A study of inmates with “serious functional impairment” (SFI) found that at least nine people in Vermont prisons are in need of hospitalization. The independent study to determine if the needs of inmates with SFI were being met underscored a number of other unmet needs.
The project was an important “first step,” advocates and the survey administrators agree, but they say it was constrained by a lack of funding and time. This is the first time such a review has been conducted by an external agency rather than the Department of Corrections.
“This is scratching the surface, but it’s the first time it’s been scratched,” said Robert Appel, outgoing executive director of the state’s Human Rights Commission.
The study was overseen by the Agency of Human Services at the behest of the Legislature through Act 87, and was conducted by Department of Mental Health (DMH) staff, and led by outgoing medical director, Dr. Jay Batra.
According to the study, there are nine inmates in need of “acute hospitalization for care,” but both Batra and Doug Racine, secretary of Human Services, admit it’s unlikely that is the full scope of the problem. About 36 percent of inmates with SFI, including nearly all the prisoners at the unit at Southern State Correctional Facility reserved for the most severely ill, declined to participate in the study.
“Some of the folks that didn’t agree to meet with us are folks who struggle the most,” Batra said.
At the time of the study, there were 121 inmates with SFI. SFI, as defined by state law, can refer to mental disorders, developmental disabilities and traumatic brain injuries. Seventy-seven participated in the study; the remainder declined to take part.
In its plans to replace the state hospital facility in Waterbury, the Shumlin administration estimates two to four beds will be needed for inmates and advocates say that is insufficient.
“We have never believed that was adequate,” said Ed Paquin, executive director of Disability Rights Vermont. Paquin said the study reinforces what his organization has observed anecdotally: There are people in prison who aren’t getting the acute care they require.
Critics also say the study doesn’t tell the whole story because it only looks at inmates already designated as SFI.
AJ Ruben, an attorney with Disability Rights Vermont, said he had hoped the working group would look at the entire incarcerated population, but the Legislature deemed that too costly.
“We are concerned that the screening process is not rigorous enough. … It’s our experience that there are many, many people in the prison who are not diagnosed with SFI but should be,” Ruben said.
Appel said the results were “valid to the extent of the protocol that the study was shoehorned into,” but he also has major concerns about how the methodology the Department of Corrections uses to assess SFI. Appel pointed out that the number of SFI inmates rose 173 percent from 2008 to 2011, which, he says, raises “serious questions about the reliability of the data.”
Batra acknowledged the study was constrained by limited resources.
“We could have been much more thorough if we had more time, most definitely,” he said.
The study notes, “For individuals designated SFI, there should be consistent process and criteria known to all facilities to identify them.” Racine said the Legislature may ask Human Services to examine the screening process in subsequent work. “I think they may want to act on things by requiring us to look at how SFI is assessed,” he said.
Eighty percent of the SFI inmates interviewed are prescribed psychotropic medications and 74 percent have a history of psychiatric hospitalizations. These findings were self-reported; Batra said confidentiality requirements prevented them from verifying this information through medical records.
The study also sought to assess recidivism rates among this prison population and found that 79 percent of those interviewed had been incarcerated previously. Recidivism, too, was self-reported.
The study’s draft recommendations call for the creation of Integrated “treatment courts” to provide an alternative to incarceration and reduce recidivism. Other recommendations include improving discharge planning for SFI inmates and providing more specialized forms of therapy to inmates. The study found that therapy is not provided often enough — generally on a monthly basis — and “the staffing patterns for treating clinicians do not match the need of these individuals.”
The study will be presented to the Legislature at the start of the 2013 session in January. Appel says he is “cautiously optimistic” that it will spur some changes, and if it fails to, the state will likely face a lawsuit.
“I think we will eventually get there, if not the state faces a legal liability.”
That’s because, in 2008, the Vermont Supreme Court ruled that Americans with Disabilities Act applies to prisons, which means the Department of Corrections must ensure it accommodates inmates with disabilities in such a way that they have equal opportunities as other inmates.
Appel says one way to approach unmet acute care needs would be to establish a treatment facility run by Department of Mental Health but housed within a correctional facility. Vermont is currently one of only a few states without an acute psychiatric care facility for prisoners. The study recommends a “specialized unit” run by mental health professionals for inmates “who are in a crisis but not needing hospitalization.”
Racine said he didn’t expect the Legislature to hand them a “laundry list” of changes to implement just yet. But, he added, “They may tell us to get cracking on some of the internal things like how we do assessments and how we do transition planning.”