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CT prison experience exacerbates mental health problems, experts and inmates say

Hartford Courant - 5/8/2023

The following article is part two in a series on mental health in Connecticut’s criminal justice system. 

When Tracy Shumaker got her period while on suicide watch at York Correctional Institution, a guard handed her a pad and told her to put it between her legs and “squeeze.” Under the weighted, denim, anti-suicide smock, Shumaker could not wear any pants or undergarments.

It was 2004, Shumaker had just been arrested, and for five days she sat in isolation without running water, requesting toilet paper two squares at a time, never seen by a physician or therapist.

“You kind of just sit there with everything,” Shumaker said. “I was already broken, I was already beat down. … They did everything else to completely break me.”

After a 2023 report from the Connecticut Sentencing Commission found that 95.5% of the state’s incarcerated population currently or previously suffered from mental health or substance abuse disorders, the Hartford Courant spoke to several formerly incarcerated individuals who opened a window into mental health treatment behind bars.

Now released, men and women shared allegations of pervasive overmedication, forced injections, and dehumanizing experiences inside Connecticut penitentiaries.

In a statement to the Courant, the DOC said the agency was among the first in the country to “establish a progressive approach to the treatment of inmates with significant mental health needs,” providing “a wide variety of medical and mental health services to the individuals under our supervision.”

At the time Shumaker was placed in York’s suicide unit, the DOC said UCONN’s Correctional Managed Health Care administered mental health services to the incarcerated population. The DOC did not assume responsibility for inmate health until 2018.

In a halfway house bedroom in Hartford, Shumaker and her roommate Samantha Wheeler chewed over their suicide watch experiences.

For both women, the time in the unit lasted roughly a week, but the torment would linger for a lifetime.

“You’re shoved in there to do nothing but think about the problem that you had,” Wheeler said. “For me it was the death of my boyfriend and instead of being somewhere where I could talk to somebody, a bunkie, a social worker, anybody, I was left to my own thoughts.”

Wheeler said prison staff called suicide watch a “double-edged sword,” saying “At least we know you’re safe.”

“But how safe are you when the thing you wanted help with now is just a repeating occurrence in your brain and you just are thinking of ways to end your life now?” Wheeler said.

Staff shortages

According to an annual report sent to legislators just before the New Year, the DOC had just seven psychiatrists serving a prison population that neared 10,000.

The agency determined that its Mental Health Services program would require a total of 57 positions for psychiatrists, psychologists, and psychiatric advanced practice nurses, in addition to 125 licensed clinical social workers and licensed professional counselors. But, at the time of the report, just 67% of those posts were filled.

The same report disclosed that 46 of the 77 required addiction counselor positions were staffed, as well as 10 of the 11 required addiction treatment counselor supervisor roles.

“Since the Department has taken over the delivery of health care to the incarcerated population, it has relentlessly — in direct competition with private sector companies — recruited health care professionals to further improve on the delivery of quality healthcare,” the DOC said in its statement to the Courant.

While the DOC said it has not had trouble onboarding addiction treatment staff, it has “had a difficult time onboarding psychiatrists due to the relative scarcity of psychiatry residencies and the continued decline of such specialists in the community,” according to the report.

The DOC documented additional personnel deficits across its general health, dental, laboratory and discharge planning services, including a shortfall of 297 nurses. The agency estimated that filling the gaps would require more than $21.9 million.

Seeking mental health treatment in prison, Wheeler and Shumaker said the “revolving door” overworked clinicians were quick to prescribe.

“When you’re one fighting a hundred, it doesn’t fare very well,” Shumaker said. “You got a few workers with multiple caseloads. Basically, you come in, ‘Are you OK? Are you going to hurt yourself? Are you going to hurt others? Do you feel suicidal?’ And if you say, ‘Well, I can’t sleep and I’m having nightmares,’ they’ll say, ‘OK, let’s try you on Trazodone or Remeron and then we’ll see you in about a few weeks to see how that works out and maybe we’ll have to adjust it.’ That’s the extent of your visit.”

Shumaker said she was diagnosed with depression and post-traumatic stress disorder by an outside physician during her trial, not DOC personnel.

“They just don’t have the people equipped to deal with getting right down to the problem,” Shumaker said. “Everybody’s trying to do the best they can, it’s just, unfortunately, certain things fall short.”

Medication

When staff called “med-line,” Shumaker said, at least 85% of the women would line up for pills. The Sentencing Commission report said that the DOC classified 81% of female inmates with a mental health disorder that required treatment.

It wasn’t unusual for Wheeler to see some women become so heavily sedated on Thorazine that they would urinate or defecate themselves without realizing.

“I was kind of like in the beginning a problem inmate, so like all their problem inmates, their thought is to medicate them so that they can’t function and they’ll no longer be a problem,” Wheeler said. “This one time they had me on such high milligrams that I went to work and all of a sudden the whole room was spinning and I couldn’t see straight.”

Against Wheeler’s wishes to lie down in her bunk, staff sat Wheeler in the hallway of the prison’s outpatient medical center, she said.

“I ended up starting to vomit and a vertigo thing happened where I couldn’t stop vomiting,” Wheeler said. “It was awful. They were like ‘You can’t leave until you stop vomiting.’ But I can’t stop vomiting because you’re making me sit here.”

After that, clinicians split Wheeler’s dosage between the morning and night. When the dizzy spells came back, Wheeler said she didn’t tell anyone.

In a statement to the Courant, the DOC said the agency’s “delivery of mental health services is based on an assessment of individual need, and delivered in concert with the security needs of individuals and the overall operation of the institution.”

“The use of medication may be a necessary treatment method to stabilize an individual,” the DOC said. “When medications are prescribed, they are prescribed and monitored by trained mental health professionals, which include: licensed doctors, APRNs, and Physician Assistants.”

Shumaker said she was prescribed the antidepressant and sedative Trazodone until her mother demanded she be taken off the drug after Shumaker called her incoherent and slurring her words.

Doctors put Shumaker on Remeron instead, but Shumaker said that was not much better.

“It felt like you were walking through molasses,” she said. “The way I walked was very slow, the way I would communicate with people was different. It slowed me down.”

Eventually, Shumaker swore off the medication altogether. She refused to go to medline and got her doctors to stop prescribing the pills, but not all inmates could do the same, she said.

Between 2008 and 2013, while working as a recreation therapist aid at Garner Correctional Institution, Norman Gaines said he was a witness to forced injections.

When an inmate refused his prescription, Gaines said staff would hold men down in four-point restraints and administer intravenous injections or force oral consumption.

In a statement to the Courant, DOC said in nearly all cases the agency provides medication on a voluntary basis.

“In extreme circumstances, just as in the community, forced medication may become necessary. If that occurs, there are robust procedural safeguards to ensure the due process rights of the patients,” the DOC said.

Garner

For almost 20 years, Garner has served as the DOC’s “dedicated mental health facility for adult male offenders requiring significant mental health treatment,” serving both sentenced and unsentenced men with “individualized treatment plans, based upon an offender’s level of functionality include extensive programming and therapy, in a group and one-on-one setting,” according to the agency.

The DOC said, “Staff at the facility, both custody and mental health, operates through an integrated team approach which ensures a continuity of custody, care, treatment and control.”

Gaines did not always see it that way.

Incarcerated from 1996 to 2022, Norman Gaines’ saw life behind bars in many DOC facilities, but his time at Garner was different.

Men would “bust their heads” on cell walls, he said. Others attempted suicide.

Some lived as ghosts of their former selves, turned into “zombies” by antipsychotic medications that also caused them to balloon in weight.

“Some of them didn’t even take showers because they were too medicated to even walk,” Gaines said.

He said he saw corrections officers pin men to the ground and strip them naked during transfers to disciplinary units, retraumatizing those who survived sexual assault in the past.

“In a place where they’re supposed to be getting treatment, they were being retraumatized all over again,” Gaines said.

Dr. Reena Kapoor, a Yale professor who served as the lead researcher for the Sentencing Commission report, said one of her biggest frustrations is the false belief that people suffering from mental health and substance abuse disorders are better off in prison because they will get treatment.

“I don’t think that’s a philosophy that we want to live by — that it’s somehow okay to put people in prison for small charges that are not very serious offenses because we think, out of some humanitarian benefit, that they’re going to get better treatment there than they would in the community,” Kapoor said.

A former DOC clinician, Kapoor said the agency does the best it can to help incarcerated men and women but also acknowledged that prison is far from an ideal treatment environment for mental health.

“I’ve always thought that your role as a psychiatrist in that setting is to help the patient access the healthiest parts of themselves,” Kapoor said, emphasizing treatments that develop coping skills, build on family and community connections, and, when necessary, offer medication.

“It’s not the ideal circumstance in which to be trying to improve people’s mental health,” Kapoor said. “There are parts of that experience that can perpetuate or even exacerbate symptoms of mental illness.”

Therapy — formal and otherwise

Across its 12 facilities, the DOC offers more than 40 addiction and mental health-related programs. The therapies, which are offered in both group and individual settings, address target areas such as trauma, PTSD, anger management, psychosocial skills, personal relationships, emotional regulation and more. While some individuals find success in these programs, others who spoke to the Courant said they either were not aware of the services or avoided them intentionally.

Gaines said part of this hesitancy was driven by the perception that “Every time you talked to a mental health counselor — when you got to talk to one — they just wanted to medicate you.”

He said that instead incarcerated men and women would turn to each other.

“I became almost like a mentor everywhere I went. I don’t know how it became that way. The torch was just passed where I just became one of the guys people used to talk to and trusted to talk to,” Gaines said. “We become almost our own counselors. Because no one else can really know what it’s like to be in a cell? And no one can really know what it’s like unless they’ve been through it.”

If it wasn’t for these networks, “prison would just be way more chaotic than what it is and people will be more chaotic coming out,” Gaines said.

Gaines said that if Connecticut is going to change how it addresses mental health in the criminal justice system, the conversations have to start with the men and women who have been through it.

“It’s a difficult thing,” Gaines said. “Society, if it really wants to make a change, you have to really listen to a lot of the issues that are going on. And, you got to deal with the population that you don’t want to deal with because we have a lot of the answers that will help society get a lot better.”

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