Correctional officers, the front line custodial staff who interact on a daily basis with prisoners, have a difficult job in the best of circumstances. Working in insufficient numbers, they are asked to exercise power over and maintain control of prisoners crowded into facilities that are often no more than warehouses, devoid of opportunities to keep their inhabitants productively and peacefully engaged. The difficulties and frustrations of work as a correctional officer are compounded when prisoners have mental illness. The at times aggressive, bizarre, or repellent behavior of mentally ill prisoners can try the patience of anyone, even mental health professionals. But few correctional officers have the training in and understanding of the nature of mental illness that would help them cope better with the challenges posed by offenders with severe illnesses. They come to their jobs with the fears and prejudices of the general population towards the mentally ill. The correctional culture of order, obedience, and discipline in which they were trained leaves them further ill-prepared for handling prisoners whose behavior is either chronically or episodically ruled by their mental illness.
Correctional staff experience prisoners at close quarter twenty-four hours a day. They come to know patterns of prisoner behavior and can detect changes in them sometimes better, if not more rapidly, than mental health staff whose interactions with prisoners may be more sporadic. In most prisons, mental health staff do not regularly monitor the mental health condition of prisoners who are not on the mental health caseload either because they were not identified as ill during the initial prison in-take screening process or because they developed mental illness or emotional crises while imprisoned. Since correctional officers have the most contact with prisoners, they can notice unusual behavior or changes that may signal a mental disorder.
Correctional officers are in a position to notice if a prisoner has suddenly become extremely withdrawn and incommunicative or if one has started to act bizarrely. They are the source of many referrals to mental health staff of prisoners, alerting mental health staff of a prisoner’s need for attention. They have the opportunity to develop a relationship with them, and if a prisoner begins acting out, they can talk to the prisoner and help calm them down. On evenings and weekends there may be no mental health professionals present at all in the prison. Correctional officers find themselves in situations in which they must assess a prisoner’s conduct and make judgment calls about whether mental health professionals should be summoned; whether to remove a prisoner from his or her cell and into an observation cell or mental health unit; whether prisoners are merely acting out for attention, or whether they are in need of an immediate mental health intervention.
Understanding the nature and symptoms of mental illness enhances the ability of correctional officers to respond appropriately to mentally ill prisoners, an ability which has become increasingly important as the number of prisoners with mental illness has grown. If correctional officers view acting out as volitional, deliberate misbehavior, if they do not realize a prisoner who is mumbling to himself is hallucinating, if they don’t realize that huddling in the corner of a cell may be a sign of crippling depression, they will not call for mental health staff.
For example, a team of experts who reviewed a series of issues relating to psychiatric services in Massachusetts prisons, found that officers were under-referring prisoners for medical services. Officers had a threshold for referrals that precluded attention for many prisoners. “Correctional officers informed us that if an inmate develops a serious mental disorder, it is not likely to result in officers’ requests for mental health attention to the inmate as long as the inmate is clean, quiet, and obedient. “Bizarre behavior” is not likely to result in a referral as long as it is not disruptive.”243 In the case of John Salvi, an prisoner who was not on the mental health caseload at the time he committed suicide, the evaluation team found there was substantial evidence that Salvi “was suffering from serious thought disorder and manifested some unusual behaviors…but he did not attract enough attention to reach the relatively high threshold that staff typically use as signals for mental health services referrals.” The evaluation team also noted that “[a]ll of the correctional officers we interviewed felt that they did not have enough training in recognizing mental illness in inmates and in making decisions about referring inmates for mental health services.”244
Training for correctional officers in mental health issues can also help overcome a common assumption that security staff and mental health staff are worlds apart in views, concerns, and methods of handling prisoners. Stereotypes also impede collaboration between custodial and mental health staff. Correctional officers often believe mental health professionals coddle their patients, are duped by manipulative prisoners, and don’t sufficiently appreciate security needs. Mental health professionals may view correctional officers as blind to anything but regimentation, control, and punishment. Better mental health training for correctional officers and more collaboration between custodial and mental health staff could overcome such stereotypes and redound to the benefit of the mentally ill offenders under the control and supervision of both.
Correctional and mental health professionals interviewed by Human Rights Watch agreed on the importance of mental health training for correctional officers. They pointed out that training on the signs of and nature of mental illness will not only enable correctional officers to better respond to problems that emerge with prisoners, but that it will also enable them to better assist mental health staff. “They need more training to give a better idea of how to identify and deal with individuals with mental health issues,” Warden Gloria Henry, of California’s Valley State Prison for Women told Human Rights Watch. “When you’re trained in security, to have people comply with rules and regulations, that’s what your expectations are. When you’re dealing with people with mental health problems, you need to know how to approach them.”245
Nevertheless, such training is sorely lacking.In 2001, according to a survey by the National Institute of Corrections, forty states claimed to provide some mental health training to correctional officers, but mostly the training was minimal. Ten prison systems claimed to include roughly four hours of mental health classes in their basic training package for new correctional officers, thirteen admitted to providing fewer than four hours, and only seven stated that they provided more than four hours of training.246
In Texas, in connection with litigation about inadequate treatment of mentally ill prisoners, the Texas Department of Criminal Justice (TDCJ) markedly increased mental health training for correctional officers. In December 2001, the TDCJ noted that the department was providing, “increased training in the recognition of and the appropriate referral of the psychotic as well as potentially suicidal patient.”247 It also noted:
We were not able to ascertain the extent of annual follow-up, or mental health in-service training for correctional officers. The National Institute of Corrections (NIC) report found that a total of forty hours of annual mandated in-service training for correctional officers was the norm.249 But the report did not provide a breakdown on the content of the in-service training and to what extent it includes mental health components.250
A 1999 report commissioned by the California Commission on Correctional Peace Officer Standards and Training reviewed in-service training in a number of states. According to the report, California provides a three-hour course on “unusual inmate behavior.” No other state reported a similar course. Ohio and Tennessee each offered a course, lasting two and three hours, respectively, titled “managing manipulative inmate behavior.” Arizona, Nebraska, and Nevada provided officers with a course titled “con games.” Tennessee offered a three and a half-hour course in “psychological testing.” Under courses on health and welfare, only eight states — Arizona, Georgia, Hawaii, Michigan, New Mexico, Ohio, Pennsylvania, and Utah — offered courses specifically on “mental health issues/special needs inmates.” While Michigan claimed to offer a rather extensive sixteen hours of training in this area, the others ranged from between one hour and forty-five minutes to six hours.251 “We have not had a good success rate in training correctional officers. We don’t have a formal training program to raise sensitivity,” Harbans Deol, medical director for the Iowa Department of Corrections, told Human Rights Watch.252
The Colorado Department of Corrections claims that it provides correctional officers with an eight-hour in-service course on mental health issues. Qualifications necessary for teaching this course are, however, limited. “Instructors for this course should be knowledgeable about human behavior and have good communication skill,” the October 2001 instructor’s guide advised.253
Providing adequate training in mental health issues to correctional staff is complicated by the educational level of most correctional officers. According to the National Commission on Correctional Healthcare (NCCHC), most correctional officers lack a university education. “Nationally, the level of a correctional officer’s education is high school,” Harbans Deol told Human Rights Watch. “That creates a problem: how do you educate these people medically?”254
Few states provide formal additional training to guards volunteering to work in mental health units within the prisons. In responses to a National Institute of Corrections survey, only Delaware, the District of Columbia, Louisiana, New Hampshire, New Jersey, New York, Ohio, and Oregon reported that they provided special training to guards on these units.255 Nevertheless, in some prisons or units that have a special therapeutic mandate of trying to treat and rehabilitate mentally ill offenders, correctional staff do work more closely with mental health staff and receive more training. The Washington Department of Corrections developed a “mobile consultation team” to help the system deal with prisoners who are particularly difficult and disruptive. Team members include not only mental health professionals, but experienced corrections officers. The team works with prison staff who have requested consultation and together they engage in joint problem solving.256 Professor Hans Toch praises innovative programs that:
Toch argues strongly, and in our judgment cogently, for mental health training for correctional officers that goes beyond “a diluted psychology-101-type lecture format.” Instead, he believes officers should receive hands-on training that presents officers with real symptoms being experienced by real prisoners in the prisons in which the officers work and that integrates those officers into the mental health teams and case conferences in which prisoners’ mental health needs are discussed.258
Dangerous situations can and do arise in prisons in which the use of force may become necessary to protect staff, prisoners, or property from injury and to maintain or reestablish control. The type and extent of force used, however, should always be proportionate to the need, and force should never be used as punishment or reprisal against a prisoner. The Eighth Amendment of the U.S. Constitution is violated when force is maliciously and sadistically used against a prisoner to cause harm, rather than in a good faith effort to maintain and restore discipline.259 In addition, the constitution prohibits officials from using force that is greater, in amount or kind, than what is needed to maintain or restore order, or when force is used without any legitimate penological purpose.
International standards mandate that “officers who have recourse to force must use no more than is strictly necessary.”260 Instruments of restraint, such as four-point restraints (a process in which the prisoner is fastened to his or her bed by the feet and wrists) or strait jackets, should only be used on medical grounds by direction of a medical officer, or by order of the prison director “if other methods of control fail, in order to prevent a prisoner from injuring himself or others or from damaging property; in such instances the directors shall at once consult the medical officer.”261 The American Correctional Association’s “use of force” policy calls on correctional authorities to seek to reduce or prevent the necessity of the use of force, to authorize force only when no reasonable alternative is possible, to permit only the minimum force necessary, and to prohibit the use of force as a retaliatory or disciplinary measure. It emphasizes the importance of operating procedures and staff training to “anticipate, stabilize, and diffuse situations that might give rise to conflict, confrontation, and violence”; and the provision of “specialized training to ensure competency in all methods of use of force, especially in methods and equipment requiring special knowledge and skills such as defensive tactics, weapons, restraints and chemical agents….”262
There are no national statistics on the use of force by staff against prisoners, nor independent research assessing how well use of force practice in any given state correctional system conforms to appropriate standards. Information about use of force typically becomes public in the context of criminal prosecutions or civil litigation addressing staff abuse of prisoners that resulted in serious injuries. Human Rights Watch was unable to determine whether mentally ill prisoners are more likely to be in situations involving use of force by staff than other prisoners or whether the force used against mentally ill prisoners is more likely to be excessive than in situations involving prisoners who are not mentally ill.
Nevertheless, some correctional experts believe that correctional officers may be too quick to resort to force and to use excessive force particularly when dealing with mentally ill prisoners. Lacking adequate training in mental illness and in conflict de-escalation, often also poorly trained in the use of force in general, their efforts to control mentally ill prisoners have led, in some cases, to prisoner deaths or other serious injuries. In the past five years, Steve Martin, a well known corrections consultant and use of force expert, has investigated over twenty cases of sudden in-custody death and numerous others of serious injuries, the majority of which involved prisoners with mental health histories. Martin describes a pattern of escalating force typical in these cases:
According to Martin, the strange, often violent, and irrational behavior of agitated mentally ill prisoners, and their protracted struggling against being restrained, can scare correctional officers into acting more aggressively than they should during a restraining process. “What is very evident in these cases is the officers are simply frightened of the detainee. You can see [on the videotapes of the incidents] they perceive the detainee as an utter immediate threat to their physical well-being. It’s a dynamic created almost from the get-go.” In one jail Martin recently investigated, the name of which he is prevented from revealing by the terms of his contract, he investigated ninety-three cases of force used against mentally ill prisoners in a twelve-month period. “I’d estimate half of these could have been avoided altogether if you’d had some health care intervention,” Martin stated.
Martin told Human Rights Watch of an event that occurred in the Los Angeles County Jail in 1999. A man, G.M., with a long history of chronic mental illnesses, who was also wheelchair-bound as a result of having cerebral palsy, was brought into the jail. He was homeless and hungry; and a jail official at some point decided to give him a sandwich. Shortly afterwards, another correctional officer decided to take the sandwich away. The action enraged G.M., who jerked his arm backwards and struggled to keep a hold on his food. This was seen as him resisting an officer and several other guards immediately joined the fray, subdued the prisoner (who was still in his wheelchair), and rushed him off to a room where he could be restrained. “Three-to-five minutes into the event, he expired,” Martin told Human Rights Watch. Not only were no mental health personnel present to explain to G.M. why his sandwich was being confiscated, no mental health staff were present to advise the security officials during the restraint itself. Instead of calling in the mental health team, guards converged on the man’s wheelchair and began aggressively restraining him. Martin’s investigation found that G.M. was manhandled out of his wheelchair and placed face up on a bed. Several correctional officers jumped on top of him to begin attaching the restraints; only after the restraints were in place and the officers got off of G.M.’s body did they realize that he had stopped breathing. The subsequent medical examiner’s report found that G.M. had suffocated after his airwaves were restricted by the weight of the guards atop his body. Martin told Human Rights Watch that G.M.:
Martin reported several other cases of mentally ill prisoners involved in altercations with correctional officers who restrained them and the prisoners died from positional asphyxiation, which is caused by an inability to breathe because of being placed in a prone position, with the arms behind the back, making it impossible for the respiratory muscles to work properly. The inability to breathe is aggravated, and a fatal outcome is likely, when the prisoner is overweight or obese and when one or more officers kneel, sit, or stand on him. For example, an overweight prisoner with a history of chronic mental illness, was acting out in his cell, yelling, and carrying on. He reacted violently when a group of officers tried to remove him from his cell. One of the officers then sprayed the prisoner with O.C. pepper gas in his face, which made the prisoner even more agitated. The officers ultimately got him down on his stomach and restrained him. He died of asphyxiation.265
A number of mentally ill prisoners have died in recent years after being placed in restraining chairs. Most of the deaths occurred in jails. For example:
The complaint against Phillips lists fifteen incidents which are alleged to typify the abuse at the hands of correctional officers to which mentally ill prisoners at Phillips State Prison are subjected . One of the examples is the following:
Jason Freeman, a mentally ill prisoner at Phillips, submitted an affidavit to support plaintiffs’ motion for a preliminary injunction in which he testified that in January 2003, after his cellmate set fire to their cell, Freeman:
Tamara Serwer, another attorney with the Southern Center for Human Rights working on the case, told Human Rights Watch that after the complaint was filed, a cadre of officers who had been particularly brutal were transferred. A new warden, who has a mental health background, took over at Phillips shortly before the lawsuit began and recognized, according to Serwer, that the culture at the facility needed to be changed.
243 Kenneth Appelbaum, et. al, Report on the Psychiatric Management of John Salvi in Massachusetts Department of Correction Facilities 1995-1996, submitted to the Massachusetts Department of Correction, January 31, 1997, p. 35; on file at Human Rights Watch.
244 Ibid., p. 39
245 Human Rights Watch interview with Gloria Henry, warden, Valley State Prison for Women, California, July 17, 2002.
246 National Institute of Corrections, Provision of Mental Health Care in Prisons, 2001, p. 9.
247 State of Texas, “Intervention Plan for Seriously Mentally-ill Offenders in Administrative Segregation,” Ruiz. v. Johnson, Civil Action H-78-987, December 15, 2001.
249 Miki Vohryzek-Bolden, Ph.D., Center for Health and Human Services, California State University, Sacramento, Overview of Selected States’ Academy And In-Service Training for Adult and Juvenile Correctional Employees, Conducted for the California Commission on Correctional Peace Officer Standards and Training, June 30, 1999, table 14a., p. 83.
250 National Institute of Corrections, Provision of Mental Health Care in Prisons, 2001, p. 9.
251 Vohryzek-Bolden, Overview of Selected States, 1999, table 9a, pp. 53-61.
252 Human Rights Watch telephone interview with Harbans Deol, medical director, Iowa Department of Corrections, June 14, 2002.
253 Colorado Mental Health Training Course for Law Enforcement and Corrections Officers. Instructor’s Guide, prepared by Richard K. Sherman, MS, October 2001, p. iv.
254 Human Rights Watch telephone interviews with Harbans Deol, June 14, 2002 and April 2, 2003.
255 National Institute of Corrections, Provision of Mental Health Care in Prisons, 2001, p. 9.
256 Hans Toch and Kenneth Adams, Acting Out, 2002, p. 357.
257 Ibid., p. 407.
258 Human Rights Watch telephone interview with Hans Toch, February 18, 2003.
259 Hudson v. McMillian, 503 U.S. 1 (1992), at 6-7.
260 Standard Minimum Rules for the Treatment of Prisoners, adopted Aug. 30, 1955 by the First United Nations Congress on the Prevention of Crime and the Treatment of Offenders, U.N. Doc. A/CONF/611, annex I, E.S.C. res. 663C, 24 U.N. ESCOR Supp. (no. 1) at 11, U.N. Doc. E/3048 (1957), amended E.S.C. res. 2076, 62 U.N. ESCOR Supp. (no. 1) at 35, U.N. Doc. E/5988 (1977), article 54(1).
261 Standard Minimum Rules, Rule 33.
262 American Correctional Association’s (ACA) public correctional policy on use of force, as published in Craig Hemmens and Eugene Atherton, Use of Force: Current Practice and Policy (American Correctional Association, 1999), pp. vi-vii. Specific standards governing the use of force in corrections are contained in the ACA’s Standards for Adult Correctional Institutions, and Standards of Adult Local Detention Facilities.
263 Human Rights Watch telephone interview with Steve Martin, attorney, Austin, Texas,October 1, 2002.
264 Ibid., April 11, 2003.
266 Frazier died on July 4, 2000. Prison officials suspended the use of the stun gun after Frazier’s autopsy. Jen McCaffrey, “Doctor: Repeated use of stun gun at prison may have led to death,” The Roanoke Times, July 26, 2003.
267 Details on Frazier’s case were provided to Human Rights Watch by Connecticut attorney Antonio Poinvert. Human Rights Watch telephone interview with attorney Antonio Poinvert, February 10, 2002.
268 The affidavit was dated November 23, 2002, and was sent to prisoners’ rights activist Mercedes Maharis. Maharis forwarded it to Human Rights Watch on February 25, 2003.
269 Human Rights Watch telephone interview with Glen Wharton, assistant director of operations, Nevada Department of Corrections, June 20, 2003. Human Rights Watch criticized the unnecessary use of firearms by prison officers in “Red Onion State Prison: Super-Maximum Security Confinement in Virginia,” A Human Rights Watch Report, vol. 11, no. 1(G), May 1999.
270 Reickenbacker v. Foster, Complaint, Civil Action No. 99-910-C-1 (M.D. La., 2002).
271 Anne-Marie Cusac, “The Devil’s Chair,” Progressive Magazine, April 2000.
272 Human Rights Watch interview with Y.E., inmate, Garner Correctional Institution, Connecticut, June 10, 2002.
273 Ruiz v. Johnson, 37 F. Supp. 2d. 855, 904 (S.D. Texas, 1999) (internal citations omitted)
274 Declaration of [Prisoner name withheld], December 17, 1999, contained in excerpted record submitted with plaintiff’s Revised Opening Brief, Hallet v. Payne, No. 00-35098 (9th Cir., June 29, 2000).
275 Washington Department of Corrections letter to [correctional officer’s name withheld] contained in excerpted record submitted with plaintiff’s Revised Opening Brief, Hallet v. Payne, No. 00-35098 (9th Cir., June 29, 2000).
276 Human Rights Watch telephone interview with Fred Cohen, attorney and monitor, February 17, 2003.
277 Human Rights Watch telephone interview with Lisa Kung, attorney, Southern Center for Human Rights, June 13, 2002.
278 Fluellen v. Wetherington, First Amended Complaint, Civil Case No. 1:02-CV-479 (JEC) (N.D. Georgia, March 15, 2002), p.11.
279 Declaration under Penalty of Perjury of Jason Freeman, Fluellen v. Wetherington, Civil Case No. 1:02-CV-479-JEC (N.D. Georgia, February 13, 2003).
280 Human Rights Watch interview with D.S., ex-prisoner, Gaudenzia House, Philadelphia, Pennsylvania, August 13, 2002.
281 The prisoner’s letter was sent to the Alliance for the Mentally Ill, June 21, 1999. It was then forwarded to Human Rights Watch.
282 Written statement by James Wilson, April 2, 1995 (copy on file at Human Rights Watch).
283 The evidence of excessive and malicious use of force at Pelican Bay lead to a court ruling that it violated the Eighth Amendment. Madrid v. Gomez, 889 F. Supp. 1146 (N.D. California, 1995).
284 This incident was one of many examples of extreme violence perpetrated by Pelican Bay correctional officers that Judge Henderson detailed in his January 1995 opinion in the Madrid v. Gomez case. Madrid v. Gomez, 889 F. Supp. 1146 (N.D. California, 1995.)The water temperature for Dortch’s bath was estimated at 125 degrees Fahrenheit.
285 Human Rights Watch interview with D.F., Corcoran, California, July 11, 2002.
286 New Jersey Prison System Report of Dr. Dennis Koson, C.F. v. Terhune, Civil Action No. 96-1840 (D.N.J., September 8, 1998), p. 38.
288 Human Rights Watch telephone interview with Janet Schaeffer, psychologist and former director of mental health services, Washington Correctional Center for Women, May 29, 2002.