The case of I.J., a schizophrenic prisoner incarcerated at various correctional facilities in New York State, illustrates the repetitive cycle of misbehavior and discipline that many mentally ill prisoners go through. We have quoted below the detailed description of I.J.s history in the complaint filed by Disability Advocates Inc. alleging inadequate mental health services and inappropriate punitive segregation for New York state prisoners.242
I.J., a diagnosed schizophrenic with borderline intellectual functioning, has been committed to CNYPC [Central New York Psychiatric Center] on twenty-nine separate occasions since his incarceration in 1981. He has a history of being suicidal when he is mentally decompensated. His admissions to CNYPC have been precipitated by depressed and sometimes self-abusive behaviors, as well as regressive behaviors such as defecating and urinating on the floor of his cell and becoming withdrawn and mute.
I.J. frequently suffers from hallucinations which are paranoid and persecutory, and which command self-harm. On numerous occasions from 1993 through 1996, he became severely decompensated, experienced paranoia and auditory hallucinations, and was admitted to CNYPC. I.J. has extreme behavioral problems, likely precipitated by his mental illness, and, as a result, has spent a large portion of his incarceration housed in twenty-three hour isolated confinement in SHU [special housing unit.] He has repeatedly suffered serious psychiatric deterioration in SHU.
During the occasions that he has been hospitalized at CNYPC or housed in an OMH [New York State Office of Mental Health] Satellite Mental Health Unit and has accepted medication, he has not presented behavioral problems and has functioned markedly better than in isolated confinement.
In May 2000, while housed in the ICP [Intermediate Care Program] at Great Meadow C.F. [Correctional Facility], I.J. was again suffering a period of serious psychiatric deterioration. During that period, I.J. was sentenced to 180 days SHU time for two incidents of use of abusive language with no testimony from mental health staff requested or proffered at the disciplinary hearings.
I.J. was transferred to SHU where his deterioration escalated. According to a misbehavior report issued on May 24, 2000, I.J. refused to obey orders to turn the light on in his cell or to remove his jumpsuit from the cell gate; he reportedly began yelling threats at the corrections officer, ripped the light bulb from his wall and smashed it against the sink and toilet in his cell.
The misbehavior report indicates that OMH staff were notified and came to speak to I.J. after which he was escorted without incident to the OMH Satellite Mental Health Unit for observation.
On the date of his hearing, June 8, 2000, I.J. again was transferred to an observation cell in the OMH Satellite Mental Health Unit due to agitated behavior and smearing feces. He was reportedly exhibiting delusional thinking, refusing to eat and refusing medication.
I.J. did not appear at the hearing regarding the May 24 incident. OMH was not consulted by the hearing officer and did not testify at the disciplinary hearing. I.J. received one year in SHU for destroying state property, refusing a direct order, and using threatening language.
Shortly after his June 8 admission to an OMH observation cell, I.J. was returned to SHU from the observation cell at his request. He was transferred back to twenty-three hour isolated SHU confinement without having accepted medication and without any indication that his condition had stabilized. No efforts to encourage compliance with medications or to consult with CNYPC are recorded in his mental health record.
I.J. continued to psychiatrically deteriorate in SHU. In August 2000, he was admitted again to the OMH Satellite Mental Health Unit for observation. His behavior was described as being loud and yelling, he reported that he was hearing voices, seeing ghosts, and that he was experiencing suicidal ideation.
Despite the OMH-observed and recorded paranoia and delusions for the two days following his admission to the OMH Satellite Mental Health Unit, I.J. was transferred back to his SHU cell on August 7, 2000. He was not seen again by OMH until September 21, 2000 when DOCS [New York State Department of Correctional Services] staff requested OMH intervention.
On September 21, 2000, DOCS staff referred I.J. to mental health staff due to his “strange behavior.” No description of his behavior was recorded, and I.J.’s OMH record does not document any intervention by OMH staff.
I.J. was subsequently seen by OMH staff approximately every two to three weeks during rounds in SHU.
In October 2000, OMH noted that I.J. was compliant with his medications and that he requested an increase in medication because he was seeing ghosts.
The following month, I.J. began to suffer severe psychiatric deterioration again. He became medication non-compliant and refused to leave his cell to meet in private with OMH staff.
On November 9, 2000, I.J.’s medication orders were discontinued because he had been refusing to take medication. No efforts to encourage compliance with his prescribed medication regime are recorded in his OMH record.
In December 2000, a month after the medication orders were discontinued, I.J. began to smear feces in his cell and became very agitated.
On December 6, 2000, I.J. refused to leave his cell to be transferred to an observation cell in the OMH Satellite Mental Health Unit. He was forcibly extracted from his SHU cell by DOCS staff utilizing a form of tear gas and an extraction team. After the extraction he was placed in an observation cell in the OMH Satellite Mental Health Unit.
Just two days later, on December 8, 2000, I.J. was returned to isolated confinement in SHU. In SHU, he deteriorated to the point where he refused to shower, refused to turn his light on, was paranoid, delusional, fearful and suspicious, and believed others to be possessed.
On January 4, 2001, I.J. finally was removed from SHU due to his beliefs that his food was being poisoned and that others were possessed, and due to his refusal to bathe. He was again taken to an observations cell in the OMH Satellite Mental Health Unit.
On January 10, 2001, I.J. was committed to CNYPC after remaining in an observation cell for six days where he continued to express paranoid beliefs and suspicions.
There is no indication in I.J.’s OMH records from June 2000 through January 2001 that I.J. was ever evaluated for psychiatric hospitalization prior to January 8, 2001.
On March 23, 2001, I.J. was discharged from CNYPC to the SHU at Clinton C.F. His discharge plan included a combination of medications, and an indication that he “will need observation, counseling and encouragement to take medications.”
I.J. was not seen in SHU by OMH staff between April 10, 2001 and May 1, 2001. On May 1, he was observed to be paranoid, and he stated that he did not fell well and that he felt confused. He informed OMH staff that he had stopped taking his medications two weeks earlier.
OMH did not take any action to remove I.J. from SHU; he was not transferred to an observation cell in the OMH Satellite Mental Health Unit. He was in fact not seen by OMH staff again for two weeks. At that time, it was noted that his paranoia had increased; he reported that he believed that corrections officers were tampering with his food. The response of OMH staff was to discontinue all of his medications because he had not taken them, and to permit DOCS to continue to house him in SHU. Despite his noted deteriorating mental condition, mental health visits were reduced to a monthly basis.
By June 2001, I.J.’s mental status had further deteriorated. He was loud and disruptive and had begun to throw feces around his cell. His behavior resulted in disciplinary charges.
OMH mental health staff reported their view that I.J. was “manipulative” and they arranged for his transfer to the Attica C.F. [Correctional Facility] SHU. OMH staff did not arrange for more intensive mental health treatment, nor did they consult with CNYPC.
On June 20, 2001, I.J. was transferred to Attica C.F. in an agitated and paranoid state. He refused to comply with a strip search at Clinton C.F. during the transfer procedure and was given an additional disciplinary ticket for this behavior.
I.J. was sentenced to two years of SHU time and 18 months loss of good time for refusing the strip search and he received six months of SHU time for throwing feces and urine at an officer.
At the Attica C.F. SHU, I.J. has continued to receive tickets for hostile and agitated behavior, and now faces nearly six years of SHU with no appreciable mental health treatment for his schizophrenia.
I.J. is scheduled to remain in SHU through July 2006 — a date more than a year beyond the maximum expiration date of his sentence.
On May 16, 2002, I.J. was transferred from the Attica SHU to CNYPC.
242 Case study excerpted from the complaint filed by Disability Advocates Inc., et al., Disability Advocates Inc., v. New York State Office of Mental Health, et al., No. 02 CV 4002, (S.D.N.Y., May 2002), pp. 28-33.