N.H. Prison Chief: Sending Violent Patients to Secure Psych Unit Rare But Necessary

Jun 12, 2018

Helen Hanks, commissioner of the New Hampshire Department of Corrections, joined The Exchange on June 11, 2018 to discuss correctional issues.
Credit Dan Tuohy / NHPR

New Hampshire Department of Corrections Commissioner Helen Hanks says only patients whose mental illness drives them to extreme violence end up in the state prison’s secure psychiatric unit, and it’s a small group -- on average occupying about 10 of the unit’s 66 beds every year.  

Hanks joined The Exchange to discuss correctional issues, including the women’s new prison, and a decline in incarceration rates in New Hampshire, which she attributes in part to drug courts and mental health courts that provide alternatives to incarceration.  

(See highlights  of the full interview below. Responses have been edited slightly for length and clarity).

The practice of transferring certain patients from the state psychiatric hospital to the secure psychiatric unit at the state prison has drawn criticism for years, and, more recently, has been challenged in court.   These patients are deemed violent but have not been charged with a crime. Although the state defends the practice, critics say it criminalizes mental health patients. 

Hanks says these patients are a threat to themselves and to hospital staff, some of whom have been injured on the job in such circumstances. 

“When individuals exceed the capacity of New Hampshire Hospital, which means they’ve engaged in significant violent behavior either to themselves or attacked somebody within the hospital, they request a transfer,” she said. “Our job at the secure psychiatric unit is just that: to create a secure and safe environment for people who, if we didn’t have the secure psychiatric unit, would likely be charged with a crime.”

Hanks also said about 90 percent of these patients have a criminal history,  and the behavior that caused the transfer is often criminal in nature. "That doesn't mean I think that they're criminals. But it does mean that their mental illness drives such violent behavior that we need to be responsive to that need."

Hanks said a different program of care for these patients would require building a new facility, and that's a decision for the legislature.

“I don’t want people to be naïve to the behaviors and levels of violence associated with that mental illness [that results in people being admitted to the secure psychiatric unit],” she said. “It doesn’t make them a bad person. It means their mental illness changes them in a way that people aren’t used to seeing. And because of that, it doesn't matter which setting we put them in; it has to be safe for the patient and safe for the community." 


Why did the new women's prison take so long to get up and running? 

I think there is a misunderstanding on the length of time it took to get open. It was the construction faze that took us a little longer. We quickly learned that the money allocated did not meet the needs of creating a parity design facility. So it took a lot more work to both understand what that additional cost was going to be and also work on getting a facility that would meet the needs of the women who are incarcerated in New Hampshire.

Hanks said that, once construction did begin, things went relatively smoothly, and that inmates were able to move in in April of this year. The new facility is approximately three times the size of the previous women’s prison in Goffstown and will provide additional services, treatment and security.

"We’ll have some really exciting things coming in the next twelve months,” she said, noting several new staff positions that will be funded as of July 1. The additional positions will include nursing and therapy staff.

Some in the inmate advocate community criticized the plan, calling it a 19th century model of incarceration, rather than a more innovative community-based approach involving half-way houses.

So we actually thought about the design quite significantly and it might be a big blocky building on the outside, but we thought about the literal path of sunlight that comes in, so it's a bright, healthy space. The women that are in our institutions have a lot of trauma history in their background -- physical, sexual, emotional trauma. And we needed to create an environment that helped them feel safe to tackle those issues.

Recruiting and retaining staff has been a big problem. What has the DOC done to address that? 

Hanks said that the Department of Corrections faces the same challenges that many employers do when unemployment is low, namely that there are fewer prospective employees looking for jobs and attracting them can be tougher.   Also, the job itself if tough. 

“Working in our environments can be stressful,” she said. “We lose about 50 percent of new people in the first year.”

In the interest of retaining employees, Hanks said, the Doc is making an effort to recognize positive behavior in staff members, use performance evaluations more frequently and thoroughly, and offer more financial incentives.

A major issue has been pay. 

“Luckily, the union and the governor came to an agreement, and we’re going to see a 9.1 percent pay increase for our security staff,” Hanks said.

This pay increase, according to Hanks, will put the DOC in a position to complete with law enforcement jobs across the state and similar corrections jobs in nearby areas such as Massachusetts.

How do you address complaints about restrictions on family visits -- a practice meant to keep drugs from entering the prison but that some find overly restrictive?

Before we started making changes in visiting, 26 percent of urine we took was positive. When we started making these changes, we saw a dramatic drop and now that's down to about 8 percent. So, changing our visiting room practices, adding our canine investigative teams, changing our mail practices, have caused a reduction in the introduction of contraband.   

My husband is on his 13th year of what is the equivalent to a life sentence, serving in Concord. We have lamented last year’s loss of visiting room privileges --kissing, food and beverage, games. Though I understand the need to safeguard against introduction of contraband, I also understand that the focus has not been on those who are proven drug users on the inside. For those inmates who have behaved perfectly and never failed a drug test, these policy changes seem overreaching. For inmates respectfully trying to do the right thing, and actively rehabilitate, this is defeating, not encouraging.  – Lisa, from Bennington.


But, Hanks said, it’s now the right time to pay attention to the needs of inmates who haven't been taking advantage of visiting hours to abuse drugs.   


What’s behind the drop in incarceration rates in New Hampshire?

Our population had been dropping, and it dropped nearly 5 percent over the last five years. We can attribute that drop actually to a reduction in new admissions for crimes and also a reduction in probation violations. And so over the last two years we have made some advances on diversion from incarceration. I think the implementation of drug courts  has made an impact.