N.Y. Law Mandates Improved MH Care for Inmates

New York prison inmates who suffer from serious mental illness are likely to receive better treatment and care in the state's correctional system than they have in the past with the enactment of a new law, which went into effect in January. Some provisions, however, have later implementation deadlines.

The legislation (A 9342) limits the placement of prisoners with mental illness in segregated confinement and removes many such prisoners from so-called special housing units (SHUs), where inmates who have committed disciplinary infractions have long been segregated from the general prison population.

The law directs the prison system instead to house prisoners with significant mental illness in residential mental health treatment units jointly operated by the Department of Correctional Services and the state Office of Mental Health. These new facilities, to be located within the prison system, will provide these inmates with out-of-cell therapy sessions and mental health treatment. The state has already begun to build and staff the new treatment units.

“This is historic legislation that demonstrates New York's commitment to providing mental health treatment for inmates with serious psychiatric disorders,” said Gov. Eliot Spitzer (D), in a written statement.“ The legislation also recognizes the need to provide a safe and secure prison environment where inmates and staff will be protected from harm. It strikes an appropriate balance between safety and security concerns and the needs of inmates with serious mental illness.”

It's anticipated that the measure—passed with overwhelming bipartisan support—will save money by reducing guard injuries and cutting unnecessarily extended sentences for prisoners whose incarceration is lengthened due to behavior related to untreated psychiatric illness.

Lt. Gov. David Paterson (D) said that the provision of appropriate treatment to inmates with serious mental illness also will enhance their ability to make a successful transition into communities upon release.

Provisions in the law detail how prisoners who are mentally ill can be treated. For example, one provision limits the shift of inmates from treatment units to segregated confinement to cases of “exceptional circumstances,” such as when a designated “reviewer” finds the inmates would pose a significant danger to themselves or others.

Disciplinary sanctions must be reviewed by a “joint case management committee” at least once every three months to consider whether the inmate should be transferred to a less-restrictive setting “based upon the inmate's mental health status and on safety and security concerns.”

Mentally ill inmates who are not removed from segregated confinement will receive increased psychiatric care compared with previous standards in the prison system, including out-of-cell treatment and counseling programs. Psychiatrists also will conduct periodic mental health assessments of all inmates who remain in segregated confinement.

The law also establishes different requirements for the varying security levels of state prisons, but all inmates with serious mental illness in isolated confinement must receive at least two hours of“ out-of-cell” treatment or therapy daily for five days each week. Before enactment of the law, prisoners placed in segregated confinement were frequently kept isolated for 23 hours a day.

The law authorizes the state's Commission on Quality of Care and Advocacy for Persons With Disabilities (CQC) to monitor the quality of mental health care for inmates and to make recommendations about needed improvements.

The CQC's oversight role is among the most significant achievements of the new law, according to Barry Perlman, M.D., legislative representative of the New York State Psychiatric Association (NYSPA), because it will help to ensure that beginning July 1, people in the prison system will get the care they need when they need it.

In addition, independent mental health experts, advocates, and family members of former prisoners with serious mental illness will be included on a new advisory council that will recommend further improvements to prison-based mental health care.

The prison system has until 2011 to construct the residential mental health units. The law also sets a 2011 deadline for the state to develop more intensive, periodic mental health screening for all inmates in the SHUs, both those with serious mental illness and those without.

“This has been an important agenda item for the New York State Psychiatric Association for many years,” said Perlman. “We have worked collaboratively with many other advocacy groups to improve the situation, with the ultimate goal of seeing the legislation passed.”

Perlman noted the treatment of prisoners with serious mental illness is an issue that generally flies below the radar of many psychiatrists because they don't interact with the prison system. He said he became aware of the prisoner-care issue while serving as chair of the New York State Mental Health Services Council, which heard emotional testimony several years ago from a former prisoner with schizophrenia about his going without treatment while in solitary confinement.

Many people in isolated confinement are mentally ill, Perlman noted, and for them—as well as for inmates without serious mental illness—the extended isolation can cause “serious decompensation.”

The issue also has risen in importance on APA's agenda, where it is a major focus of the Committee on Persons With Mental Illness in the Criminal Justice System, according to Henry Weinstein, M.D., the committee chair. The New York law echoes many of the long-term goals that APA has set for states to implement quality treatment of prisoners with mental illness. Great variation remains among states in the quality of such care, he noted.

The text of A 9342 is posted at<http://assembly.state.ny.us/leg/?bn=A9342>.▪