In 1992, assigned as a correctional captain at the newly formed Mental Health Treatment Center (MHTC) located at the Central New Mexico Correctional Facility 30 miles south of Albuquerque, was my introduction to the seriously mentally ill up close and personal. Although having worked as a correctional officer inside the Santa Fe prison in 1985 through 1989, it was a sporadic interaction and only with those locked up and classified as special needs inmates that required little care except their basic food, drinks, shower and medication. There was an occasional use of force or cell extraction of those unwilling to comply with direct orders to come out of their cells but within5 minutes, these individuals were restrained and put in a straight jacket or other soft restraints to keep harming themselves or others.
At the MHTC, under the guidance of Dr. Eloy Romero, this treatment unit was formed to handle the most seriously mentally ill (SMI) inmates housed in the New Mexico prison system. The transition for this unit was from a lock up with punitive elements in place to a more open minded therapeutic milieu that enhanced and encouraged treatment practices that would stabilize and allow these SMI inmates to be reintegrated back into the general population along with the proper medications provided by their case by case assessments. It was to be the genesis for my interest in the mentally ill as I had to transform my security mind to a more open mind that allowed more flexibility in inmate movement, inmate behaviors and inmate disciplinary. Gradually understanding the principles required to maintain a successful treatment center, it took 48 specially trained and volunteering officers and 4 recreational specialists to embrace the new concept and make it work. The reason for this unit’s existence was the mass number of SMI’s coming into the prison system and having difficulties coping with general population functions. My tour of duty there lasted for 3 years as I was rotated out to an assignment as a program director since learning the fine balance of security and programs as an essential part of sound correctional practices
The closing of many state hospitals and the results of deinstitutionalization was not just a problem that occurred in California. There were drastic changes in the laws by many state governments regarding the management and treatment of mentally ill persons. The political climate of California’s governor and other public leaders led to a dramatic change in the treatment of the mentally ill everywhere. New Mexico was no exception to the problem. Dr E. Fuller Torrey writes in his book “The Insanity Offense” the following quote on the Lanterman-Perris-Short Act (LPS) passed in California in 1967. The LPS act modeled “most state commitment statutes today” and is used today in various states. One should take the time to read this act and see how it changed the way the mentally ill were treated as it limited the treatment options for individuals. Dr. Torrey writes that the makers of the LPS Act actually believed that almost all persons with psychiatric needs and disorders could in fact be competent enough to make “informed decisions regarding their need for treatment.” In due time, it was believe that this act in fact created more homicides by the mentally ill as the number of violent offenses rose to a staggering number and spiraling out of control. He also writes that it was the distrust of psychiatric help and treatment as well as the involuntary psychiatric hospital commitments that propelled Lanterman to go forward and lead up to the LPS act. Doctor Donald T. Lunde, a longtime Bay Area psychiatrist who became “widely known in the American court system for his frank and eloquent testimony on all manner of grisly crime and human behavior” wrote “Yes, the LPS. It was in effect certainly at this time. It was now impossible to commit somebody for a prolonged period in the state of California, even though you know, as was mentioned repeatedly here (Herb Mullin’s trial, 1973) that the patient is dangerous to himself or others.” The law provides very limited, very specific numbers of days that you can keep somebody. Beyond that, even though a person may continue to be obviously dangerous, he must be released.” In that trial, the jury found Mullin to be guilty of ten counts of murder on August 19, 1973. He was sentenced to life in prison where the mental health officials could not release him. Thus the public became aware of the needs to change their approach to the mentally ill and sought relief through the courts and other avenues
It was becoming clear that California had failed in the psychiatric field as their laws did not protect their citizens from the acts of the mentally ill as there was an “increase in episodes of violence, including homicides committed by the mentally ill.” Over the next 30 years the rates of violence, homicides and suicides increased as more and more mentally ill persons were being neglected and left to fend for themselves on the street and the prisons. Untreated and left to deal with their own problems, these people were trying to cope with life the best they could be with their disorders hampering their ability to be successful and productive citizens, they had become society’s burden as well as their off springs. In 1999 the state of California reported a prison population of 20 % being mentally ill and in need of treatment. The consequences of the past became predictable for the future. Dr. Torrey reports that “in 2005, a federal judge looking at the California prison system and its problems ordered a “takeover of medical incompetence and at times outright depravity” in the manner it took care of its prisoners.
Moving away from California’s trials and tribulations regarding the treatment of the mentally ill it must be mentioned that during this time, California psychiatry influenced most others throughout the country and many models were mimicked or adapted for their own applications nationwide. Arizona, always in the role of catching up is coming to the culmination of the California system as it was in 2005 and is now experiencing a heavy flow of mentally ill persons being incarcerated into their prisons leaving them with inadequate care and resources. A conservative state that is financial troubled with their budget; the legislature did allocate $ 1 billion dollars to run its prison system. Hardly enough to address their operational needs and the burdensome and expensive costs to treat the seriously mentally ill prisoners, their care is sparse and sporadic as case by case crisis intervention identifies these inmates and puts them in a higher custody level with the result being isolation and sparse treatments available. Sparse treatment includes limited staffing, physical space and access to more professional resources.
Being among those correctional officials that found it difficult to manage and deal with these SMI prisoners, it was clear that the “mixing of the mad with the bad” was a dangerous combination inside prisons. Adding the elements of overcrowding, idleness and understaffing, this condition fuels a disaster in the making and is at the cusp of exploding. Today, we are trying to piecemeal this problem today with sporadic and weak attempts to treat the SMI’s in Arizona’s prisons. The bizarre behaviors are puzzling to untrained staff and overwhelm the psychiatric staff assigned to these prisons. Officers react to their conduct with extreme caution or extreme force regardless of their mental conditions. In the five years employed by the Arizona prison system I saw few who were sensitive to their needs, and I saw only a handful take the time and effort to ensure their personal safety was ensured by taking the time to do a good evaluation and prescribe the right medication to allow them to function as good as possible under strict conditions.
Arizona prison time is hard time; very much like the same mentality that exists inside the California prisons their rules are strictly enforced and the consequences are real. One important fact that many officers often forget is that SMI inmates “find it difficult to understand or follow” rules and regulation thus are punished for breaking rules they do not comprehend or have an awareness that they did something wrong. Chief Supreme Court Justice wrote in 1999 “It must be remembered that for the person with severe mental illness, who has no treatment, the most dreaded of confinements can be the imprisonment by his own mind, which shuts reality out and subjects him to the torment of voices and images beyond our powers to describe.” Comparing New Mexico prison cultures with the Arizona prison cultures I can see similarities but certainly not with the same intensity or unpredictability that exists in these Arizona prisons. Arizona crisis management is daily compared to infrequent accounts in New Mexico. Their culture related to race, ethnicity and gangs are the same. Their culture in taking care of each other is indifferent to say the least and the comparison between training and cultural awareness and diversity is night and day with New Mexico shining in the sun. Arizona is 10 years behind the times in prison life and management. There are no accreditation processes in place to ensure continuity and compliance with any other standard but their own policies which are flawed to say the least. This lack of accreditation and audit performed activities [such as those done by the American Correctional Association] leads to chaos and disarray of rules and regulation enforcement causing more stress and confusing to the mentally ill as well as staff who suffer a high rate of disciplinary for their lack of knowledge of these policies and insufficient training in the handling of these special needs offenders, It is also the main reason why Arizona is suffering in the area of mental health treatment as change is slow and an uphill battle through traditional barriers put in place over the years by those authoritarians who refuse to admit that SMI prisoners have special needs and should be treated different than other non-mentally ill prisoners. Today the Arizona prisons are filled with SMI inmates at their Level V [the highest custody level] and who suffer with inadequate care and treatment as Arizona struggles to catch up with the times.
Dr E. Fuller Torrey’s book “The Insanity Offense”