State’s housing of civilly committed draws fire

By Max Sullivan msullivan@seacoastonline.com

December 27. 2015 3:15AM

HAMPTON — State Rep. Renny Cushing wants to bar the state from sending civilly committed patients with no criminal record to the state’s Secured Psychiatric Unit on the grounds of the men's state prison in Concord and managed by the Department of Corrections.

Cushing, D-Hampton, filed legislation this month seeking to make the change.

People deemed too dangerous to be kept in New Hampshire Hospital, the state’s acute care psychiatric hospital in Concord, can be sent to the Secured Psychiatric Unit (SPU) if the hospital does not have means to deal with their violent behavior. At the SPU, they are mixed with convicted criminals serving time in state and county jails, people found not guilty by reason of insanity and sexually violent predators.

New Hampshire Hospital transferred 51 people to the SPU between 2012 and 2015, according to the Department of Health and Human Services. Fifty were on an emergency basis. The state hospital transfers an average of 13 people to the SPU each year, the average length of stay not being known, according to DHHS.

Cushing’s bill would require patients too dangerous for state hospital to be placed in another facility, outside the state if necessary. He’s advocated for changing the system since he toured the prison in 2009.

Wire fence near the entrance to the Secure Psychiatric Unit at the New Hampshire State Prison for Men. State Rep. Renny Cushing filed legislation this month that would bar the state from sending civilly committed patients with no criminal record to the SPU. Nancy West courtesy photo

“I’ve been outraged (that) we, in the year 2015, sent people to prison when they’re sick instead of to a hospital,” he said. “There would be an outrage if we treated people who had cancer by sending them inside the prison walls and having them attended to by prison guards instead of nurses and doctors, but that’s what we do with severe mental illness.”

New Hampshire Associate Attorney General Anne Edwards said the SPU is an adequate mental health treatment center. Patients receive the same care they get at New Hampshire Hospital, she said. The only difference is strict security measures to keep dangerous patients from hurting staff, themselves or each other.

“I understand what the representative is saying, and he clearly has his view on that," Edwards said. "This is a treatment unit. This isn’t a jail cell."

Beatrice Coulter, 58, was hired last May to work as a nurse at the SPU. She has been a nurse since 1981, previously working in an involuntary hospitalization facility near Newark, NJ. Coulter lasted four days at the SPU before she quit, saying she was horrified by the facility and had a moral obligation to distance herself from it.

“I became aware of the fact that individuals who had never been adjudicated were being detained in SPU,” Coulter said. “I knew that was a very serious problem and I ethically wanted nothing to do with the place.”

Coulter said SPU is not an accredited hospital and does not receive federal reimbursement for Medicaid like other hospitals. DOC spokesman Jeffrey Lyons confirmed the SPU is not an accredited hospital, as it governed by its own statutes and does not receive federal reimbursement.

Edwards said the SPU is not the only place in the health care community that places non-criminals with prisoners. Places like drug rehabilitation facilities often have a mix of non-criminals there voluntarily alongside those ordered by a judge to be there.

“It’s not uncommon in treatment facilities to have sort of a mixed patient population,” she said. “It makes it challenging to maintain appropriate boundaries and safety and things like that, but that is how the Secured Psychiatric Unit is set up and that’s how it has been run.”

The civilly committed have daily contact with prisoners inside the SPU. They walk the same halls and spend time in the same common rooms. Edwards said no patients are handcuffed unless circumstances require it. She said there have never been serious injuries caused by altercations between patients, but that small disagreements sometimes result in pushing and shoving.

“People with specific (mental) conditions tend to become agitated with each other. That’s no different at the Secured Psychiatric Unit than at New Hampshire Hospital,” she said. “It’s a matter for the staff to manage at all times.”

Edwards is not aware of any specific complaints by family members of civilly committed patients, but said it would not surprise her if someone were concerned. However, she said while people who are civilly committed might have no criminal background, their restrictions are not so different from prisoners.

“The people who are there under a civil commitment already have their liberties restricted,” she said. “That’s what the civil commitment law allows. We

already have removed some of their freedoms ... Only for a limited time and only through a degree that is necessary, but they’re already under a restrictive (setting).”

Coulter disagreed. She said there should be a fundamental difference between a civilly committed patient’s restricted freedom and that of a convict. If a patient has not committed a crime, she said, they should be managed by DHHS, not the DOC.

“(The SPU) is under the jurisdiction of the Department of Corrections,” she said. “They are subject to the rules and regulations of the prison. So at that point, one has to wonder how we could ever possibly say that they are not being treated as prisoners.”

The potential for a secure, multi-program forensic psychiatric hospital was examined in a 2010 House study committee. Based on the findings, legislators asked DHHS and DOC to come up with a proposal for improving the system. The departments proposed the psychiatric unit be limited to sentenced state and county inmates and that a new facility should house patients too dangerous to be kept in the state hospital. The proposal suggested people found not guilty by reason of insanity also be kept in the new facility, not the SPU.

No facility has been constructed despite the DHHS and DOC recommendations.
“The state knows it’s a problem,” Cushing said. “The problem is the Legislature has refused to fund and build a multi-purpose forensic state hospital.”

If the Legislature decided to separate criminals from the civilly committed, Edwards said “that’s a sound policy decision and certainly one we would help implement and defend.” “It’s up to the Legislature to determine the best way to provide services it needs to be providing,” she said.

Coulter said she believes no one has stopped the current practice because most don’t know it exists. She said there have been many times in psychiatric history where inhumane practices needed a closer look before society put it behind them.

“I think it’s just a scab that hasn’t been picked at yet,” she said. “(The civilly committed) have freedoms that are different. They have not committed crimes.”

Andrew Gorrill