous and wasteful changes to prison policies and practices, and the Disability Rights web site states:
Due in part to our advocacy, the NC Department of Public Safety (DPS) made substantial reforms to its policies in 2016, including a limit on days in segregation for inmates with mental illness. Also, NC DPS opened four therapeutic units to provide an alternative to segregation for inmates with mental illness.
These “substantial reforms” are nothing to brag about.
There is a blatant conflict of interest inherent in Disability Rights playing such a major role, indeed overstepping their professional bounds, in creating mental health policies that should be created by licensed mental health professionals. Disability Rights, which has a contract with North Carolina and a federal mandate to protect the rights of inmates with disabilities, has not and cannot critique or criticize the misguided policies for which they claim at least partial responsibility.