State Prison Leaders Promise Changes to Mental Health Services - North Carolina Health News
At a conference for mental health advocates, prisons director David Guice outlines changes, new services.
By Rose Hoban
Telling a room full of advocates that the North Carolina prison system is in the process of “re-missioning” itself, David Guice, commissioner of Adult Correction and Juvenile Justice, promised changes in the treatment of prisoners with mental health problems.
“We realize today, we really truly realize, that we cannot continue to do business today the way we did it in the past,” said Guice, who came to the state’s prison division after being head of the parole system.
Guice also quoted statistics that underscore his point: The North Carolina prison system discharges some 23,000 people annually, and about half of them return by the year’s end.
“That tells me we have failed,” he told a roomful of people at the annual conference of the North Carolina chapter of the National Alliance on Mental Illness last week at the McKimmon Center on the N.C. State campus.
While people in the room listened respectfully, and applauded when prison leaders thanked NAMI leaders for working with them, those same leaders say they’re hopeful but cautious the changes Guice wants to bring to North Carolina’s system will take hold.
The 2014 death from dehydration of Michael Anthony Kerr, an inmate with mental health issues, which came after months of increasingly restrictive measures and solitary confinement – or what prison officials call “segregation” – has highlighted the need for North Carolina prison reform, particularly in the treatment of people with moderate to severe mental health problems, who make up about a fifth of the prison population.
“About 15 to 20 percent of individuals inside of prison systems nationwide have a diagnosis of mental illness, and that’s not counting any type of substance abuse disorder,” said David Junker, the new director of behavioral health in the prison system.
“We are having to deal with what is in front of us. We have often talked about the reality that prisons have become the de facto state hospitals in our country.”
Often people with mental health problems have been identified as “malingerers,” said North Carolina NAMI head Jack Register, who invited Guice and his deputies to come to the meeting and present. But Register said he’s hearing that word less frequently from the leadership at the prison division.
“[Guice] is a big believer in culture change,” said Register, who said Guice’s senior leadership is slowly changing attitudes about the mentally ill under their supervision. But he also said that “if they weren’t being kicked in the butt by him, they wouldn’t do it.”
Guice said he’s been traveling the state talking to prison staff and community leaders, proselytizing for creating a system where positive behavior is rewarded, not just where negative behavior gets punished.
“I think I have sort of set the tone as to how important it is for this vision and this message and the new direction that we’re headed is going,” Guice said.
In the past, the disciplinary system has been all stick and no carrot. But Guice said it’s hard for prison and parole officials, who were trained in a punishment-based system, to change.
“What’s been lacking has been the system of incentives and being able to provide those incentives,” he said.
“We can’t do it quickly,” said Kenneth Lassiter, deputy director of operations. “We can’t just turn a switch and think it’s going to change, because this is a culture that has been embedded.”
Lassiter admitted that after 30 years working in the system, he needed to change his mind too.
“To be honest, NAMI actually helped me drink the Kool-Aid,” he said to applause.
But with a staff of about 12,000 people in the system, getting change to all levels will take time.
One of the ways prison system leaders are getting the message across is by requiring all employees to be trained in crisis intervention training, a method of de-escalating violence that’s been disseminated widely within the police community and now is being applied to prison workers.
“We’ve trained over 2,500 staff,” said Director of Prisons George Solomon. The initial CIT training took place at Central Prison in Raleigh. He noted that North Carolina is one of the first places to use CIT in prisons. “We have required that the facility heads and the senior management of those facilities also attend CIT, and we’re about 99 percent complete with them.”
Solomon said that close-custody correctional officers, sergeants, lieutenants, captains, unit managers and facility administrators are all required to attend CIT classes.
He said corrections officers using CIT techniques have had fewer violent confrontations with inmates and fewer officers have been assaulted.
“The data tells the story,” Guice said.
He said that prison officials are also now more aware that they can’t just give a book of rules to a prisoner and expect those rules to be followed. Infractions of those rules often lead to prisoners being sent to seclusion, where they’ll spend 23 or more hours a day.
Part of the answer, Guice said, is programming, in the form of classes, work opportunities, even access to some distraction that can be used as an incentive for better behavior.
That extends to providing prisoners who are in seclusion with iPads or iPods, allowing them to read or listen to music to calm themselves.
Money, legislative, attitude changes needed
Guice served in the state House of Representatives, and in 2011 was the primary sponsor of the Justice Reinvestment Act, which he said put these changes in motion. This past year, he convinced his former legislative colleagues to appropriate money for his priorities, including $25 million to give correction officers a raise.
The Division of Adult Correction and Juvenile Justice received funding for mental health beds at Central Prison.
“We were able to get about $45.6 million to be able to create eight therapeutic-control units, behavioral-control units, for those with mental illness,” Guice said, “so we would no longer be placing [the mentally ill] in that level of housing that is not appropriate.”
The department is also on the receiving end of several competitive national grants to create safe alternatives to seclusion.
And last year, the department convinced the legislature to allocate $7.3 million to create technical-violation centers, temporary custody so that parolees who, say, miss a meeting with their parole officer, don’t get sent back to jail.
“If they are technical violators, [a judge] can send them to a technical-violation center for 90 days,” he said. “And it’s heavy programming. So we were able to open up two of them, and they’re just about full.”
But Guice encouraged people at the conference to contact their legislators to support the changes he’s trying to make.
“I know who has the vote and who has the voice,” he said. “But I also know who has the knowledge about the issues, and normally it’s not the person who has the vote and the voice.”
“It is our responsibility to assist them, and to do it in a way that – as my dad would say, the proper way to help educate folks on the issue.”
Register agreed that the legislature needs further education on these issues, and he’s said that Guice has, so far, been a good partner.
But he also expressed some healthy skepticism about changing a large, entrenched system.
“I want to trust what we’re seeing,” he said. “But what’s the real deal? Are we really seeing a reduction in numbers, something different, or is it a smokescreen?”
Even as NAMI leaders and other mental health advocates are happy to be included in these discussions, Register said he’s holding off on a final judgment of how much change Guice will be able to make.
“His work at the prison is not done,” he said.