1. Mental Health Issues for the Incarcerated Patricia A. Streeter and Sandra Bailiff Girard Attorneys______________________________ Michigan Partners in Crisis Winter Meeting December 1, 2008

2. Overview Prisoner intake and screening for mental illness Prisoner intake and screening for mental illness Case examples, what can go wrong Case examples, what can go wrong Why it happens: outside expert findings Why it happens: outside expert findings on intake diagnoses, treatment not required, staffing

3. Adult Prisoner Intake Two primary reception areas Charles Egeler Reception and Guidance Center in Jackson for men Charles Egeler Reception and Guidance Center in Jackson for men Robert Scott Facility in Plymouth for women (soon to be Huron Valley) Robert Scott Facility in Plymouth for women (soon to be Huron Valley) Egeler FacilityScott Facility

4. Documents at Intake Presentence Report (PSI) A critical document, relied on for major MDOC decisions, including prior mental health treatment or conditions affecting mental functioning (CHI) Presentence Report (PSI) A critical document, relied on for major MDOC decisions, including prior mental health treatment or conditions affecting mental functioning (CHI) Sheriff’s questionnaire on jail behavior, relied on for continuity of mental health medications, notes on potentially suicidal behavior Sheriff’s questionnaire on jail behavior, relied on for continuity of mental health medications, notes on potentially suicidal behavior

5. Intake Testing The MMPI is no longer given to every newly committed prisoner The MMPI is no longer given to every newly committed prisoner Replaced with an in-person mental health/suicide screening Replaced with an in-person mental health/suicide screening Only some given a short-form version of the MMPI Only some given a short-form version of the MMPI

6. Case example The case of Chad Childers, a young man, history of paranoid schizophrenia The case of Chad Childers, a young man, history of paranoid schizophrenia Sent from Lapeer County jail with his diagnosis, his 3 meds, and a letter from his psychiatrist Sent from Lapeer County jail with his diagnosis, his 3 meds, and a letter from his psychiatrist

7. At Intake All medications were discontinued, later a few restarted All medications were discontinued, later a few restarted Was denied his diagnosis, given less severe one (mental disorder NOS) Was denied his diagnosis, given less severe one (mental disorder NOS) Given medical accommodation to be on a lower floor, placed at highest Given medical accommodation to be on a lower floor, placed at highest Mother in almost daily contact trying to get his medications restarted Mother in almost daily contact trying to get his medications restarted

8. Result Discovered having a psychotic break and had developed a serious infection (cellulitis) Discovered having a psychotic break and had developed a serious infection (cellulitis) Required acute psychiatric care but not provided because there is no where in the MDOC to provide acute psychiatric care also needing medical attention Required acute psychiatric care but not provided because there is no where in the MDOC to provide acute psychiatric care also needing medical attention Over a year later had still not fully recovered Over a year later had still not fully recovered

9. Another example The case of Timothy Souders The case of Timothy Souders Transferred to Southern Michigan prison Transferred to Southern Michigan prison His psychotropic medications were reduced from 5 to 3, and changed His psychotropic medications were reduced from 5 to 3, and changed Heat-related complications Heat-related complications Sent to segregation, actively psychotic, placed in 4-point restraint, died of dehydration Sent to segregation, actively psychotic, placed in 4-point restraint, died of dehydration

10. Prison Population 2008 and Projected

11. Mental Health Treatment Level Only 2.2% to 3.2% of prisoners entering the system accepted for admission (2007) Only 2.2% to 3.2% of prisoners entering the system accepted for admission (2007) Far below the national level 16% Far below the national level 16%

12. Findings of Outside Experts: 1. The current mental health system in the MDOC routinely and predictably fails to identify persons with serious mental health needs

13. Findings of Outside Experts: 2. The MDOC has never demonstrated the ability to identify, through its screening procedures, a percentage of prisoners for treatment consistent with national data on prevalence of mental illness in correctional settings. 2. The MDOC has never demonstrated the ability to identify, through its screening procedures, a percentage of prisoners for treatment consistent with national data on prevalence of mental illness in correctional settings.

14. Findings of Robert Cohen, M.D., Independent Medical Monitor, Hadix v. Caruso: Mental health care reflected a substantial failure to identify serious mental illness on intake Mental health care reflected a substantial failure to identify serious mental illness on intake The referring diagnosis of over half of a sample of incoming prisoners were downgraded by the RGC psychiatrists The referring diagnosis of over half of a sample of incoming prisoners were downgraded by the RGC psychiatrists

15. Recent MDOC Changes “Bridge” order to continue psychotropic medications at intake “Bridge” order to continue psychotropic medications at intake Including “mental retardation” Including “mental retardation” for additional consideration in prisoner discipline for additional consideration in prisoner discipline Additional considerations in prisoner discipline and placement in segregation Additional considerations in prisoner discipline and placement in segregation

16. Further Information Partners in Crisis website: www.mipic.org www.mipic.org Prisons & Corrections Section of the State Bar of Michigan, conference website: www.BalancingOurPriorities.org www.BalancingOurPriorities.org www.BalancingOurPriorities.org Patricia A Streeter, website: www.PatStreeter.com www.PatStreeter.com