Mental Health

Much was made of the tragic, self-inflicted gunshot death, of Sen. Creigh Deed’s son over Thanksgiving. It once again focused attention on Virginia’s broken mental system. I have written regularly about the large number of over-medicated inmates and their “thorazine” shuffle, how prison psychiatrists write prescriptions for “cocktails” of multiple anti-psychotic meds with little or no actual treatment being offered.

      And it is even worse. Forget the long-term health concerns from poorly managed anti-psychotics; there is the lack of coherent mental health care on site that is equally appalling.

      The prison employs three women in a “psychology” office. Problem is, none are psychologists. All three have BAs in psychology but nothing further. They serve as “gatekeepers” – they make “treatment” recommendations – for the D.O.C. psychiatrist who literally is a “Doc-in-the-box.” Medicated inmates speak to the psychiatrist via videoconference for less than 5 minutes every 90 days. There is no other medical treatment except blood work (these psychotropic drugs can cause liver damage).

            The “psychologists” are quick to offer diagnosis and place an inmate in a category: bi-polar disorder; schizophrenia; depression; there is a “top ten” list and men are neatly packaged into them. But, without meaningful one-on-one care all that is done is place the men in a drugged stupor. And these labels – so easy to attach – become self-fulfilling. These labeled men then tell you they can’t “help” their behavior. They have a “disorder.” And they use the disorder as a crutch; and they believe they are entitled to disability and release from prison without addressing why they did what they did. They are lied to repeatedly about their condition and then over-medicated and under treated. They go home and fall back into the same self-destructive lifestyle. And they return.

            That isn’t mental health. Many men here have significant psychological issues. However, the answer isn’t always high doses of mind-numbing chemicals and catch all diagnoses chosen from the newest DSM like one would order off a menu. Legitimate mental health education requires one-on-one treatment and regular assessment and control of prescription medication. That doesn’t happen in here.

            Like most things involving the Virginia Department of Corrections, mental health treatment exists only as words not as a real program. The cost – to provide actual in-patient treatment – would be staggering. Instead, the men are treated like cattle at a slaughterhouse. Each night forty to forty-five of the seventy-two men I reside with line up for pill call. And they have their pills placed in small Dixie cups – Seroquel, Prozac, trazadone, thorazine, the list (and the pill colors) are endless.

            They take their pills, numb their minds, and stagger back to their bunks. Some day they will be released; but what are the ramifications for DOC’s mental health failure? What indeed.

Disability 101

United States Senator Tom Coburn is on a quest. He wants to get control of Social Security disability payments that go out monthly to twelve million citizens at a cost of $150 billion. As they say in here, “That’s a lot of cheddar!” Senator Coburn is in the classic sense of the word a curmudgeon. His nickname, “Senator No,” tells it all. His goal is to rein in runaway federal spending. The more I see him talk about debt and deficits and rampant federal spending for things most of us could never imagine government spending money on, the more I like him.

            Here’s his take on SSI disability: It started out as a noble program in the 1950s to provide a living income to citizens who, because of physical or mental disability, were incapable of providing for themselves. Qualification for disability was strictly controlled and limited. The Social Security Administration maintained an employment “grid” that included virtually every known job in the country. If the disability applicant had the skills necessary for any job on the grid, their application was denied. It didn’t matter if the job was available. If you possessed the requisite skills, you weren’t disabled.

            As a young lawyer just starting in practice I remember agreeing to handle a disability appeal pro bono. “Jane” was a thirty something white woman who looked much older. Life had not dealt her a fair hand. Her left side was partially paralyzed, the result of multiple minor strokes in her teens and twenties. She spoke with a slow, slightly slurred speech pattern. She was close to being classified as legally blind. She “heard” voices and twice each week visited the health clinic for psychotropic meds to control her schizophrenia. She lived with her elderly mother in subsidized housing.

            I took on Jane’s case after one of our firm secretaries told me her church had been providing meals to her and her mother at regular intervals. When I met her I was shocked. I was twenty-five years old and didn’t know people like Jane existed (side note: I recalled my initial encounter with Jane when I found myself in jail with the flotsam and jetsam that makes up most of the inmate population).

            She showed me her disability denial. Based on the grid, the Social Security Administration determined Jane could work assembling boxes. I read the denial and grew angry. There were no box assembly jobs around East Tennessee. And Jane, well it was obvious she couldn’t work. We appealed; I found a Psychiatrist willing to testify about her mental condition; and Jane, began receiving disability.

            Now, almost eighty percent of those applying for disability get it. Lawyers – who used to take one or two such cases on to remind themselves why they went to law school, to bring “justice for all” – began warehousing thousands of disability cases each year and earning millions in legal fees, all paid by the Federal government. Disability became an income supplement after your unemployment ran out.

            Think I exaggerate? Walk through any prison today and listen to the number of men (and woman) who will seek to receive disability upon release. Meet “Screw Loose” a diabetic college student. “I don’t need re-entry. When I walk out the front door I’m goin’ right back home. I’ll sit on my fat ass and get my disability check” (as an aside the disability check didn’t stop him from getting arrested and sent back to prison two more times). The disability system, like so much else going on in the country today, is in need of overhaul.

            What does this have to do with a prison blog? Well, one of the big “industries” inside is helping guys understand what benefits are available once they return to “the street.” And disability income is a biggie. Face it; employment opportunities for convicted felons are limited. Add to that the high percentage of those in prison with little to no education, poor work and credit histories, and their likelihood of successfully re-entering society drops even more. Disability becomes a no-brainer. So many of those behind bars are classified with mental disorders and kept medicated that it becomes easier to say you are disabled than to say you’re alright.

            And prison itself is schizophrenic. Everything in here is done for you, yet nothing is done to help you, I mean really help you, put your life back together and be an active participant in society. Prison is about the have nots. Most of the men I’ve met along the way – save the overtly violent, sociopathic ones – are men who candidly never had a chance to succeed. America isn’t much on Horatio Alger’s stories of pulling yourself up by your bootstraps. These men were born to poor, uneducated, alcoholic or drug-addled mothers. Violence and neglect were the norm in their life, not the exception. Does that excuse their crimes? No. But, it does explain why so often they turn to disability claims as a way of “getting what’s due me.”

            It’s a short-sighted approach and one that’s destined for failure. But then again, so is this country’s current reliance on prison as means of dealing with those struggling on the outside to be let in. Most of the incarcerated don’t look like me. They didn’t have the opportunities I had. Maybe that justifies me getting sent here. After all, I threw away a pretty good deal.

            That’s not how it is with the vast majority of men I’ve met. They’re on the outside looking in. Sadly, so were their families. That doesn’t justify what any of them have done. Nor is it an excuse. But, perhaps, just perhaps we can pause and realize things aren’t fair for everyone. The preamble of the United States Constitution begins with these transcending words:

            “We the people of the United States, in order to form a more perfect union, to provide for the common welfare …”

            That is a goal that should drive this country forward. Senator Coburn is right. SSI disability is a mess. But so is our neglect of those hanging on by a thread on the fringe of the American dream. Prisons aren’t the answer; neither is a rigged system that leads folks to “get what’s due” them.

Pascua Mensaje

I’m learning Spanish, mostly by fits and starts. It’s a tough process for a guy my age especially in here with the never ending distractions of broken, stupid men doing foolish self-destructive things. The language is beautiful. There’s a reason it’s one of the romance languages; it just sounds beautiful.

            I find it easier to read Spanish than speak it. My accent isn’t great. The words on the paper, however, make sense. And, I read an Easter message – “Pascua Mensaje” in Spanish which made sense to me. It was about the three parables told in Luke 15 about the lost sheep, the lost coin, and the lost son. The writer said the parables’ meaning is determined by where you’re sitting when you hear – or read – them. If you’re sitting with the Pharisees and scribe (i.e. the law-abiding citizens of the time) the “lost” stories will concern you (“why such a big deal about a lost, sheep, coin, or errant boy?)

            But, if you’re in the dirt, sitting with the sinners, the broken and disenfranchised fringe people, you see the message in a different way. Put another way, for those on the outside looking in, the three parables all point to a God who actively searched for “the lost” and rejoices when they are found. It is the ultimate message of God’s grace fully revealed on that, first Easter morning.

            And the funny thing is, the parables were told so that everyone would understand, “I’m one of the lost.”

            I know, you’re wondering what that has to do with prison? A lot. This is the world of the lost. Hundreds of the men here, roughly two-thirds, are on their second, third, even fourth trips to prison. To a man, they will tell you, “I ain’t never comin’ back.” Yet, they return to streets worse off each time feeling more victimized, less empathetic, less responsible. They return to the same lives they lived each time before. And, like a patient suffering from schizophrenia, they believe the results “this time” will be different.

            They are lost, hopelessly lost. Worse, they don’t even know it most times. I think that’s where the Pharisees and scribes (and most “good,” law abiding folks) were when they heard the story. “I’m ok; I’m not lost.” Been there.

            Monday morning, April 1^st, the day after Easter, my friend Gras will leave this place he’s called home since 1995. Seventeen years locked up. He came in as a young, Cuban-American, man the son of naturalized U.S. citizens – exiled from Castro’s Cuba – who was 26 when the gate closed and now goes out a 44 year-old man. Twenty gets you seventeen. Seventeen years, seventeen years in the wilderness that is prison.

            We said our goodbyes yesterday and he had the look of a man ready to live his life. He told me he “found himself,” in here. I knew what he meant. His seventeen years wasn’t wasted. He earned his BA, then went and earned a secondary college degree from a Mexican University. He became a licensed, master electrician, HVAC specialist, and plumber. “I was given a second chance,” he told me and I thought of the lost son. “Pascua,” he told: “Easter.” “My folks celebrated last week. My dad told me the line the father said in the parable of the prodigal son, “for this son of mine was dead and has come to life again; he was lost and has been found.”

            The significance of the Pope’s Maundy Thursday trip to an Italian juvenile detention center didn’t escape me either. The leader of the 1.2 billion member Roman Catholic Church went and washed the feet of a dozen juvenile inmates. The church, the new Pontiff has proclaimed, must get out into the streets with the people. What better way to begin but in a prison. I pass no judgment on the problems facing the Roman Catholic Church, but it’s hard not to be awed by a man who would do what he did.

            Pescua Mensaje, an Easter Message, God gives second chances; God searches for the lost. It is a message that resonates with me, never more so, than in here.

            “Feliz Pescua. Dios liberar los presos.”