Cameron MacKenzie

From Prison Focus Issue 52
Summer 2017


A PSU or Psychiatric Services Unit is a secure housing unit for prisoners with solitary terms who are deemed to require an advanced level of mental health care. In the words of the Mental Health Services Delivery System (MHSDS) Program Guide: “Inmate-patients who are serving an established and approved SHU term and require an Enhanced Outpatient Program (EOP) level of care shall be referred to a PSU.”
PSUs were created as part of the Statewide Mental Health Program (SMHP) initiated in response to the 1995 federal court ruling in the Coleman vs. Brown class action lawsuit regarding the treatment of prisoners with mental health diagnoses. This ruling found that California prisons were in violation of the 8th Amendment’s prohibition on cruel and unusual punishment because they did not provide adequate mental health care. Other states, when forced to reckon with the unsuitability of solitary confinement for those with mental health symptoms, chose to move people out of solitary. For instance, New York has the SHU Exclusion Law, passed in 2008 and implemented in 2011, which restricts the placement of prisoners with serious mental illness in disciplinary confinement entirely.

Instead of ending solitary confinement for Californians with mental health diagnoses, CDCr chose to implement SMHP, with the stated goal of providing “ready access to mental health services” for prisoners. The program also aims to “ensure that the individual functioning of seriously mentally disordered patients is optimized so that their care may be maintained in the least restrictive environment.” This doublespeak is not lost on those with serious diagnoses who are still placed in solitary confinement conditions with no substantive out-of-cell time.
According to policy, PSU prisoners are supposed to be offered at least 10 hours of scheduled structured therapeutic activities per week, and to be regularly evaluated both medically and psychiatrically by health-care professionals. Therapeutic treatment activities may include individual or group psychotherapy, although during group therapy, prisoners are kept in individual cages because they are not allowed to be unshackled around others. According to one report we received, this programming may consist of nothing more than watching television. The average stay in the PSU lasted 86.63 days, with a range of 3-229 days.

The actual provision of this care is monitored by a Special Master, as part of the Coleman ruling. In the last (26th) round of reports, filed May 2016, the Special Master found that the initial contact timeframe for individuals placed in the PSU was only 76% compliant; the rate of interdisciplinary participation in treatment planning meetings was 79% compliant; and only 57% of PSU prisoners were offered ten hours of group therapy per week. Looking at the Step system by which prisoner-patient progress is measured, out of 1460 Step actions taken in the monitoring period, 793 or 54% maintained the prisoner at his current Step level. The primary reason for prisoners being retained at their current levels or having their levels increased was listed as “participation.”

In light of these findings, it is reasonable to ask if prisoner participation in treatment programming has been adversely affected by the State’s failure to meet the standards set by the Coleman ruling. Given that privileges in the PSU are earned through progress on the Step system, and that prisoners are penalized for not participating fully in treatment, it is all the more crucial that the CDCr ensures this treatment is provided. Whether the programming that is offered is suitable and applicable to the prisoners and constitutive of “adequate mental health care” is a further question.
Following the closure of the PSU at Pelican Bay at the end of 2016, there is currently only one prison in California with PSU facilities - CSP Sacramento. California Prison Focus has received a number of letters from prisoners in the PSU at Sacramento, many of which report serious deficiencies in their care. The issues highlighted by these letters are summarized below:

While prisoners are officially encouraged to speak out in order to receive help if they are having thoughts of suicide or self-harm, we have received multiple reports of prisoners not receiving the help they need, including guards refusing to remove suicidal prisoners from their cells, and even being threatened with physical violence for speaking up. Similarly, when people harm themselves, rather than getting placed in “crisis beds,” where they are under 24-hr supervision, reports are that they are immediately returned back to their cells instead.

Security welfare checks, are a constant and severe problem threatening the mental health of prisoners across all solitary units, especially the checks throughout the night, causing sleep deprivation, which is a known form of torture. This issue is reportedly exacerbated by the placement of sensors directly on the cell doors in the PSU at CSP-SAC. Recent reports from the PSU are that the checks are loud and regular, but are not thorough, with most officers rushing by and not even looking into the cell. These “welfare” checks have already been the focus of human rights scrutiny for their failure to provide any welfare to prisoners, but rather have negative, physical and mental health consequences. (For more on the security welfare checks, see page 5)

A serious issue CPF is concerned with involves the state abusing its right to administer medication involuntarily, with many prisoner-patients in the building forced to take the same medication, despite differing individual needs of their conditions. One report to CPF describes overmedicated prisoners as “walking zombies”, some of whom now need to use walkers to get around due the effects of these medications upon their equilibrium.

When prisoners in the PSU are written up for rule violations, they must undergo a mental health evaluation in order to determine if their mental health condition played a part in their violation of the rules. In one letter CPF received, a prisoner describes how these evaluations are often conducted as many as ten days after the violation. The results of these belated evaluations are then used to determine the prisoner’s state of mind at the time of the violation, with the usual conclusion being that mental illness played no part (due to the length of time between violation and evaluation), so the prisoner may be held fully responsible and face disciplinary action.

For one piece of positive news, thanks to the efforts of prisoner advocates within the PSU, there is now a ‘disability desk’ in the PSU law library, providing physically disabled prisoners with equal access to legal information.

CPF stands in solidarity with prisoners of all types, including those with mental health diagnoses. CPF understands that mental health conditions are common to all people, and we reject any “stigma” or negative treatment based on a mental health diagnosis. All individuals deserve support and respect. If you are currently incarcerated in the PSU, previously have spent time in the unit, or have other accounts of CDCr’s provision of mental health services, CPF welcomes all submissions. Be sure to note in your letter whether you give permission for your account to be anonymously shared with others.