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Mental health Don’t treat psychiatric patients like criminals

Portsmouth Herald - 9/25/2016

Once again New Hampshire’s Health Human Service and Elderly Affairs Committee is meeting to debate the issue of housing individuals in the Secure Psychiatric Unit of the New Hampshire State Prison. They’re in the SPU because they have been assessed to be a threat to themselves or others, but have never been tried or convicted of a crime.

There have been as many as 15 patients at a given time in the unit. Though caregivers in the prison are nurses, social workers and psychiatrists, they are employed by the Department of Corrections and the facility is overseen by the Department of Corrections. Inmates are under the control of corrections officers – prison guards. It is not a hospital and patients are not afforded the benefits of the Patients Bill of Rights.

As a state legislator and a member of the HHS and Elderly Affairs Committee, I listened to families of inmates and a former inmate talk about what it’s like to be in the unit. Visitors must submit to a criminal background check – even in the instance where a parent who wants to visit his child is a police officer. They pass through metal detectors and adhere to strict visiting schedules. Parking is a distance away which creates problems for elderly visitors or those who may have trouble walking. When entering the prison, family members pass by razor wire and are exposed to the repeated clicking and clanging of metal doors locking behind them. There are times when family members or others visit and are told that they cannot see their loved ones because of “security” issues. No further explanation is given.

Through the years there have been numerous proposals by commissions and committees addressing the need for an alternative to the SPU. Each time the N.H. Legislature has voted down legislation introduced to correct this injustice. As a steadfast advocate for families coping with loved ones in the SPU, Hampton Rep. Renny Cushing, along with the Treatment Advocacy Center, and the New Hampshire branch of the American Friends Service Committee have filed a complaint with the U.S. Department of Justice Civil Rights Division seeking an investigation into this practice. Rep. Cushing has stated the problem of housing mentally ill people in a prison setting is both “symptom and symbol” of a larger picture of mental health insufficiencies in New Hampshire.

There was a time in the late 1980s and early 90s when New Hampshire was recognized as a leader in the transition from the institutionalization of people with mental illness to a system of community based care. As years went by, fewer dollars were budgeted and the system began to deteriorate. Underfunded community health services prompted the creation of a 10-year plan by the Department of Health and Human Services. Implementation of the plan stalled and stumbled. As a result, the Justice Department intervened and concluded New Hampshire was in violation of the Americans with Disabilities Act in 2012. In response there have been some important changes made in recent years including increased mental health funding, housing for those living with mental illness in community settings, telemedicine laws making it easier for patients to access psychiatric help in areas where there is a shortage of psychiatrists, and continued access to medications that are working without having to get prior authorization.

While these important initiatives are benefiting many people coping with mental illness, there is much work to be done to restore our state to its former place as a leader in the delivery of mental health services. Currently it is not unusual for patients experiencing an acute mental health episode to be held in hospital ER’s for up to five days while waiting for an available bed to open up in an appropriate psychiatric setting. Our prisons have become de facto treatment centers for those suffering from mental illness. It is estimated that a full 25 percent of inmates in New Hampshire jails are on psychotropic medication. Homelessness, unemployment, domestic violence and substance abuse issues are just some of the problems that are often secondary to mental health issues.

As a state legislator I am committed to keeping the issue of mental health in the forefront of the next legislative session. The stigma of mental illness is still with us. We need to stop compounding it by treating some of our most vulnerable citizens like criminals. And we need to adequately fund community based mental health programs.

—The writer is a Democratic state representative from Portsmouth’s Ward 5 and a member of the Health and Human Services and Elderly Affairs Committee.