Last July, after a wrongful death lawsuit was filed by the family of a mentally ill prisoner who hanged himself in his cell at ADX-Florence in Colorado, the Director of the Bureau of Prisons sent all federal inmates a "suicide prevention" memo. In it, he urged them to seek "help" if their feelings of "sadness, anxiety, fear, loneliness, anger, or shame" left them with suicidal thoughts. He told them, too, that he wanted them to "succeed" in prison. Directly from the desk of Director Charles E. Samuels Jr., the memo stated:
Anytime you want to speak with a psychologist, let staff know and they will contact Psychology Services to make the necessary arrangements. Psychologists are not the only Bureau staff available to provide you support. Your unit officer, counselor or case manager, work supervisor, teacher, and treatment special are available to speak with you and provide assistance, as are the other staff in the institution, including recreation specialists and lieutenants. Help is available.
One prisoner who got the memo was Percy Barron, another inmate at the Colorado prison. His attorneys say that he did precisely what Samuels asked him to do, which is to ask for help when feeling suicidal. What happened? Nothing good. Distraught over the death of his mother, Barron was not given any timely treatment -- his requests were ignored -- so he swallowed a bunch of over-the counter and prescription pills that he had in his cell. Then, after he was rescued by the prison's medical staff, Barron was disciplined for the suicide attempt.
I'm told by Barron's attorneys that the discipline of their client was withdrawn after they complained about it. But the gulf between what Samuels promised in his memo and what is happening inside our federal prisons evidently still exists. For example, here is the link to the BOP's "inmate discipline" policies. What the rules show is that federal officials moved in 2011 to "increase the severity level for tattooing and self-mutilation to a high severity level prohibited act." In other words, inmate conduct frequently accompanied by mental illness is being punished more severely.
Meanwhile, Barron is not alone. Another federal inmate in Colorado, Jack Powers, whose gruesome story we chronicled last year in The Atlantic, was recently disciplined by prison officials for cutting off his earlobes -- acts of self-mutilation that are part of his long-diagnosed mental illness. Powers was written up with an "incident report" and lost "good time' on his record -- meaning that he lost credit for days off his prison sentence (there is no parole in the federal system). His underlying mental illness? It still hasn't been adequately treated.
Last Monday via email, I asked David Berkebile, the warden at ADX-Florence, to help me understand what the prison's policies are with respect to mentally ill prisoners who seek help, don't get it, and then hurt themselves. I asked him how he could square the treatment of Barron and Powers with the terms of Samuels' "suicide prevention" memo. I asked him what policy justified the punishment of mentally ill federal prisoners. I have not yet received a response from Berkebile -- or from the Justice Department.
While waiting for the feds to explain themselves, I reached out for help to Jeffrey Metzner, a renown forensic psychologist with decades of training and experience evaluating mental illness in prison inmates. Metzner told me that while he wasn't familiar with current BOP policies as they relate to Barron, "the logical solution is to prohibit self-mutilation as being the basis for a disciplinary infraction." He also provided me with helpful context and perspective on the scope of the problem and the challenge that prison officials face. Metzner said:
I have evaluated correctional mental health systems in state prisons that had policies and procedures that made self-mutilation a disciplinary infraction that could lead to a variety of disciplinary measures following a "due process" hearing. Historically, I think the basis for some of these policies and procedures was related to tattooing and gang affiliations. From a mental health perspective, I do not have any problems with such a regulation specific to tattooing due to obvious security issues from a correctional perspective...
Inmates who self-mutilate are problematic from a correctional perspective because they frequently require transport from a locked down setting such as administrative segregation to either the institution's emergency room or equivalent (i.e. an infirmary) or at times to an outside medical facility in order to receive medical/surgical interventions that are not available within the prison complex. Such inmates who self-mutilate usually participate in such behaviors on multiple occasions, often within relatively brief periods of time. This behavior is both disruptive to the functioning of the correctional institution as well as very expensive related to both medical costs and the need for custody transport.
These inmates are problematic from a mental health perspective because it is often very difficult to determine whether the behavior is a reflection of a suicide attempt, an attempt to achieve some other goal (e.g., change cells, change housing unit, attempt to talk with another inmate, etc.) or symptomatic of an underlying mental disorder (usually a personality disorder-most commonly borderline personality disorder or antisocial personality disorder).
In correctional systems that do not have an adequate mental health system, these inmates represent the "mad versus bad" dilemma. Custody staff often views these inmates as having a mental illness (i.e. "mad") that should essentially be solely handled by the mental health staff. At the same time, mental health staff frequently views these inmates as being "bad" and not having a mental illness. Therefore, mental health staff often perceives no responsibility in managing these behaviorally disruptive inmates. In an adequate mental health system, these problematic inmates need to be managed jointly by both custody and mental health staffs based on a treatment plan that is developed jointly by the staffs with input from the inmate.
Either the Bureau of Prisons is serious about wanting to help suicidal inmates or it is not. If it is serious, then it cannot punish such inmates, especially those who seek help before acting. Nor can federal officials plausibly claim that they are serious about responding with aid to self-destructive inmates when they punish mentally ill prisoners who harm no one but themselves. These policies violate federal law, the Eighth Amendment's "cruel and unusual punishment' clause, and reasonable standards of decency in a just and moral society.
This piece is part of The Atlantic's continuing series, An American Gulag. The series landing page is here.