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When patients become inmates

Concord Monitor - 10/1/2016

State Rep. Renny Cushing rewinds 30 years, over and over again.

That’s when New Hampshire lawmakers had a chance to do the decent thing, says Cushing, a Hampton Democrat. It’s when mental illness could have been viewed for what it is, an illness, not a weakness or a nuisance or an embarrassing flaw to be swept aside, out of sight.

Instead, a recommendation in 1985 by the state psychiatric society – to remove mental illness from Department of Corrections oversight and align it with the Department of Health and Human Services – was ignored.

And with that, the procedure would continue: Sending mentally ill patients deemed dangerous to themselves or others, but who had never been charged with a crime, to the state prison’s Secure Psychiatric Unit, or SPU.

They’d be housed with mentally ill individuals who had been arrested for violent crimes. That’s the way it was then, and that’s the way it remains today, even following two recent attempts by Cushing to change our system.

“I don’t think anything has changed in 30 years,” Cushing said. “Lots of people in our society are touched by mental illness. I get frustrated when I listen to some of my legislative colleagues that it’s not that big of a deal that we take people with mental illness and put them inside a prison.”

Cushing is known for his laser focus on social issues. His father was murdered by a cop 40 years ago, yet he’s a leading voice against capital punishment. He helped create the Clamshell Alliance, an organization that opposed the building of the Seabrook Nuclear Power Plant, also in the 1970s.

He sat with me in the empty dining room adjacent to the State House cafeteria, closed in the late afternoon. The air conditioner hummed in the background and a woman replaced full trash bags with new ones.

Not far away, down a narrow hallway that cuts below North State Street leading to the Legislative Office Building, a subcommittee had voted recently not to recommend House Bill 1541.

Soon, Cushing will get another chance.

On Oct. 21, the House Health and Human Services and Elderly Affairs Committee will meet at 10 a.m. in room 205 of the LOB to talk about his bill. He hopes families of mentally ill patients locked up inside the prison will come, tell their story, and explain why the practice is wrong. Cushing’s bill

Cushing’s bill would prohibit “persons who are involuntarily admitted to the mental health services system. . . who have never been charged with a crime or convicted of a crime to be placed in the (SPU)… Such persons shall be placed in a therapeutic institution in this state or in another state.”

That last part really stings Cushing. He says we’re the lone state in the nation with this sort of system, one that mixes criminals with non-criminals, which means loved ones are required to undergo background checks before they can visit those never arrested. Patients are given prison numbers, and the entire scenario sends a strong, negative message to outsiders.

Also, the quality of care there, while up for debate, has been called into question.

“Can you imagine going to the hospital because you have a problem with your gall bladder or you’re someone with a heart problem?” Cushing asked rhetorically, “and you hear, ‘By the way, this is a really big challenge, I think we’re going to take you out of the hospital, stick you in the prison and hold you there. Maybe you’ll get better.’ ” Behind the times

Our views toward this type of sickness, Cushing believes, is why there aren’t enough beds at the state hospital. It’s why the mentally ill who are categorized as dangerous don’t have a specialized place of care.

Asked to describe the facility that the state needs, Cushing said, “Build a secure therapeutic hospital. This is like for 30 years where it was referred to as being a temporary situation where we will eventually create a hospital.”

Cushing is careful to say that those who work at the SPU “are trying to do their best in an awful situation.” He lays blame squarely at the feet of his fellow lawmakers.

The problem? Money, of course.

According to Cushing, New Hampshire needs to get its priorities in order.

“It’s the Legislature,” he said. “(The Department of) Corrections and Health and Human Services have both identified this as a problem. Both have come to the Legislature, and (the Legislature has) said, ‘We’re not going to cough up any money.’ ”

Move to the other side, to some in the State House and those connected to the prison system. You’ll hear that Cushing’s vision is too expensive and too broad.

Rep. Joseph Guthrie, a Republican from Hampstead, voted against HB 1541. He cited several points to me, blending the need for a change in the system with a need for specificity.

“Recommending some action on this bill right now would be almost like kicking the can down the street,” Guthrie said. “It wouldn’t accomplish anything. Something needs to be accomplished in this area and it should be put on the front burner to take a look at.”

Elsewhere, Jeff Lyons, the public information officer at the state prison, defended the quality of care at the prison. He said professionals such as psychiatric social workers, clinical mental health counselors, registered nurses, doctors and psychiatrists are part of the team.

Lyons also said that corrections officers “cross-train with New Hampshire Hospital for specialized training on how to work with persons who are mentally ill.”

“At any given time we have eight or nine persons civilly committed in the SPU,” Lyons wrote in an email. “While they are here, they receive excellent mental health treatment based on their individual needs but in a more secure setting.”

Cushing and other critics have said the treatment at the SPU simply doesn’t measure up. At the recent HB 1541 hearing, parents told horror stories, about a patient whose toenails grew long enough to curl under and jab his skin. About a patient pulling out his fingernails and toenails. And about that same patient violently taken down to the ground for touching a corrections officer.

However, some wonder, couldn’t that have happened anywhere, at any facility that treats violent, mentally ill patients? Or would these kinds of episodes have been avoided in the proper setting?

Perhaps. Lawmakers like Cushing and Rep. Pamela Gordon, a Democrat from Portsmouth, simply don’t believe that a non-criminal segment of the mentally ill population should be sent to prison. These people are sick, after all.

“I voted in the minority because I believed that housing mentally ill people behind locked doors surrounded by razor wire is a violation of their civil rights,” Gordon told me in an email. “If we are to be judged as a state on how we treat our most vulnerable people, we need to do the right thing by building a secure facility at the New Hampshire State Hospital.”

Gordon added that the Legislature has voted down measures connected to the issue for “12 years.” Talk to Cushing, and he’ll inevitably steer you toward the number 30.

As in years. 30 years and counting

Actually, it was 31 years ago when a psychiatrist named Joseph Sack went to Concord and introduced House Bill 634, which read, in part, “these patients who have not been charged with any crime will be treated in a patient population of charged and convicted criminals and that such an environment will tend to produce an adversarial rather than a therapeutic setting.”

Since then, a pair of bills, in 2005 and 2010, sought to build a secure facility unit at the state hospital. Both failed, rejected because of the cost and, lawmakers said, more research was needed.

“Frustrating,” Cushing called it.

This summer, Cushing joined hands with the nationally-known Treatment Advocacy Center, plus Arnie Alpert and Maggie Fogarty, co-directors of the American Friends Service Committee. They filed a complaint with the Department of Justice hoping to change the state’s system and are still waiting for a response.

And then there was House Bill 1541, which, like other proposed bills, was shelved for a rainy day.

“What happens,” Cushing asked, “if you have a loved one who you try to get help for and all of a sudden they end up with a prison number behind bars?”

When Guthrie was asked if that scenario would affect him, he said, “No question about it. Rep. Cushing has grabbed this and he’s pushed it to the forefront, and I think that’s the way to get things done, by pushing.”

Which is what John Broderick, former chief justice of the state supreme court, has been doing this year. Broderick was attacked by his mentally-ill son Christian in 2002 and suffered broken bones in his face.

Christian, deemed competent to stand trial, was sentenced to 7½ to 14 years in prison, with four years suspended. He was paroled in 2005.

The experience pushed John Broderick into action, after an experience that broke his heart, along with bones.

Broderick now works for the Change Direction campaign, which seeks to alter the state’s view on mental illness and thus change the state’s culture.

Broderick declined to comment for this column, worried his words might be politicized. But I’ll bet the judge agrees with Cushing and what he’s trying to accomplish.

Cushing and others have been at it a long time, thinking ahead of the curve, fighting to a change our perceptions of an illness that has nothing to do with weakness.

“It’s been a dirty little secret for 30 years, festering for 30 years,” Cushing said.

“And no one wants to talk about it.”