Head Games

At least one out of every five Colorado prisoners is mentally ill -- some violent, some undetected or untreated. How did the Big House become the Bug House?

White was an aggressive advocate for his son during his time in the DOC. (His son was released last year and is currently establishing a new life; White asked that his first name not be published.) One health-related concern, he recalls, required 38 phone calls to resolve, by which time the condition had cleared up on its own. "I'm sure I was perceived as a very large pain in their backside," he chuckles.

His son had a rocky start in the prison system. While in jail, he'd been taking a mood stabilizer, an anti-psychotic and an anti-depressant that seemed to relieve his symptoms. But prison pharmacies often use older versions or approximate substitutes of certain medications -- with more severe side effects -- because of cost concerns. (Picture the worst kind of bean-counting HMO, multiply its ruthlessness tenfold, and you might come close to the bottom-line strictures of prison health-care systems.) The prison formularies didn't work on White's son, who had a psychotic episode and ended up strapped to his bed, "four-pointed" for two days.

White's son was sent to San Carlos -- where, White says, he received excellent care: "They put him back on the original medication. Wonder of wonders, he improved." Back in general population, though, he had problems maintaining the same regimen of meds, resulting in subsequent writeups. Many of the problems mentally ill prisoners encounter come from "destabilizing" as a result of denial of meds, ineffective meds or inconsistent meds; White says he's also heard of inmates selling their meds to other prisoners seeking to get high.

Mark Seibel had an untreated "psychotic" illness.
Mark Seibel had an untreated "psychotic" illness.
Lee Vasquezdiaz is stuck in lockdown for behavior he 
blames on ADD.
Lee Vasquezdiaz is stuck in lockdown for behavior he blames on ADD.

"If you're mentally ill and in prison, you're more likely to be victimized by other inmates," he notes. "And if the inmate who's mentally ill is violent, the guards and other inmates are at risk."

Prison officials maintain that inmates in segregation are put there because of bad behavior, not mental illness. But that's a distinction that easily blurs. Surveys in several states indicate that supermax prisons have a disproportionate number of seriously mentally ill prisoners, from 30 to 50 percent, apparently because lockdown is the simplest way to deal with their behavior. The American Psychiatric Association has noted a tendency among prison mental-health workers to devote resources to the most obvious cases -- psychoses, major depression, those who are disruptive and need to be "managed" with heavy sedatives -- while offering little treatment to prisoners whose illnesses may be just as serious but don't cause as much stir.

Jim Michaud, the DOC's director of mental-health services, says that around 30 percent of CSP inmates have been diagnosed as mentally ill. He acknowledges that there are "special challenges" to treating patients in a high-security prison, but he insists the care at CSP is comparable to what the mentally ill receive at other prisons. "Sometimes they prefer high security," he says. "They prefer being alone, even when it isn't necessarily good for them."

Not all of the delusional or most vulnerable inmates wind up at San Carlos. The mail Westword receives from CSP prisoners includes ample evidence of paranoia, hallucinations and obsessive thinking. One recent letter contained hair samples, which a prisoner wanted tested because he's convinced his keepers are lacing his food with mind-altering drugs. Psychologically, almost no one does well in isolation, but the mentally ill tend to fare worse than most.

Among the inmates themselves, there are all sorts of theories about how one ends up in CSP as opposed to San Carlos or one of the "special needs" units at other prisons. Prisoners claim that schizophrenics, bipolars and others who happen to respond well to DOC-approved drugs, such as Thorazine or lithium, are more likely to find a bed at San Carlos. Those with more convoluted treatment needs or sketchier diagnoses -- such as anxiety disorders or attention deficit disorder, a condition that is commonly treated with stimulants -- wind up in the hole.

Michaud says the mental-health staff doesn't provide medications for a case of ADD "unless it severely interferes with management of the institution." Stimulants such as Ritalin are unlikely to be prescribed because they can be readily abused. "We're cautious with drugs like that, particularly because of the substance-abuse problems of our population," he explains.

Having ADD has nothing to do with placement in administrative segregation, Michaud says. But try telling that to Lee Vasquezdiaz.

"No one in all the facilities I've been in has ever done anything about my condition," complains Vasquezdiaz, a CSP inmate doing twenty years for a robbery and assault committed when he was seventeen. "When I tell them I have ADD, that it was a formal diagnosis with a prescription and everything, they say that the meds for it are stimulants and can't be given out. But they have non-stimulant alternatives, and when I bring that up, they act as if they can't do anything."

Vasquezdiaz can't see the review board to get out of CSP until he goes six months without "negative chrons" -- rule violations noted by his keepers. He says he's received chrons for running too fast down the stairs in leg shackles ("if that's possible"), using a piece of paper to cover a light in his cell that stays on 24 hours a day ("three feet from my face when I go to sleep") and covering a window.

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