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Bar News - June 22, 2007

Mentally ill filling the jails: Official says facility needed



The following article is the first in a two-part series by Elizabeth Dinan, writing for the Portsmouth Herald.  She is looking at crime and mental illness and mental illness and homelessness in New Hampshire and the impact they have on the state prison system.  Part 2 will run in the next issue of NH Bar News. 


New Hampshire needs a secure psychiatric facility because the mentally ill don’t belong in jail, according to Al Wright, superintendent of the Rockingham County House of Corrections.


“We are not a mental health facility. We don’t have psychiatric nurses, and we don’t have psychiatric caregivers,” Wright said. “The mentally ill are supposed to be held in the least restrictive environment by law. This is a confinement facility where people are sent for punishment.”


In spite of that, U.S. Department of Justice statistics show 64 percent of local jail inmates, 45 percent of federal inmates, and 56 percent of people incarcerated in state prisons have some form of mental illness.


The county jail in Brentwood is no exception. And inmate Jason Fuller is the latest example.


Fuller’s history of mental illness reached life-and-death proportions at Portsmouth Regional Hospital April 24 when he slashed his wrist, threatened to kill an EMT with a knife, and asked a Portsmouth police officer to shoot him.


It could be months before the resulting felony charges against Fuller go to a grand jury and, if he’s indicted, months more will pass before he goes to trial. So unless someone posts his $20,000 cash-only bail, he’ll remain locked in the county jail.


And if he’s found guilty, he’ll likely live there for the term of his sentence.


Meanwhile, Fuller’s public defender is seeking his commitment to a state psychiatric unit in Concord. But Wright’s experience has shown beds there are scarce.


The state psychiatric hospital bed count is 325, Wright knows off the top of his head, down from 3,000 in the 1960s and 1970s. Meanwhile, the state’s overall population has doubled, he reminded.


“We need a secure psychiatric unit inside a state prison,” Wright said. “I’ve got a crisis list at all times, and the most needy are those with mental illness. I don’t think that’s why the county jail exists.”


That’s why Wright spent 14 months volunteering on a committee that ultimately recommended establishing a secure psychiatric unit at Concord’s abandoned Tobey Building. The proposal had the backing of the Department of Health and Human Services and the state Corrections Commission, but was given the thumbs down in March by Gov. John Lynch as cost prohibitive.


The price tag, Wright said, would be $48 million to $68 million, phased in over six years. The result, he said, would be a staff of 223 — mental health workers and security — for a “high-maintenance” population of mentally ill lawbreakers, numbering about 68 at a time.


“Rockingham County certainly could fill it,” he said.


And if you don’t call it a prison or a jail, Wright said, the mentally ill who are committed there remain eligible for Medicare and Medicaid. Once they go to jail, “they lose all benefits,” he said.


Ill and on the street


When the mentally ill are also homeless, said Portsmouth Police Chief Michael Magnant, his department is often told by social service agencies, “We don’t have the beds.”


“That’s why I’m the only act in town,” Wright said.


Helen Watkins, the county jail’s mental health counselor, said she knows of one residential psychiatric facility on the Seacoast — a home in Greenland with eight beds for people who are largely developmentally disabled, as opposed to having mental illness.


Watkins cites data showing the cost of releasing a mentally ill inmate without any counseling support at $35,000 per client because of cost associated with recidivism. With the help of a case manager, the cost goes down to $3,000 each, she said.


A study by the American Psychiatric Association of New York’s homeless mentally ill population concluded that the mentally ill homeless have a higher arrest rate for violent and nonviolent crimes than “domiciled” mentally ill people.


Watkins suggests a local, stopgap solution of a mental health day-care center.


It’s a poorly kept secret, she said, that mentally ill people who are homeless use hospitals, libraries and other public places to wash up and hang out when they are turned away during the day from the local homeless shelter.


“This is a non-funded thought,” she said. “But that’s OK. I’ve crossed bigger hurdles.”


At 63, Watkins said it’s a goal she’d like to accomplish before retirement. She suggests someone may like to donate a home for the purpose.


“If you don’t ask, you don’t receive,” she said.


She’s also spoken with representatives from Habitat for Humanity asking if they’ll build a home on the Seacoast for mentally ill women.


There is more money for women, she said.


On Thursday, Wright said the latest news from the governor’s office is a proposal for another committee to study the concept of a secure psychiatric unit, this time at a cost of $500,000.


“I suppose it’ll be outsiders. They know better,” Wright said, explaining the half-million dollars. “Give me the 500 and I could buy a hotel somewhere.”


Give Wright an old hotel, he said, and he’ll convert it into a secure facility for the mentally ill.


Wright has also been asked to speak at Harvard University on the subject of mental illness and crime.


“This goes way beyond our ability,” he said of corrections departments. “It’s a fact that needs to come to people’s attention.”


Part 2 of the series looks at challenges to the Portsmouth Police Department and recidivism associated with mental incompetency findings.


This article is reprinted with permission from the author and from the Portsmouth Herald in which it appeared on May 3, 2007. 


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