Posted 05 November 2007 - 12:44 PM
Posted 21 November 2007 - 04:32 PM
State's sole in-patient mental health hospital near Utica strives to reduce the number of times inmates return
By PAUL GRONDAHL, Staff writer
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First published: Monday, October 21, 2002
MARCY -- The Central New York Psychiatric Center, five miles west of Utica, where the state's most deranged and dangerous prisoners are sent, has a split personality.
On the outside, it's a maximum-security prison with three rings of tall fences bristling with razor wire encircling the 10-acre complex.
On the inside, it's a hospital with spotless linoleum floors, examination rooms and a therapeutic calm.
The duality of the architecture underscores a debate that has gone on for 160 years: How best to treat the so-called criminally insane in New York state.
Beginning with the Utica Lunatic Asylum in 1843, convicted state prisoners with mental illness and violent pasts have been shuffled between two agencies: correction and mental health. Class-action lawsuits brought on behalf of the inmates in the mid-1970s forced the closure of two correction-run psychiatric facilities and the opening of CNYPC under the state Office of Mental Health in 1977.
The toughest prisoners to manage wind up at CNYPC, known as Marcy. It is the state's sole in-patient mental health hospital for 68,000 inmates at 70 prisons statewide. Only prisoners who are involuntarily committed through a court procedure are treated here.
Marcy has 500 employees and 190 beds for prison inmates. The number of beds has remained roughly the same for two decades.
Two years ago, the facility operated at 105 percent capacity. In 1991, the peak year, there were 1,400 admissions for Marcy's 190 beds. Exceeding capacity was a chronic problem, according to executive director Hal Smith, who oversees the state's entire forensic mental health system. Smith said he has stabilized the annual number of admissions to about 850 per year in recent years.
His facility is a confinement of last resort.
"Being both mentally ill and criminal, they're the most disenfranchised population there is," said Smith, a 30-year veteran of the field who was involved with the design of the facility.
The average length of stay at Marcy is 42 days. Smith's stated goal is to provide medication and treatment, to stabilize the inmates and to return them to prison. Undercutting that objective is Smith having to turn over each of his 190 beds four to five times each year to meet demand.
Budget constraints come into play. It costs $550 per day for an inmate at Marcy. By comparison, the cost is $70 per day for an inmate in a standard prison cell.
The readmission rate is 65 percent. Some inmates have been in and out of Marcy more than a dozen times. About one-third of the patients come directly from solitary confinement in The Box, the most rigid and punitive level of incarceration.
At Marcy, patients are not handcuffed, shackled or locked down as they had been in prison. Patients live in dormitory rooms. Their weekly schedule involves a minimum of four classroom sessions and four recreation periods, in addition to therapy sessions.
There has been just one suicide death in the 25 years Marcy has been operating.
Six of seven patients interviewed there said they had been patients in community mental health facilities or state psychiatric hospitals before winding up in prison. Five of them had been convicted of murder. They agreed to talk if their last names weren't used.
"I like it here. It helps relieve my stress," said Gary, 37, who'd spent six years in prison for armed robbery and assault on Long Island. He's been in and out of Marcy 15 times.
"He's one of our frequent fliers," Smith said.
Dan, 29, entered prison at 16 and is serving a 23-year-to-life sentence for murder in Tioga County. He spent seven of those years in solitary confinement for his behavior.
"I really bugged out in The Box. I'd get into an extreme rage and flood my cell, try to start a fire, anything I could," he said. After 13 months at Marcy, Dan graduated from a leadership program and will work as a mentor when he's sent back to prison.
Reducing the number of "frequent fliers," as Smith calls them, is one of his top priorities. Advocacy groups cite the revolving-door aspect as a major failing.
Smith contends he can reverse the high recidivism rate at Marcy as a result of a recent state Supreme Court decision OMH won. It gives OMH staff the legal authority to medicate over an inmate's objection any former CNYPC patient for one year after he has been released back to a prison setting. Previously, an inmate could be medicated over his objection only while confined to Marcy.
"That will give us some continuity so they don't go off their meds and decompensate once we send them back to prison," Smith said.
Prisoner advocates consider the ruling a setback in their efforts to gain more humane treatment for mentally ill inmates.
"It's horrible," said Cliff Zucker, executive director of Disability Advocates. "Imagine guards holding you down as you object and then you're injected with a powerful tranquilizer. That's supposed to be therapeutic?"
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