Prison a wasteland for mentally ill
ON THANKSGIVING 2004, a notoriously mad inmate named Richard A. Street hanged himself in a segregation unit at the 800-inmate, maximum-security state prison in Walpole. His death marked the start of a rash of 12 suicides in Massachusetts prisons in 26 months, compared with five in the nearly six years before. A look at Street's prison experience might explain this phenomenon, which is unfortunate but not uncommon in modern prisons.
Street, 53, was a wretched man who had indiscriminately shot two people one night in Boston in 1980 and then went on to exhaust the patience and resources of the Massachusetts prison system. Suffering from schizoaffective disorder and calling himself "Jesus Christ, Future King of the Vampires," he would rant, self-mutilate, and perform naked pirouettes around a basketball in the prison yard.
Recently the state Department of Correction commissioned a report on suicide prevention in Massachusetts prisons and has promised to put its recommendations into practice. Street's chilling case starkly illustrates the need for changes.
I obtained Street's medical records for the spring of 2004, after he had been in the prison's disciplinary detention unit, an alternative form of segregation, for about 10 months. In a six-week period, Street, a thin man with a bushy, reddish-brown beard and long dark hair, was twice found hanging in his cell. He repeatedly gouged his skin, swallowed an 1 1/2-inch piece of metal, and was taken to a local emergency room six times. He smeared feces in his hair and complained that solitary confinement was making him hurt himself.
Photographs show a handcuffed Street displaying a gruesome array of scabbed and mottled wounds on his legs and arms. Nonetheless, his records suggest a skepticism, common on the part of overworked prison clinicians, of Street's pathology. After he had been found "unresponsive" and with gauze tied around his neck, a clinician wrote that Street "is not depressed . . . nor at risk of harm due to mental illness." He had been known to "feign unconsciousness," the record noted.
Five days after Street's death, I toured the so-called Ten Block segregation unit where he died. The unit was four tiers of dingy, claustrophobic cells, a prison slum where Street had been confined around the clock with only his hallucinations and voices as company. My tour guide declined to take me down the rows of inmates in the 60-cell unit, given the proclivity of many to scream or throw bodily fluids. Inmates were so unpredictable that they were shackled when let out of their cells. Clearly, there was more going on with these inmates than sheer criminality, and the conditions were part of the problem.
Twenty-five years before my visit to what is now the Massachusetts Correctional Institution-Cedar Junction, Harvard Medical School psychiatrist Stuart Grassian conducted a study of 14 Walpole inmates who, like Street, had been housed in solitary confinement. He was surprised by what he would later call the "toxic" effects of isolation. Some inmates were hypersensitive to sounds or obsessed with thoughts of torturing guards; others described feelings of panic and fear of suffocation. This was the effect on inmates in general; imagine the impact on those already suffering from mental illness. It is no wonder then that six of the system's 12 most recent suicides occurred in segregation units. That is 50 percent of suicides among about 4 percent of the prison population.
Psychiatric experts say they can judge the quality of a prison system's mental health program by a quick visit to its solitary confinement units. In many states, they are dumping places for the mentally ill.
Street's suicide and those that followed are, in large part, a direct result of a huge influx into prisons of people with mental illness, an inability of prisons to deal with them, and a heavy reliance on isolation as a quick fix to a complex problem. The suicides, many avoidable, represent a failure of policy and compassion.
After Street's death, the sentiment among officers on a union website was that he had belonged not in prison but in a mental hospital.
The rash of suicides is just the latest in a series of crises that beg for better care of the mentally ill -- the 2003 killing in protective custody of defrocked priest John Geoghan and the 1996 suicide of John Salvi among them. Now, after yet another report and another outcry, will the call be heeded?
Mary Beth Pfeiffer is writing a book about mental illness and criminal justice. 
