by J. Clement Cicilline
For many years, the
State of Rhode Island’s Adult Correctional Institute has controlled a certain
number of mentally ill inmates by placing them in solitary confinement, a
practice that is not only inhumane, but universally regarded as ineffective in
managing their behavior over the long term. Worse, it exacerbates underlying
psychotic symptoms of the inmate, seriously impeding opportunity for recovery.
This practice, now being addressed through a federal class action lawsuit filed
by the American Civil Liberties Union National Prisoner Project and the Rhode
Island ACLU affiliate, should be of profound concern to all Rhode Islanders.
This raises a deeper
question of why are so many mentally ill individuals living in incarcerated
settings these days? I want to offer an anecdotal account, which, I concede may
not be historically precise.
Back in the 60s and
into the 70s there were about 2500 to 3000 people residing at the Institute of
Mental Health in Cranston. They were housed in less-than-desirable conditions
in several buildings on what is now the Pastore Center. At that time, laws were
in place that made it too easy for a person to be institutionalized. It is more
than fair to say that a majority should not have been there and were committed
against their will. It was a life sentence for many.
Through intense and
concerted advocacy, the laws were changed, and an enlightened state government
took decisive action. Most importantly, a very strong partnership had been
established with the system of community mental health centers allowing for the
implementation of a very careful plan for bringing the patients from the state
hospital back to the community. This project was supported by state funds. Over
time, this initiative was so successful in not only “emptying” the
state hospital, but also in slowing down the admission rate. For many, many years
the number of people in state psychiatric inpatient status was – 100.
But, that old adage of
being victims of one’s success applies here. Over the past 25 to 30 years,
there has been a dramatic and egregious reduction in financial support of the
mental health care system by the executive and legislative branches of state
government, both Democratic and Republican, that has crippled the capacity to
respond to the need. This has been cruel and crushing to children as well as
Moreover, state policy
has essentially blocked persons in need of state hospital care from receiving
it because the state opts to rely on a federal funding formula to lower its
share of the cost of operating that facility. This might seem to be sound
budgetary practice, but it deprives people of needed psychiatric care. With the
state hospital door closed, the state prison door swung open.
So, it should not be
surprising to hear people say that the ACI is the largest mental health
institution in the state. But, even that isn’t true because correctional
officers are not trained clinicians and are in no position to provide the
services that mentally ill inmates require.
What needs to be done
is for the State of Rhode Island to get back on track in terms of how it treats
its mentally ill citizens? There was a time when we were rated Number One in
the country for the array of service options available. If we pride ourselves
as compassionate individuals, we have to stop mistreating mentally ill inmates
with solitary confinement, we have to provide salubrious services in
appropriate settings, we must create meaningful diversion programs that keep
mentally ill persons out of prison, and we must financially support programs
that are truly helpful to anyone who has a mental illness. Just like any other
disorder, untreated mental illness can just get worse. The humane thing to do
is consequential reform of our mental health system. For those who fret about
the expense, this path, in the long run, is much more cost-effective than
denial or neglect.
virtually every family has had some experience with mental illness, we will be
helping those who are most dear to us.
J. Clement Cicilline,
President, Board of
Former President &
CEO, Newport County Community Mental Health Center
November 4, 2019