Unhealthy situation Sunday, August 14, 2005
Peter Reuell 508-626-4428 Metrowest Daily News
It's less than half the size of the state's largest prison, but the women's prison in Framingham houses by far the largest number of inmates with mental illnesses in the state, a Daily News review of state Department of Correction records shows.

Of the 645 inmates serving time in Framingham, 391 are classified as "open mental health cases," meaning more than one of every two inmates suffers from some form of mental illness.  That's nearly three times the state average.

Statewide, nearly one in four inmates in Massachusetts prisons suffers from some form of mental illness, ranging from mild depression to debilitating diseases such as schizophrenia and bipolar disorder.

To many, though, prison is simply one more stop in a revolving system that punishes those with mental illnesses for their symptoms while doing little to treat the underlying disease.

It's a carousel ride Leslie Walker knows all too well.

"I worked in the public defenders' office for 16 years," said Walker, executive director of Massachusetts Correctional Legal Services, a Boston-based prison advocacy group.

"A huge number of cases I had there were people that had already cycled through, and you knew they were going to come back.  I had one client, the day he got out of Bridgewater (State Hospital), he went to a liquor store with a knife and said, 'Give me all your money,' and he's now serving a double-digit sentence.

"Everyone knew it was preventable.  Why it ever had to happen in the first place is beyond me."

Nationwide, the mentally ill population behind bars has been growing for decades.  Some studies suggest as many as one in six inmates suffers from some form of mental illness.

In Massachusetts, as in other states, officials for years have struggled with questions of how to punish people with mental illness for the crimes they commit, yet still ensure they receive the services they need -- and how to ensure they continue to get those services after their release.

Of the 9,618 inmates in the DOC's 16 facilities, records from the state Department of Correction show 2,342, or about 24 percent, are classified as "open mental health cases."  Of that number, 1,652 -- just over 70 percent -- receive some sort of psychiatric medication.

But what explains the high number of Framingham inmates with mental illness?

Experts would point to the history of trauma, abuse, or domestic violence, as well as family issues experienced by the prison's all-female population, particularly if they have children.

Although prisons do have mental health professionals on staff, their numbers remain relatively low.

Statewide, the DOC employs just over 86 mental health professionals, or one staff person for every 110 inmates.

Factor administrators, nurses and other staff out, and the ratio jumps to one staff person for every 135 inmates, and all the way up to one staff member per 506 inmates when counting only the department's 19 psychologists and psychiatrists.

"It's a very big problem," Steve Kenneway, president of the Massachusetts Correction Officers Federated Union, said last week.  "There is a great deal of mental illness involved with every shift."

Correction officers do receive some mental health training, but it's largely focused on suicide prevention, not on spotting the symptoms of mental illness.

"By the time you're done with the class, you're suicidal, that's how boring it is," he said.  "When we realize a lot of people have mental illness is when we catch them hanging.  A lot of times, that's the first time we actually realize someone had a problem."

But if inmates with mental illnesses present a challenge while they're in state custody, most will eventually be released; and it's then that real challenges come into clear focus.

Once released, it can be a daunting task for those with mental illnesses to connect with local services, and with little access to counseling and virtually no access to medication many eventually wind up back in prison.

It's a revolving door that is clearly frustrating for officials like Lawrence Weiner, a regional mental health administrator at the state Department of Correction.

For years, Weiner worked with inmates with mental illnesses in Walpole and would try to connect soon-to-be-released prisoners with local clinics, but consistently met resistance due to inmates' uninsured status.

"(They'd ask), do they have a MassHealth card? Well, they're going to have to pay cash right off the bat," he said.  "You tell that to somebody going home...they would just take their supply of meds and hopefully it would bridge them to some point."

The unfortunate fact, Robert Kinscherff said, is that once released, former inmates are free to make their own choices.

"After their probation or parole ends, unless they're under a guardianship, they're presumed to be a legally free adult like the rest of us," said Kinscherff, assistant commissioner for forensic mental health services at the state's Department of Mental Health.  "Free to make those good choices and bad."

To help former inmates make those "good choices," Kinscherff said, the state created a half-dozen "forensic transition teams," which work to smooth the re-entry process.

Beginning six months before their release, the teams work to ensure inmates can connect with local services and are able to get any medication they may need once released.

"The forensic transition teams work on the idea that the first few months are the ones where people are more likely to go off their meds or stop treatment," Kinscherff said.

So far, the teams have proven a huge success.

In those crucial three months after their release, inmates who work with the teams are half as likely as those who don't to re-offend, he said.

Despite their success, the transition teams can't be used for all inmates.

Since the program was launched by DMH, inmates aided by the transition teams must meet specific guidelines and suffer from "serious and persistent" mental illness.

Those who don't meet that criteria aren't ignored, though.

A unique effort, launched by the DOC last year, allows every inmate to apply for health care benefits though MassHealth, the state's public health insurance plan.

Veronica Madden, the DOC associate commissioner for Re-Entry and Reintegration, said that inmates armed with that coverage can get prescriptions for medication and even make appointments with primary care doctors and mental health services.

"This is huge," Madden said.  "You can't make someone who's free make those choices when they go out on the street, but it's very different now.  They have the capability to get into a clinic, they can see a primary provider.  It absolutely does (give them a better chance.)"

It's a chance advocates like Walker say is long overdue.

"For my money, that's the best thing DOC has done on re-entry to date," Walker said this week.  "It's absolutely, hands-down, a miracle and a wonderful achievement, and there's not a prisoner who would disagree with it.

"I was thrilled when I heard that.  It's a great first step, but there's so much more to be done."

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