1. 1
T.R.
v.
South
Carolina
Department
of
Correc7ons
November
3,
2014
Stuart
Andrews
Nelson
Mullins
Riley
&
Scarborough
LLP
1320
Main
St.,
17th
Flr.
Columbia,
SC
29211
www.mentalhealth4inmates.org

2. 2
T.R.
v.
South
Carolina
Department
of
Correc7ons
January
8,
2014:
Final
Order
Judgment
for
Plain5ffs:
! Class
of
3,500
Inmates
with
Serious
Mental
Illness
! ProtecNon
and
Advocacy
for
People
with
DisabiliNes
Ruling:
! Inmates
with
serious
mental
illness
exposed
to
substanNal
risk
of
serious
future
harm.
! SCDC
has
been
aware
of
risk
for
over
12
years
and
has
failed
to
take
Nmely,
reasonable,
or
effecNve
steps
to
abate
the
risk.
! SCDC
to
present
remedial
plan
in
180
days.

3. 3
Have
Prisons
Become
Our
Hospitals?
! Dorothea
Dix
to
Deins5tu5onaliza5on
• 1850s
–
First
U.S.
Mental
Health
Hospitals
• 1955
–
1
Psychiatric
Bed
for
Every
300
U.S.
CiNzens
• 2005
–
1
Psychiatric
Bed
for
Every
3,000
U.S.
CiNzens
! Prison
Beds
Replace
Hospital
Beds,
Community
Services
• Ten
Times
More
Persons
with
Serious
Mental
Illness
in
Jails/
Prisons
than
Hospitals
• 40%
of
Persons
with
Serious
Mental
Illness
in
Jails/Prisons
• 15-­‐20%
of
Incarcerated
Persons
have
Serious
Mental
Illness

4. 4
Judge
Baxley's
Findings
! "Thus,
over
70,000
cases
of
every
imaginable
sort
have
come
to
this
Court
over
the
years.
This
case,
far
above
all
others,
is
the
most
troubling."
! "Inmates
have
died
in
the
South
Carolina
Department
of
Correc5ons
for
lack
of
basic
mental
health
care,
and
hundreds
more
remain
substan5ally
at
risk
for
serious
physical
injury,
mental
decompensa5on,
and
profound,
permanent
mental
illness."

5. 5
Legisla5ve
Proviso
CommiSee
Report
October
2000
! "First
and
foremost,
inmates
with
mental
illnesses
are
not
receiving
adequate
treatment
for
their
illnesses
and
oUen5mes
leave
prison
worse
off
than
when
they
entered."
! "Second,
the
public
is
being
short-­‐changed
because
these
inmates
are
eventually
released,
only
to
return
to
their
local
communi5es
and
commit
more
crimes
secondary
to
inadequately
treated
mental
illnesses."

6. 6
July
2003
DMH
Report
! Psychiatric
services
"are
in
disarray"
due
to
understaffing,
resul5ng
in
"extremes
of
poor
care,
inhumane
treatment
and
dangerousness
.
.
.
."
! Medica5ons
abruptly
discon5nued
"without
approval
of
psychiatrists
or
other
clinical
staff."
! Inadequate
programming.
! Mentally
ill
inmates
in
solitary
"receive
liSle
or
no
mental
health
treatment."
! No
QA/QI
program.

7. 7
Chronic care for prisoners with disabilities does not
conform to nationally-accepted guidelines for
mental illness… The lack of a comprehensive
chronic care program puts patients at significant
risk of harm.
Pltfs’ Ex. 106
PLTF. EX.
106 7

8. 8
Sufficient
Number
of
Trained
Mental
Health
Staff

9. Ratio of Psych/NP FTEs to
Area and Outpatient
Mentally Ill Inmates
9
9
APA Recommended
Psych/NP FTE Ratio
1:1
1:500
1:1000
PLTF. DEMO.
PX24

10. Kentucky South
1:1
1:75,000
10
10
Source: Testimony of Drs. Haas, Metzner, and Patterson
Carolina
PLTF. DEMO.
PX147

11. 11
Crisis
Interven5on
Program

12. 12
Crisis
Interven5on
! Inadequate
Management
of
ASempted
Suicides
and
Self-­‐Injurious
Behaviors.
! Non-­‐Therapeu5c,
Puni5ve
Environment.
• Disciplinary
segregaNon
units
• No
contact
with
psychiatrist
• Limited
counselor
contact
• Strip
cells
! Excessive
Reliance
on
Security
Responses.
• Use
of
force
• SegregaNon
• Disciplinary
sancNons
! Alterna5ve
CI
Placements
at
Lieber
2008-­‐10.

13. 13
Crisis
Interven5on
! Condi5ons
of
CI
Segrega5on.
• Stripped
out
–
inmates
and
cells
• Maybe
paper
gown,
security
blanket
• No
maaress
• Cold
cells
• Foul
cells
– Human
waste,
blood
• No
showers
or
hygienic
care
! Stays
Up
to
14
Days.

14. 14
14
4
Non Mentally Ill
Inmates
26
Mentally Ill
Inmates
Sources: Pltfs’ Exs. 227, 357
PLTF. DEMO.
PX30

15. 15

16. 16

17. 17

18. 18

19. 19

20. 20
Overview
T.R.
V.
SCDC:
Remedial
Plan,
180
Days
Adequate
Mental
Health
Staffing
! Psychiatrists
! MSWs
and
Psychologists
! Trained
Clinical
Counselors
Capital
Improvements
! Infirmary
Sefngs
for
Crisis
Interven5on
! Space
for
Individual/Group
Therapy
Reform
Prac5ces
! Reduce
Use
of
Force
! Reduce
Long-­‐Term
Segrega5on
! Increase
Staff
Training
! Meaningful
Quality
Review
! Improve
Iden5fica5on
System
! Improve
Administra5on
of
Medica5ons
! Develop
Reliable
IT
System
! Improve
Crisis
Interven5on

21. 21
Web
Sites
" www.mentalhealth4inmates.org
" hSp://www.free-­‐5mes.com/cover/horrors-­‐behind-­‐these-­‐
walls-­‐012214
" hSp://m.theatlan5c.com/na5onal/archive/2014/01/when-­‐
good-­‐people-­‐do-­‐nothing-­‐the-­‐appalling-­‐story-­‐of-­‐south-­‐
carolinas-­‐prisons/282938/
" Charleston
The
Post
and
Courier
3-­‐part
series:
hSp://www.postandcourier.com/ar5cle/20140412/
PC16/140419720;
hSp://www.postandcourier.com/ar5cle/20140412/
PC16/140419801;
hSp://www.postandcourier.com/ar5cle/20140413/
PC16/140419799;
hSp://www.postandcourier.com/ar5cle/20140414/
PC16/140419653