Balancing Budgets on the Mentally Ill

Budget cuts and care for the mentally ill come face to face in Ohio, where AFSCME's largest affiliate — OCSEA — is fighting back.

By Clyde Weiss

Lima, Ohio

With its barbed-wire fences and guard towers, Oakwood Correctional Facility resembles any of Ohio's 32 other prisons, but it's not. Within its walls, the 122 inmates appear indistinguishable from the 44,700 other prisoners incarcerated throughout the state system. But they're not.

Oakwood is one of only 13 state prisons nationwide that incarcerate and care primarily for mentally ill criminals. At this northwest Ohio institution, 88 psychiatric attendants, called "PAs," help the prison's four psychologists and psychology assistants care for the inmates, while 104 corrections officers (COs) and other security staff maintain order. Ohio Civil Service Employees Association (OCSEA)/AFSCME Local 11 represents both categories of workers.

This is no ordinary penitentiary. PA Clayton Ingram, who has been here nearly 19 years, puts it this way: "The inmates know they're in prison, but they look at it like a hospital."

Under the ax

Throughout the country, prisons are falling under the budget ax as state lawmakers choose to cut essential services rather than increase revenue or tap "rainy day" reserves. Ohio is a prime example. Last year, when Gov. Bob Taft (R) issued an executive order cutting state spending by $233 million, the budget of the Department of Rehabilitation and Correction — where OCSEA represents nearly 12,000 employees — was slashed by $19 million.

At risk was the Orient Correctional Institution, which employed 433 AFSCME members. In an effort to prevent its closing, OCSEA lobbied legislative supporters — Democrats and moderate Republicans — arguing that a private prison should be closed instead. The effort failed, but with help from contractual provisions to aid displaced workers, 250 of the 350 Orient workers affected found jobs elsewhere in the prison system.

Meanwhile, here at Oakwood, Warden Christopher Yanai was assured that his facility would not suffer the same fate. However, a statewide hiring freeze prevented Oakwood from filling nine PA vacancies.

To prevent the closing of additional facilities, OCSEA is helping craft legislation that would develop new state revenue sources. Dave Sloan, a CO and a former PA at Oakwood, says further budget cuts threaten the safety — as well as the jobs — of the prison's remaining employees who are forced to do more with less. "It's reached a critical point where people's lives are in danger," says Sloan, who is OCSEA's statewide vice president.

Overtime burden

One consequence of a hiring freeze at Ohio's prisons is increased overtime. During the first three months of this year, COs earned $1.2 million in overtime — much of it mandatory — a 44-percent increase over the same period in 2001. Ten prison employees last year actually earned more than the department's director because of the extra work.

But overtime is a two-edged sword. As Sloan explains, "It's great because people like to see extra money in their pockets. But eventually, you want to spend some of that time home with your family. It's gotten to the point where these workers live in the prisons. As a result, they're not as attentive, not in as good a mood. They're edgy. It shows in their work, and it creates problems for them at home."

Ada Frazier, a PA in Oakwood's female unit, lives that reality. Employed here less than four years, she lacks the seniority to avoid mandatory overtime. With two young children at home, that's tough. "I don't see them very much because I'm always here," she laments. "I drop the kids at the babysitter at 6:30 a.m., come to work and stay until 9:30 p.m., then pick them up, go home, get a few hours of sleep and then come back here the next day. I don't get to spend much time with them."

Oakwood isn't the kind of place to be tired or preoccupied with thoughts of family. Danger is everywhere, attentiveness is critical. Although most of the prisoners are taking some kind of medication, such as anti-depressants, sedatives or anti-psychotic drugs, they can lash out unexpectedly. For example, an inmate recently punched a female PA in the face. "You have to be mentally alert in this environment, because the people you're dealing with are more unpredictable than a normal prisoner," says PA (and steward) William Lotz.

Vital care

Nationwide, according to the U.S. Department of Justice, 191,000 state-prison inmates, or about 16 percent of the states' total prison population, were considered mentally ill in midyear 2000. Yet less than 2 percent of them were housed in facilities, such as Oakwood, that provide 24-hour psychiatric care.

Such specialized care is vital, according to the Judge David L. Bazelon Center for Mental Health Law, a nonprofit legal-advocacy group in Washington, D.C. Mentally ill inmates in ordinary prisons, the organization says, "are shunned by their peers, serve longer sentences, and are more likely to fight and have discipline problems."

"These people need this place," maintains Oakwood PA Roger Jones. "The inmates say that if they had to go back to a regular institution, they wouldn't be able to make it."

The average stay at Oakwood is just over 100 days. Says Warden Yanai, "Our goal here is to provide intensive psychiatric treatment so they can be returned to their parent institutions — and hopefully adjust to that environment and take advantage of the rehabilitation programs that are offered there."

Each PA has received five weeks of specialized training, plus three weeks of general instruction, to deal with mentally ill inmates. "PAs are unique," Yanai says. "Each housing unit has a corrections officer, but the primary supervision, management and daily care is directed by the psychiatric attendants."

Close call

In Dayton, 74 miles south of Lima, a different institution for the mentally ill continues to experience its own budget crisis. Twin Valley Behavioral Healthcare, a regional state psychiatric hospital, survived the budget ax when Governor Taft signed legislation last December that spared the Department of Mental Health from a proposed $30 million cut, and restored $23 million that was cut earlier.

In a state that has seen its mental hospitals shrink from 17 in the late 1980s to nine today, the threat of further consolidation seemed unlikely. Nevertheless, confronted with a shortfall in its $160-million hospital budget for fiscal 2003, the department was forced to consider closing three to four more. Twin Valley, which employs about 250 at its Dayton campus — including 163 OCSEA members — was among the targets.

At that point, department officials turned to OCSEA to help rally the Dayton community — and others throughout the state — to support the mental health facilities. OCSEA, representing many of the workers at those facilities, readily agreed and employed a variety of measures to mount a counterattack. Union members and staff attended town hall meetings across the state making forceful statements and generating positive press coverage and joined with the National Alliance of the Mentally Ill/Ohio to coordinate efforts to save the facilities.

In October, for example, at a crowded meeting in a gymnasium across from Twin Valley, OCSEA joined law-enforcement officials, mental health advocates, Oakwood employees and Dayton residents in helping to create the political pressure needed to save the hospital. "After that, it was clear to the state mental-health director that the impact of closure would be pretty bad on the community," recalls Cathy Graves, an activity therapist at the hospital, as well as vice president and chief steward of OCSEA Chapter 5710.

The governor also was convinced that "this is an essential human service the state has an obligation to provide," says department spokesman Sam Hibbs. As a result, Twin Valley's 100 residents were not dispersed to other, more distant institutions. Still, a hiring freeze was imposed, and a unit that housed about 60 maximum-security patients — open since 1980 — closed last July because of budget cuts. Fifty OCSEA members there were laid off.

That empty unit now stands as a constant reminder of growing budget pressures that may yet claim a state psychiatric hospital, like Twin Valley, or another prison, such as Oakwood Correctional Facility. If that happens, society in general — as well as those institutions' inmates and patients — will suffer.