Dealing with at-risk inmates

The recent rash of suicide attempts at the Penobscot County Jail is a pointed reminder of how poorly equipped jails are to handle inmates with serious mental health issues. Jails are not designed as treatment centers and not even as places to protect people intent on hurting themselves. It is time to explore alternative solutions for these inmates because the problem is only going to get worse.

A partial solution that I propose is to pass a new law that I call the Forensic Commitment Act. It is similar to the current law for committing mentally ill patients to a mental hospital. The current law, Judicial Procedure and Commitment, does not work well for inmates.

Under it, a psychologist or psychiatrist must certify that a patient is both mentally ill and poses a likelihood of serious harm to themselves or others due to that mental illness. This is the famous “blue paper” process.

There are two major flaws in attempting to use the mental commitment law with inmates. First, the typical inmate may not meet the mental illness requirement even when he or she attempted to commit suicide.

These inmates are often immature, impulsive, self-destructive and even irrational, but this does not mean they are mentally ill, which usually is interpreted as being psychotic. Such people fall into the category of personality disordered and not into the classic mental illness diagnosis such as schizophrenia or major depression.

Second, a mental hospital may not accept the inmate even if he is “blue- papered.” This can be because there are no beds that can accommodate such a person or the hospital may feel it has no legitimate treatment to offer. After all, hospitals are meant for sick people – not the behaviorally disordered.

When the inmate is rejected or discharged from the mental hospital system for whichever reason, the jail is stuck with a person it can’t effectively manage.

My solution is a special commitment law that commits an incarcerated person to a Forensic Behavioral Unit rather than a hospital. Such a unit is not meant to be a treatment facility, though it could provide treatment. It might be housed in a hospital, but not necessarily so.

Inmates would have to have a mental illness to be admitted, but only proved to be a danger to himself or others. As with commitment, the jail could begin the application process and psychologist or psychiatrist could certify the level of danger.

When a judge signs the order, the inmate is involuntarily placed in the unit. Under this process, the unit would also have emergency guardianship powers. This would include the power to sedate and control the inmate.

Similar legal safeguards as in the mental illness commitment law would apply to these inmates. The emergency commitment would be for 15 days and then there would be a District Court hearing for the inmate. Two outside examiners, either psychologists or psychiatrists, would be appointed to examine the inmate and present their findings to the court.

As with the current commitment law, if both find that the inmate is not a present danger, then the inmate is automatically released from the commitment. After the hearing the judge sets the length of the commitment.

This law would immediately ease the pressures on jails that are now being inappropriately forced to try to maintain the safety of unmanageable inmates. There is already a forensic psychiatric unit at the Augusta Mental Health Institute, but it has few beds and operates under the assumptions of mental illness and treatment.

Under my proposal, these units would not be hospitals, but extensions of the prison systems. They would be obligated to admit any inmate committed to them by the court. Both jails and the inmates would benefit from this new conception of how to handle at-risk inmates.

Robert Gallon, Ph.D., is a psychologist in Bangor who participates in many commitment and State Forensic Service evaluations.