State Rep: No Treatment Standards Reviews for Decades at Secure Psychiatric Unit

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Nancy West Photos

Photos of the Secure Psychiatric Unit of the State Prison for Men in Concord. Top left photo shows metal booths where some mentally ill patients receive group therapy. Top right shows a typical cell at SPU. Below photo shows the prison fencing outside the unit.

By Nancy West,

State Rep. Renny Cushing said annual reviews of the clinical and treatment standards at the Secure Psychiatric Unit at the men’s prison in Concord have not been conducted as required by law for decades.

Cushing based his statement on records he received from the state after filing right-to-know requests to obtain the documents. Oversight of the Secure Psychiatric Unit has been controversial as more patients and inmates complain that it is a prison, not a psychiatric hospital and more lawmakers vow change.

Department of Corrections spokesman Jeff Lyons released a statement saying Cushing was incorrect, but it is unclear whether Cushing and the department are talking about the same kinds of clinical reviews.

The annual reviews mentioned in law are supposed to be completed by the commissioners of the Department of Corrections and Department of Health and Human Services, but haven’t been, said Cushing, a Hampton Democrat.

“I have just done a quick first read through of the 700 plus pages (and note the 44 pages that have been completely redacted), but it is clear to me that there has not been a required view under RSA 622:46 since 2006, and the only other year going back to at least 1993 that a review was done was 2004,” Cushing said.

In response to an inquiry made on his behalf by a researcher in the House, some sort of review is currently underway, Cushing said.

For years, Cushing has been fighting to stop the practice of holding mentally ill people who haven’t committed a crime in prison, commingled with convicted criminals who are mentally ill, those deemed incompetent to stand trial and others found not guilty by reason of insanity.

“(It’s) outrageous,” Cushing said of the “joint failure” by the commissioners of the Department of Corrections and Health and Human Services to conduct the annual reviews.

“It underscores the need to address the original sin of the Secure Psychiatric Unit, and transfer jurisdiction over treating our severely mentally ill citizens back to the Department of Health and Human Services,” Cushing said.

Department of Corrections response

Lyons emailed the following statement:

“In response to your inquiry:

It is incorrect that there were no clinical standard reviews of the Secure Psychiatric Unit since 2006. In 2005, the Department of Corrections was litigated by New Hampshire Legal Assistance referred to in US District Court Order as Thomas Holliday et. al v. Stephen Curry (also known as the Holliday Court Order), which resulted in numerous requirements including the creation of the Residential Treatment Unit.

As part of this joint effort between the Department of Corrections and NH Legal Assistance to obtain compliance with the court order, the clinical standards of both the Residential Treatment Unit and the Secure Psychiatric Unit were reviewed regularly until approximately 2011.  These aggressive efforts resulted in the Department of Correction being found in compliance with the Holliday Court order. DHHS has been working since 2017 on an updated audit tool to complete their statutory review of the SPU. In addition, for every transfer back to NHH, NHH reviews the patients record which is also part of a long-term Memorandum of Understanding between SPU and NHH.”

Nurse advocate:

Beatrice Coulter, a registered nurse who co-founded Advocates for Ethical Treatment for Mental Illness with Wanda Duryea, said clinical reviews that are done to comply with a consent decree secondary to litigation are not standard clinical reviews.

“A standard clinical review would be mandated most likely in administrative rules and occur with regularity independent of a court order,” Coulter said.

Since Lyons indicated there have been no reviews since 2011, they were clearly done to satisfy the court and were not ongoing quality and clinical reviews, she said.

“That is unacceptable. In that time period there have been two deaths as well,” Coulter said.

Coulter worked as a nurse at the Secure Psychiatric Unit for less than a week before resigning because of what she saw as unethical treatment of mentally ill patients.

“As for New Hampshire Hospital reviewing patient records when they are returned to NHH, it would seem that a hospital that transfers individuals to a prison is probably not the best suited to be doing any reviews.

“That may explain why they transfer civilly committed individuals to a facility that includes 23 hour lock downs, tasers and pepper spray,” Coulter said.

Hollis case

Andrew Butler, 21, of Hollis was recently transferred from the Secure Psychiatric Unit back to the New Hampshire Hospital, then released to his home with his father, Douglas Butler, after his lawyer argued in federal court that he shouldn’t be held in prison because he hadn’t committed a crime.

Butler’s case drew a great deal of attention as the former star athlete at Hollis Brookline High School was well-known and loved in the community.

Friends and supporters raised money to “Free Andrew” and marched from the state prison to federal court on a day his case was scheduled for conferencing. He was released before the court took any action.

The state says it is legal to hold non-convicted mentally ill patients in prison if they are deemed too dangerous to themselves or others to be housed in New Hampshire Hospital, the state’s psychiatric hospital.

On July 2, Gov. Chris Sununu signed HB 1565, which requires the Secure Psychiatric Unit to be accredited as a behavioral health facility. Cushing had wanted to require accreditation by the Joint Commission.

Cushing, state Sen. Kevin Avard, R-Nashua, and other lawmakers have promised to work on new legislation to make changes in how mentally ill patients are housed.

Andrew Butler of Hollis:  ‘I do appreciate all the support’


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