Care of the Mentally Ill in Prisons

A common problem facing the mentally ill inmates today is whether or not the use of restraints is safe and effective, or a deadly abuse of power. There are a plethora of articles that support either side, but in order to form an unbiased opinion, one must hear both arguments. There are several positive aspects of restraints. For example, when restraints are used inmates no longer have the ability to inflict damage upon oneself or others, additionally inmates are stabilized instead of hospitalized due to restraints.

On the contrary, negatives of restraints can result in serious injury and sometimes death if used improperly. The use of restraints can also cause an abuse of power between the guards and the inmates, as well as provoking unnecessary use of excessive force. Should the mentally ill patients be required to use restraints, or is it acceptable to use a case by case basis? Is completely eliminating restraints the solution?

“Commentary: The Use of Restraint and Seclusion in Correctional Mental Health” provides information on limiting the use of mental health restraints in order to stabilize mentally ill inmates. Restraints are designed to be used in a safe and therapeutic environment for mental health patients, however, jails and prisons are quite the opposite. Often times, being in jail will heighten the symptoms of those who are afflicted by mental health disorders. The mentally ill are more likely to end up in restraints, become sexually victimized or be sent to spend time in a segregated unit. Correctional officers lack the proper training and mental health expertise to treat these inmates. It is not appropriate to use restraints in an unsupportive environment, “the environmental conditions often exacerbate the clinical condition of the inmate requiring seclusion or restraint.” (Appelbaum, 2007) There are some advantages of using restraints such as preventing self-harm or the harm of others, and sometimes in short periods of time, restraints can actually be useful in stabilizing a mental health patient rather then moving them to a hospital. There are far more cons than pros with the use of restraints. Restraints cause severe emotional distress for the already panicked inmates, and increased levels of anxiety which lead to violent and uncontrollable behavior. There have been several instances where too much time in a restraint chair, in fact has result in death or serious injury.

A true life example of such a tragedy is written in “Death by the Devil’s Chair”, in which Radley Balko from the Washington Post goes in depth about a man, Andrew Holland, who was diagnosed with schizophrenia. Holland was shackled to a restraint chair for 46 hours. He was left to fend for himself strapped naked, except for a helmet and a blanket, to a restraint chair with no food, no water, and no bathroom breaks. Once the guards finally cut him loose so to speak, he hit the floor of his cell and 40 minutes later, stopped breathing. His cause of death was a pulmonary embolism, caused by a blood clot in the leg which became dislodged after the prolonged period of immobility. Restraint chairs have not only caused the deaths of numerous of inmates, but are often more significant among the inmates who suffer from some type of mental disorder. When used properly, inmates are put into a restraint chair if they attempt to harm themselves or others, however when used improperly they can be deadly. The use of such restraint requires a professional, unfortunately, often times guards will abuse their power and neglect the mentally ill inmates. There have been laws restricting the use of the restraint chair from 2-4 hours, the highest being 16, but 46 hours is unheard of. The county refuses to comment on the reasoning for Holland’s prolonged period of restraint.

In another instance, a group of researchers in the United Kingdom conducted a review to find out whether or not restraint and seclusion usage are safe or effective for managing violent and unpredictable behavior for a short period of time. They gathered reviews and qualitative studies ranging from 1985-2002. They were able to identify thirty-six studies considered eligible for their research. However, much like several articles I have read, there was quite a bit of trouble trying to conduct any type of study of this topic due to the fact that there is no randomized control group in each study. The studies found had many implications and limitations such as a small sample size, selection biases, and the results being recorded incorrectly or not clearly. In conclusion to this study, there is not enough evidence readily available to prove whether or not restraints are considered a safe and effective management for violent outbursts. In other words, any correctional facilities who are using these restraints should proceed with extreme caution and therefore, only use restraints as a last resort.

In reference to policy regarding the use of a restraint chair, Vermont was one of the few states who had an intense outline of their proceedings. According to the statutes of Vermont Correctional Facility laws, in order to be authorized to put an inmate with serious mental illness into a restraint chair, one must “be given permission after a psychiatrist, physician or qualified mental health professional agrees there are no medical or mental health reasons not to use it.” (State of Vermont, Department of Corrections, 2006) In addition to this, the policy states that the restraint chair should NOT be used as a form of punishment among inmates. The conditions for using such an extreme method of restraint are as follows:

• When an inmate becomes violent or is deemed uncontrollable
• In order to prevent injury to one’s self as well as the injury to others, or damaging of property.
• If a healthcare professional has requested the inmate be restrained for their own safety.
• When an inmate requests the chair because they are having suicidal thoughts or tendencies
• Lastly, when transporting a violent inmate from one facility to another.

If the restraint chair is used, it should only be used by a correctional officer trained specifically to operate the chair. Within this document it is specified that inmates who have a serious mental illness should in no way have the use of leg irons and metal handcuffs while restrained to the chair.

In an attempt to find answers to these heinous problems, “Care of the Mentally Ill in Prisons: Challenges and Solutions” discusses the different solutions for treating those with mental illness in cost effective and humane ways rather than the improper use of restraints. Dr. Anasseril Daniel claims that the rate of mentally ill people being admitted to prisons over the last three decades has increased tremendously. The implementation of acute care services may be the solution to these problems. “The advantages of acute care psychiatric units in prisons include: creating a therapeutic milieu consistent with the correctional mission, safe and proper implementation of specialized treatments, such as involuntary medication administration consistent with the Washington v. Harper criteria for the gravely disabled offender who is noncompliant.” (Daniel, 2007) The Washington v. Harper Supreme Court case followed Walter Harper who was a mentally ill inmate in a Washington prison. He claimed that the involuntary administration of medication was a violation of his due process rights. These innovative treatments need to be implemented in all prisons to work towards preventing a high level of recidivism and abuse of the mentally ill within prisons.

In response to the growing problem of the mental illness crisis of whether or not to use restraints, I believe we should eliminate them all together. We only think about the fact that they are being retrained and will not be let out into the public, but very little consideration is being given to the very serious risks that come along with being restrained for several hours at a time. In reference to the article about Andrew Holland, had he not been shackled and deprived of food and water, as well as soiling himself for 46 hours, he would have never gotten an intense blood clot from immobility inevitably causing his death. A safer way of managing mentally ill inmates, may simply be pharmaceutical sedation as opposed to restraints. If Andrew had been sedated and hospitalized rather than strapped to a chair with his own filth, he would very well be alive today. There are negatives regarding sedation as well, giving too high of a dose or too little, however if there are trained personnel on the prison grounds at all times, there would be a lower percentage of these negatives. I am not proposing that we let the guards have complete control over injecting the inmates with whatever sedated chemicals they please. On the contrary, I think if we had specialized wings of the prison facility for the mentally ill with qualified mental health physicians within them, we would be able to execute this sedation properly. Another reason that sedation may be the key would be because of the excessive force used by correctional officers to contain the inmate and confine them to the chair or restraints. Mental illness is a disease and these people are not acting out for their own enjoyment of being beaten and strapped to a chair or handcuffed and tossed into a cell. We could easily test the response to restraints and the response to sedation within the mentally ill inmates present in one specific prison. Alternating outbursts with either one, researching which method seems more safe and effective.

Another alternative, and this one is a stretch, would be to reopen asylums. Prisons should not be becoming the new asylum for people that the police do not know what to do with. Even in asylums, there could be the use of restraints, however, in a therapeutic environment, it could put the inmates at ease. Hospitalization and therapy are strong alternatives to restraining a patient, and if we could find enough passionate mental health care professionals, this could prove to be a great idea. If possible, I think we should do a trial run and examine a group of mentally ill inmates within a prison setting, while at the same time examining a group in a psychiatric hospital. This would be the perfect way to distinguish whether the use of restraints truly depends on a safe environment. Perhaps, if the environment itself is insignificant, and either way it could cause harm to the patients or inmates. In another sense, this alternative could prove that asylums would be a better rehabilitation center for the mentally ill and decrease recidivism rates as well. The only way to know for sure would be to test these theories and potentially combine the two into one.

In conclusion, the use of restraints on mentally ill inmates in prisons can prove to be fatal. There are far more negatives to using such extreme methods than there are positives, and as literature suggests, there are alternatives to this method. If additional research were to be funded, and studies completed we may discover that new alternatives, not involving physical restraints, might be the best option. Once we can provide proper resources and management of medication, there should be little to no reason for the use of restraints at all.

Sources:

Source 1:

“Daniel, A. E., MD. (2007, December 01). Care of the Mentally Ill in Prisons: Challenges and Solutions. Retrieved from http://jaapl.org/content/35/4/406

Source 2:

Balko, R. (2017, August 25). Death by the Devil's Chair. Retrieved from https://www.washingtonpost.com/news/the-watch/wp/2017/08/25/death-by-the-devils-chair/?utm_term=.a414274cce71

Source 3:

Appelbaum, K. L. (2007, December 01). Commentary: The Use of Restraint and Seclusion in Correctional Mental Health. Retrieved from http://jaapl.org/content/35/4/431

Source 4:

State of Vermont, Agency of Human Services Department of Corrections, 1-6 § Security and Supervision (2006).

Source 5:

Nelstrop, L., Chandleratts, J., Bingley, W., Bleetman, T., Corr, F., Cronin Davis, J., . . . Tsuchiya, A. (2006, March 02). A Systematic Review of the Safety and Effectiveness of Restraint and Seclusion as Interventions for the Short?Term Management of Violence in Adult Psychiatric Inpatient Settings and Emergency Departments. Retrieved from https://sigmapubs.onlinelibrary.wiley.com/doi/full/10.1111/j.1741-6787.2006.00041.

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