Mentally ill people
locked in, and out as a cascade of failures leaves mentally ill people
warehoused and vulnerable in New Jersey prisons
Sunday, December 19, 2004 BY JUDY PEET Star-Ledger Staff
Brad Deblasi went to prison because he robbed a gas
station, broke into a motel room for a place to sleep and tried to sell catnip
to undercover cops.
But Deblasi's fatal crime, his mother said, was being
mentally ill.
Deblasi, like many mentally ill people, failed to
adapt to rigid prison conditions and ended up in solitary confinement.
Overcrowding forced him to double up with a gang member doing time for
aggravated assault.
"Brad always did and said the wrong thing; that was part of his
illness," said Kathryn Deblasi, a nurse.
"Anybody could have predicted what would happen."
On
Forty years after
A three-month Star-Ledger analysis of the state's prisons, drawing on
interviews with state officials, mental health advocates, prisoners and
corrections experts, reveals a system that does little more than warehouse and
medicate thousands of mentally ill inmates.
Court papers, Department of Corrections documents and academic
research also describe a system that is underfunded
and ill-prepared to meet the growing needs of those it is
supposed to help. Consider:
Prisons are now the state's largest inpatient psychiatric hospitals and the
Corrections Department will spend $50 million next year to medicate 3,200
mentally ill inmates
with an array of psychoses.
The department releases, on average, 46 mentally ill prisoners onto
bars within a year.
Twenty-two states have special courts dedicated to finding alternatives to
prison for mentally ill offenders.
Mentally ill inmates are the most likely to be raped, beaten and robbed. This
year alone, two mentally ill inmates were killed by other prisoners at East
Jersey State Prison.
"We were so intent upon throwing away the key, we didn't notice we were
locking up too many people who don't belong there," says Assemblyman Peter
Barnes (D-Middlesex), a
retired FBI agent and chairman of the Law and Public Safety Committee.
And while the problems extend far beyond
Because of mandatory sentencing laws,
The number of inmates diagnosed with mental illness jumped 60 percent since
2000, and treatment costs nearly quadrupled.
Prison as the primary source of psychiatric treatment is inhumane and
inefficient, say a growing number of politicians, analysts and advocates. Many
of these reformers
pin hopes for change on acting Gov. Richard Codey,
who said he would make mental health reform a priority.
Corrections Commissioner Devon Brown, who was a prison psychologist 30 years
ago, hopes Codey will push for alternative programs
now in use in other parts of the country.
"The prison system was designed to provide order, safety and security ...
(but) we are now asked to pick up where every aspect of society has tried and
failed," Brown said.
"We are supposed to correct the incorrigible, punish the wicked and
rehabilitate the wretched. There has to be a better way."
A UNIQUE POPULATION
Mentally ill inmates are not the criminally insane. The rare few who
avoid prison because
they are "not guilty by reason of insanity," are sentenced to
Instead, many of the mentally ill inmates in prison were never diagnosed until
behind bars, criminal researchers say. Some are what used to be called insane,
but many are not so
easily categorized. Each case is individual, and symptoms can constantly
change.
Mentally ill inmates may be passive or hyper. They may seem normal, but a
little quirky, or suffer raging hallucinations. They may be confused or
combative. Some crave physical contact, while others can be frightened to the
point of violence by touch or even a stare.
Personalities can change instantly.
One of the few things they have in common is drug addiction, often a form of
self-medication, experts say. At least 70 percent of drug offenders in state
prisons are mentally ill, Brown says.
Male inmates are twice as likely as women to suffer from schizophrenia,
psychotic disorder or dementia. Women have much higher rates of depression,
bipolar disorder and post-traumatic stress disorder. Approximately 16 percent
of all male inmates in
are diagnosed as mentally ill. Among women inmates, nearly 40 percent are being
medicated.
On one end of the spectrum might be inmates like Deblasi,
whose illness could be misinterpreted as a bad attitude. Or Gregg Starace, 40, who has had debilitating anxiety for as long
as he can remember and whose childlike vulnerability would be irresistible to
prison predators.
On the other end are inmates like Alexandra Osterman.
Osterman says she was first hospitalized for
psychosis as a teenager. She was diagnosed with a severe personality
disorder, stabilized on medication and released. She says she had nowhere to go
and ended up on the streets.
She stopped taking her medication and switched to heroin. It was cheaper and
better at quieting the voices in her head, she said. Fire somehow eased her
anguish.
In 1991, Osterman was convicted of torching a
She was sentenced to 40 years in Edna Mahan Correctional Facility for Women in
prison doctors recognized her mental illness. Ask her, and she'll push up her
prison-issue sweat shirt and pants leg to display a horrifying pattern of mutilation
begun in jail: Dozens of scars crisscross her forearms and wrists, but the
worst are the mottled brown scars seared into her right calf.
"The cutting helps quiet the voices in my head," she says in a soft,
chilling monotone during a cellblock interview. "The burns, well I was
more serious about killing myself those times."
Osterman, 33, and 12 years into her sentence, is
smart, strong-willed and profoundly psychotic. She is among 359 inmates housed
in specialized psychiatric units at four of
the nine adult penitentiaries.
The state has been under a court order since 1999 to build mental health units
in all prisons, but Brown said the state doesn't have the funding.
THE BEST OF INTENTIONS
The decline of the mental health system began with the
best of intentions; everyone agreed
too many insane asylums were snake pits of neglect and abuse.
In 1963, President John F. Kennedy
signed legislation creating the community mental health system. With better
diagnoses and breakthroughs in psychotropic medication, the
idea was to remove the mentally ill from institutions and place them in the
community, where they would get support and treatment and live productive
lives.
During the next four decades, asylum populations in
Those deinstitutionalized did not, however, go directly to jail.
Patients were simply let out and expected to hook up with the new community
mental health system. From the beginning, however, community treatment was
grossly underfunded. It has hobbled along since, said
Debra Wentz, CEO of the
Association of Mental Health Agencies of
Instead of a small army of psychiatric workers originally envisioned to help
the mentally ill stay on their medication and find work, shelter and friends,
Wentz said there is a
fragmented system that serves 300,000 people a year but misses hundreds of
thousands more.
People lost in the system often end up on the street, where they self-medicate,
absorb the sociopathic culture of gangs and pick up
an assortment of related health problems, said
Elaine Goodman, a law enforcement educator for the National Alliance for the
Mentally Ill.
They are among the three-time drug losers, the prostitutes and the petty
thieves, the people most affected by mandatory sentencing laws.
A report issued last fall by Human Rights Watch estimated that thousands of
mentally ill people are imprisoned for crimes "they might never have
committed had they been able
to access therapy, medication and assisted-living facilities," all of
which are cheaper in the community than in prison.
"Psychiatric hospitals, bad as they were, at least had some work ethic.
They taught people to be responsible and to care for each other," Wentz
said. "On the street, it's different.
By the time these people are diagnosed as mentally ill in prison, their
behavioral problems are also massive.
"And they are now in a place -- with its harsh rules and paramilitary
structure -- that almost guarantees the mental illness will get worse. It's a lose-lose situation."
In the past, Brown noted, "there was discretion for the courts to give
these people a break, but new mandatory sentencing leaves no option but
prison."
They are people like William Giammusso, 37, the
counter. Giammusso
counts the number of letters in words, sentences, paragraphs:
"Quick dissolve Maalox -- 19 letters. General
anxiety disorder -- 22 letters. My earliest dreams were nightmares about
counting."
In his adult life, Giammusso says he received 18
different psychiatric diagnoses, including obsessive compulsive disorder and
general anxiety disorder. He claims he was arrested 23 times, once for forging
a prescription for 913 Xanex tablets. "I liked
the number," he said.
What Giammusso does best, he says, "is annoy
people to the point where they want to hurt me." That is why he likes
prison, "because it is safer than the streets."
Protection means more guards. Staffing and expensive medications contribute
heavily to the $45,000 a year it costs to incarcerate a mentally ill inmate;
sane inmates cost $28,000.
Prison officials put Giammusso in the general
population, but he did, indeed, annoy too many violent people. He is now in the
psychiatric wing at South Woods Correctional Facility in
Giammusso has been let out before, but he said he
never had enough money to pay for his medication. As a drug felon, he wasn't
eligible for public assistance.
Paroled murderers can receive public funding for housing, job training and
prescription medications. Under federal law, drug felons cannot.
So Giammusso keeps falling off his medication and
coming back to prison, each time for a longer mandatory minimum sentence as a
repeat offender.
The majority of mentally ill inmates, like Giammusso,
are nonviolent, Brown said. Others are behind bars for violence, including
murder. What is surprising is how few inmates had
any contact with the mental health system before they became violent.
According to an analysis by the Center for Mental Health Services and Criminal
Justice Research at
"There was rampant, undiagnosed trauma," said Nancy Wolff, who
authored the study. "They are poor, fragile, illiterate, often
neurologically impaired, jobless, sick and have been victims of things (such as
rape and violence) that you or I could never have survived."
"But nobody noticed until they lashed out, and then it was too late."
INEXCUSABLE TREATMENT
By the 1990s -- when the state closed
undercover investigation by a state senator named Richard Codey
-- the Corrections Department was foundering in a sea of seriously mentally ill
inmates.
The department had few psychiatrists. Some were improperly licensed.
Corrections officers weren't trained to recognize mental illness. There were no
special treatment cells.
Inmates often were improperly medicated and much more likely than other
prisoners to end up locked down in isolation, according to court documents.
Osterman -- the woman with the horrifying pattern of
self-mutilation -- was one of those inmates.
Between 1992 and 1997, Osterman cut herself,
overdosed on medication, tried to hang herself, set
herself on fire and ingested objects that included a belt buckle and eyeglass
lenses, her lawyers said.
In response, prison officers placed her in solitary confinement for weeks, even
months at a time. She was beaten, stripped naked and locked down in a cell
without a toilet, 24 hours a day.
When her illness got worse, she was placed in a restraint chair for 17 hours.
She managed to get free and set herself and the chair on fire. The Corrections
Department charged
her $400 for damage to the chair, but it never gave her a psychological
evaluation.
Eventually, Osterman's disease soared out of control.
She was temporarily shipped off to Ann Klein, where she met Patricia Perlmutter, an attorney from the Mental Health Law
Project at Seton Hall. The law clinic was investigating prison psychiatric
conditions.
Osterman became a lead plaintiff in a landmark
class-action case, C.F. vs. Terhune, which was filed
early in 1996.
In a report prepared for the court, Dennis Koson, a forensic psychiatrist hired by plaintiffs, called
conditions for mentally ill people in
have seen in my 15 years of inspecting correctional systems nationwide."
"The mere existence of these human beings in such states of extreme
crisis demonstrates the gross inadequacy of the crisis intervention at the
NJDOC," he said.
Koson described conditions in which severely mentally
ill inmates were three times more likely than other prisoners to be placed in
administrative segregation, under conditions he
said were almost guaranteed to precipitate psychosis.
They were kept in their cells for days at a time, some lying in their own
waste, mute or incoherent. They were taunted by corrections officers,
terrorized by other prisoners and
ignored by "grossly inadequate" medical staff, Koson
said.
In 1999, the state, without admitting any wrongdoing, agreed to massively
upgrade standards of care in 10 categories involving mentally ill inmates.
Among the categories were screening, corrections officer training, crisis
stabilization, patient care, staffing and policies.
Monitors tour the prisons four times a year to assess improvement. To date, the
state has reached compliance with only two of the 10 standards: screening and
officer
training.
Perlmutter and other plaintiff attorneys say they are
frustrated with the delays in implementing the settlement. The monitoring
reports detail the problems, but the
Corrections Department refuses to release the reports, citing a confidentiality
agreement included in the settlement.
Attorneys also are banned from discussing ongoing problems. But they do say
that -- after 50,000 hours of training and $200 million invested by the
department -- conditions have
improved for mentally ill inmates.
There are now special psychiatric wards or cellblocks in four of nine adult
prisons, and three facilities have crisis-stabilization units equipped to
handle active psychosis. And there have been major improvements during intake,
the first 48 hours of screening of new prisoners.
All new inmates now are given complete physical and psychological evaluations
by licensed doctors. If mental illness is diagnosed, individual treatment plans
must be
drawn up. Therapy is scheduled, although corrections officials admit that talk
therapy in prison is extremely limited.
Inmates often have concurrent problems, such as addiction, disease and mental
retardation. Those who appear to be functional are placed in the general
population, which means
they stay on regular cellblocks.
Others, whose mental conditions are deemed too fragile, are put in one of the
mental health units in Edna Mahan,
It is a constantly shifting population. Some people deteriorate and are moved
to the crisis unit at New Jersey State Prison in
"It's not so bad if you are pretty nuts, because they treat you better on
the special units," said Giammusso, the
compulsive letter counter. "The problem is if you are really
crazy, which they are not equipped to deal with. Or if you are mentally ill but
it doesn't show so much. Then you end up in general, and things can get really
ugly."
For Deblasi , then 19, things got ugly soon after he arrived at the
Garden State Reception and Youth Correctional Facility in
Deblasi's mental health problems dated from
kindergarten, his mother said, when he compulsively took "all the
teacher's pens, or all the paper clips." Medicated for most
of his life, he spiraled out of control in his late teens, falling into drug
addiction and petty crime.
Those crimes escalated in 2002 when he joined in on a gas station robbery. Deblasi carried an empty pellet gun, which his mother said,
"the clerk laughed at." His partner carried
a baseball bat and used it to beat the clerk.
Deblasi, as co-conspirator to the assault, received a
12- year mandatory minimum sentence. Accompanying him to prison was a report
from
The report suggested Deblasi be treated with Ritalin,
a stimulant Deblasi already was taking, and Lithium,
an antidepressant.
Kathryn Deblasi said her son never received those
drugs, although he was on some medication. The Corrections Department refused
to discuss his case, citing confidentiality.
Terrified in prison, Deblasi, a suburban kid from
"Of course the guards found it," his mother said. "From then on,
things were a nightmare."
Deblasi was punished with a transfer to
Unable to follow orders, Deblasi
was locked down in administrative segregation, where inmates stay in their
cells 23 hours a day.
Administrative segregation is what used to be called solitary confinement.
Brown said, however, that the swollen prison population forces the department
to double up in
solitary.
"We take the mental condition of the inmate into
account when selecting a cellmate," Brown said.
Deblasi was locked down with Rayshon Gaddis, a reputed gang member.
At
It took four months for the state medical examiner to complete the autopsy. The
cause of death was blunt trauma. The weapon was a fist.
The day before Thanksgiving, Gaddis was indicted for murder.
WHAT NEXT?
Last month, Brown announced a "breakthrough," in inmate mental health
treatment. The department entered a partnership with the
Unlike private contractors, UMDNJ is a nonprofit corporation. Eliminating the
profit motive is expected to upgrade care.
The university already announced plans to expand therapy options and create
internships and fellowships to increase staffing at the prisons.
Brown, who brokered the deal, said he was "delighted that we are finally
coming up to par with other states in prison mental health care."
But he warned that up to par is not enough.
The Corrections Department administers approximately 5.3 million doses of
psychotropic medication every year, including antipsychotics,
antidepressants and antimanics, in addition to drugs
to treat often serious side effects of the psychotropics,
such as tremors and convulsions.
The medications are extremely complicated. Often seriously ill inmates are on a
smorgasbord of drugs, many of which have potent side effects. Some psychotropic
drugs take weeks to show their effect and can be affected by physical changes.
A schizophrenic inmate stabilized on antipsychotics,
for example, could spiral out of control if bullied by a corrections officer or
threatened by another inmate. That
person might become actively paranoid, hear voices, lose complete contact with
reality or become suicidal.
Against odds, Brown said, "some mentally ill people do get better in
prison, although it is pitiful that people have to come to prison to get
treatment.
"The problem then is, so what? Without programs to help them continue
treatment out of prison, what's the point?"
Currently , there are two parole officers in the state
trained to work with mentally ill parolees.
The special parole officers are in
Brown said he has "no illusions" that the majority of them will end
up back in prison.
"Not only aren't we curing anyone, they are coming in sicker than they
used to," Brown said. "It is time for all our brother and sister
agencies of government to work together
to change the system.
"It's time for change. If not now, when?"
Copyright 2004 http://www.NJ.com. All Rights Reserved.
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