Mental disorder

Central Prison changes way of dealing with mentally ill

cjarvis@newsobserver.com, ablythe@newsobserver.comMay 5, 2013 

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RALEIGH — A prisoner mumbles and paces the common area in a mental health unit at Central Prison, occasionally letting loose a loud scream that echoes off the yellow concrete walls.

That draws a quick reaction from a correctional officer who, rather than forcing the inmate back into his cell, calmly asks him what the problem is. Confused and increasingly frustrated, the prisoner shouts at the officer.

“OK, I hear you. Don’t yell at me,” the female officer says, and gestures toward the hallway. “Come with me for a minute.”

With a little more coaxing, the inmate follows her to the nurses station.

That was good, says the group leader in this role-playing session with correctional officers and nurses in the maximum-security prison’s new mental health unit. The officer kept calm, she asked the inmate to make a decision rather than forced him, and she realized he needed his medication.

The “inmate” is actually Benny Langdon, a former administrator at Central Prison who has become an evangelist for teaching police, prison officers and others a non-aggressive way of defusing encounters with the mentally ill. Over the past 25 years, crisis intervention team training has spread among law enforcement agencies across the country.

Now it is being tested in the nation’s prisons, which have become the largest repositories for people with mental health problems. The training here in Raleigh, which began late last year, is the first time it has been tried in a North Carolina prison.

“It is mostly verbal,” Langdon says, “and less moving hands, body, not advancing, talking to the subject. Teaching them you don’t have to go hands-on. There’s less risk of being hurt. It’s effective. It just works.”

‘Meanest of our mean’

Central Prison’s sleek and spotless five-story mental health unit, which opened in January 2012, stands in stark contrast to the castle-like granite remnants of the 129-year-old prison. Its mental health approach is also markedly different from the days when the state’s mentally ill were locked away in solitary cells and forgotten. “It’s the largest of our largest, the meanest of our meanest, the sickest of our sickest,” Warden Kenneth Lassiter said of Central Prison at a crisis intervention team conference in Raleigh in February. “We locked them away.”

Years of budget cuts and high staff turnover led to inhumane conditions detailed in an internal report in 2011, which said the prisoners were not only left untreated but also ignored, isolated and unmedicated in sometimes fetid cells. Inmates’ health, safety and dignity were compromised, the report said.

As a result of that report, Central Prison has begun crisis intervention training, and hired more mental health staff and social workers. Prisoners are now let out of their cells for 10 hours a week to join group therapy or individual counseling sessions. Tamper-proof, anti-microbial and fireproof mattresses are now in use, replacing what had been a source of frequent vandalism.

There is now a “treatment mall,” a yellow-walled unit that has rooms for individual counseling and group therapy, a chaplain’s office, a fresh-air basketball court, and an activity room with a window view of the south side of Raleigh. “The first thing they do when they walk in here is stare out that window,” says Peter Kuhns, head of the prison’s psychology staff.

On a visit to the new wing in February, an agitated prisoner with a history of violent outbursts is strapped into a “spider chair” that allows him to meet with Stephen Lucente, a prison psychologist, in a private room, instead of accompanied by a pair of guards the way it used to be.

An Eagles song plays on a local radio station from speakers spread throughout a unit where radios are not allowed, and prison officials say the rotating selections have the intended calming effect. Some prisoners are watching television in a common area, while the muffled sound of an inmate singing or hollering – hard to tell which – as he stands at the window in his cell draws little attention.

Kuhns says the man must not be taking his medications, because when he does he is calm, even sweet-natured. Lucente, in an interview later, says the new approach requires a fundamental restructuring of relationships inside the prison walls.

“Part of what CIT (crisis intervention team training) is designed to do is trying to get institutions to think in a different way, not just think of them as mental-health issues,” Lucente said. “Maybe there are some biological brain issues here and not just some knucklehead guy banging on the door.”

There are about 37,000 prisoners in North Carolina’s system, and the state estimates that 14.6 percent of them suffer from serious mental illnesses such as schizophrenia and bipolar disorder. That’s more than 5,500 people. The state’s mental hospitals only have room for 850 patients, by comparison.

Central Prison can hold up to 1,000 prisoners. The new mental health wing has about 150 patients now, and can expand to 216.

These may be small steps toward dealing with an overwhelming problem, but those inside Central Prison say they are optimistic. Not incidentally, there is also a new warden who has fully bought into the crisis intervention team concept.

“Violence is down a lot,” says the warden, Kenneth Lassiter, “From my officers, it is working. It is truly working.”

A change in thinking

No one imagined that a Central Prison warden would become a partner with the mental-health advocates.

The collaboration started with a protest on Nov. 14, 2011. That day an Associated Press article about the damning internal report was published.

That night the Wake County chapter of the National Alliance on Mental Illness was outside the prison.

“We were just trying to draw attention to the fact that people in prison are people, too,” said Gerry Akland, president of the Wake chapter. “They need dignity and respect. We wanted something better.”

It wasn’t the first time that the prison’s problems had been on public view. In 1997, a federal audit slammed the prison’s mental-health care for inadequate staffing, an out-of-date facility, poor management and overuse of drugs and restraints. The audit followed the death of a mental health patient from dehydration.

But this time prison officials were open to change.

After the protest, Akland was invited inside to see for himself. He was convinced the people working there wanted to do better.

“It’s so easy for those of us on the outside to criticize,” Akland said. “The previous warden wasn’t open to letting people come in and determine how things were going. I went away feeling I want to work with them, not fight them.”

That opportunity came up last year when the NAMI state chapter suggested prison officials attend a crisis intervention team conference in Denver. Lassiter, Akland and Kuhns attended. All three say they expected something academic but were struck by the possibilities for trying this new approach in Central Prison, where all prisoners with mental health issues are sent.

“A light bulb went off,” said Lassiter, who says he came out of the old-school corrections mentality. “Our goal was to start it in six months and we did.”

Skeptical at beginning

Changing the culture inside a prison isn’t easy. In this case, it requires persuading correctional officers to get in touch with difficult prisoners’ emotions.

Having completed four rounds of training now, the therapists have come to expect that some of the officers will be skeptical or outright hostile on the first day, but by the end of the four-day session they are enthusiastic.

“Teaching that they have to be kinder and gentler with the inmate doesn’t work very well,” Kuhns said. “We come from the position of teaching you techniques to help you verbally control the situation. That makes it safer for everyone. When you react to them, you are weaker.”

Kuhns says a key part of the new training is explaining to the correctional officers, nurses and other staffers, that it isn’t necessarily a prisoner’s fault when he breaks the rules or becomes belligerent.

“Prisons are finally waking up to the possibility that we are going to have to deal with these people for quite a while,” Kuhns said. “Prisons didn’t ask for this. Obviously, prisons are not very good places for people with severe mental illness.”

Lassiter, Kuhns and Lucente say they don’t have data measuring the training’s effectiveness yet – in terms of how often force is needed, how often prisoners harm themselves, for example – but what they’re hearing from the officers and nurses is encouraging.

“These guys are different,” says Lucente, who works with prisoners who are on lockdown all day. “There’s something different going on; there’s something in the air. It’s going to take a while to change the culture, the feel of how the old-style prisons were run. I think we’re going to see some very interesting changes coming up.”

Jarvis: 919-829-4576

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