Locking up the mentally ill

By LANCE TAPLEY  |  April 3, 2014

And state inadequacy is blatantly behind the request to send Michael back to prison. As Michael put it, “They wanted a bed” freed up.

A letter to the court from Assistant Attorney General Katherine Greason states: “Every patient who unnecessarily remains at Riverview represents a defendant whose time in jail is extended as he or she waits for a hospital bed to become available.” As the county sheriffs constantly complain, the jails are bursting with mentally ill inmates.

If Riverview can get rid of its most disruptive patients, it would be easier for the state to tell the feds the hospital is doing better — and, please, give us the $20 million back. Deficient care in the ward for difficult forensic patients was a big cause of the loss of funds. That’s where Michael spends much of his time.

In a hearing last November, Justice Marden, who was the trial judge when Michael was found not criminally responsible for the assaults on prison guards, found a contradiction, a circular logic, in what the state said in 2006 about Michael and what it’s saying now.

Eight years ago the state argued that, before getting psychiatric care, Michael should complete his sentence at the prison because it could always send him to Riverview on an emergency basis. But now, Marden noted, “Riverview is saying he’s not amenable” to treatment, so he should go to the prison. The judge adjourned the hearing until he could hear, he said, how Michael would be dealt with at the prison.

A personality disorder, which the state says Michael has, is usually deeply ingrained, often demonstrated by disruptive behavior, and — within and without the psychiatric profession — controversial. But the profession recognizes that personality disorders are serious mental illnesses and that they can be amenable to treatment.

“We treat people with personality disorders who are probably as ill as anyone we have,” said Robert Anderson, a psychiatrist at Kennebec Behavioral Health, a community mental-health agency, at the Augusta forum last fall.

Personality disorders, though, are not easily responsive to drugs. And if treatment works, it often includes a lot of psychotherapy. In other words, personality disorders are expensive illnesses to treat.

Prisoner advocates say that, because of the expense, corrections systems use personality-disorder diagnoses to deny or reduce prisoner mental-health care. That is part of a “diagnosis game,” said Alan Mills, an attorney at the Uptown People’s Law Center in Chicago and, nationally, a leading prisoner advocate.

Here’s an example of what could be called a diagnosis game: the law establishing Maine’s expanded state-prison Mental Health Unit — now 32 cells, up from 16 — was designed to take from the county jails their most-disruptive mentally ill inmates. But the law specifically excludes from the unit people who have personality disorders.

Joseph Fitzpatrick told me this is to ensure that these numerous inmates won’t take up all the space. The drafters of the bill, he said, wanted the unit’s beds reserved for patients who could be more easily treated with drugs.

WHAT MICHAEL FACES

If Michael is sent back to prison because Riverview doesn’t want to treat his personality disorder, and if the prison Mental Health Unit prefers not to treat personality disorders, his fate in prison would not be promising.

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