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Advocates worry of looming mental health crisis inside North Carolina prisons

Vigil for Freedom and Racial Justice
Jonathon Gruenke
Tina Marshall props a sign against a bush outside the North Carolina Executive Mansion in downtown Raleigh Friday afternoon as a part of the Vigil for Freedom and Racial Justice December 16, 2022. Marshall and other advocates are calling for justice, fairness and second chances for people incarcerated in North Carolina.

Samuel C. Wendt suffers from post-traumatic stress disorder, a consequence he says resulted from military duty in Iraq and Afghanistan. He's incarcerated at Tabor Correctional Institution and says he still needs mental health care.

"I can tell you from my personal experience that I'm a better person when I'm able to talk out my problems," said Wendt, 43, during a telephone interview from prison. "And prison is not a place where you can cry on other people's shoulders. It's just not."

I'm a better person when I'm able to talk out my problems. And prison is not a place where you can cry on other people's shoulders. It's just not.
Samuel C. Wendt

Wendt isn't alone. A U.S. Department of Justice report estimates more than one-third of people in prisons have a history of mental health problems.

At Tabor City, where Wendt is serving a 26-year sentence for a statutory rape conviction, he says there are many people in need of mental health care.

"I can't stress enough that prisoners need mental health care," Wendt said. "And I'm not just talking about me."

But they aren’t always getting that care, according to interviews WUNC conducted with dozens of prisoners and advocates. They say restrictions to prevent the spread of COVID-19, and now staffing shortages, mean extended lockdowns and isolation. That can make it hard for prisoners to see psychiatrists. It has even impacted virtual telehealth appointments.

One way this has manifested is in self-harm. There were 13 prisoner suicides last year in North Carolina. That's the highest annual total since at least 1991, according to data from the N.C. Department of Public Safety. Overall, there were 3,347 events that required a self-injury risk assessment last year. That's up from 3,099 in 2019.

N.C. Department of Public Safety
Suicides in North Carolina prisons by year.

Joseph Williams directs the UNC Health correctional psychiatry program, which began in 2015. The program now has 15 psychiatrists who provide both in-person and telehealth care. Williams says staffing shortages impact telehealth services as well, because there aren't enough staff to escort a prisoner to the designated virtual care space.

"It deprived some of these incarcerated folks of their ability to frequently and easily see their mental health providers just because that would involve movement of incarcerated individuals, and the prison was really trying to dampen down on that to minimize the spread of the virus," Williams said.

In 2019, about 31% of new prisoners were referred for mental health services after their initial intake screening, according to data from the Department of Public Safety. That increased to 47% in 2021.

The prison system currently has a 36% vacancy rate for licensed mental health clinicians, according to DPS data. System wide, the correctional officer vacancy rate is around 40%. Staff make up by far the single largest budget item for not just prisons, but the entire Department of Public Safety. Prison Custody and Security receives $900 million in state appropriations, or more than 36% of the entire Public Safety budget.

N.C. Department of Public Safety
Prison suicide rate per 10,000 inmates by year.

Prison health care and pharmacy makes up another sizeable portion of the budget — $288 million. Of that, $41 million is dedicated to mental health. Williams says the staffing level affects both medication assessment and therapy for inmates.

"Folks would maybe not have those medication changes made quickly enough to be able to address worsening mental health symptoms," Williams said. "And that would contribute to worsening mental health."

Advocates call for reducing prison sentences as a solution

Prison reform advocates say this is all the more reason to cut more prison sentences short. Since a peak in 2011, the North Carolina prison population has been in steady decline, and is now at its lowest point since 1995.

Kristie Puckett-Williams is the deputy director for engagement and mobilization for the ACLU of North Carolina. She's happy to see the population trends, but there are still close to 30,000 people currently in prison in the state. She wants society to offer better programs to people in need; people like her before she spent time in jail and on probation for larceny and drug convictions.

"I was a victim of domestic violence. I needed financial assistance. Instead of being offered financial assistance, I was offered [Division of Social Services] to take away my kids. I was offered to be locked up myself," Puckett-Williams said. "If anybody had asked me, 'Well what do you need?' I would have told them, had I received those things, incarceration wouldn't have even been on the table."

Puckett-Williams led a weeks-long protest in December by the governor's mansion in downtown Raleigh. She advocates for various criminal justice reforms, but one of her biggest passions is to improve living standards inside prisons.

"Humans deserve to be treated like humans," Puckett-Williams said. "And the conditions inside of North Carolina's prisons and jails and carceral systems are inhumane. They are torturous."

Division of Corrections leadership say they recognize the need for more mental health care. The prison system is working with the American Foundation for Suicide Prevention's Project 2025, which is aiming to reduce the annual rate of suicides by 20% by 2025.

N.C. Department of Public Safety
Annual average daily prison population. The average population is now at at its lowest point since 1995.

Lewis Peiper is the prison director of behavioral health and says leadership is addressing the issue "head on." He says that the majority of suicides are among prisoners who have not been flagged for a self-injury risk assessment. That indicates that inmates who see mental health providers are less likely to commit suicide, but also that they aren't reaching everyone who needs these services. Peiper says prison staff encourage inmates to speak up if they have a friend who is struggling.

"It's all hands on deck," Peiper said. "Let's help each other out here."

In some corners of the North Carolina legislature, a few lawmakers have started to take notice. Senator Natalie Murdock represents parts of Durham County and introduced legislation last session to widen the use of a program that allows for the early release of medically fragile prisoners.

"I think that there's to say that if we don't think this person is physically a threat to their community, why are they still incarcerated?" Murdock said.

Janelle and Leroy.jpg
Janelle Kase
Janelle Kase and Leroy Wentzel. Wentzel was released from prison and is serving probation while living with Kase, his daughter, in Pennsylvania.

Her initial legislation would not apply to many people, but she says it's a start.

"Particularly if you are elderly and have family members that say, you know, we are happy to house our loved one. They can still be monitored in various ways," Murdock said.

This exact scenario played out just three days before Christmas.

Leroy Wentzel, who will turn 80 in March, pleaded guilty in 1995 to killing his sister-in-law's husband, and was serving a life sentence. He had mounting health problems, and his daughter, Janelle Kase who lives in Pennsylvania, began advocating with the parole board for his release. Late last year, the board agreed. And on a wet and rainy December day, Wentzel went home with his daughter.

"And when I got through the gate, I saw my daughter standing there and she was already crying," Wentzel said. "And we grabbed each other and hugged and kissed. And we still do that today. But what a feeling, man."

Advocates say they want this kind of release effort expanded. They say that would not only benefit the person released, but help alleviate problems caused by staffing shortages, including lack of access to mental health care.

Jason deBruyn is the WUNC health reporter, a beat he took in 2020. He has been in the WUNC newsroom since 2016.
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