Community-Academic Partnership to Improve the Psychiatric Care of Justice-Involved Individuals with Serious Mental Illness

Community perspective by Donna Winant
Academic perspective by Carol Lim, MD, MPH

Community Perspective
Family and Friends of Individuals with Mental Illness (FFIMI), a grassroots organization in MA formally established in August 2018, advocates to change the current system of placement for those with SMI who are justice-involved. FFIMI members including myself have loved ones with SMI who were, or still are held at Bridgewater State Hospital (BSH), which is a medium-security men’s psychiatric facility in Bridgewater, MA that houses pre-trial detainees and patients with civil commitments.

When an individual with SMI is taken into legal custody, it begins a uniquely traumatic experience adding to the difficulties of dealing with the already significant challenges of mental illness. They are taken away from their family, life events, and family members began to miss and mourn the loss of their presence. I became one of those family members when my grandson was placed at BSH. Once this occurred, our family could no longer enjoy treks of miniature golfing, restaurants, family birthday parties and barbecues and the annual highlight, a deep-sea fishing excursion. That loss is why I began to advocate for family-centered changes at BSH. 

I requested opportunities for family meals and these discussions with BSH leadership led to families being allowed to order in meals from several local restaurants. Every family greatly enjoyed this! As Art Historian and Adjunct Professor, I proposed a pilot program to conduct art classes for BSH families. It was approved! This provided a fun activity that families could engage in together.

As I became acquainted with the families and our common hardships, I was motivated to move forward to advocate around more serious concerns. I began a letter writing campaign to government officials and mental health organizations to propose improvements in mental healthcare, especially for those who were incarcerated. From this solo beginning, an amazing group of committed family members banded together to help form FFIMI.  

“As I became acquainted with the families and our common hardships, […] I began a letter writing campaign…to propose improvements in mental healthcare, especially for those who were incarcerated.”

Prior to the inception of FFIMI, my husband and I, along with others, had been advocating for a shift from a Department of Correction (DOC) model to a treatment-oriented psychiatric care model at BSH. It was in April 2017 that Governor Baker ordered a new system of healthcare at BSH to provide comprehensive psychiatric care delivered by trained mental health professionals for those with SMI. While families and patients found great relief when BSH became more of a therapeutic setting, this psychiatric care was only available to those not fit to stand trial.

Those with SMI who achieve a level of stability and are legally competent to stand trial are then transferred from BSH to county jails. County jails are not built to serve those with SMI. Most correction officers lack the training and qualifications to support the treatment of individuals with SMI and access to trained mental health clinicians is often limited. Being placed in county jail without sufficient resources for mental health, and the potential of victimization from other inmates, puts them at risk of deterioration or suicide.

FFIMI is advocating for secure-hospital facilities to provide a continuum of safe and comprehensive care across the entire spectrum of the legal and justice system. It is important to note that some jails are working to implement new programming and additional medical staff for mental health units. This is a good start but the continuum of care must serve all those with SMI who are incarcerated. We are proud to be working in partnership with the MGH Schizophrenia Clinical and Research Program Correctional Psychiatry Working Group.

Academic Perspective
The Correctional Psychiatry Working Group was formed within the MGH Schizophrenia Clinical and Research Program in November 2020. The group consists of mental health professionals at MGH who are based in Boston, MA. Our members also provide care to patients outside of MGH in the Suffolk County jails, affiliated community mental health clinics, and programs funded by the MA Department of Mental Health. Our goal is to promote recovery-oriented psychiatric treatment of individuals with SMI and criminal justice involvement, through a partnership with community stakeholders.

As a first step, we connected with FFIMI and held a meeting with the FFIMI Steering Committee to understand their lived experiences and identify their needs. Four priority areas were identified:

  1. Equipping mental health centers with screening tools to identify those at risk for criminal justice involvement and prevent incarceration,
  2. Improving processes by which mental health clinicians in correctional facilities engage family members in treatment planning during the initial months of incarceration,
  3. Delivering resources and psychoeducation to caregivers to assist with navigating the legal and treatment systems, and
  4. Scaling up mental health services within correctional facilities. 

FFIMI helped solidify our first action plan, which is to focus on the fourth priority area of scaling up mental health services within correctional facilities, specifically by proposing to create a specialized psychiatric unit within the Suffolk County jails in Boston, MA.

FFIMI introduced us to Superintendent David Tuttle at Worcester County Jail, who has developed a specialized mental health unit within Worcester County Jail that will provide much needed mental health services with highly-trained professionals, as well as rehabilitation resources and programs. Currently, the Suffolk County jails have only outpatient-based mental health clinics and solitary rooms for Safety Watch, where individuals at risk of self-harm are monitored until stabilized. The structure of this service does not permit focused attention to each individual’s unique mental health needs.

Our working group is researching and putting together plans of how individuals with SMI can be housed in a live-in, specialized psychiatric unit that could offer higher-quality psychiatric treatment and the full continuum of care. It would separate them from the general population where they are often victimized and traumatized. It would provide more structured therapy and services to this group including skill building, peer support, individual cognitive behavioral therapy, and group therapy on substance use. It will also give them an opportunity to learn appropriate skills to manage their mental health symptoms both when incarcerated and when integrating back into society. 

“[We are] researching and putting together plans of how individuals with SMI can be housed in a live-in, specialized psychiatric unit that could offer higher-quality psychiatric treatment…[and] an opportunity to learn appropriate skills to manage their mental health symptoms both when incarcerated and when integrating back into society.”

We are excited about our ongoing workshops and collaboration with FFIMI. We are creating a powerful collective voice for meaningful policy change. 

Authors

Carol Lim, MD, MPH
Fellow, MGH Public and Community Psychiatry
Correctional Psychiatry Working Group Organizer,  
MGH Schizophrenia Clinical & Research Program

Community-Academic Partnership to Improve the Psychiatric Care of Justice-Involved Individuals with Serious Mental Illness