Did Harrisburg State Hospital's closure lead to more mentally ill

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1 1 Did Harrisburg State Hospital's closure lead to more mentally ill prisoners? Daniel Simmons-Ritchie By Daniel Simmons-Ritchie the author Follow on Twitter on July 23, 2015 at 6:30 AM, updated July 23, 2015 at 12:44 PM "The patients coming to us now, they are very, very ill." Todd Haskins, PrimeCare Medical EDITOR'S NOTE: In 2006, with some controversy, the state shuttered central Pennsylvania's only mental hospital. The closure of the Harrisburg State Hospital came with a promise from state officials to the counties it served: mentally ill people wouldn't end up on city streets. Instead, savings from the closure would be reinvested in caseworkers and other programs to help the region's mentally ill live in the community. Today continues a multi-part package that will publish over the next couple of months looking at people with mental illnesses and the overworked and underfunded system that's now in place to serve them. Nearly a decade after its final patients were discharged, opinion remains deeply divided in the midstate over the 2006 closure of the Harrisburg State Hospital. For some local officials those impacts couldn't be clearer. Dominick DeRose, warden for Dauphin County Prison, believes that loss of bed space has meant more mentally ill people are entering the criminal justice system. "They did not close Harrisburg State Hospital," he said. "They just renamed it the Dauphin County Prison." But others, such as Dan Eisenhauer, director of Dauphin County's mental health and intellectual disabilities program, believes there is no connection between the hospital's closure and the prevalence of mental illness inside the county prison. "People who are telling you their opinion about what has changed since the closure of the state hospital are largely opinions coming from people who never understood how an individual gets to a state hospital," he said. That division over the closure's impact has been fueled in part by a lack of hard data. Unlike the state prison system, most county prisons in Pennsylvania don't track rates of "mental illness" and "serious mental illness" among inmates. Compounding matters, despite repeated requests, the state Department of Human Services was unable to provide PennLive with recent statistics on the fate of former patients in the Harrisburg State Hospital. However, although data is limited, there are some avenues to analyze the impact of the hospital's closure. An increase in seriously mentally ill inmates?

2 One method of analysis is to look at the proportion of inmates, on an average day, who are prescribed psychotropic medications. PrimeCare Medical, a contractor that provides health care to Dauphin County Prison and 28 other county prisons in Pennsylvania, provided PennLive with extensive figures on prescriptions rates in prisons that it contracts with. PrimeCare's figures go back as far as the Harrisburg-based company has contracted with each prison. In the case of Dauphin County Prison, the contractor began providing health care services to its inmate in 2006, the same year Harrisburg State Hospital closed Percentage of Dauphin County Prison inmates being prescribed psychotropic medications % % 24.56% 24.59% 24.98% % 11.4% 12.36% 12.94% Graphic by Nick Malawskey. Source: PrimeCare Medical. At first blush, the prescription rate figures for Dauphin County Prison show a clear trend. In 2006, the year that Harrisburg State Hospital closed, 13 percent of Dauphin County's inmates were prescribed

3 id Harrisburg State Hospital's closure lead to more mentally ill prisoners? psychotropic medications on an average day. That rate has increased significantly over the past nine years. Last year, nearly a third of its inmates were on psychotropic medication. EXPLORE: View an interactive map of psychotropic medication rates in other county prisons across Pennsylvania. Todd Haskins, vice president of operations for PrimeCare Medical, believes that increase reflects a surge of seriously mentally ill people into the prison system people who might otherwise have been treated in Harrisburg State Hospital if it still existed. He views the impact of that closure as a continuation of a national trend, beginning in the 1960s, where states began shuttering or downsizing state hospitals. Many policy experts believe that those former patients or people who would otherwise have been patients in those facilities ended up on the streets or in the criminal justice system. Haskins said that, in general, psychiatrists across his company have observed increases in seriously mentally ill inmates in all county prisons that it contracts with in Pennsylvania. He believes those increases are fueled not only by the closure of Harrisburg State Hospital in 2006 but also the closure of Mayview State Hospital in 2008, Allentown State Hospital in 2010 and the gradual downsizing of the state's six remaining facilities. "Those poor folks who were in the state hospitals, they went someplace and they went back into the community," he said. "And I think the numbers correspond with those closures." Those observations within the company are hard to back up with data Haskins' company hasn't tracked rates of serious mental illness over the years but he believes they're at least partially reflected in the company's data on prescription rates for psychotropic medication. Overall, according to PrimeCare Medical's data, the proportion of inmates in prisons it contracts with in Pennsylvania who are prescribed psychotropic medication has risen from 21 percent in 2006 to 28 percent last year. Haskins added that he didn't believe there was always a correlation between an increase in the proportion of seriously mentally ill inmates in a county prison and its prescription rates. As an example, he pointed to Cumberland County Prison, which, like Dauphin County Prison, contracts with PrimeCare Medical and is based in a county formerly served by the Harrisburg State Hospital. Unlike Dauphin County Prison, the rate of inmates prescribed psychotropic medication actually decreased in the Cumberland County Prison over the past nine years. In 2006, 30 percent of inmates were on psychotropic medication on an average day. Last year, the rate fell to 20 percent of inmates. But, Haskins said, regardless of that decrease in prescriptions rates, PrimeCare's staff in the Cumberland County Prison had personally observed significant increases in the proportion of seriously mentally ill inmates. "They never had to deal with that before so their numbers maybe deceptive," he said. "The numbers don't represent fully the increase in acuity. The patients coming to us now, they are very, very ill."

4 id Harrisburg State Hospital's closure lead to more mentally ill prisoners? In the absence of better data, Haskins said he still believed the rates provided a rough feel in many of Pennsylvania's county prisons of the increase in seriously mentally ill inmates. Caution and skepticism But some mental health advocates and experts are cautious about reading too much into PrimeCare's prescription medication figures. David Zug, Dauphin County Prison's psychologist and a PrimeCare Medical employee, is one of them. On one hand, Zug doesn't disagree with Haskins. He believes that there's little doubt that the proportion of seriously mentally ill inmates has gradually increased in the Dauphin County Prison since he began working at the facility in He believes a major driver for that increase has been gradual restrictions on bed space in Harrisburg State Hospital and its eventual closure in However, Zug said he wasn't sure whether the recent spike in rates of prescription of psychotropic medication in the Dauphin County Prison was reflective of an increase in inmates with serious mental illnesses. "I can't say one way or another," he said. Zug suggested that there may be other possible explanations for the increased rate of prescription for psychotropic medication. For instance, he theorized, more people in the community may be receiving prescriptions for psychotropic medication from their family doctors. In turn, when people from the community arrive in prison they may be more likely to seek medication for a perceived mental illness. Presented with PrimeCare's medication figures for the Dauphin County Prison, Sue Walther, executive director of Mental Health Association of Pennsylvania, said she was troubled by the high rate of inmates on psychotropic medication in the prison. "it certainly is concerning," she said. "I don't want people who have mental illness to be in a county jail if we can do better we should do better." Walther, a strong supporter of the closure of state hospitals, added however that she was skeptical that there was a connection between increasing prescription rates within the prison and the closure of the Harrisburg State Hospital. "I feel like we always leap to cause and effect and I don't think we can necessarily do that," she said. Agreements and disagreements Haskins, the executive for PrimeCare Medical, doesn't dispute that the data is still open to interpretation. He agreed with Zug that there are other factors that are likely influencing the psychotropic medication rates in Dauphin County Prison. However, Haskins said, looking at the data across PrimeCare-contracted county prisons, he believed there was a

5 5 clear connection between the prescription rates in Dauphin County Prison and an increase in seriously mentally ill inmates due to the closure of Harrisburg State Hospital. Still, regardless of differing interpretations of the data, Haskins said the major thing that he, his staff, and correctional officials across the state agreed upon is that are seeing inmates who are more severely mentally ill than ever before. "We are seeing inmates who come in who are profoundly psychotic," he said. "We have never really seen that, but over the last few years it's increasing more and more." Daniel Simmons-Ritchie joined PennLive in Simmons-Ritchie is the recipient of a fellowship through the John Jay College of Criminal Justice and the Langeloth Foundation. Simmons-Ritchie previously wrote an awardwinning series that explored similar issues in South Dakota's jails at his previous employer, the Rapid City Journal. Since arriving here, he served as one of two primary writers on an in-depth look at heroin in the midstate called Addiction Crisis in Pa PennLive.com. All rights reserved.