Questions raised about Corrections care
Bounced from criminal justice system to mental health programs
For a five year period, Leah Matteson's mentally ill son, Patrick Cristaldi, was in and out of the criminal justice system from the age of 17. Matteson says her son didn't receive proper care in prison. She provided this high school yearbook photo of Patrick.
In August 2000, Leah Matteson and her family moved from Cambridge, N.Y., across the state line to Bennington: Matteson had heard the Bennington school system had a good program for children with serious mental illness.
Her son Patrick Cristaldi had been diagnosed with Tourette syndrome at the age of 7. (The neurological disorder is characterized by tics and involuntary vocalizations, such as shouting, and is associated with impulsive behavior.) Later, he was diagnosed with obsessive-compulsive disorder, anxiety disorder, attention deficit hyperactivity disorder and bipolar disorder. When he was 13, he tried to hang himself.
Patrick spent the next nine years in and out of The Brattleboro Retreat, a mental health and addictions treatment center. Some of his manic episodes were so severe that he displayed psychotic symptoms.
During one episode when he was 17, Patrick picked up an object in the yard, swung it and hit his brother, who had tackled him to bring him under control. His mother called 911 for an ambulance. Instead, three police cars arrived.
Patrick was handcuffed, taken to the police station and charged with a felony for assaulting his brother. Ultimately, he was allowed to go to The Retreat, although the charges remained in place.
As Matteson tells the story, for the next five years her son ricocheted back and forth between the “silos” of the state’s systems of mental health and criminal justice. (Confidentiality rules prevented the Department of Corrections from commenting on Matteson’s allegations.)
Matteson, who is president of the board of the National Alliance on Mental Illness of Vermont and coordinator of education and training at the Vermont State Hospital, says Patrick was not given counseling, had no coordinated treatment plan and was frequently held in segregation as discipline for behaviors arising from his disabilities. In addition, she tells of poor community case management and lack of communication between local mental heath providers and the Department of Corrections.
Patrick graduated from high school in June 2005, and in January 2006 he enrolled in the Community College of Vermont. But by spring he was not doing well and began hanging out with friends who used drugs. Twice he voluntarily entered the substance abuse program at The Retreat. The second time he was released before he was ready, Matteson said, because his insurance coverage would no longer pay for treatment. Still not stabilized on his medications, according to his mother, Patrick had a psychotic break, got in a fight with his best friend and broke his jaw.
Patrick was taken to the Marble Valley Regional Correctional Facility in Rutland that night, a Thursday, Matteson said, and his medications were taken away.
On the following Monday Patrick appeared in court with delirium tremens, an acute and potentially fatal consequence of rapid alcohol or drug withdrawal, and he had had no medications for the five days he had been in the holding tank in Rutland, Matteson said. “Thank God, the judge knew he was in DTs, so they sent him to Vermont State Hospital,” she added.
The result was a second felony conviction.
Patrick was sent to Northwest State Correctional Facility in St. Albans in 2007. There, he was put in a cognitive self-change program for violent offenders that required participants to write monthly “thinking reports.” But Patrick was unable to complete the assignments without help: Since middle school, he had had an Individualized Education Plan and a one-to-one aide.
Matteson enlisted Vermont Legal Aid in an effort to get an accommodation for Patrick’s disability. It took months to get the needed help, Matteson said, and because Patrick missed two months’ work, he was expelled from the program. Ultimately, he was provided with an aide and did complete the cognitive self-change program, Matteson said, although he was not given counseling.
When Patrick was released in October 2007, his mother said, he was not on the right medication and was manic. Consequently, he violated a condition of his parole and was immediately reincarcerated, first in Rutland and then in the Chittenden Regional Correctional Facility.
When Patrick was released in October 2007, he violated a condition of his parole and was immediately reincarcerated, first in Rutland and then in the Chittenden Regional Correctional Facility, his mother said. At the time, he was not on the right medication and experienced manic episodes, Matteson said.
In December 2008, he was moved to Newport and put in the cognitive self-change program again. When he asked for an accommodation for his disability, he didn’t receive a response within the 10 day period, Matteson said, and was kicked out of the program for what she calls “his verbal thoughts and expressions.” He will have to wait a year before he can re-enter the program, she noted.
Matteson charges that her son has been in corrections for three years without therapeutic care and that he has been punished for behavior arising from his disability.
“Eventually, these people are going to come back out into the community, and they’re going to reoffend, and they’re going to get reincarcerated because there’s no system in place,” she says. “There’s no collaboration. Our mental health system is so broken.”
Lawsuits, probes bring issues to state’s attention
There are several explanations for the situation Matteson described.
First and foremost is a lack of mental health expertise within the criminal justice system. Within corrections, overcrowding, frequent transfers of prisoners and high staff turnover makes sustained treatment difficult.
Another factor is the lack of coordination between the Department of Corrections and other departments in the Agency of Human Services.
The state, aware of these problems, is taking steps to improve its treatment of mentally ill offenders.
The Department of Corrections is emerging from what Commissioner Andrew Pallito calls “a particularly problematic time.” In the 11 months between November 2002 and October 2003, seven offenders died in the custody of the Vermont Department of Corrections. Three of the deaths were suicides.
The Agency of Human Services commissioned an investigation into the cause of the deaths. Attorneys Michael Marks and Philip McLaughlin, who investigated the seven prison deaths, acknowledged in their report that the department faced “enormous challenges” – tight budgets, lack of beds, a prison population with high levels of substance abuse and mental illness and high inmate turnover.
But they concluded that “there are significant areas in which the Department should improve the provision of mental health services to inmates.”
The Marks and McLaughlin report spurred a 2005 “plan of response” by the Department of Corrections that included restructuring leadership, establishing an internal investigations unit with a toll-free number for prisoners and staff, developing protections for whistle-blowers and creating greater transparency.
While the Department of Corrections has implemented the recommendations, A.J. Ruben, the supervising attorney for Vermont Protection and Advocacy, a nonprofit organization that defends the rights of people with mental illness and disabilities, maintains that the most important reforms of the past six years have come about through legal challenges.
In 2006, a settlement reached between the Department of Corrections and Vermont Protection and Advocacy added protections that ended a longstanding policy of disciplining prisoners “based solely on the symptoms of their disability,” Ruben said. The settlement restricted the use of segregation as a response to prisoners who harmed themselves. Instead of punishing suicidal prisoners, corrections personnel were required to respond therapeutically to mentally ill inmates. (One of the cases investigated by Marks and McLaughlin concerned a prisoner who hanged himself in a segregation cell after being kept there with little release time for 118 days.)
See sidebar, “Officials: Suicidal inmates monitored more closely”
A second major advance was achieved in 2008 when the Vermont Supreme Court ruled that the state’s prisons are subject to the Americans with Disabilities Act. The ruling came about through the efforts of Robert Appel of the Human Rights Commission and Barbara Prine of Vermont Legal Aid’s Disability Law Project.
The ruling requires the Department of Corrections to provide reasonable accommodations to ensure that offenders with disabilities have the same opportunities as other inmates.
In May the legislature passed a bill, S-2, which replaced the term “serious mental illness” in statutes relating to offenders with the broader term “serious functional impairment.”
The earlier language had a narrower scope: While psychoses, depression, anxiety, bipolar disorder and other illnesses were covered, developmental disabilities, traumatic brain injuries and dementia were not. Prisoners with serious functional impairments now have the same protections afforded prisoners with serious mental illness, including protection against prolonged segregation.
Tough environment for mentally ill
Some things, however, haven’t changed.
“In the most general terms,” said Ed Paquin, Vermont Protection and Advocacy’s executive director, “we have an overcrowded system, and we have a system that is not geared towards giving the level of treatment that should be given for people who have serious functional impairments.”
Prison, he observed, is “a very tough environment in which to be mentally ill.”
A key factor is extreme overcrowding.
On August 6, according to Commissioner of Corrections Andrew Pallito, the State of Vermont was housing 1,599 prisoners in-state. The number of in-state beds is 1,600. “We have periods when we’re over,” Pallito observed. “We’re dealing with a lot of flow.”
Source: Vermont Department of Corrections, monthly population statistics, 1984-2010
Attorneys Marks and McLaughlin quoted one superintendent who told them that within the course of a year, she processed 1,900 prisoners into her facility and 1,700 out of it. She asked, “Do you think I know who they are, let alone tell you that I provide them corrections and rehabilitative services? I stash them until they are moved.”
Paquin said some counseling is provided, some therapy groups offered, “a lot of medication given” and a unit in Springfield made available to people needing more intensive treatment, “but it’s not what we would consider what reaches the community standard of care.
“What is generally available for people who have very serious mental illnesses, particularly when they are in mental health crises, is more of the nature of containment and control than treatment,” he said. “There doesn’t really exist, in our opinion, any ready access to hospital level of care.” He noted that by law, prisoners have a right to medical and mental health treatment that meets the community standard.
Paquin’s assertion is supported by the January 2008 annual report of the Joint Legislative Corrections Oversight Committee.
“We learned from several sources, including the Department of Corrections itself, that treatment is designed to stabilize conditions so that each inmate can function in the prison setting,” the committee said. “The administration and the legislature have never given the Department of Corrections the funding needed to provide the kind of intensive treatment necessary to ensure success upon re-entry.”
Disabled inmates max out sentences
Many of the complaints that Vermont Protection and Advocacy and the Human Rights Commission receive are about the kinds of problems Matteson described – issues relating to discharge planning, long-term segregation and access to needed treatment, and difficulties receiving accommodations required by the ADA.
Paquin gave an example of what happens to prisoners with disabilities who are not provided with accommodations so that they can participate successfully in programming.
An offender with a two- to five-year sentence may be eligible to get out of prison after serving the minimum time if he completes a program for violent offenders, Paquin said. But if he drops out of the program or fails it because no accommodation was made for a learning disability or hearing deficit, he can’t take advantage of that opportunity.
Likewise, prisoners with serious functional impairments typically need support in the community to succeed when they leave prison. If housing, mental health services and other supports are not in place when they have served their minimum sentences, they will not be released. 6
The result is that prisoners with disabilities are more likely than other prisoners to serve their maximum sentences.
Paquin attributes the no-win situation to policy decisions.
“Vermont has gone in the direction of incarcerating a lot of people – it has demanded a lot of accountability for crime,” Paquin said. “Even outside of corrections, we have a human service delivery system that has been strapped budget-wise for years now and underfunded. We don’t have adequate housing resources in this state. We don’t have adequate developmental services. Our mental health services are not what they should be.
“We do a lot of things right,” he declared. “But in order for a social service system to work, it has to be funded so that community supports are available and adequate to meet folks’ needs. There’s a tremendous amount of stress on the system.”
Copyright, Vtdigger.org
