A new report from Disability Rights New York, the federal watchdog for people with disabilities in the state, found rampant abuse and neglect within the mental health treatment unit at the Attica Correctional Facility.

Under state law, people with diagnosed serious mental illness, who face punitive solitary confinement in excess of 30 days, are to be diverted from a Special Housing Unit (SHU) to a Residential Mental Health Unit (RMHU). Unlike the SHU, the RMHU is supposed to be a therapeutic, non-disciplinary unit operated by both corrections and mental health staff.

People incarcerated in the RMHU remain in their cells for at least 19 hours a day. They are to be let out for four hours each weekday to participate in programming and get one hour for recreation, according to the report [PDF].

The law requires RMHU patients receive therapy and programming “in settings that are appropriate to their clinical needs” while ensuring the “safety and security of the unit.” Their mental health needs are to be considered before restricting their time out of cell, reviewing their disciplinary segregation sanctions, or taking other actions against them.

While in theory the RMHU is supposed to be a therapeutic alternative to punitive solitary confinement, in reality there are many similarities between the two.

Cell Shields

Take, for example, the use of “cell shields” in Attica’s RMHU. DRNY describes the shields as “a restrictive device that can be affixed to an inmate’s cell door.” It is made of Plexiglas with small air holes at the bottom.

Air can typically flow through the metal mesh gate that covers RMHU cells. However, when a cell shield is installed, the air grows hot and stale, visibility is limited, and it becomes harder to communicate with people outside the cell, including mental health staff. The person’s isolation is intensified, and especially for those prescribed psychotropic medications that cause heat sensitivity, the stress can be dangerous.

Cell shields are permitted in response to people who spit, throw feces, urine, food, and other objects through their door. They may be used against those who refuse to keep their hands inside or attempt to assault or harass staff. They can be used when someone is “so disruptive as to adversely affect the proper operation of the unit.”

In practice, Attica officials use shields against everyone, regardless of their disabilities or whether they’re in a treatment unit. There are no policies limiting their use in the RMHU. A cell shield order expires after one week but it can be renewed indefinitely. DRNY found Attica “liberally renews orders even where there is no new misbehavior for excessive periods,” and often fail to include the written justification for their renewal as required by law. The shortest amount of time a shield was applied was 32 continuous days. The longest was 379.

Participant A has intellectual and mental disabilities and was brought to the unit because of a past incident involving “unhygienic acts.” He was given a cell shield immediately.

The order for his cell shield was renewed repeatedly for 379 continuous days as his condition deteriorated. He told staff he wanted to die and was hospitalized after swallowing a straightened paperclip.

After 21 days, the hospital returned him to the RMHU, but “because he made no progress,” he was transferred to a psychiatric center nine days later. There, he told staff he self-harmed due to depression and hopelessness. He felt suicidal about being in the RMHU.

Before he returned to Attica, staff at the psychiatric center recommended Attica’s staff help him develop and use his coping skills. They felt it was important that he be closely monitored for warning signs for suicide and self-harm.

Prison officials ignored these recommendations, immediately renewing his cell shield order upon his return. The order was justified using his original order, which had nothing to do with his current condition or behavior.

Participant B had a cell shield for a month because he reached through a locked door hatch on his cell. The order claimed this “created a potential safety and security issue” and that his “behavior” was “extremely disruptive and adversely [affected] the proper operation of the RMHU unit.”

Participant B started to have mental health episodes. He threatened self-harm and was moved to a crisis unit for observation within one week. Within three days, he told a psychiatrist that he had suicidal ideation and was “depressed due to recent punishments from [corrections officers].” His medications were increased, and he was released back to the RMHU.

His cell shield was still in place when he returned. There is no record that prison officials consulted with mental health staff about the shield order before or after he was sent to the crisis unit.

Patients felt the shields were used to punish them and told DRNY they “send the message that ‘we’re animals.'”

Out-Of-Cell Restrictions

When out-of-cell restrictions are in place, prison staff are supposed to provide “alternative mental health treatment and/or other therapeutic programming.”

At Attica, this was simply a cell-side interview—a conversation between mental health staff and the patient at their cell door. This does not qualify as effective mental health care. Such interactions are devoid of privacy and having such conversations through a cell door, and sometimes a shield, are not conducive to treatment. Officers can overhear what are supposed to be private and intimate conversations, the fear of which prevents some individuals from having conversations at all.

Participant A was given 120 days in the SHU for telling mental health staff he wanted to leave a classroom to avoid being around people who angered him. He had been behind a cell shield for 237 days straight. But even though the incident was strictly verbal in nature, mental health staff issued a misbehavior report against him.

Participant A was restricted from out-of-cell programming for 18 days as a result. When the restriction ended, he self-harmed and reported feeling hopeless. He was sent to the psychiatric center for observation.

There, staff helped him develop coping skills, remain engaged in therapy, and encouraged him to verbally acknowledge to staff when he was angry and request a time out. He was soon able to be around his peers without incident.

“Participant A’s success at [the psychiatric center] indicates that Attica’s RMHU’s punitive approach was not clinically justified under [law] and needlessly contributed to further deterioration in his condition requiring inpatient hospitalization,” DRNY wrote.

Restricting what little time patients have out of their cells means they can be locked up for 23 hours straight.

The restrictions are only to be used in exceptional circumstances. DRNY found that in nearly every case, Attica officials imposed restrictions without considering the person’s condition. There is not even space for clinical assessment on the forms used to document restrictions.

Participant C faced programming restrictions after threatening corrections officers. Mental health staff had noted that same day that he was doing well but was “struggling with security.” Around this time, he was having trouble taking his medication and had limited coping skills and insight. His social worker noted he needed structure, attention, and group therapy.

Instead, officers locked him in his cell and took away his programming for 9 days.

Training

Disability Rights New York found the corrections department staffed the RMHU with SHU officers and other untrained staff in violation of the law. Their presence and harassment contributed to the feeling among patients that the RMHU was a punitive unit.

These officers reportedly “hit people’s triggers” and “exacerbated people’s underlying mental health conditions to the point where they contemplated suicide or engaged in self harm.” They issued reports that led to cell shields and restrictions, and retaliated against those who filed grievances by “withholding supplies or turning off hot water.”

“The SHU officers verbally harass us[,] also by turning our water off, or our lights so we can’t write,” one patient said. “In the winter time, they open all the windows to freeze us out, throw water on us, and leave the window open all night.”

Such training and staffing issues are longstanding. In 2011, DRNY recommended prison officials increase the number of specially trained officers in mental health units, and shared concerns again when they visited Attica in 2015 to research this report.

While the department claimed SHU officers only worked in therapeutic units on nights, weekends, and holidays, DRNY found them there during the week. This was discovered because the officers had filed misbehavior and negative reports.

Thirty-six percent of the negative reports issued by officers to eight individuals between January and November 2015 were written by officers, who had not participated in legally mandated training.

The department told DRNY it “made every effort” to train the officers and offered overtime pay in an attempt to get officers who were on vacation during the trainings to attend.

“Therefore,” DRNY noted, “SHU officers were invited—but not required—to attend the most recent training.”

Three patients said one SHU officer “antagonized RMHU participants, falsely reported misbehavior that served as the basis for cell shields, and denied showers and hot waters on holidays.”

“Often ‘security concerns’ run counter to the beneficial or positive intentions of the programs,” one patient said. “Not all CO’s are empathetic or sympathetic to the needs of prisoners with serious mental health issues and, in fact, if anything, do things which tend to aggravate the problems of prisoners with these issues.”

“Attica in particular is a case in point, as there are many times when there are no RMHU officers present and thus we have no choice but to have to deal with regular SHU officers,” they said.

Another patient said, “Nearly all [corrections] and security staff do not want the program operated because they believe because we’re in prison we deserve to suffer. This attitude is carried out in their daily dealings.”

Location

Attica’s aging architecture and the decision to put the RMHU inside the SHU present obstacles to the therapeutic needs of those forced to live there.

The corrections department justified staffing Attica’s treatment unit with SHU officers because of its proximity to the SHU, which created a “staffing efficiency.” This efficiency, however, “greatly diminished the therapeutic environment.”

Even though the missions of each unit are diametrically opposed and they are legally supposed to be separate, the corrections department openly associates the two. Officers responded to a RMHU grievance by writing, “Grievant is advised that they are subject to follow the rules pertaining to the area they are housed in, which is [the] SHU.”

Patients do not have access to “incentives” like showers, phone calls, and recreation even if they earn them. “If family did not answer the phone,” DRNY observed, “the call was still ‘counted’ by Attica staff,” whereas mental health units at other NY prisons let patients call again later.

Patients experience “great disruptions in programming” because prisoner movements in the SHU halt movements in the RMHU.

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Disability Rights New York concluded cell shields should no longer be used presumptively in mental health units. Mental health staff must work with corrections staff to develop standards in compliance with the law and recognize their deference to corrections officials is “causing psychiatric harm to its patients and does not fulfill the legal mandate of joint operations.”

Mental health conditions and therapeutic needs should be considered before imposing restrictions, and there must be written justifications.

Meaningful opportunities for alternative therapy must be made available for those on restrictions, and restrictions should be viewed as a sign that a person needs therapeutic support.

Legally mandated training should not be considered optional and the unit must be moved to a location that can actually support the program and its therapeutic requirements, even if that means moving it to another facility entirely.

These recommendations boil down to urging the corrections department and health staff to recognize the patients’ mental health needs and stop breaking the law.