Nathan Woodliff-Stanley, Executive Director Mark Silverstein, Legal Director

February 6, 2014 SENT VIA Email Rick Raemisch Executive Director Colorado Department of Corrections Rick.Raemisch@state.co.us Kellie Wasko Deputy Director Colorado Department of Corrections Kellie.Wasko@state.co.us Re: Prolonged Isolation of Seriously Mentally Ill Prisoners in the Colorado Department of Corrections Residential Treatment Program

Dear Mr. Raemisch and Ms. Wasko, We write to update you on one facet of the American Civil Liberties Union of Colorados (ACLU) continuing investigation into the Colorado Department of Corrections (CDOC) treatment of seriously mentally ill prisoners. Specifically, we are writing about CDOCs continued confinement of some seriously mentally ill prisoners in prolonged isolation within the Residential Treatment Program (RTP), a program which we understand is designed to provide intensive mental health treatment to CDOCs most seriously mentally ill prisoners. At the outset, we want to acknowledge the steps CDOC has taken in recent months to move a significant number of seriously mentally ill prisoners out of administrative segregation. We appreciate the many statements Mr. Raemisch has made publicly about Colorados overuse of administrative segregation and the dire effects on mental health that prolonged isolation can have on prisoners. We also appreciate our discussion to date regarding legislation to codify CDOCs current policy barring seriously mentally ill prisoners from placement in administrative segregation. Still, we are concerned you may not fully appreciate that, despite CDOCs recent policy shift, some seriously mentally ill CDOC prisoners continue to languish and mentally deteriorate in prolonged isolation, even while housed in the RTP. Through dozens of records requests and recent visits with several CDOC prisoners in the RTP, the ACLU has learned that some seriously mentally ill prisoners continue to be held in conditions that are virtually identical to administrative segregation. As you may know, prisoners at levels 1-3 of the RTP are held in isolation for 22-plus hours per day. These prisoners have very limited privileges, take their meals in their cell, only leave their cell in shackles for solitary exercise and shower time and occasional group therapy, and by and large are denied

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meaningful human contact. CDOC has previously pledged to the ACLU that prisoners will be held in these low levels of the RTP only for short periods of time and that prisoners would not be retained in the low levels for misbehavior stemming from mental illness. Yet, Sam Mandez a prisoner whos plight the ACLU has gone to lengths to highlight in a film - 1 which you, Mr. Raemisch, to your great credit, watched, shared with CDOC staff and encouraged legislators to watch continues to deteriorate in prolonged isolation within the RTP. As you may recall, Sam was placed in administrative segregation when he was nineteen years old for minor prison rule infractions. He then spent the next 15 years in administrative segregation, and in his profound isolation, became seriously mentally ill. Sam began hearing voices in his head telling him to harm himself and, as a result, Sam repeatedly did harm himself and attempt suicide. While Sam has never seriously harmed another inmate or staff member in prison, he was never able to meet CDOCs behavioral expectations to work his way out of administrative segregation. It was not until the ACLU became involved in Sams case that in November 2012, CDOC finally transferred Sam out of administrative segregation and into the new RTP. In the fourteen months since Sam was transferred to the RTP, he has spent all but two months in conditions almost identical to administrative segregation. He is stuck in the lowest levels of the RTP, relegated to spending virtually his entire day inside his cell alone with his thoughts, and he is deteriorating in this isolation. CDOC refuses to promote Sam to higher levels of the RTP because of relatively minor prison rule infractions that appear closely related to Sams mental illness, such as engaging in self-harming behavior. Records produced by CDOC regarding Sam reflect that for the vast majority of his days in the RTP, Sam has left his cell only a few times a week to exercise and once a week to shower. The centerpiece of RTPs therapeutic intervention for Sam appears to be group therapy, which he is offered 0-3 times per week, and which centers on a non-individualized workbook-based curriculum. Notably, during his first twelve months in the RTP, Sam never refused individual therapy and refused group therapy only twice; yet, during that same time period, CDOC cancelled Sams scheduled therapy 31 times, which means one in every four scheduled therapy session was cancelled. Of perhaps greater concern, while in isolation at the RTP, Sam receives negligible oneon-one contact with mental health professionals. During his first nine months in the RTP, Sam spent an average of seven minutes every week meeting one-on-one with a mental health professional. It was surprising to us to learn that the longer Sam has been in the RTP program, the less time he has spent meeting individually with a mental health professional. Recent data provided by CDOC shows that from May 28, 2013, through December 31, 2013, Sam spent an average of four minutes each week meeting one-on-one with a mental health professional. Many weeks and months Sam had absolutely no individual mental health contacts. In Spring of 2013, for instance, Sam went 114 days without an individual mental health contact. Sam reports that he cannot recall the last time he met alone with a mental health professional. Sam became seriously mentally ill in the solitary conditions of administrative segregation, so it should come as no surprise that Sam continues to deteriorate mentally in the solitary conditions of the RTP. Recently, we received a deeply disturbing report about Sam by forensic psychiatrist Dr. Jeffrey Metzner, who has worked extensively with CDOC in the recent
The film, OUT OF SIGHT, OUT OF MIND THE STORY OF SAM MANDEZ, can be viewed here: http://vimeo.com/78840078.
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past. We have attached the report, which was prepared at the request of Sams defense counsel, for your review. It confirms what the ACLU has long understood to be true that Sam is receiving grossly inadequate out-of-cell time, and that the dearth of individual therapy CDOC provides to Sam is particularly egregious. Dr. Metzner opines that Sams treatment in an RTP setting has failed, and that Sam must now be transferred to a mental hospital for intensive treatment and increased out-of-cell time. Dr. Metzner confirms that the negative behaviors which hold Sam in the low levels of the RTP are certainly associated with both his serious mental illness and personality disorder. 2 Most importantly, Dr. Metzner reiterates that Sams mental illness is exacerbated by CDOC continuing to house him in isolation and that if he remains in this setting, it is likely Sam will experience continued deterioration. We wish we could tell you that Sams treatment in the RTP program is uniquely deficient, but through our investigation, we are learning that other prisoners in the RTP are also stuck in prolonged isolation and receiving plainly inadequate mental health care. Numerous RTP prisoners report spending the vast majority of their day in their cell and leave the cell only to engage in group sessions during which they must follow a non-individualized workbook-based curriculum. Further, most of these prisoners report that they are receiving no individual mental health contacts and, thus far, CDOCs response to our records request has borne this out. We have recently received complete records for a prisoner other than Sam Mandez who has been in the RTP for approximately one year. During that time, he has spent an average of four minutes a week meeting one-on-one with a mental health professional. As you must know, RTP cannot be successful with the therapeutic model described herein. CDOCs experiences with the Offenders with Mental Illness program and both of your own statements reflect the professional consensus that seriously mentally ill prisoners will not get better, and are likely to deteriorate, in isolation. Further, a strong therapeutic relationship between a patient and mental health care provider, which can be established only through consistent one-on-one contacts is the centerpiece of meaningful therapeutic intervention. RTP simply cannot be successful without ensuring prisoners have regular individual mental health contact with a consistent mental health professional. Finally, it is clear to the ACLU that CDOC has far too few staff in the RTP to provide intensive mental health treatment to the approximately 240 prisoners slated to be in the program. Recent data from CDOC reflects that approximately 1 in 4 RTP groups are cancelled, and the number one reason for those cancellations is staffing shortage. It stands to reason that if CDOC does not have sufficient staff to hold its scheduled groups, it cannot devote the much greater staff time required to provide frequent individual mental health contacts with RTP residents.

Of course, prisoners who act out because of their mental illness should not be penalized for their misbehavior by assignment to isolated confinement the very condition of confinement that exacerbates mental illness. We have understood that this vicious cycle in which a prisoners mental illness is exacerbated by isolation, causing the prisoner to act out, and then guaranteeing that prisoner remain in isolation is what CDOC sought to end by establishing the RTP program as an alternative to administrative segregation for seriously mentally ill prisoners. Yet, just as Sam Mandez was stuck in administrative segregation due to a series of relatively minor prison rule violations related to his mental illness, he now appears stuck in isolated confinement in the low levels of the RTP for a series of relatively minor prison rule violations related to his mental illness. We have been told by CDOC repeatedly that prisoner misbehavior stemming from mental illness would be handled clinically whenever possible, but that does not seem to be the case for Sam.

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We hope this letter has given you some insight into the distance that remains to be traveled to provide CDOCs seriously mentally ill prisoners with adequate mental health care in a setting that does not isolate prisoners. We look forward to our continued collaboration on this matter. Sincerely,

Rebecca T. Wallace Staff Attorney, ACLU OF COLORADO cc. encl.

Mark Silverstein Legal Director, ACLU of Colorado

Senator Jessie Ulibarri - senator.ulibarri@gmail.com Dr. Jeffrey Metzners Supplemental Report regarding Samuel Mandez

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