Prison is no place to treat mentally ill

IN APRIL, LEO MARINO, a 43-year-old man with a long history of suicide attempts, killed himself in an isolation unit at Bridgewater State Hospital (BSH). He’d managed to choke himself with a large amount of wet, wadded-up toilet paper – materials that staffers made readily available to him despite the fact he tried to end his life the same way one day earlier.

In the month preceding his suicide, Mr. Marino was frequently placed in isolation in the Intensive Treatment Unit, a small, bare, segregated cell where patients are secluded from the general population. This kind of forced isolation was not only in direct conflict with his dire mental health needs, but also failed in the single task of keeping Mr. Marino alive, which was BSH’s sole justification for keeping him in such a harsh, restrictive setting.

Unfortunately, Mr. Marino joins a long line of preventable tragedies at BSH that emphatically underscores the reasons why individuals like him should receive mental health services in a psychiatric hospital and not a prison.

Despite its name, Bridgewater State Hospital is not a “hospital” but a medium-security prison. Most people believe Bridgewater is the place where criminally insane, wildly violent and dangerous prisoners are sent. But, the majority of BHS patients have never been convicted of a crime. Many patients have been committed after being found incompetent to stand trial or determined not responsible for their actions.

If patients like Mr. Marino were treated at a hospital under the purview of the Department of Mental Health — not the Department of Corrections – they would be engaged with the world through therapy and programming, and closely monitored. The current system at BSH is riddled with a lack of interventions, with no alternatives or intensive therapy for its most vulnerable patients.

As it stands, BSH is being asked to do the impossible: provide hospital-level care in an understaffed, underfunded, antiquated facility imbued with a punitive, correctional culture. Mental health workers at BSH are not properly trained and are inadequately supervised. In addition, an overabundance of security precautions contributes to significant delays in medical response times. This failure of mental health treatment combined with harsh security measures is quite simply a recipe for tragedy.

Not surprisingly, 48 other states have already come to these conclusions. Massachusetts is one of only two states that confines individuals with mental illness to a correctional facility. BSH persists – grossly underfunded, with inadequate clinical staffing, minimal therapeutic treatment, leaking roofs, and trailer buildings erected as “temporary” in (what year?) but which have long since become permanent.

What is the Commonwealth waiting for? This is not a new problem; it has gone on for decades, across multiple administrations. There truly is no reason for the state’s failure to move forward expeditiously to remedy this longstanding problem.

The state’s own analysis through the Department of Mental Health made it abundantly clear that BSH, as controlled by the Department of Corrections, is incapable of providing the appropriate medical and mental health staffing necessary for the care and treatment of patients with mental illness. The report also found that BSH is incapable of effectively changing the prison culture that exists in a correctional facility where patients often receive punishment in lieu of treatment.

We implore Gov. Charlie Baker and the Legislature to accept this obligation and charge the Department of Mental Health with the sole responsibility for caring for BSH patients. None of the incremental changes in policies and practices or reviews over the years have come close to the structural and transformative change that is needed. Enough is enough. Until fundamental systemic changes occur, more preventable patient deaths like Mr. Marino’s will certainly follow.

Christine Griffin is the executive director of the Disability Law Center, Inc.