For the mentally ill behind bars in Montana, life goes from bad to worse 

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The ACLU of Montana intervened on Katka's behalf, filing a lawsuit against the state and the DOC in 2009. The suit alleges that DOC placed the teenager on behavior modification plans at least six times between September 2008 and September 2009. The lawsuit also claims that Katka was pepper sprayed and shot with an electroshock gun.

Katka attempted suicide four times. Twice, he bit through his wrist until he punctured a vein. His attorneys say that during his last suicide attempt, Katka used a shaving razor to slit his wrists while he was in the shower. Emergency personnel had to resuscitate him.

As with the Walker and Wilson lawsuits, the Katka case alleges the state violated constitutional protections against cruel and unusual punishment.

Dr. Terry Kupers is a clinical psychiatrist and professor at the Wright Institute Graduate School of Psychology in Berkeley, Calif.. He's also a forensic mental health expert who's consulted with the U.S. Department of Justice and Amnesty International. He testified during the Katka and Walker legal proceedings. The DOC's use of behavioral management plans, even after the Walker decision, exacerbates mental illness, Kupers says. He maintains:

"What happens is a series of worsening punishments. They reach the point where they're both unconstitutional and cause human breakdown. That's what happened in both the Walker and Katka cases."

Kupers says long periods of stress and anxiety actually alter how the mind works: People in their teens and early 20s, like Wilson and Katka, have rapidly developing brains. Neural pathways are blazing emotional trails that the mind will follow for years to come. When young people experience repeated cycles of disorganized thinking, hallucinations or depression, they become more prone to that, as pathways in the brain that are triggered by psychotic episodes or manic episodes become habituated. "It's like a rut in a road," Kupers says.

click to enlarge Montana State Prison, at Deer Lodge - PHOTO BY CHAD HARDER

There are other similarities among the cases, including the antisocial disorder diagnosis. Kupers says that while some studies show that approximately 15-25 percent of any prison population has antisocial personality disorder, that number plummets when doctors evaluate a more extensive list of diagnostic criteria that includes, for instance, the inability to empathize with others.

Kupers says institutions can use antisocial personality disorder diagnoses and another classification, "malingering," which means exaggerating or faking, to skirt constitutionally mandated treatment responsibilities.

"What the psychiatrist is essentially saying is this individual does not warrant mental health services," Kupers says. "They actually should be treated as just an ordinary prisoner and punished when they do something wrong...I believe what's going on is the budget for mental health services within [a given corrections department] is relatively very inadequate. And then the psychiatrist justifies the inadequacy by saying 'This person doesn't really need treatment.'"

DOC declined to comment on that allegation, citing pending litigation.

Katka's attorneys, including Ron Waterman, who's filed multiple cases against DOC, say they also see an inordinate number of antisocial diagnoses in the state prison system.

"Oftentimes, those people who come through the system somehow or another are magically cured of those diseases and those mental health issues and they all end up as an antisocial personality," Waterman says. "It is a pattern that is remarkable in the frequency."

District Judge Jeffrey Sherlock intervened in the Katka case last August. He prohibited DOC from placing Katka in solitary.

Katka is now on parole, living with his grandfather outside of Havre. Waterman says he's responding well to the ongoing mental health treatment he's had access to since the ACLU intervened.

"Security comes first"

The Montana State Prison in Deer Lodge houses murderers, thieves and rapists. Some of the men who live there aren't welcome anywhere else.

"We do not have a choice who comes to us," says Montana State Prison Health Services Bureau Chief Cathy Redfern. "We get what we get. And we deal with who we have."

DOC staff declined to comment on the Wilson and Katka cases. However, Redfern and some of her colleagues agreed to talk to the Independent about the overall challenges that come from housing—and providing medical careto hundreds of mentally ill inmates.

Since the Walker decision, the men's prison has increased its mental health staff significantly. It now has 21.5 mental health positions; one of them is a psychiatrist. Other facilities contract out for psychiatric services. The Crossroads facility, where Colton Wilson is now, uses tele-medicine.

Montana State Prison Mental Health Program Director Jill Buck says even the slightest staffing increase helps. In 2010, MSP received funding to hire three temporary mental health staffers. "We found that just having those mental health techs on night shift decreased those acting-out behaviors," Buck says. "It helped with counseling, de-escalating situations."

They've since lost funding for two of the three positions.

Montana State Prison is the only DOC facility with specific accommodations for inmates with psychiatric problems. Two mental health units at the Men's Prison accommodate 25 prisoners. Buck says she has to be selective about whom she admits there. "We don't like to put straight behavioral problems on the unit, because we do have severely mentally ill people in our unit," she says. "We do have to make sure we protect them."

DOC Senior Legal Counsel Diana Koch says that courts sometimes sentence severely ill prisoners to the Warm Springs State Hospital. But that facility isn't secure, meaning if inmates are dangerous, they'll likely end up in the prison.

"Some of them come to Montana State Prison, even if they have not reached maximum benefit at the hospital," Koch says. "When they start acting out at the hospital, the only place that they can go is to the prison."

In 2007, DOC and the Montana Department of Public Health and Human Services, which operates the Warm Springs State Hospital, asked the Montana Legislature for help. They proposed creating a "Secure Treatment and Examination Program," a forensic unit on the Warm Springs campus. It would have been a place where violent offenders could receive treatment for mental illness in a secure hospital setting.

click to enlarge Colton Wilson - PHOTO BY CHAD HARDER

Disability Rights Montana, which advocates for people with mental illness, criticized the proposal, which would have cost $3.8 million to get off the ground and an additional $4.6 million in new funding annually. Disability Rights attorney Anita Roessmann argued that legislators would be wiser to put that money into community programs such as facilities that stabilize people in crisis, "so folks don't have to be driven across the state in the back of a police car."

The bill died in a House legislative committee during the 2007 session.

Lewis and Clark County Prosecutor Leo Gallagher echoes Roessmann when saying part of the reason people end up in jail is that there are too few services. "There's not a good mental health system in the communities," he says. "There's a dearth of psychiatric care." For instance, Gallagher says, there's a three-month wait to even get a pre-sentence mental health evaluation at the state hospital.

Lewis and Clark County doesn't yet have a mental health court. Missoula does. And it helps keep offenders with psychiatric illnesses out of prison, says Deputy Missoula County Prosecutor Leslie Halligan.

Mental health court participants voluntarily participate in a judicially supervised treatment plan developed by a team of court staff and mental health professionals. A lot of what the courts do is simply help people access hard-to-find services.

Buck, at DOC, says that many inmates at the Men's Prison haven't received any mental health care prior to being incarcerated. "A lot of inmates cannot afford mental health care in the community," she says.

"They come here and they get top-notch mental health care."

Buck's worked for the Men's Prison for 13 years. She bristles when asked if prison care is inadequate. The facility is accredited by the National Commission on Correctional Health Care, she points out, and employs licensed professionals. "We care about these inmates. We care about their mental health issues. We want them to succeed."

There are actually some benefits to receiving treatment in prison, Buck says. It offers time for people to work through mental health and behavioral challenges while abstaining from alcohol and drugs.

But, Buck adds, "When you're trying to provide therapy in a secure environment, that's a challenge in and of itself. Security comes first. And that's our motto."

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