ON THE CURRENT STATUS OF SERVICES FOR PERSONS WITH MENTAL ILLNESS IN MAINE’S
JAILS AND PRISONS:
CITIZEN’S COMMITTEE ON MENTAL ILLNESS, SUBSTANCE ABUSE, AND CRIMINAL JUSTICE
In the fall of 2000, NAMI Maine released a report on conditions for people
with mental illness and/or substance abuse in Maine’s jails and prisons.
That report raised serious concerns about inmate suicide, inadequate or
unavailable mental health services in many of Maine’s jails, and the use of
segregation as a common practice for handling psychotic or highly symptomatic
inmates with mental illness. The
report was prompted by the suicide of 18 year old James Thomas, a Lincoln County
Jail inmate transferred to Maine’s most restrictive prison because of his
suicidal behavior in the jail and the jail’s inability to secure treatment
services for him. Although the law doesn’t allow jails to transfer inmates to
prison because of medical or mental health problems, difficulty coping with
difficult behaviors, lack of services inside the jails, and inability to access
community mental health services often brought jail inmates with mental illness
to the supermax prison.
The facts in 2000 were startling:
· A prison inmate suicide in 1998 and 2000.
· Over 5,000 of Maine’s jail inmates were in need of mental health treatment with most of Maine’s 15 jails reporting inadequate or no mental health resources.
· A massive outlay of cash was occurring nation-wide for construction of new correctional facilities – Maine too, building a prison in 1992, a prison in 2000, as well as new juvenile facilities. A $20 million increase in the Department of Corrections budget between 1990 and 1999 was primarily devoted to operational costs.
· National recidivism rates were 80% for inmates with mental illness.
· A lack of community services, in-jail services, and diversion programs leading to a policy of transferring mentally ill inmates from county jails to the supermax as the only other alternative to “manage” their behavior;
· Inmates in 23-hour lock down for years at a time;
· A policy of stripping psychotic inmates and placing them in stripped down cells. A policy of disciplinary punishment for suicide attempts. All of the above conducive to poor mental health outcomes for inmates.
· Inmates who did manage to get treatment in a hospital were returning to prison from psychiatric hospitals with no discharge plan and no instructions for their care and treatment.
· Legislation requiring assistance to county jails and a state-wide strategy for diversion which was not/or partially implemented.
NAMI Maine called for immediate
action, including increased funding for mental health/substance abuse services
in Maine’s correctional facilities, the creation of effective diversion
programs, improved training for law enforcement and correctional staff,
cessation of any use of Maine’s super maximum security prison for inmates with
mental illness, and expansion of quality review boards for Maine’s prisons.
Two years have passed since these findings and recommendations were
released. In the last six months,
five inmates have successfully committed suicide in Maine’s jails and prisons.
This report is a call to action prepared jointly by The Maine Sheriffs’
Association, the Maine County Commissioner’s Association, and NAMI Maine.
News reports in 1978 and 1979 are headlined “Plans would bolster jails’ mental health service” Maine Sunday Telegram, March 11, 1979 and “Better mental health care for prisoners under study” Kennebec Journal, November 22, 1978. Both articles describe deplorable conditions for people with mental illness who are arrested and shortages of treatment for them – both in correctional facilities and at the State Hospitals. Both articles describe a commission that is recommending change. Twenty years later, news coverage looks much the same. (See summary of newspaper articles over the past three years- attached
are the facts about conditions for people with mental illness in Maine’s Jails
and prisons. Between 1998 - 2002:
Two external audits of health care at the Maine State Prison’s
facilities (carried out by expert in national accreditation standards) were
conducted – one in December of 2000 and one in November of 2001.
The results are summarized in the attached chart.
The audits show significant deterioration in the prisons’ ability to
provide medical and mental health care in a manner that meets national
standards. Specifically, between
2000 and 2001, non-compliance with national standards more than doubled, with
the auditor noting there is “a notable slippage in the quality of care
delivered at these facilities within the last year.”
During the same time frame (1999-2002) multiple efforts have been made to
improve Maine’s response to people with mental illness who are in jail or
prison. These included:
The groundwork has been laid. The
Maine Legislature and stakeholders with an interest in the safety and well being
of people with mental illness who are incarcerated understand the problem and
have discussed successful solutions. The
Maine Department of Corrections and the Maine Department of Behavioral and
Developmental Services have also recognized (l) the need to work together and
(2) the need for system change. The
Department of Corrections created and filled a position of Director of Mental
Health, further recognition of the need for additional attention to the needs of
inmates with mental illness or those with co-occurring substance abuse problems.
Nonetheless, real change, change that keeps people with mental illness
out of jail and prison and assures their safety when they are inside, has been
slow to materialize. There is a
growing crisis in Maine’s jails, including a series of inmate suicides/deaths
in Maine’s jails and prison in the Spring of 2002.
The fact that Maine’s correctional facilities are the largest providers
of mental health services in Maine document the failure of
deinstitutionalization and the failure of the state to meet its promise to
people with mental illness and their families.
Barriers to Change
to change include budget deficits, differences in system philosophies and
training, and stigma and public distaste for criminal offenders. In addition,
the problem crosses legislative committee jurisdictions (Judiciary, Health and
Human Services, and Criminal Justice) as well as Departments of government
(Public Safety, Corrections, Behavioral and Developmental Services), and levels
of government (County, City, State). All
must be involved in an effort to design the plan to bring real
change. It is especially important
that Counties participate in reform efforts.
recent deaths of seventeen inmates is a painful and tragic reminder of the need
for immediate reform. As described
in the Criminal Justice Committee’s Report on the Needs of People with
Mental Illness who are Incarcerated there is a need for jail diversion,
in-jail mental health programming, training, advocacy and oversight, and
additional in-prison programming.
Two years after NAMI Maine’s first report, and six months after the
Legislature’s impressive response, little has changed
-- except in Maine’s jails
where suicide and suicide attempts are on the rise.
Maine’s jails are overcrowded and unsafe, they have few if any mental
health services available for inmates and are unable to access psychiatric
hospital beds for those who are deemed eligible for involuntary hospitalization
due to suicidality or homocidality. Seventeen
inmates died in the last two years – many of them by hanging.
Maine’s prison system continues to have one of the highest number of
mentally ill inmates in the nation and to lack adequate staff to meet their
needs. There has been an inmate
suicide in the prison system for four of the past five years. External reviews of health and mental health services
and procedures in the prison system document a growing, rather than shrinking,
failure to meet national accreditation standards.
These audits show significant deficits in the prison’s ability to
protect the health and safety of inmates.
The promise that hospitals would close and community services would meet
the needs of people with mental illness and their families has not been met.
State spending on mental health is shrinking – 30% less than in
1955. Between 1990 and 1997, per capita state spending on mental health fell 7%
when adjusted for inflation. During
the 1990s state spending for mental health services grew 33 percent, total state
spending grew 56%, and spending on corrections grew 68%.
As a result, the share of state spending devoted to mental health is
dropping – by 15% from 1990 to 1997 (shrinking from 2.12% of state spending to
1.81% of state spending). 
jails and Maine’s emergency rooms feel the impact of inadequate community
systems of care most acutely. The
revolving door from the street, to the jail, to the emergency room, and back to
jail is costly in human lives and in dollars
In fact, The Economist, in August of 2002, says “Some believe that
the upturn in the crime rate is directly linked to the number of unreformed
ex-convicts on America’s streets.” Unless
mental health and substance abuse services are sufficiently available, and
unless those services are mobile and include outreach, Maine’s jails and
prisons will continue to be the largest providers of mental health services.
The fact that Maine has expanded its spending on community-based services
has not solved the problem. In
fact, the people in Maine’s jails and prisons are those people who cannot
access community services. And once
there, they cannot access hospital psychiatric services either.
To many jail administrators it seems there IS no community mental health
The deaths of seventeen inmates in Maine’s correctional facilities in the last two years is a tragedy and a disgrace. Any other publicly funded and publicly governed institution in Maine where Maine citizens are housed and for whom government is responsible, that had 17 deaths would be investigated and possibly lose its license. No other public institutions in Maine are unlicensed, un-accredited, and ignored by the State in terms of funding, attention, and assistance. Instead, the problems associated with the incarceration of people who break STATE laws is left to Maine’s property tax payers.
Certainly no facility
responsible for persons with mental illness should be left in a condition where
the health and safety of these vulnerable people is at risk. Unfortunately,
jails and prisons are the largest providers of mental health services in the
nation and the least trained, the least equipped, and the most under-resourced.
This must change.
In addition to the health and safety risks to inmates, correctional
employees are also placed at risk. Staff
turnover, under-staffing, under funding, and facilities that don’t meet health
and safety standards create unhealthy and dangerous work environments.
Maine’s correctional system is in crisis.
Immediate action is needed. The
Citizens Committee on Mental Illness, Substance Abuse, and Corrections and NAMI
Maine call for the following:
1. As originally enacted in 1995, Title 34-B, section 1219, the Legislature called for the production and implementation of a comprehensive state strategy for preventing the inappropriate incarceration of seriously mentally ill individuals and for diverting those individuals away from the criminal justice system. The strategy must be developed with the participation of all stakeholders. This process could begin by holding a state-wide summit to bring together top decision and policy makers from the three branches of state government (Legislative, Executive, Judicial) and County government to review current conditions and plan improvements. The Chief Justice, Legislative leaders, Commissioners of BDS and DOC, and County officials should make decisions about how to reduce incarceration rates and improve treatment inside jails and prisons in Maine. In times of budget deficits, it is important to recognize that the cost of incarceration ($50,000 for a supermax bed; between $24,000 and 40,000/year for a jail bed) far exceeds the cost of community treatment ($10,000/person for an ACT team). This summit must be designed to develop a plan and implement it. It is also important to note that the Judiciary must be involved if real change is to occur – mandatory sentencing laws and misunderstanding about mental illness contribute to the problem. Finally, the four legislative committees of jurisdiction (state and local government, health and human services, judiciary, and criminal justice) must also be involved if change is to be enacted. These participants must develop AND IMPLEMENT a plan for change.
2. Implement and fund the recommendations included in the report from the Committee to Study the Needs of People with Mental Illness who are Incarcerated. These recommendations must be enacted in full. Of special note is their recommendation that the judiciary receive training in diversion strategies if the root of the problem is to be addressed.
3. Carry out the recommendations made by the 1999 Maine Inpatient Treatment Initiative Report. These recommendations involve improved community services for people with mental illness – noting that the new AMHI will be too small if these improvements are not made.
4. Increase mental health support to local jails through performance standards for community agencies providing services and require reports about actual services provided. Title 34B, section 3604, paragraph 4 requires mental health providers who receive funding from the state to serve jails. Insure that all contracts do, in fact, include this requirement. And, monitor what is actually provided and if it is helpful. Insure flexible funding so that these services can be provided.
5. Assure that correctional officers and law enforcement officers receive required training about serious mental illness, suicide, and appropriate interventions. Require that these facilities report to DOC documenting that required training has occurred. Fund the police, jails, and prisons so that they can afford to train their staff.
6. Develop partnerships between the Department of Corrections and community psychiatric hospitals to provide inpatient treatment for adolescent forensic patients.
Insure that inmates who have been “blue-papered” actually are
admitted to a psychiatric bed. Require
jails to collect this information and report annually to DOC regarding their
need for psychiatric hospitalization and their ability to obtain it.
Require jails to provide an annual report to the Legislature on their
ability to treat and care for inmates.
Provide physical improvements at the prison facilities that are old and
out dated and which have been
for renovation or rebuilding. A
bond package has been proposed. Even
though the bond
is needed, correctional buildings are not the appropriate answer to the needs of
people with mental illness.
Adequate community mental health programs and diversion are the answer.
Eliminate the prison protocol that penalizes inmates who make a serious
suicide attempt or who are
punished because of the symptoms of their mental illness, mandating
treatment instead of punishment.
Develop a treatment first approach instead of the current situation where
jails are the placement of last resort.
10. Change the Community Corrections Act from a subsidy to a proportional reimbursement to county jails from the state general fund. Base the amount provided to each jail on the number of inmates and the cost of bed-days. Provide an incentive for obtaining accreditation by providing a higher percentage of state general fund dollars for jails who obtain accreditation.
Carry out a full, independent review, by mental health and co-occurring
disorders experts on the treatment programs at the prison’s mental health unit
and in Maine’s 15 jails. Report
the findings of this review and
needed modifications to the legislature. Fund
the modifications recommended by that review.
Expand the number of beds that will be available at the new Riverview
Psychiatric Center, now under
construction. Use the expansion
footprint built into the design. Fund
this expansion immediately.
Please call NAMI Maine at 207-622-5767 for hard copies of the attachments!!
Summary of External Audits of Maine’s Prison Facilities
Summary of Events 1999-2002
Survey of Maine’s Jails
 Bazelon’s Disintegrating Systems, pg. 15-15
 The Economist. “Too many convicts”. August 10, 2002.
 Skyrocketing costs are described in Community Corrections in America. National Coalition for mental and substance abuse health care in the justice system. CSAT No. 5-H87-T100290. 1996. “Costs of the correctional system are escalating faster than any other costs of government, including the even no infamous costs of health care. Punishment costs are one fourth of Alabama’s entire state budget.” Pg. 13