Privatization of prison medical & mental health

Michael Shell BrightCrow at InfoAve.Net
Fri Sep 25 08:15:32 JEST 1998

Dear Friends,

We are under seige in the South Carolina Dept. of Corrections (SCDC).  The
Intermediate Care Services (ICS) program I've worked with for the past four
years is being disbanded by Commissioner Michael Moore and Gov. Beasley's
government, in order to hand a big contract to Correctional Medical Services
(CMS), part of a huge, private, for-profit HMO corporation.

All of our 430+ psychiatric patients are being taken from us (18 clinical
counselors and psychologists) and being moved to Lee Correctional
Institution in Bishopville, which will be under contract to CMS.  We have
been kept out of the loop all through the planning and decision-making
process.  Even our ICS director has not been allowed to have any part in the
process-- in fact, Headquarters has excluded mental health professionals
both within and outside the agency.

Now we are told we are to stay at Broad River Correctional Institution
(BRCI), where our program was housed, to take care of a newly centralized
HIV/AIDS inmate prison, modeled on the one in Alabama.  (Last month the
agency did mandatory HIV testing of all inmates.)  This half of the story,
about the utter lack of planning for the 600+ HIV/AIDS patients being
brought to BRCI, is just as horrendous.  Again, counseling staff are only
being included at the last minute.

I've been taking the matter to Columbia Friends Meeting for several weeks,
and our discussion after meeting for worship last weekend focused on my
telling them everything I knew or could surmise about this shift.  Our
clerk, Jerry Rudolph has done a search of the Web for information about CMS
and has mounted a web page at our meetings Internet site.  I encourage you
to visit the following URL:


Please note that efforts have been being made to distinguish clearly between
substantiated facts and unanswered questions.  The page includes links to
national Internet articles about privatization of medical and mental health
care in prisons, to articles about CMS in particular, to S.C. news media,
and to S.C legislative and governmental officials.

Though this particular situation is in South Carolina, you need to be
concerned, because the story is repeating itself all over the country.
Privatization of prisons is the going thing with conservative governments--
and their big business lobbyists and buddies.

Please share this URL and the rest the information with anyone you know who
has a concern for mental health patients or for the trend toward
privatization.  I'm also attaching a piece I wrote last weekend summarizing
the history of mental health treatment in SCDC and describing the ICS
program which is being disbanded.

Pray for us and for out patients.

Blessed Be,


In the late 1970's, there was almost no direct care for mentally ill inmates
in the South Carolina Department of Corrections (SCDC).  Few of those
inmates had even been identified as mentally ill.  At some point (date?),
the most seriously mentally ill male inmates began to be gathered in one
living unit at Kirkland Correctional Institution (KCI), and a portion of the
agency's social work staff began to develop methods to manage these patients.

In the early 1980's, the agency built Gilliam Psychiatric Services at KCI.
This later became Gilliam Psychiatric Hospital (GPH).  GPH was designed for
and continues to serve acutely psychotic, suicidal or otherwise disturbed
male inmate patients for all of SCDC.  Inmates enter GPH either by Voluntary
Admission (by signing a consent form) or by Involuntary Commitment (which
requires documentation by the committing clinical staff person, approval and
signature from an SCDC doctor and, ultimately, the determination of a
Probate Court that the patient is committable).  GPH patients are housed and
treated (both with psychiatric medication and with individual and group
therapy) until they are considered to be stable.  They are then returned to
their originating institutions, or, in some cases, referred to the present
Intermediate Care Services (ICS).

During the 1980's, former SCDC Commissioner Parker Evatt expanded the
Division of Human Services agency-wide, to include placing clinical social
work staff at every SCDC institution.  Included in this expansion was the
establishment of Transitional Care Units (TCUs) at a number of major
institutions around the state (including KCI, CCI, Women's Center, Leiber
and Perry).  TCUs had the function of housing and treating inmates who for
psychiatric or other reasons were temporarily unable to live and care for
themselves safely in general population.  The design was for inmates to be
referred into TCUs by institutional social workers, and for them to stay for
90 days (with possible extensions).

In fact, the TCUs also became de facto long-term care residential centers
for the most severe of the chronically mentally ill inmates.  Acutely
psychotic or suicidal inmates continued to be referred to GPH, but the most
severe of them were then transferred to TCUs once they were stabilized on
medications.  The TCUs were staffed with clinical social workers,
psychiatric nurses and psychologists.  KCI's TCU originally filled half a
dorm (32 beds) and eventually expanded to that whole dorm (64 beds).  The
TCU design was continued agency-wide into the mid-1990's.

Mental health professionals were aware that the mentally ill population in
SCDC was much larger than GPH or the TCUs could adequately serve; that, in
fact, many of the prison system's clinically mentally ill inmates had not
yet been identified.  In 1993, the agency was finally persuaded to begin an
expansion and centralization of long-term psychiatric care.  When Central
Correctional Institution (CCI) was closed in January of 1994, the population
of its TCU was transferred to KCI, the TCU there was expanded to two dorms,
more clinical staff were transferred in, and the whole was renamed
Intermediate Care Services.  ICS was also tasked to identify patients
throughout the system and, if necessary, bring them to KCI for residential care.

Almost simultaneous with this expansion, the new Commissioner, Michael
Moore, did away with the Division of Human Services and with the assignment
of clinical social workers to all institutions.  The 130+ social workers on
staff were all either reassigned to other jobs or left the agency.  Some of
those people joined ICS staff, others joined what came to be called the
"Behavioral Medicine" staff, a sort of at-large clinical staff whose role
was to travel to different institutions and to assess and provide short-term
counseling or referral for troubled inmates.  Only inmates referred to ICS
or Behavioral Medicine by Medical staff presently receive any counseling
services in SCDC.

During its first two years, ICS led a system-wide process of identifying and
evaluating mentally ill inmates.  Those judged most severely chronic were
transferred to ICS at KCI.  Eventually, several institutions were designated
as Regional Mental Health Centers.  At these institutions, less severely
mentally ill inmates are housed in general population, but are served by a
small, resident mental health staff.  There is now also a designation of
Out-Patient, under which a stable mental health patient lives in a regular
institution but can go to Medical staff for a treatment referral if he
believes he needs clinical help.


ICS is presently housed at Broad River Correction Institution (BRCI), where
it moved in January of 1998.  It has approximately 430 patients.  Of these,
128 are severe, chronic psychiatric patients, who are housed "single-celled"
(i.e., without roommates) in one dorm designated as Intermediate Care Unit
(ICU).  Though many of them are fairly stable and self-sufficient in terms
of Activities of Daily Living (ADLs), they tend to be easily distressed and
sometimes poor on compliance with psychiatric medication.  Some of them,
even on the highest safe dosages of medication, are still extremely
delusional and bizarre in their behavior.

About twice that many patients (256) are "double-celled" (i.e., with
roommates) in a separate dorm, the Umbrella Unit.  These latter are more
able to care for themselves without weekly or daily supervision.  In
addition, BRCI has a lock-up unit of 40-some chronic psychiatric patients
(single-celled), and these too are part of the ICS population.

There is also a Habilitation Unit of 128 mentally retarded inmates.  Though
these latter are not counted in the ICS population, the supervisor and staff
for that program are under the direction of the ICS Director.  Additionally,
BRCI has a Handicapped Unit of roughly 120 inmates.  These presently have no
assigned staff, and the staff of Hab Unit has been covering them in a de
facto way.

ICS has a staff of eighteen masters level clinical professionals, most of
them with from ten to twentysome years of experience in the field, many of
them long time SCDC employees.This Treatment Team includes the director,
supervisors for ICU, Umbrella Unit and Lock-up, and a staff of clinical
correctional counselors and psychologists.  All staff have caseloads of
30-45 patients each.  Staff are responsible for monthly treatment plans, at
least bi-weekly clinical sessions with each patient, and often weekly or
daily crisis or preventive counseling sessions, not only with their own
caseloads but with whomever else needs help at a given moment.  They work
daily with Security, Medical, Education and Administrative staff to
coordinate services and behavioral management.  They also shared duties on a
24-hour/7-day on-call rotation.

Case management includes the gamut of counseling, crisis intervention,
maintaining of medication compliance, referral and follow-up on Medical and
other services, new patient assessment, and referrals to Crisis
Intervention, Mental Health Observation and GPH admission.  ICS clinical
staff hold three weekly treatment team meetings (one for each unit),
together with Security staff.  They sit on Adjustment Committee
(disciplinary), Job Board, Institutional Classification Committee (which
determines levels of confinement in lock-up) and State Classification
Committee (which determines when and if patients are to be released from
lock-up).  There are numerous other overlapping duties which ICS staff fill,
in the process of coordinating their work with that of other disciplines at
BRCI and throughout SCDC.

All ICS staff are S.C. Licensed Masters Social Workers, and all maintain at
least 20 hours per year of continuing education in their fields, plus an
additional 20 hours required by the agency.  They also do in-service
training for each other, for Security staff, and for staff of other disciplines.

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