Welcome Back to The Dark Ages…

This past week, the nation was shocked to learn of the story of Stephen Slevin.

Slevin

After suffering from years of severe depression, Mr. Slevin (59) awoke one morning and decided to drive cross-country with no set route or destination in mind. On August 24, 2005, he was arrested on aggravated DWI charges and for driving a vehicle that he did not own, which landed him in the Dona Ana County (New Mexico) Detention Center. He was immediately placed naked, with only a suicide smock on, into a padded cell to await processing. Slevin was then moved for 2 weeks of observation before being placed in solitary confinement. For the first three months living in a segregation cell, Slevin was able to write letters; some to his sister and others were sent to his very own jailers politely requesting assistance for medical attention, trouble sleeping, and increasing panic attacks.  Within 3 months of solitary confinement, he became delirious and had profound symptoms of psychosis. Slevin lost the ability for most meaningful communication, was no longer able to write, and spent the entirety of his days rocking back and forth. Initially, he was able to get out of his small cell a few times a month, but he eventually would go for periods up to four months without ever walking out his cell doors. Slevin was given food and medication, but was not bathing, had fungus growing on his skin, developed bedsores, and even had to perform his own tooth extraction due to severe decay.

During May 2007, Slevin was sent to a psychiatric facility for two week where there was drastic improvement in his cognitive and mental functioning due to the proper care, socialization, and medication he was provided. Unfortunately, he was returned to his segregated cell at Dona Ana Detention Center, where he  once again rapidly decompensated. On June 22, 2007, Slevin’s case was finally brought before a judge and was eventually dismissed.

The news story that swept the nation was not the shocking fact that Stephen Slevin spent 22 months in solitary confinement under inhuman conditions; instead, it was headlines of him being awarded $15.5 million in a lawsuit that caught the media’s eye. Slevin, who was recently diagnosed with lung cancer and given 1 year to live, suffers severe post traumatic stress that this windfall of money can only offer minimal relief from.

One has to wonder how many other Stephen Slevins are currently lost in our criminal justice system, not receiving proper care, treatment, or case management? A quick search on the internet yields a startling number of local news stories, blogs, and videos on this very topic. Most of these tend to be “after the fact” stories… like those of Armando Cruz or Tony Lester… who’s suicides could have been prevented with the appropriate mental health care received prior to or during their incarceration.

I am left wondering who is to blame for the downfall of our system? The US is plagued with ineffective policy, legislation, and improper funding towards every aspect of mental health treatment and care; maintains a longstanding stigma on the incarcerated and mentally ill;  supports a broken punitive-based judicial system; and endorses the misguided privatization of our very jails and prisons.  The answer appears to be as vague as the path to fix it, as this has become everyone’s problem – from policy maker, to consumer, to tax payer.

For informational purposes, I’ve decided to include two of my favorite videos on this very matter…

FRONTLINE: The New Asylums (2005)
America’s severely mentally ill, who once would have been in state psychiatric hospitals, are now in state prisons. Why is this happening? And what is mental health care like behind bars? FRONTLINE goes deep inside Ohio’s prison system to examine a troubling and growing issue.
Direct link where additional information and continuous video play pack available HERE.

Fault Lines: Mental Illness in America’s Prisons (2009)
Al Jezeera’s correspondent Josh Rushing goes deep inside one of the largest prison systems in the United States to look at the criminalization of the mentally ill.

There is no single answer that can once again take us back out of the Dark Ages in how we mistreat and subsequently criminalize the mentally ill. But in the coming weeks I look forward to exploring one significant step that we can take as a nation to address our most vulnerable people – the movement towards the creation and regulation of Mental Health Courts throughout all of our federal, state, and local jurisdictions!

From “Old Dominion State” to “New & Improved Dominion State”

Born and raised a proud Virginian, I’ve unfortunately come to know that my state has a checkered history of making legislative decisions that are most definitely not for the “common wealth” of it’s constituents.

While doing research on the state of mental health treatment in Virginia, I have come across numerous statistics that corroborate what we as social workers see all too often.

The National Alliance on Mental Illness (NAMI) currently gives Virginia a grade of “C” (on an A – F scale), in its treatment of the mentally ill. See the breakdown below:

NAMI Score Card VIRGINIA

On a good note, Virginia was able to improve from it’s 2006 rank of “D” and is currently offering more services to the mentally ill than many states with dismal numbers like Arkansas, Kentucky, Mississippi, South Dakota, Wyoming, and our dear ol’ neighbors, West Virginia.  Virginia now is on the positive side of the national average; however, there still is a great amount of room for improvement.

Currently Virginia’s urgent needs towards mental health include:

  • Expand community services, including case management and crisis services
  • More housing options
  • Health care coverage for uninsured persons that includes mental health care

In recent years, the Treatment Advocacy Center has also identified another crucial barrier to treatment of mental illness. They specifically looked at the disproportionate number of mentally ill incarcerated within each of the 50 states. Regarding the odds of a seriously mentally ill individual being in jail or prison compared to a hospital, the odds in Virginia was 3.6 to 1 that they would be incarcerated. This means that in 2004–2005, throughout the state, there were almost four times more individuals with serious mental illnesses in jails and prisons than in hospitals. Virginia was ranked #32! Ouch.

In 2008 a Virginia state mental health commission estimated that “15 percent of all inmates in states prisons and jails are seriously mentally ill.” Roanoke County Sheriff Gerald Holt said it was 25 to 30 percent in his jail. In Virginia Beach, Sheriff Paul Lanteigne “estimated that it typically takes at least six months to find an available bed for a deranged inmate at Eastern State Hospital or a nearby psychiatric center. Scores of people are sitting in his jail today, long after they would normally have been released on minor charges, because they are too sick to be freed.”

In summary, national surveys and state reports both suggest that at least 15–20 percent of jail and prison inmates are seriously mentally ill. We have thus effectively returned to conditions that last existed in the United States in the 1840s:

Mentally Ill Incarceration Over Time
It is imperative that we as dedicated Virginians, work to stop the “frequent flyer” cycle of mentally ill being incarcerated versus receiving necessary treatment. This will come from utilizing assisted outpatient treatment, implementing mental health courts, maintain critical assessments and evaluations of state and local policies and programs, shift state and federal funding to address current service gaps, and work on reliable prevention and intervention services to address mental health before an individual is deemed dangerous.

When Tragedy, Mental Health Policy & Practice Intersect…

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For six months I’ve had the opportunity to intern as a therapist at a children’s acute psychiatric facility. It didn’t take long to see the competing agendas of all the key stakeholders: clinicians from various fields, parents, patients, the hospital, and insurance. I’ve bared witness to numerous parents begging and pleading for the mental help that their child so desperately needs, and listened to the heartbreaking stories of the children who struggle on a daily, or even hourly basis, to pretend to exist as “normal.” I’ve seen policies affect the quality of care, most specifically how insurance dictates a patient’s treatment and length of stay. I sometimes feel as though we spin a roulette wheel and see where chance lands each child on what service we’ll be allowed to provide, regardless of symptoms they present. I’ve sat around tables finagling with billing employees on a single word choice in a health record and how that could negatively impact coverage. The hospital even conducts strong-armed meetings, where the message is quite clear – more patients equals more money and better reporting numbers. I’ve seen pressure to lower admission criteria, which robs the bed of another child in crisis. I’ve also seen countless parents adamantly protesting the release of their child (and sadly, the mental health clinicians typically agree), yet show up on discharge day putting up yet another brave front and knowing we’ll probably see each other again next week. The clinicians always sense the fear, anxiety, and apprehension in the parents, and empathize with the utter lack of options throughout the state. Until there is a day where policies and control over care are put back into the hands of the patient, family, and clinicians, I know that other tragedies loom around the corner.