North Carolina corrections chief David Guice wants more than $20 million to improve the treatment of people with mental illness in the state’s prisons. His request comes on the heels of two recent reports showing neglect and abuse of prisoners with psychiatric disabilities in North Carolina, and the death in custody of one such individual, Michael Anthony Kerr. According to autopsy report findings released in September, Kerr died last March of dehydration after being held in solitary confinement for 35 days.

Guice heads up the state’s prison system as commissioner of the Department of Public Safety’s Division of Adult Correction and Juvenile Justice. His request was made last Thursday at a meeting of the state’s Joint Legislative Oversight Committee on Justice and Public Safety, held to discuss North Carolina’s treatment of prisoners suffering from mental illnesses.

At the meeting, Guice cited the difficulties in providing adequate care for 4,600 people – 12 percent of the total prison population – requiring mental health services. The prison system wants the state’s upcoming budget to include funding for more than 300 additional mental health care staff statewide, 64 more for Central Prison’s mental health unit, and 76 probation officers.

As NCCapitol reports on the meeting:

Deputy Commissioner of Prisons Kenneth Lassiter told lawmakers he’d like them to receive more frequent treatment, “but every time a segregated inmate comes out of a cell, it takes two staff members” to escort the inmate to an appointment. “Are you keeping them in [their cells] for 23 hours?” committee co-chairwoman Rep. Pat Hurley, R-Randolph, asked Lassiter. “Yes, ma’am,” he answered. “Day after day after day?” she asked. “Yes, ma’am,” Lassiter responded. “Don’t they get worse?” Hurley asked. “Some do,” he answered.

According to the story, Guice stated that system has already started implementing changes, including crisis intervention training for prison workers and a review of all policies dealing with prisoners with mental health problems. He warned, however, that “the needed fixes – more therapy, more medical oversight, specialized units – won’t be cheap, especially in a system that’s already underfunded. For example, he said, budget cuts have emptied one-third of the beds at Central Prison’s inpatient unit for severely mentally ill inmates.”

Recent reports on the treatment of people with mental illness held in North Carolina assert that the state’s Division of Prisons has made little progress to date in protecting these individuals from neglect and abuse, including inadequate health care and the extensive use of solitary confinement.

Report: North Carolina State Prisons’ Use of Solitary Qualifies as “Torture”

One recent report, Solitary Confinement as Torture, published by the Human Rights Policy Seminar at the University of North Carolina (UNC) School of Law, is based on research and interviews with prisoners and focuses on the treatment of incarcerated people suffering from mental disorders and the use of isolation.

The 216-page report denounces the use of solitary confinement as “torture,” and reach the “straightforward and simple” conclusion that “solitary confinement is ineffective at decreasing violence within prisons; it is ineffective at preserving public safety; it is ineffective at managing scarce monetary resources; and it violates the boundaries of human dignity and justice. Prison officials and the courts must find a way to end the practice without delay.”

The report also documents North Carolina’s failure to provide the rehabilitation opportunities essential to successful reentry into society—in large part due to the prison system’s inclination to place people in solitary for petty offenses and “almost a complete disregard of prisoners’ average mental health needs.” In fact, according to the study, as much as 10 percent of North Carolina’s prison population has been held in prolonged solitary confinement at any given time in recent years.

The UNC report recommends specific “systemic reforms,” including decreasing prison populations, increasing efforts at rehabilitation, changing the “institutional culture” in prisons and ultimately abolishing the use of solitary confinement.

In an email response to Solitary Watch, UNC law professor Deborah M. Weissman, a collaborating author of the report, wrote:

Mental health systems in NC are underfunded and fail to provide critical care and services to many individuals who, as a consequence of their mental health illnesses, wind up in prison. Either due to a lack of care, lack of training, or lack of other alternatives, individuals whose mental illness manifests as criminal behavior are sent to prison where their situation further deteriorates. Many of these individuals wind up in solitary confinement due to their inability to comply with prison system directives. The harm they suffer is egregious and likely permanent.

Weissman noted that “necessary reforms that have been clearly identified have not been fully implemented.”

Investigation: Mass Shortages Found in NC State Prisons’ Mental Healthcare Personnel

A recent investigative report by the publication INDY Week, “Prison System Short on Psychologists, Long on Mentally Ill Inmates,” finds that the North Carolina state prison system has a serious shortage of mental health personnel. According to the report, “Two years ago, the North Carolina prison system promised change after blaming staff shortfalls for the problem of mentally ill prisoners left isolated in cells splattered with human waste,” but “mental health advocates say they are still waiting for prison officials to deliver on that promise.”

The article includes the following table, highlighting the mental health staff vacancy rates in the North Carolina state prison system:

North Carolina Department of Public Safety (NCDPS) spokesperson Pam Walker told INDY Week that almost one-third of the 98 positions for prison psychologists were unoccupied as of November 3. Not only are 60 percent of senior psychologist positions vacant, but 22 percent of the prisons’ 1,314 nursing positions – which are critical to providing people with mental health disorders daily assessments – remain open.

Terri Catlett, deputy director of health services for state prisons, denied that prisoners suffering from mental illnesses were “in any additional danger because of the staff vacancies.”

The INDY Week investigation notes that, according to a 2010 report by the Wake County chapter of the National Alliance on Mental Health (NAMI), approximately 5,513 prisoners, or 14.6 percent of the state prison population, were diagnosed as “severely mentally ill” in 2006, and the number of incarcerated people with mental illnesses was increasing sharply—a trend that would suggest an increased need in personnel to provide adequate care and treatment.

Vicki Smith, executive director of the nonprofit Disability Rights NC, believes the prison system’s unremitting personnel shortages were a cause in Michael Anthony Kerr’s death. Quoting Smith, the INDY Week study states:

“In any facility where you find a high rate of vacancy, you have a lot of workers putting in overtime. If you have people working a lot of overtime, they’re not letting downtime. Poorly trained, overworked staff always contribute to abuse and neglect.” Disability Rights N.C. opened an independent investigation into Kerr’s death and found “severe deficiencies” in the care for mentally ill prisoners. The group asked Gov. Pat McCrory to declare a hiring emergency in North Carolina prisons and to authorize an expedited hiring system to fill the vacancies.

Solitary Watch obtained a copy of the Disability Rights NC’s letter making the request to commission an accelerated employment system. Dated October 3, 2014, the letter urges the governor to immediately address the severe statewide mental health staffing shortages in the NC DPS.

In another story, INDY Week reports that the Disability Rights NC’s investigation into Kerr’s death, noting that, according to Smith, the probe found “severe deficiencies in the provision of services to inmates to mental illness—such significant problems that constitutional rights are implicated.”

Smith also said that prisoners suffering from mental illness will no longer be held in solitary confinement for more than several days if health care staff find that it would be detrimental. She further stated that prisoners will no longer be placed in isolation based on their symptoms.

In an email response to Solitary Watch, Smith wrote:

The inadequacies of treatment for people with mental illness start long before they end up in prison. Many prisoners like Michael Kerr are in prison because of the criminalization of the symptoms of their mental illness. Failing to offer affordable, accessible mental health community based service has both an immediate and long term cost. But budget writers are motivated to look only at what those services cost in the short run and err on the side of short term savings. As a result police are often the first responders to a mental health crisis. Jails are filled with repeat offenders jailed for having untreated symptoms. They are put on a path that ends in prison where they continue to be punished for having a mental illness. What is happening in our state prisons is horrendous and requires reform. Segregation is used to manage behaviors related to mental illness and minimize the disruption to the general population. It is cruel and inhumane but if you look at the path of prisoners like Mr. Kerr, we failed him much earlier when his mental health needs where ignored. A travesty from beginning to end.

The Death of Michael Anthony Kerr

Michael Anthony Kerr spent 35 days in”restrictive housing” – solitary confinement – at the Alexander Correctional Institution in Taylorsville, NC. The man was transferred to Central Prison’s hospital in Raleigh via prison van but was dead by the time he arrived. According to his recently released autopsy report, Kerr died from dehydration in his solitary cell March 12 of this year. The report also shows that Kerr was not receiving treatment for his schizoaffective disorder.

During his 35 days in isolation, Kerr was cited for flooding his cell on two different occasions. Prison staff responded by shutting off the water supply to the man’s cell, which, according to the NC DPS, is permissible when a prisoner abuses plumbing facilities.

The NC DPS, which has released almost no information on Kerr’s death, responded to prison officials’ negligence by terminating a total of nine employees, including Captain Shawn Blackburn, the former captain who ordered that Kerr remain handcuffed for five days. Blackburn appealed his termination, but last week lost his case.

Th NC DPS said that 30 staff members have been disciplined or demoted as a result of Kerr’s death. But a state investigation revealed that the prison discipline system is not equipped to manage people with mental illnesses.

The United States Department of Justice (DOJ) opened a criminal investigation into Kerr’s death days after the autopsy report was released, with a federal grand jury in Raleigh, NC, issuing subpoenas to obtain related records from the NC DPS after the agency’s lack of cooperation became public.

Track Record of Prisoner Abuses in North Carolina Prisons

The North Carolina prison system has for many years faced criticism for its track record of the mistreatment of people with mental health disorders.

An incident similar to the Kerr tragedy took place at Central Prison in 1997, when an audit found that Vietnam veteran Glen Mabrey, who suffered from mental illness, died of thirst after being held in solitary confinement. Like Kerr, Mabrey’s water had been cut off, in this case for four days, after he had intentionally flooded his cell.

In 2011, an internal review of conditions inside North Carolina’s Central Prison found that prison staff neglected the needs of prisoners suffering from serious mental illnesses. According to the News Observer:

Years of budget cuts, hiring freezes and high turnover led to staffing shortages in critical jobs, especially nurses and doctors. Staff failed to maintain up-to-date records, track medications or respond to calls for medical help. The report says that nurses acknowledged not knowing which inmates were which and that patients were given too much prescribed medication or none at all.

According to the story, the report also said there have been multiple deaths resulting from medical conditions, including the case of Levon Wilson, who suffered from bipolar disorder. An autopsy report shows Wilson, who was arrested on misdemeanor charges, was moved from Central Prison to WakeMed Hospital in Raleigh in September of 2010, with “moderately high levels” of the medication lithium in his bloodstream. The News Observer reports:

[Wilson’s] cause of death is listed as “complications of lithium therapy,” which led to kidney and bowel problems. Still, the state doctor performing the autopsy declared Wilson’s death as “natural.”

DOC officials refused to release a separate internal review of Wilson’s death, citing federal medical privacy laws.

The story also reports that the same internal review also says that, due to staffing shortages, patients were left unsupervised:

Inmates cut themselves and swallowed nails, batteries and shards from plastic eating utensils. The review found numerous inconsistencies and contradictions in written records of observational rounds. The report also found that inmates in “therapeutic seclusion” were often locked in cells for extended periods without being let out for meals, recreation time or to shower.

A 2012 INDY Week article describes what life is like in solitary confinement in North Carolina prisons. The story describes conditions in the intensive control unit, or ICON, at Central Prison, focusing on the story of Chris McBride, who was placed in ICON after he and a group of other prisoners held a work-stoppage to protest their long hours. According to a letter from McBride:

Solitary confinement is hell. I agree with the public—it is a form of torture. It is a tiny cell about 6 feet by 8 feet. . . We are in this cell 23 hours a day. We are allowed to come out for recreation five times a week for one hour. The rec is a cage. They just stick us in a little cage and we can walk around. That’s it. We are only allowed to take three showers a week. . . So if you add up five 1-hour recs, and three 10-minute showers, that’s 5½ hours. Let’s round that up to 6 hours. There’s your answer. Out of the 168 hours in a week, we are out of our cell 6 hours. . . . . . Normal rules don’t apply to solitary. They are supposed to, but they don’t.

In yet another incident of prisoner abuse at Central Prison, where around 600 people are held in “Close Custody,” prisoners launched a hunger strike in 2012 protest of various prison conditions, the demands of which included “[a]n immediate end to the physical and mental abuse inflicted by officers” and “[t]he end of cell restrictions.

In May of last year, Solitary Watch reported on a federal lawsuit filed on behalf of eight people held in solitary confinement at Central Prison against officers and administrators at the prison. According to the suit, guards used “blind spots” – areas in the prison out of view of surveillance cameras – to beat handcuffed and shackled prisoners.

The beatings took place in Unit One, a cell block commonly known as “The Hole,” where people are held in isolation.

The abuse claims made by the eight prisoners were substantiated by medical records which documented “blunt force injuries,” including broken bones and concussions, sustained while they were isolated from other prisoners. One man was unable to walk for months after his hip was fractured.

The lawsuit named 21 guards accused of participating in the abuse at the maximum security prison in Raleigh as defendants.

Followings hearing on the suit, the judge ordered that additional cameras be installed that would provide surveillance of the blind spots and that digital videos of the surveillance be kept sufficiently long enough to be used by any prisoners who file complaints.

Advocates Call for Greater Oversight of State Prisons

Asked by Solitary Watch to comment on the state of the North Carolina prison system, North Carolina Cure (NC-CURE) Director Elizabeth Forbes responded:

There have been countless issues of abuses of mentally ill prisoners, including the most recent incident– the death of Michael Anthony Kerr. I think this was one reason for Dr. John Carbone’s demotion. It’s just one more lawsuit resulting from his negative and cavalier attitude toward the mentally ill. Regarding Kerr, our inside sources told us that the guards specifically punished him and he was taken off his mental illness medication… The problems in North Carolina state prisons originate from severe staff shortages and lack of oversight.

Solitary Watch also contacted North Carolina Prisoner Legal Services attorney Michele Luecking- Sunman, who stated in a telephone interview:

There have definitely been some horrific things that have happened in North Carolina’s prisons in the last several years, and we have and do have pending litigation to try to address the deficiencies that are causing these acts that are occurring.

There’s always a need for greater oversight of mental healthcare in prisons and there is some evidence that there has been some ongoing oversight in North Carolina, but I think that there needs to be more. When there are experts brought in or experts who look at the system to the extent that their recommendations can be followed, they should be followed. A lot of times prisons are under pressure in terms of funding or what not, but the pressure needs to be there for experts in mental health fields to be the ones that are determining how people are housed when they have mental illness and they shouldn’t always default to custody level people. We need to see treatment instead of punishment when somebody is acting out in a manner that is because of their mental illness.