Therapy cages at state prison
(4-9-19) New Hampshire’s abhorrent practice of housing its seriously mentally ill citizens, who have not been charged with crimes, inside a state prison rather than treating them in a hospital is again making headlines.
Governor Chris Sununu sought to stop this horrific practice by requesting $26 million in funding to build a 60-bed state hospital that would be opened by June 2021 with its own secure unit.
But Democrats on the state’s finance committee rejected Sununu’s plan, opting instead to spend $5 million to renovate rooms in an existing state hospital for a limited number of higher-need patients.
What makes this dispute newsworthy is it has pitted two groups, both created to help patients, against each other.
Disability Rights Center-NH opposed building a new state hospital. In a statement, it agreed that civilly committed patients should not be housed in a state prison, but it argued that building a new state hospital would “divert precious funds and workforce from where they are most needed: community-based mental health services.”
“Spending millions of dollars to significantly expand the state’s mental health health institutional bed capacity undermines the state’s ability to invest in much needed sustainable changes to the state’s community mental health system.”
It called for more spending on assertive community treatment, supportive housing, supported employment and mobile crisis response teams.
The CEO of the New Hampshire (state) Hospital, Lori Shibinette, issued a sharply-worded rebuttal. The need for a 60-bed facility was documented through a “thorough, public and collaborative process” during a two year period, she noted. The Disability Center’s preferred alternatives, she said, “would do absolutely nothing to help people in hospital emergency departments (needing) a bed in a psychiatric facility…”
For the most seriously mentally ill patients, she wrote, such programs as housing first, assertive community treatment, job help and other supports simply are “stop gap measures at best.”
Sadly, while this debate is going on, there are no immediate plans to stop sending patients, who have been involuntarily committed, to the state prison. Although their only crime is that they got sick, they are housed behind barbed wire fences and relegated to solitary confinement.
Republicans could try to restore the governor’s plan when the finance committee’s recommendations are voted on April 11th, but that is judged unlikely.
The underlying issue here is a never ending argument about whether or not all individuals with serious mental illnesses can have their needs met in a community or if some need longer term care.
This is not a new debate nor are the two sides newcomers to it.
The Disability Rights Center – NH is part of a national network of what commonly are known as Protection and Advocacy [ P&A] organizations. Here’s their roots.
The Protection and Advocacy concept was initially triggered by a series of local television news broadcasts that Geraldo Rivera did for the ABC News affiliate in New York City in 1972. Rivera’s investigative reporting exposed abuse, neglect and lack of services and supports at Willowbrook, a state institution for people with intellectual and other disabilities on Staten Island. These broadcasts galvanized the state’s senior senator, Jacob Javits, to action, incorporating the first P&A program – PADD (Protection and Advocacy for People with Developmental Disabilities) – in 1975 in the renewal of the Developmental Disabilities Assistance and Bill of Rights (DD) Act.
The DD Act provided for the governor of each state to designate an agency to be the P&A and to assure that the P&A was, and would remain, independent of any service provider… The initial focus of PADD and subsequent P&A statutes was to safeguard the well-being of individuals living in institutions…
While P&As were created to monitor and protect persons in institutions, over time, most have expanded their mission to become advocates for all disability issues. In this role, P&As have fought against the construction of any new institutions.
I will yield to legislative experts here, but my reading of Sen. Javits’ legislation finds no language stating that P&A’s should block construction of hospitals. Rather, this thinking appears based on the argument that institutions, by their nature, are dehumanizing and destructive to mental health.
While this proved true in our past, there are mental hospitals that are humane and help patients. A prime example is McLean Hospital. But these hospitals are only available to those with big checkbooks. They have managed to avoid the horrors of the old state hospital system because they are well-funded.
So what is the answer?
The solution for both sides would be to stop fighting over scraps and demand that individuals with mental illnesses have a full array of services available to meet their individual needs – whether that be longer term care, crisis care or community assistance. Persons with mental illnesses are not cogs.
The New Hampshire legislature would be wise to listen to what CEO Lori Shibinette wrote in her statement about the most seriously mentally ill: “We need to stop trying to fit this population into a system of care that does not meet their needs.”