Times In-Depth: Erie County Prison becomes hub for care of mentally ill [Erie Times-News, Pa. :: ]
(Erie Times-News (PA) Via Acquire Media NewsEdge) June 22--Nurse practitioner Char Riddle logs on to her computer and checks the admissions from the night before.
Behind her on a whiteboard, the names of patients in crisis are penned in erasable ink.
On this day, five must be checked every 15 minutes to make sure they have not committed suicide. Seven others require reviews every 30 minutes.
Riddle heads out with staff to visit with one man on the list who believes creatures are crawling under his skin.
When they reach the heavy metal door, Riddle hits the intercom button.
"Riddle. Bravo," she says.
The door swings onto the clinic: One of several two-story cell pods at the Erie County Prison.
A long-swelling movement to close government-run mental health institutions that began in the 1960s culminated in 1999 with a landmark U.S. Supreme Court ruling, Olmstead v. L.C., which barred unjustified segregation of those with disabilities.
Compelled to comply, Pennsylvania developed a plan to end unnecessary hospitalization of thousands of mentally ill individuals.
The population in Pennsylvania's state hospitals -- about 35,100 in 1966 -- had declined to just 1,600 by 2010. That was the year that Erie County's local resource for mentally ill criminal defendants -- Warren State Hospital's forensic unit -- was closed.
Each year since then, the state has continued to move more individuals from hospital settings into the community, at the same time others in the community are newly diagnosed with mental illness.
Mental health care is available in Erie County. But some who need it most do not get it until they land in prison.
For any number of reasons -- the nature of their illnesses, the contraction of mental health services at local hospitals, limited residential care for the seriously mentally ill -- the safety net does not scoop them up until their disease spirals out of control and puts them in contact with police.
As a result, a mental health clinic teeming with some of the county's most desperately ill individuals has been established within the hard walls of the Erie County Prison, where a full 30 percent or more of the average daily population of 620 prisoners suffer from a serious mental illness.
The program, in place for five years, is experiencing bigger numbers than ever.
The mentally ill men and women crowding the cells of the Erie County Prison fall under the care of Char Riddle and a team of mental health experts from Stairways Behavioral Health.
The recent counseling session that Riddle conducted in Bravo, or the prison's B pod, took place at a varnished metal table in a common room that smelled of disinfectant and human bodies.
The man Riddle visited had sent a note for help. Afflicted with paranoid schizophrenia, he had been having delusions that his longtime probation officer was seeking to harm him.
Creatures he referred to as "tapers" were getting under his skin, he wrote. He wanted police sent to his home to check his family.
He told Riddle and his mental health counselor, Frank Quinn, on this day that he was feeling better after receiving some additional medicine.
His chronic fear and confusion set in years ago when he was a teen, he said. He wants to be normal again.
What is normal?
"Feeling calm and watching movies," he said.
Another man on the watch list that day was isolated in the restricted housing unit. He had eaten no food, taken no medication and exhibited no insight into his circumstances.
His case had barely begun to move through the court system. But he had packed his bags. He thought he was going home.
"Who told you that?" a nurse said.
"God," he said.
Riddle treats patients both in the prison and at an outpatient clinic that Stairways runs for those in the criminal justice system.
"What I see in here probably rivals what is seen in an inpatient mental health hospital," she said. "We are providing hospital-level treatment because they are so decompensated when they get here."
Mentally ill inmates arrive on any given day, actively hallucinating, paranoid or suicidal, suffering from the most extreme mental ailments, including schizophrenia, bipolar disorder, mood disorders and severe depression.
The prison clinic is not the largest mental health facility in the county. But its caseload, due in part to the high levels of poverty, substance abuse and homelessness among the prison population, represents one of the greatest concentrations of profoundly mentally ill individuals in the county, officials said.
By way of comparison, an estimated 9.6 million adults, or 4. 1 percent of the overall adult population in the United States, suffered from a serious mental illness in 2012, according to the National Institute on Mental Health.
The prevalence of mentally ill inmates is not a problem unique to Erie. Approximately 21 percent of inmates nationwide had a recent history of a mental health condition, according to the National Alliance on Mental Illness.
Prison systems in Cook County, Ill., which serves the Chicago area, and in Los Angeles are now said to be the nation's largest mental health providers, dwarfing services offered by state-run institutions.
Violent crimes committed by the mentally ill have renewed the attention on the mentally ill in the criminal justice system.
Those with mental illness are more likely to be a victim of a crime, rather than a perpetrator. Some of the mentally ill in the Erie County Prison face charges from serious violent episodes. More often, they face nuisance charges.
No one regards the Erie County Prison mental health program as the solution to the problem of mentally ill defendants in prison.
"Prison was never meant to be a substitute for a community-based mental health facility or hospital for seriously mentally ill citizens that need institutionalization," Erie County President Judge Ernest J. DiSantis Jr. he said. "We want to make sure the people who are incarcerated are the people who need to be."
The Erie County Prison mental health program is instead considered an opportunity -- for professionals to meet and treat mentally ill offenders and, hopefully, divert them from future encounters with the law.
"A large proportion of the persons are in here because their mental health decompensated, and they had interaction with law enforcement," Riddle said.
The prison's clinic is one of many initiatives that Erie County officials have taken to handle an influx of seriously mentally ill individuals pouring into the prison and Erie County courtrooms.
In years past, a prison stay too often exacerbated the problems of the mentally ill who landed there.
The prison psychiatrist, assisted by staff counselors and a nurse, was in the building only about 12 hours a month. Available psychiatric medications were limited and dated. The wait for an inmate to see a doctor could be as long as six to eight weeks, said Wendy McCullough, Stairways' director of forensic services.
In 2009, Erie County channeled $400,000 from its human services budget into the prison. The county entered into a contract with a new provider, Stairways, to create a mental health clinic in the prison, where the average daily cost to house an inmate is $72.
Now two psychiatrists spend 12 hours a week in the prison. Riddle, who, as a registered certified nurse practitioner can prescribe medication, spends 30 hours a week there and supervises the program.
Also on the team are two full-time master's level mental health counselors, and a nurse. McCullough provides drug and alcohol services.
"All the components are there," said Gary Lucht, a former Erie County Prison warden and the administrative director of Stairways' forensic programs.
When the program began in 2009, the mental health team had an average caseload of 219 patients a month. In 2013, that number swelled to 282.
Some of the inmates are not only mentally ill but also criminally minded. Riddle said she focuses on the patient rather than the criminal charges.
She remembers the first mentally ill homicide suspect she met. Dried blood still covered him.
"You see things in here and experience things in here that the average person does not," Riddle said.
She tries to remember that "the person sitting there is troubled and ill, also." She said, "You really have to care for that person aside from what you might think or believe" about their alleged actions.
Many in the prison, at East 18th and Ash streets, are awaiting trial and have not been convicted. Those facing lower-level charges who do not present a danger to the community sometimes enter the local courts' pretrial bond reduction program, which allows them to post nominal bond and return to the community for treatment.
Inmates who begin services in the prison and end up on probation or parole can in many cases continue the services at the forensic outpatient clinic that Stairways runs at 2911 State St.
"We try to make it a seamless transition," McCullough said.
Records do not exist yet to track whether the combination of services has affected the defendants' recidivism rate.
"The hope is always that (if) you can get them in the mental health system and stabilized, you are going to reduce recidivism overall," Riddle said.
"Every day we see somebody who had interaction with law enforcement and the criminal justice system when they never had an issue before," she said. "They do their treatment, stay on their medications and see their therapists. We see success stories like that every day."
The prison mental health program has changed the way Erie County Prison staff perceive and interact with mentally ill inmates, said Kevin Sutter, who became warden in late 2012, after 19 years with the state Department of Corrections.
Instead of using force to stop behavior that might not be in the mentally ill inmate's control, officers now say, "'Something is wrong with this guy, let's get some mental health people involved,'" Sutter said.
In 2008, the year before the Stairways program started, guards trying to control inmates used physical restraints 18 times and chemical restraints 95 times, a number that might have included the use of pepper spray, Riddle said. In 2013, the prison used physical restraints four times -- three times on one inmate -- and no medicine to subdue an inmate, Riddle said.
Sutter said corrections workers have used the term "hug a thug" to refer to mental health care for inmates. He said that culture has changed.
On a recent day, guards and supervisors repeatedly stopped by Riddle's office to share their observations of inmates and report those who might need attention.
"It has helped our operation immensely," Sutter said. "I can call Char at 3:30 a.m. and say, 'Hey, something bad is happening,' and we will deal with it."
Riddle and the staff are quick to note the program can't offer the level of care available in an outpatient clinic or hospital.
No therapy in the classic sense takes place. Some inmates are too sick to be in the prison, regardless of the charges against them, and they need to be hospitalized right away.
The mental health team's attempts to get inpatient treatment for the most critically ill, however, are often stymied by long waits for admission to the state forensic mental hospital at Torrance, east of Pittsburgh, where 48 western Pennsylvania counties, including Erie County, share 100 inpatient forensic psychiatric beds.
Riddle and the staff at the Erie County Prison also must navigate a sterile, regimented system geared for security, not care. Counselors cannot be in the pods at mealtimes. Other times, emergencies trigger lockdowns, which stop activity immediately.
On a recent day, one inmate pitched a cup at a corrections officer amid a tantrum. He would not leave his cell when ordered, even after he had been hit with pepper spray.
Guards convened in a hallway. Nearly half a dozen suited up in riot gear, while other staff, including a nurse with a gurney, stood by for an "extraction."
The inmate took one glimpse at the show of force and walked from his cell with a halfhearted curse. The episode threw off mealtimes for the pods, and thus, mental health checks with the inmates.
Riddle said many families of mentally ill inmates have been trying to stabilize their loved one for years. Once that person's illness brings them into contact with law enforcement and lands them in the prison, many believe, "they are finally going to get some help," she said.
"It happens," Riddle said. "It just takes time.
"My desire is to see them walk out and hold some kind of job and be successful in their families and in their lives and not be chained by their disease."
LISA THOMPSON can be reached at 870-1802 or by e-mail. Follow her on Twitter at twitter.com/ETNthompson.
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