What Andrew Holland’s Death Reveals About Caring for Mentally Ill Inmates
On January 22, 2017, Andrew Holland, an inmate being held in the San Luis Obispo County Jail in California, died from a pulmonary embolism that is believed to have stemmed from being securely confined, while naked, in a restraint chair for nearly 46 hours.
The 36-year-old man had been booked into the jail in September 2015 for battery, resisting an officer, and a probation violation. Holland had been diagnosed with schizophrenia, which was likely a contributing factor to his arrest, incarceration and subsequent placement in the jail’s restraint chair.
In response to their son’s death, Holland’s parents filed a suit against the county and in July 2017, the Holland family was awarded a $5 million settlement.
It is not my intention to cast blame on who’s responsible for Holland’s death, but rather how this case illustrates the ongoing challenges correctional institutions face dealing with large numbers of mentally ill offenders. Correctional facilities do not have the proper staffing, training, healthcare programs, funding, or general resources to adequately deal with and treat the growing population of mentally ill inmates.
How Restraints are Used in Corrections
In a March 2018 CorrectionsOne column, Darrell Ross wrote about the wide use of restraints in corrections. These restraints range from mechanical handcuffs, leg shackles, waist chains, restraint straps for ankles, soft restraints, straitjackets, restraint chairs, and restraint boards. The use of restraints has had a controversial history emanating from several successful lawsuits in which restraint devices were used for punishment and often in conjunction with prolonged periods of confinement without appropriate medical assessment.
The restraint chair is intended to control physically aggressive, self-destructive, or otherwise violent inmates who cannot be controlled by other means. Holland was placed in the restraint chair after engaging in serious self-destructive behaviors while being held alone in an isolation cell. Video evidence shows Holland visibly harming himself in the isolation cell on January 20, 2017 and, in response, jail employees placed him in the restraint chair.
If used properly, a restraint chair can be effective in reducing the risk of further self-inflicted harm. However, it is imperative that detainees be medically monitored at predetermined intervals (i.e., every 15-20 minutes). In my experience, detainees should not be left in a restraint chair for more than two hours. Holland was in the restraint chair for nearly 46 hours, a blatantly excessive amount of time, which is clearly a violation of its intended use. In addition, he was held in the chair naked and in his own feces, which raises serious ethical, departmental, and legal concerns about the treatment of mentally ill offenders.
Corrections and Mentally Ill Inmates
In December 2015, I published an article The Challenges of Incarcerating Mentally Ill Inmates, which focused on the challenges associated with incarcerating mentally ill inmates in prisons and jails. What I addressed back in 2015 still holds true today: Prisons and jails were never designed to house mentally ill individuals, particularly those with serious psychological disorders that often lead to self-destructive behaviors.
The percentage of incarcerated individuals with psychological or psychiatric disorders has been steadily increasing since the 1960s, which by most accounts stems from the deinstitutionalization of our nation’s mental health system. As a result, prisons and jails have become the de facto state psychiatric hospitals responsible for confining and caring for the mentally ill. There are more seriously, and persistently mentally ill individuals imprisoned in correctional institutions today than in all U.S. state psychiatric hospitals combined.
How Did We Get Here? The Deinstitutionalization Movement
In 1955, the number of individuals confined in psychiatric facilities peaked at 560,000 patients. Today, there are fewer than 35,000 patients in psychiatric hospitals, and that number continues to decline.
In 1963, President John F. Kennedy signed the Community Mental Health Act to provide federal funding for the construction of community-based preventive care and treatment facilities. However, it was not until 1965 with the passage of Medicaid that states were “strongly persuaded” to move patients out of state mental hospitals. The Medicaid program excluded coverage for people in “institutions for mental diseases.”
Patients were often released to the community without adequate support services, leading many to become entangled in the web of the criminal justice system. That has led to our current predicament, a growing social problem of inadequate care for the mentally ill that continues to plague our nation’s prisons and jails.
It should be noted that while most psychological disorders are not necessarily the cause of criminality, the frequency and intensity of some of these disorders are significantly higher within our nation’s prisons. That suggests that some psychological disorders may warrant the attention of law enforcement and lead to an arrest, thereby contributing, at least indirectly, to criminality.
Prisoners with mental illness are more likely than other inmates to be held in solitary confinement, be financially exploited, physically and sexually assaulted, attempt or commit suicide, or be intentionally self-destructive.
Recommendations for Addressing Mentally Ill Inmates
So what can be done to alleviate the mistreatment of mentally ill prisoners? A comprehensive 2014 Treatment Advocacy Center Study provided some recommendations for facilities, as well as for what needs to happen at the local, state and federal level.
Within an institution:
- Establish careful inmate intake screening. Enhanced screening protocol can help a facility identify an inmate’s medication needs; determine if they have suicidal thoughts and ideations; identify if they are prone to anger outbursts and have self-destructive behaviors; and note other risks associated with an inmate’s mental state.
- Reform jail and prison treatment laws. Mentally ill inmates need to receive appropriate and necessary treatment protocols, just as inmates who have other medical conditions like heart disease and diabetes. In order to properly care for mentally ill inmates, facilities need to employ licensed and trained healthcare professionals who can provide adequate care and treatment.
- Institute mandatory release planning. Before mentally ill inmates are released from facilities, develop a plan to help them access support within the community and find resources that can help foster their recovery and treatment in the outside world.
At the local, state and federal level:
- Implement and promote additional diversion programs such as mental health courts. The U.S. Bureau of Justice Assistance provides support developing and implementing mental health courts in communities. These innovative and collaborative efforts bring system-wide improvements that address the needs of adult offenders with mental disabilities or illnesses.
- Initiate court-ordered outpatient treatment programs. These specialized courts can provide support to at-risk individuals to help them live safely and successfully in the community.
- Reform outdated or inadequate mental illness treatment laws and practices. Legal barriers must be eliminated so individuals can readily access treatment before they become so disordered that they commit acts resulting in arrest, prosecution, and subsequent incarceration.
- Fund and encourage further research. There must be comprehensive cost studies comparing the true costs of housing individuals with serious mental illness in prisons and jails with the costs of appropriately treating them in the community.
The aforementioned recommendations fall under the general premise that mentally ill individuals would be better served in hospitals, not in prisons and jails; however, the U.S. mental health system is essentially broken and in need of desperate repair that could only come from widespread reform.
Until that occurs, our nation’s correctional institutions will continue to be flooded with mentally ill inmates who will find themselves trapped within a criminal justice system that is easy to enter, but quite difficult to leave.
About the Author: Dr. Michael Pittaro is an Assistant Professor of Criminal Justice American Military University and an Adjunct Professor at East Stroudsburg University. Dr. Pittaro is a criminal justice veteran, highly experienced in working with criminal offenders in a variety of institutional and non-institutional settings. Before pursuing a career in higher education, Dr. Pittaro worked in corrections administration; has served as the Executive Director of an outpatient drug and alcohol facility and as Executive Director of a drug and alcohol prevention agency. Dr. Pittaro has been teaching at the university level (online and on-campus) for the past 15 years while also serving internationally as an author, editor, presenter, and subject matter expert. Dr. Pittaro holds a BS in Criminal Justice; an MPA in Public Administration; and a PhD in criminal justice. To contact the author, please email IPSauthor@apus.edu.