Beatrice Coulter and Wanda Duryea: Secure Psychiatric Unit is not a hospital; it is a prison unit

Saturday, May 12, 2018

Once again the Secure Psychiatric Unit is in the news. A writ of habeas corpus recently filed in U.S. District Court has fueled the ongoing debate.

A civilly committed young man with no pending criminal charges or conviction seeks release from SPU to be treated in an accredited mental health facility. Thankfully, this will be heard in a federal court. We hope that court that will show little tolerance for the civil rights violations that have become an accepted standard of practice in New Hampshire.

We need to understand how this ever became “legal.” For that is when SPU became a true threat to the people of New Hampshire, when the illusion of it being a “hospital” began to take hold. The reality however, is quite different. SPU is a unit in the prison. It resides with the other numerous buildings on the prison campus. There is a for-profit contractor in SPU called Mental Health Management. The unit is an entity unto itself. It is not subject to any of the regulatory rigors other health care facilities are as it has been exempted. Psychiatry practiced in a regulatory black hole.

Through the years, the Legislature has created statutes not to protect the civil rights of individuals with mental illness, but to accommodate the utilization of the prison as an extension of New Hampshire Hospital. This practice has been in existence for more than 30 years. It has created a culture that has given legitimacy to that which is not legitimate.

It costs about $300 a day to incarcerate an individual in SPU. The cost of treating a patient at New Hampshire Hospital is nearly four times that. The disparate care is evident.

SPU is a troubled place. Suicides and sexual assaults of female inmates by a corrections officer are some of its more remarkable events. Recently the Disability Rights Center has been squaring off with the Department of Corrections in a federal court to obtain records over an inmate death in the Residential Treatment Unit. RTU is upstairs from SPU. Testimony in the Legislature over the past several years by those directly impacted has painted a troubling picture with allegations of abuse, neglect and substandard care.

At some point the saga of SPU will begin to change. That seems inevitable. However, we will be left with the troubling question of how this ever became normalized. That will prove to be an enormous challenge as well. Misguided cultures often persist, even in the presence of regulatory reforms. The “everybody does it” defense can be quite convincing.

Hopefully, the time is coming that will usher in a reset of the ethical, clinical and legal practices that have permitted this for so long. We must never forget that SPU did not happen in a vacuum. It was given permission by a Legislature unwilling to fund an appropriate facility. It also was allowed to take root in the presence of silence, silence by those who should have objected so long ago. It is a political juggernaut that has played out openly on the backs of vulnerable individuals.

The very embodiment of utilizing a prison for civilly committed individuals promotes stereotypes that we would all like to believe had long since vanished. They will persist in the presence of such practices. The time for these to be challenged may now be underway.

The Constitution is alive and well. It will hopefully free this young man from the clutches of a system that has strayed far from its intended mission. Godspeed, Andrew.

(Beatrice Coulter and Wanda Duryea are the co-founders Advocates for Ethical Mental Health Treatment, and former board members of Citizens for Criminal Justice Reform.)