Correctional Psychiatric Treatment Unit
Follow-up Inquiry

• Abstract
• Introduction
• Methodology
  • Interviews with the Director and Program Administrator
    • Staffing issues
    • Policy issues
  • Interviews with inmates
    • Staffing issues
    • Policy issues
  • Interviews with corrections officers
    • Staffing issues
    • Policy issues
  • Interviews with mental health staff
• Concerns after follow-up inquiry
• Recommendations after follow-up inquiry
• Conclusive summary

Abstract

The Correctional Psychiatric Treatment Unit (CPTU) of Kentucky State Reformatory is located in LaGrange, Kentucky. CPTU houses persons who have been adjudicated and convicted of a crime or crimes and have been diagnosed with a mental illness.

In January of 2002, Protection & Advocacy (P&A) determined that probable cause existed to believe that persons incarcerated at CPTU were being subjected to alleged abuse and neglect. P&A initiated an investigation of CPTU. In December of 2002, P&A issued a report consisting of a description of that investigation, its findings, conclusions, and recommendations.

In the report, P&A stated that it would return for a follow-up inquiry to CPTU in six to eight months. In July of 2003, P&A staff conducted a follow-up inquiry. This report summarizes the findings of the follow-up inquiry to the investigation and makes further recommendations.

Introduction

P&A is a federally mandated program that protects the rights of citizens with disabilities in the Commonwealth of Kentucky. The federal Protection and Advocacy for Individuals with Mental Illness (PAIMI) Act[1] charges all P&As to investigate abuse and neglect of individuals with mental illness who live in facilities if probable cause exists to believe that the incidents occurred. Prisons are included in the federal statute's definition of facilities.[2] In January of 2002, P&A determined that probable cause existed to believe that persons incarcerated at CPTU were being subjected to alleged abuse and neglect. P&A initiated an investigation of CPTU.

After interviewing persons incarcerated at CPTU, mental health staff, corrections staff, and the CPTU administrator, P&A found that a few corrections officers were perpetrating incidents of verbal abuse within CPTU. In addition, there were allegations of physical abuse which P&A was not able to substantiate. The investigation found that the majority of CPTU staff was committed to the mental and physical health and well being of prisoners receiving treatment in CPTU. The actions of a minority of corrections officers, however, who were influential because of their authority or their personalities, perpetuated a climate of abuse in direct contradiction to the stated mission of CPTU to provide psychiatric treatment.

After concluding its investigation, P&A met with administrative officials from CPTU, the Kentucky State Reformatory, and the Division of Mental Health for the Kentucky Department of Corrections to discuss its findings and recommendations. The meetings were productive and some recommendations were implemented, while others were taken under advisement. In July of 2003, P&A staff conducted a follow-up inquiry to observe and evaluate the changes made at CPTU. This report summarizes the findings of the follow-up inquiry to the investigation and makes further recommendations.

Methodology

Protection and Advocacy conducted its follow-up inquiry in July 2003, through personal interviews with inmates, corrections staff, and mental health staff. All of the interviews of inmates and staff were voluntary. In addition, P&A interviewed the Director of the Division of Mental Health for the Department of Corrections (the Director), and the Licensed Psychologist Program Administrator of CPTU (the Program Administrator).

Interviews with the Director and Program Administrator

During P&A's meeting with them, the Director and the Program Administrator reviewed several of the changes P&A recommended in its original report. They outlined whether they had agreed with the recommendations and whether any changes consequently had been made at CPTU.

Staffing issues

Reclassification of staff and adding staff positions

Protection and Advocacy's initial investigation recommended that CPTU corrections officer positions should be reclassified, requiring greater experience in the mental health field, and providing higher pay. The Director stated that while he agreed with P&A's recommendation, he had met to discuss the matter with the Commissioner and the Deputy Commissioner of Corrections, and that a pay differential would not be implemented.

The Director and Program Administrator stated that they did not agree with P&A's recommendation that CPTU needs two psychiatrists. However, they did agree one more Department of Corrections psychiatrist was needed. They were able to use P&A's CPTU report to convince the Kentucky Personnel Cabinet to give back one full time psychiatrist position that had been lost some years ago when the position was not filled.

The need for increased training

Employees of CPTU attended a daylong training on April 30, 2003 on the broad range of correctional mental health topics, from suicide prevention to building relationships among staff. The Director provided P&A with a training agenda and stated that similar training would be conducted twice a year.

In addition, the Director stated that he and the Program Administrator had given a copy of P&A's CPTU investigation report issued in December of 2002 to all employees. They then met with the employees and told them that they should take any concerns or complaints to the Program Administrator first, and if they are not happy with his response, they should go to the Director.

Individual staffing changes

In its initial investigation, P&A found that a few corrections officers, by their authority or by the influence of their personalities, had perpetuated a climate which is hostile to the goals of mental health treatment at CPTU. Both Kentucky State Reformatory and CPTU have made the following staffing changes to remove abusive staff.

• Kentucky State Reformatory has permanently rotated out the former CPTU Captain, who is now working at KSR in another capacity. The vacant Captain's position has not been filled and may not be filled in the future. While the day shift Senior Lieutenant supervises all shifts, each of the three Lieutenants also report to the Day Captain for Kentucky State Reformatory. If CPTU refills the CPTU Captain's position, all three Lieutenants will report directly to the Captain.
• Kentucky State Reformatory permanently rotated out the previous day shift Lieutenant, who has since left employment with the Kentucky Department of Corrections.
• The Chief Psychiatrist is the new mental health/corrections liaison.
• A mental health staff person was rotated out of CPTU.
• Two corrections officers were rotated out of CPTU for engaging in an inappropriate public display of affection in front of inmates and making inappropriate comments to the inmates about how they looked at the female corrections officer involved.
• A correctional staff person who allegedly engaged in verbal abuse of inmates and excessive force was rotated out of CPTU for several months until receiving training to address the problem areas. Kentucky State Reformatory rotated him back into CPTU, where he is currently employed.

Policy issues

Cell entries and extraordinary occurrence reports

Protection and Advocacy's initial investigation concluded that overuse of forceful entry into an inmate's cell to quell disruptions (cell entry) was largely the result of a few corrections officers alternately ignoring and antagonizing the CPTU inmates, all of whom have mental illnesses. In addition, the number of cell entries was not being documented fully in extraordinary occurrence reports (EORs).[3]

At the meeting on July 23, 2003, P&A asked the Director and the Program Administrator whether either had inquired about the number of EORs. The Director and the Program Administrator stated that they believed that the number of cell entries had decreased since P&A's initial inquiry. Officers now allow inmates to make noise for longer periods, thus generating less cell entries. This has somewhat increased the noise level and disruption; however, officers also try harder to de-escalate disruptive behaviors by talking the inmate out of the behavior or redirecting him.

Lockdown and C-Wing

Lockdown on C-Wing consists of locking an inmate in a cell for an indefinite time. While on Lockdown, the inmate is not allowed to participate in activities or leave his cell. New inmates are held in lockdown for 24 hours a day, without mental health treatment, for up to three weeks or longer while their paperwork is processed. Both mental health staff and inmates alleged that inmates were placed in lockdown for filing grievances. All staff agreed that inmates were placed in lockdown for refusing to take medication for three days in a row, despite the inmates' right to refuse medication. Staff persons stated that they placed inmates in lockdown to preempt dangerous behaviors, regardless of whether such behaviors had occurred. The initial report of P&A recommended that all procedures governing the lockdown process be re-evaluated.

When asked by P&A at the July 23, 2003 meeting, both the Director and the Program Administrator stated they did not believe inmates were being placed on lockdown as frequently for refusing to take medications. They said that staff is waiting to see if a person exhibits symptoms and behaviors warranting lockdown. If, however, an inmate does not follow his treatment plan and refuses to take medications, staff persons believe the inmate is not following what the CPTU program requires. The treatment team then makes the determination on an individual basis whether to place the person on lockdown for refusing medication.

Protection and Advocacy also asked whether the Director and Program Administrator had addressed the allegations about staff placing inmates on lockdown for arbitrary and lengthy periods. They stated that they thought staffing changes have dealt with this problem. When asked about new inmates being held in lockdown for up to three weeks with no mental health treatment, the Director stated that he did not have the power to change this procedure. He said that he had referred the matter to the Department of Corrections in Frankfort.

Relationships between mental health staff and corrections officers

The Director and the Program Administrator stated that relationships between mental health staff and corrections staff have improved dramatically. The Director credited the Program Administrator's leadership for this progress. Mental health and corrections staff persons, however, continue to differ about whether inmates on five-minute and fifteen-minute watches should be allowed blankets, a mattress and a gown.[4] The corrections staff does not want the inmates to be given anything that they could use to try to commit suicide. The CPTU Psychologist wants inmates to be given these items for humane reasons, because the cell is bare concrete and it is cold in the C-Wing unit. Protection and Advocacy asked who, under the current organization structure, has the final say about whether inmates should be provided with blankets, a mattress and a gown. The Director responded that the Psychologist has the final say.

Interviews with inmates

After the release of its December 2002 report, P&A received letters from four inmates housed in CPTU who requested to meet with us during our follow-up to the investigation. Protection and Advocacy investigators met with each of these inmates during the follow-up inquiry and met with other inmates as requested.

Staffing issues

Verbal harassment

Several inmates stated that some corrections officers continue to taunt and curse inmates to instigate a reaction by the inmate that results in the inmate being placed in an isolation cell. Inmates reported of taunting, cursing and unprofessional conduct. For example, it was asserted that a corrections officer asked what two inmates were doing during recreation when they had walked to the water fountain. As the inmates returned, the corrections officer said, "What are those two fucking whores doing?"

One inmate stated that on Feb. 24, 2003, a corrections officer verbally harassed him and cursed, telling him to "shut the fuck up." This inmate filed a grievance about the incident, but had not heard back from internal affairs at the time of Protection and Advocacy's follow-up inquiry. Three inmates expressed doubt as to whether their complaints were objectively investigated since they alleged that the CPTU Senior Lieutenant's brother works in internal affairs.

Excessive force and improper use of restraints

Several allegations of excessive force were made, ranging from misuse of the cuffing-up procedure to kicking. (These are discussed more fully below.) Several complaints were made to the P&A investigators about one particular officer verbally abusing inmates, kicking them, and threatening them with lockdown. A corrections officer concurred that the officer named had verbally harassed inmates.

Four inmates stated that, prior to corrections officers entering a cell, they are immediately supposed to instruct the inmate to cuff up.[5] If the inmate refuses to cuff up and exhibits dangerous behavior, the officers can forcefully enter the cell. The inmates alleged that the some officers never tell the inmates to cuff up, when entering the cell. As they enter, they say "Why didn't you cuff up when I asked you to?" Alternately, allegations were made that one officer jerks the inmates' hands up through the tray slot in the door when instructing them to cuff up, thus causing the inmate to fall down.

Two inmates also observed excessive use of force while an inmate was in restraints. They asserted that in December 2002, they witnessed an inmate strapped to a restraint chair with one arm restrained. One inmate stated that the inmate was putting up a fight with the free arm, while a corrections officer punched the restrained inmate in the chest and arm.

Policy issues

Lockdown and C-Wing

Inmates continue to assert that if they do not take their medications for three days in a row, they are placed on lockdown until they take their medication. Four inmates asserted that corrections officers still use the threat of being locked down in C-Wing (isolation wing) as a threat to inmates whom they deem uncooperative, regardless of whether dangerous behavior is involved. Inmates also alleged that if an inmate asks to leave the CPTU program, officers immediately place him on lockdown until he is transferred out of the treatment program.

Possible discrimination on the basis of disability

One inmate stated that, while he has a doctor's orders requiring use of a wheelchair, corrections officers frequently refuse to let him use it. He has filed a pro se claim under the Americans with Disabilities Act in federal court regarding this issue. Another inmate noted that he had observed a forceful cell entry of this inmate's cell, when he was exhibiting no behavior other than sitting on his bed.

Interviews with corrections officers

Five corrections officers were interviewed by P&A investigators. Protection and Advocacy informed the corrections officers of the reasons for the investigation and the follow-up inquiry. Some officers corroborated portions of the inmates' assertions of verbal harassment and excessive or improper use of force; however, some disagreed that improper behavior by officers is a problem. Most noted overall improvements in operations since P&A's initial investigation.

Staffing issues

Reclassification of staff and adding staff positions

As P&A has previously noted, the majority of CPTU staff-corrections officers, administration officials, mental health workers and nursing staff-consists of competent, caring, dedicated individuals. These CPTU staff persons appear to be committed to the mental and physical health, and well being, of the individuals housed and receiving treatment in CPTU. A few corrections officers, however, continue to verbally harass inmates or use excessive or improper force against them. In addition, P&A previously found that mental health and corrections staff did not work well together, exacerbating overall staffing problems and negatively affecting the quality of mental health treatment provided.

Changes in corrections staffing

Several personnel changes in corrections have been initiated by the CPTU administration to address these problems,[6] in addition to installation of security cameras in all three CPTU wings. Most of the corrections officers interviewed supported those changes, although one felt neutral about them. One corrections officer noted that the changes in personnel regarding the Captain and Lieutenant level of supervision have made his working environment much better and less stressful. Before this change, the officer said he had often felt "stuck between a rock and hard place." A Lieutenant agreed that the personnel changes were good. The Lieutenant stated, however, that since they do not have a Captain, and there is one Senior Lieutenant to whom the other shift lieutenants must report, the lines of authority need to be confirmed to all staff. The fact that the Senior Lieutenant has been given the responsibility for all three shifts should be made clearer to all.

Relationships between corrections staff and mental health staff

The confusion about roles between corrections staff and mental health staff continues to exist, although in the perception of the corrections officers, tensions have abated greatly. The corrections officers interviewed all thought that mental health staff and corrections staff persons are working together better, although one officer noted that they still have a long way to go. A Lieutenant stated that there is now more unity where there used to be a complete split between the mental health workers and corrections officers. As noted earlier, however, the problem of who has final decision-making authority has not been resolved regarding whether inmates on five-and fifteen-minute watches are given blankets, mattresses and gowns.[7]

Even with the changes in corrections staffing, verbal harassment and excessive or improper use of force by some corrections officers continues to be a problem. One officer interviewed corroborated the inmates' assertions that another corrections officer verbally harassed inmates, apparently to goad them. Two officers interviewed stated they had not witnessed any verbal harassment (or excessive use of force) since Protection and Advocacy's initial report in December 2002; however, one officer admitted "some tempers get the best of people at times." A Lieutenant stated that CPTU now is taking quick action to address situations where corrections officers are verbally abusive to inmates. For example, a newly employed CPTU officer who screamed at inmates and who would become very agitated lasted one month.

Excessive force or improper use of force

Misuse of their positions of authority by a few corrections officers continues to result in abuse of inmates. One corrections officer stated that she observed three male officers force an inmate to repeatedly put his head in a toilet. At about 6:30 a.m., the three male officers were in the control room of one of the wings. The officer who witnessed the event heard one of the male corrections officers say, "You all, watch this. It is really funny, I have been doing this all night." He then asked one of the male officers to push the button that flushed the toilet in a cell from the control room. The officer said to the inmate over the speaker to his room, "Name of inmate, go to the toilet and put your head into the toilet. If you don't we will come into the room."

The officer who witnessed the incident said that the inmate got up out of bed, walked over to the toilet, and put his head in it. The officer who called out the inmate's name flushed the toilet. The officer who witnessed this incident said she saw the inmate raise his head and water was dripping off him. She witnessed this happen two times.

The corrections officer stated that she reported this incident to the head of the unit. She and one of the officers who was in the control room were asked to write statements. The two officers involved were immediately removed from the unit and later fired. The corrections officer who witnessed the incident stated that, because she reported the incident, on-going harassment from other corrections officers has become so uncomfortable that she has given notice of her resignation.

When P&A asked the inmate about the incident, he said, "The officers were only playing a game."

As stated above, however, not all officers agreed that excessive or improper use of force is a problem. Two officers stated that they had not seen any incidents of improper use of force since P&A's initial report of December 2002, although as previously noted, one officer said that "some tempers get the best of people at times." A Lieutenant concurred: she stated that she has not seen any excessive or improper use of force under her supervision. She noted that CPTU would not tolerate excessive force and would not find it acceptable under any circumstance.

The Lieutenant thinks staff is working great and that CPTU is "picky" about who is hired. The Lieutenant stated that three currently open positions would not be filled until the right people for the jobs are found.

Policy issues

Lockdown and C-Wing

The corrections officers interviewed seem to concur with inmates that there has been no change in lockdown procedures. The officers stated that inmates who refuse to take medication for three days in a row are still placed on lockdown, although the individual officers do not make this decision themselves. One corrections officer stated that staff must complete certain paperwork for inmates who are placed on lockdown; however, it is not uncommon for an inmate to be on lockdown for thirty days or more without paperwork. Consequently, there may be no record of why an inmate was placed on lockdown or how long he stayed on lockdown. It is unclear why this continues to happen since the Lieutenant stated that lockdowns are reviewed daily by a committee consisting of corrections and mental health staff, as well as the appropriate unit administrator.

Two officers did say that that they thought the number of cell entries was down. A Lieutenant interviewed stated that the number of cell entries has dropped "dramatically." At the time of P&A's follow-up inquiry in July 2003, on the Lieutenant's shift there had been no cell entries in a month. The Lieutenant said that, overall, corrections officers are doing a better job of talking to inmates. They also try to locate a corrections officer with whom the inmate relates well to talk with the inmate if there is a problem.

Access to psychiatrists

Only one officer commented about the lack of inmate access to psychiatrists and noted there had been no change. Protection and Advocacy had noted in its earlier report several inmates reported that they were not able to meet with a psychiatrist as needed to discuss their medication. With only three psychiatrists employed to cover five facilities in the entire state, the need for more psychiatrists is very real. It is uncertain whether the addition of one psychiatrist will address this problem if the new psychiatrist is to serve all five facilities.[8]

Specialized training

Protection and Advocacy previously recommended comprehensive staff training on mental health issues. A full day of training was held in April 2003 and the corrections officers interviewed found it very helpful, particularly the segment dealing with suicide prevention. They expressed a desire for more frequent comprehensive training in the future, although one officer said that he would prefer shorter training periods (less than a full day).

Interviews with mental health staff

Protection and Advocacy previously noted in its initial investigation that confusion about the roles of mental health workers and corrections officers, as well as confusion caused by dual lines of authority, hindered the mental health treatment of inmates in CPTU and caused tension between mental health and corrections staff. Although working relationships appear to be somewhat improved,[9] continuing problems still affect mental health treatment.

Protection and Advocacy interviewed four mental health staff persons. Three concurred with both inmates and corrections officers that inmates are placed on lockdown status for refusing medication for three consecutive days. Two mental health staff persons affirmed inmate assertions that corrections officers still use lockdown on C-Wing as a threat to inmates.

Of extreme concern is the fact that, despite the scrutiny of both the CPTU team that reviews lockdowns daily, as well as the weekly treatment team's status assessment, one inmate allegedly became so seriously dehydrated while in isolation that he required hospitalization. According to one of the mental health staff persons interviewed, this process began when the inmate tore up his blanket while in lockdown status. Because CPTU staff persons were concerned that the inmate might hurt himself, his paper gown, mattress and blanket were removed from his room. At the time, this inmate had been in isolation for over a year.

One staff person reported that the inmate was observed placing his face near a light for warmth since he was naked and had no blanket to keep warm. He then began to refuse food and water. Staff reported to the treatment team that the inmate neither ate nor drank water, and his behavior was becoming increasingly strange.

The inmate refused food and water for three weeks. Each week his refusal to eat and drink and his unusual behavior were brought up during the treatment team meeting. He was moved to a front cell for observation, but received no further medical attention.

During the weekend of the third week, the head nurse visited him and immediately requested that he be sent to the community hospital. As he began to recover, he became stronger and his behavior became more combative. The community hospital gave him Haldol[10] and he returned to CPTU. Because he was stronger, more rational and talkative, he was given candy if he continued to take his medication. Within two weeks, he was placed in the treatment program.

Concerns after follow-up inquiry

The degree to which inmates on lockdown are monitored and provided with timely medical and psychiatric treatment continues to be a great concern. Specifically, the case of the inmate who became dehydrated while on lockdown status and required hospitalization is instructive. P&A is concerned that inmates are not always being monitored carefully when placed on lockdown status despite the installation of cameras in each unit, review of lockdowns daily by a team made up of mental health and corrections staff persons and a unit administrator, and weekly treatment team assessment. The inmate who was taken to the hospital due to alleged dehydration is an example of the need for much more careful monitoring of inmates while on lockdown or in isolation.

Another concern is the use of lockdown after an inmate refuses to take his medication for three days. An inmate should have the right to participate in the program and refuse to take medication. Lockdown should only be used in instances in which the inmate refuses medication and exhibits behaviors that mental health staff persons think is a precursor to violent behavior. If the inmate refuses to take his medication and he merely exhibits unusual behavior not known to be a precursor to violent behavior, the inmate should not be placed on lockdown and should be allowed to remain in the program.

Finally, it is troubling that the same kinds of allegations continue to surface regarding problematic corrections officer conduct and disagreements between corrections staff and mental health staff regarding treatment decisions. These problems could be greatly reduced by replacing the dual administrative structure with one line of authority for both corrections officers and mental health workers; by implementing a zero-tolerance policy concerning excessive use of force and verbal or physical abuse; and, by implementing a policy prohibiting retaliation against inmates or staff who report allegations of abuse or neglect to a supervisor, internal affairs, or P&A.

Recommendations after follow-up inquiry

Protection and Advocacy made several recommendations in its December 2002 report, many of which were implemented by the Kentucky Department of Corrections and the Correctional Psychiatric Treatment Unit. The following recommendations were not implemented, and since Protection and Advocacy's follow-up inquiries indicate that the critical problem areas have not been addressed, P&A restates the following applicable recommendations with further suggestions.

• CPTU should adopt its own policies regarding excessive or improper use of force, and physical or verbal abuse. The policies should include a clear "no tolerance" mandate for excessive or improper use of force and physical or verbal abuse by staff. The policies should prohibit retaliation against inmates or staff who report allegations of abuse or neglect to a supervisor, internal affairs, or P&A.
• CPTU should provide training that is more frequent. While the all-day training that was provided to all CPTU staff persons last April was a good start, training should be continued on a regular basis.
  • Corrections officers should be provided with mental health training that is more in-depth than the standard two hours provided during orientation for new officers. Corrections officers working in CPTU need more mental health training in suicide prevention.[11]
  • CPTU should continue to provide its staff extensive training on de-escalation and other techniques that would reduce and perhaps eliminate the use of restraints.
  • The Federal Consent Decree of 1981 should be included in future training. While many employees know that it exists, not many know that abuse of a prison population with mental illness precipitated this class action. Understanding the Consent Decree would help staff to appreciate the positive reforms that have taken place for prisoners with mental illness in Kentucky.
  • To address problems when mental health treatment decisions appear to conflict with security concerns, mental health staff persons employed in CPTU should receive training on security measures, rules and responsibilities while being employed in a prison.
• Protection and Advocacy acknowledges that the needs of the CPTU inmate population are complex and that interacting with the inmates is challenging. Many of them have assaulted staff and other inmates, thrown feces and urine, destroyed property, flooded cells and threatened staff. Therefore, P&A recommends correctional positions be reclassified and a pay differential instated to reflect the greater demands of these jobs.
• The position of CPTU corrections officer should be reclassified to psychiatric correctional officer, with the new position requiring a background including mental health training or experience working with persons with mental illness.
• Protection and Advocacy further recommends that corrections officers who work with the CPTU population be given a pay differential. The position should have higher pay due to higher employment qualifications and greater job responsibilities.
• The dual administrative structure continues to cause problems that could be addressed if one line of authority were implemented. Currently correctional and mental health staff persons have separate chains of command creating an "us v. them" mentality that undermines the mission of the unit. The CPTU is unique in that equal numbers of clinical staff and security staff work there. The corrections officer chain of command should be clarified to reinforce that all CPTU shift lieutenants assigned to CPTU report directly to the Captain (if this position is refilled) or to the Senior Lieutenant if there is no Captain. The CPTU Captain or Senior Lieutenant should report to the Program Administrator for CPTU.
• Because CPTU provides medical and psychiatric services, as would a licensed psychiatric hospital, it should be licensed as a psychiatric hospital. An outside licensing agency needs to monitor the use of its mental health treatment practices.
• At least two more psychiatrists should be hired and assigned to CPTU since inmates continue to assert that they are unable to meet with psychiatrists as often as needed to discuss their medication. Even with four psychiatrists[12] employed to cover five facilities statewide, the need for more psychiatrists is very real, as it is unlikely that four psychiatrists can meet the needs of the burgeoning inmate population with mental illness. Understandably, much of the psychiatrists' time is taken up by traveling to and from the five facilities. Applying a community standard of access to psychiatric professionals for a 150-bed psychiatric treatment unit does not seem reasonable.
• New inmates needing mental health treatment continue to remain in isolation on hold ticket status without mental health programming. The classification process is very slow. While the CPTU Director stated that he had brought this matter to the attention of the Kentucky Department of Corrections, the DOC has yet not acted to address the problem. Protection and Advocacy recommends that the DOC examine this process carefully and draft new policies to allow inmates to move into the treatment program without staying in isolation for weeks.
• The need for independent monitoring or oversight of grievances is heightened in complaints involving inmates with mental illness. Institutional investigators, well meaning and diligent as they might be, do not generally have psychiatric medical training. In addition, given the inherent and bilateral resentment in the relationship between inmates and staff, it is not surprising that prison officials are reluctant to accept the word of a prisoner in the absence of undisputed, ironclad, corroborating evidence. In the CPTU, specifically, the impartiality of internal investigations is further brought into question by the fact that one of the institutional investigators is related to the Senior Lieutenant. Further, both mental health staff and inmates continue to allege that inmates are placed in lockdown for filing grievances. For these reasons, it is almost impossible for any grievance mechanism to have credibility in the absence of some oversight by neutral, disinterested parties. Protection and Advocacy recommends external involvement by an ombudsman as a final reviewer of CPTU inmate grievances to remedy the problem.[13]

Conclusive summary

The administration and staff of the Correctional Psychiatric Treatment Unit of Kentucky State Reformatory have begun the process of improving treatment for inmates with mental illness. Much more needs to be accomplished. While the majority of the staff persons are competent, caring, dedicated individuals, a few officers still engage in excessive or improper use of force, and verbal or physical abuse. Any abuse of an inmate should not be tolerated.

Protection and Advocacy is aware that many, if not all, of the recommendations it makes in this report require additional funding, legislation, or promulgation of new administrative rules and polices. These factors, however, should not be used to compromise the mission of CPTU to provide therapeutic mental health benefits to inmates. Protection and Advocacy strongly urges that funding be increased for these necessary mental health programs to ensure high quality and effective mental health treatment for prisoners.

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