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T.R.  v.  South  Carolina  Department  of  Correc7ons  

November  3,  2014  

Stuart  Andrews  Nelson  Mullins  Riley  &  Scarborough  LLP  

1320  Main  St.,  17th  Flr.  Columbia,  SC  29211  

www.mentalhealth4inmates.org  

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T.R.  v.  South  Carolina  Department  of  Correc7ons  January  8,  2014:    Final  Order  

Judgment  for  Plain5ffs:  

! Class  of  3,500  Inmates  with  Serious  Mental  Illness  ! ProtecNon  and  Advocacy  for  People  with  DisabiliNes  

Ruling:  

! Inmates  with  serious  mental  illness  exposed  to  substanNal  risk  of  serious  future  harm.  

! SCDC  has  been  aware  of  risk  for  over  12  years  and  has  failed  to  take  Nmely,  reasonable,  or  effecNve  steps  to  abate  the  risk.  

! SCDC  to  present  remedial  plan  in  180  days.  

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Have  Prisons  Become  Our  Hospitals?  ! Dorothea  Dix  to  Deins5tu5onaliza5on  

•  1850s  –  First  U.S.  Mental  Health  Hospitals  

•  1955  –  1  Psychiatric  Bed  for  Every  300  U.S.  CiNzens  

•  2005  –  1  Psychiatric  Bed  for  Every  3,000  U.S.  CiNzens  

! Prison  Beds  Replace  Hospital  Beds,  Community  Services  

•  Ten  Times  More  Persons  with  Serious  Mental  Illness  in  Jails/Prisons  than  Hospitals  

•  40%  of  Persons  with  Serious  Mental  Illness  in  Jails/Prisons  

•  15-­‐20%  of  Incarcerated  Persons  have  Serious  Mental  Illness  

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Judge  Baxley's  Findings  

! "Thus,  over  70,000  cases  of  every  imaginable  sort  have  come  to  this  Court  over  the  years.    This  case,  far  above  all  others,  is  the  most  troubling."  

! "Inmates  have  died  in  the  South  Carolina  Department  of  Correc5ons  for  lack  of  basic  mental  health  care,  and  hundreds  more  remain  substan5ally  at  risk  for  serious  physical  injury,  mental  decompensa5on,  and  profound,  permanent  mental  illness."  

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Legisla5ve  Proviso  CommiSee  Report  October  2000  

! "First  and  foremost,  inmates  with  mental  illnesses  are  not  receiving  adequate  treatment  for  their  illnesses  and  oUen5mes  leave  prison  worse  off  than  when  they  entered."  

! "Second,  the  public  is  being  short-­‐changed  because  these  inmates  are  eventually  released,  only  to  return  to  their  local  communi5es  and  commit  more  crimes  secondary  to  inadequately  treated  mental  illnesses."  

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July  2003  DMH  Report  

! Psychiatric  services  "are  in  disarray"  due  to  understaffing,  resul5ng  in  "extremes  of  poor  care,  inhumane  treatment  and  dangerousness  .  .  .  ."  

! Medica5ons  abruptly  discon5nued  "without  approval  of  psychiatrists  or  other  clinical  staff."  

! Inadequate  programming.  

! Mentally  ill  inmates  in  solitary  "receive  liSle  or  no  mental  health  treatment."  

! No  QA/QI  program.  

7  Pltfs’ Ex. 106

Chronic care for prisoners with disabilities does not conform to nationally-accepted guidelines for mental illness… The lack of a comprehensive chronic care program puts patients at significant risk of harm.

PLTF. EX.

106 7  

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   Sufficient  Number  of  Trained  Mental  Health  

Staff  

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Ratio of Psych/NP FTEs to Area and Outpatient Mentally Ill Inmates

APA Recommended Psych/NP FTE Ratio

1:500   1:1000  1:1  

PLTF. DEMO.

PX24

10  10  

1:75,000  1:1  

Source: Testimony of Drs. Haas, Metzner, and Patterson

Kentucky South Carolina

PLTF. DEMO.

PX147

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Crisis  Interven5on  

Program  

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Crisis  Interven5on  

!  Inadequate  Management  of  ASempted  Suicides  and  Self-­‐Injurious  Behaviors.  

!  Non-­‐Therapeu5c,  Puni5ve  Environment.  

•  Disciplinary  segregaNon  units  •  No  contact  with  psychiatrist  •  Limited  counselor  contact  

•  Strip  cells  !  Excessive  Reliance  on  Security  Responses.  

•  Use  of  force  •  SegregaNon  •  Disciplinary  sancNons  

!  Alterna5ve  CI  Placements  at  Lieber  2008-­‐10.  

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Crisis  Interven5on  

! Condi5ons  of  CI  Segrega5on.  •  Stripped  out  –  inmates  and  cells  

•  Maybe  paper  gown,  security  blanket  

•  No  maaress  

•  Cold  cells  •  Foul  cells  

– Human  waste,  blood  

•  No  showers  or  hygienic  care  ! Stays  Up  to  14  Days.  

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Non Mentally Ill Inmates

Sources: Pltfs’ Exs. 227, 357

Mentally Ill Inmates

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PLTF. DEMO.

PX30

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Overview  T.R.  V.  SCDC:    Remedial  Plan,  180  Days  

Adequate  Mental  Health  Staffing  

! Psychiatrists  ! MSWs  and  Psychologists  

! Trained  Clinical  Counselors  Capital  Improvements  

!  Infirmary  Sefngs  for  Crisis  Interven5on  

!  Space  for  Individual/Group  Therapy  

Reform  Prac5ces  

!  Reduce  Use  of  Force  !  Reduce  Long-­‐Term  

Segrega5on  

!  Increase  Staff  Training  !  Meaningful  Quality  

Review  

!  Improve  Iden5fica5on  System  

!  Improve  Administra5on  of  Medica5ons  

!  Develop  Reliable  IT  System  

!  Improve  Crisis  Interven5on  

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Web  Sites  

"  www.mentalhealth4inmates.org  "  hSp://www.free-­‐5mes.com/cover/horrors-­‐behind-­‐these-­‐

walls-­‐012214  

"  hSp://m.theatlan5c.com/na5onal/archive/2014/01/when-­‐good-­‐people-­‐do-­‐nothing-­‐the-­‐appalling-­‐story-­‐of-­‐south-­‐carolinas-­‐prisons/282938/  

"  Charleston  The  Post  and  Courier  3-­‐part  series:    hSp://www.postandcourier.com/ar5cle/20140412/PC16/140419720;  hSp://www.postandcourier.com/ar5cle/20140412/PC16/140419801;  hSp://www.postandcourier.com/ar5cle/20140413/PC16/140419799;  hSp://www.postandcourier.com/ar5cle/20140414/PC16/140419653