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Secure Psychiatric Unit at New Hampshire State Prison. Photo by Wanda Duryea

In the spring of 2015, an experienced nurse started work in the forensic unit of the New Hampshire State Prison for Men. She expected her clients would have two characteristics: they would be male, and they would all have been sentenced by a court to the prison.

That is not what she found.

When she observed a woman incarcerated in the men’s prison, the nurse asked what she was doing there. The answer stunned her. As did the tortured logic to rationalize her presence.

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Wanda Duryea

The woman was not an inmate, she was told.

She had been transferred from the state psychiatric hospital. She was civilly committed. She had not been sentenced by a court.

She was in fact the victim of a series of statutes and administrative rules in New Hampshire that departed from constitutional protections, civil rights, evidence-based practice, and dignity.

Subsequently, the nurse (one of us) would learn there were other civilly committed individuals held in this prison psych unit. Some were deemed incompetent to stand trial, some were Not Guilty by Reason of Insanity (NGRI) and some had no criminal justice involvement at all.

They were comingled among the inmates. They had inmate numbers. They were de facto inmates—subject to the rules and policies of the state Department of Corrections and managed by corrections officers.

What was more stunning was the explanation of their presence from the nursing staff .

‘We’ve Been Doing This for Years”

One nurse opined that it was based on New Hampshire law, and therefore completely legitimate. Another added: “We have been doing this for years.”

No one seemed to have any working knowledge of the American Disabilities Act (ADA), which prohibits discrimination based on disability.

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Beatrice Coulter

The ignorance of those involved in this remarkable deprivation of liberty was evident.  But while it did not serve these vulnerable individuals well, it has served the state well.

In the late 1980s, the state passed legislation that allowed civilly committed individuals deemed “dangerous” to be transferred into a prison facility called the “Secure Psychiatric Unit.” This unit would come to house women, individuals with developmental disabilities and pre-trial detainees.Any behavioral challenge that came its way, the state sent to the prison

Thus, any behavioral challenge that came its way, the state sent to the prison.

Why was this allowed to continue?

The answer was simple: it was cost-efficient. The state could send forensic patients to the prison at a fraction of the cost of hospitalization. The state rationalized that the presence of nurses and behavioral health professionals effectively made the prison a forensic hospital.

What they did not address was individuals were being sent from a licensed, accredited state hospital to a prison psych unit with no license, no accreditation and no oversight by any state agency.

Due process for this population had long been abandoned. Individuals would (and still do) languish there for years. It is a drab facility with little to offer, other than control, concrete, steel and, sadly for some, death.

The nurse reached out to another individual (the second writer of this essay) recognizing something needed to be done.

Magical Thinking

Together we were amazed at how few knew of this practice.

The tortured logic and false narratives the state put forth to legitimize it were shameful. The state said it was a “forensic hospital, ” or that it was not part of the prison. There was also the bizarre defense of the “separate door,” in which the fact that the entry to the prison had a separate entrance for those who were civilly completed made it a separate facility.

It was all magical thinking.

We testified in the legislature and wrote op-eds. We encouraged those individuals impacted by this practice to testify. We were interviewed by national publications.

It was finally announced that the state would build a forensic hospital on the grounds of the state hospital in Concord, N.H.. The funding was approved and the planning began.

But as of this writing a shovel has not broken ground yet. It is only 24 beds, a fraction of what is needed to serve this population and their specific treatment needs.When New Hampshire had the opportunity to do the right thing, it chose not to. 

When New Hampshire had the opportunity to do the right thing it chose not to.

We believe the state continues to want the option of utilizing the prison as a substitute for hospitalization.

This practice must end..

We believe this will only stop with a class action lawsuit. We know individuals that are willing to become plaintiffs. Until a court halts this practice those with serious mental illness remain at risk. We would welcome help from the legal community.

Sadly, a new facility is not reform.

True reform will occur when the state is prohibited from incarcerating seriously mentally ill individuals that have not been convicted of crimes.

Wanda Duryea and Beatrice Coulter are co-founders of Advocates for Ethical Mental Health Treatment.  Beatrice, a registered nurse since 1981, has coordinated civil commitments in an urban hospital emergency department for several years. Wanda, a graduate of Everest University, was former executive director of Citizens for Criminal Justice Reform and treasurer of the New Hampshire Indian Council.