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People Say They Languish in Texas Prisons’ ‘Mental Health’ Unit

“They were destroying me,” said one person placed in the Texas Department of Criminal Justice’s “Program for the Aggressive Mentally Ill Offender.”

A Texas Department of Criminal Justice office in Austin, Texas.
Larry D. Moore via Wikimedia Commons

In the nine months after Edee Davis arrived at the Texas Department of Criminal Justice’s William P. Clements Unit near Amarillo, Texas for mental health treatment, she says she only attended three peer-group sessions facilitated by a counselor.

But, in grievance forms obtained by The Appeal, Davis says mental health staff lied and said she’d attended more.

Davis was supposed to be receiving acute mental health care under a voluntary TDCJ program called the “Program for the Aggressive Mentally Ill Offender” or PAMIO. The program is part of the TDCJ’s broader system of managed care, through which the prison agency partners with Texas universities to provide detainees with health care.

In a grievance form filed in March 2022, and reviewed by The Appeal, Davis accused a counselor of falsifying her participation in counseling sessions.

“My mental health files in medical (I recently reviewed) are full of false reports on me and my attendance in groups I have never been to,” Davis wrote in an April letter to The Appeal. “There is no mental health treatment here.”

“The PAMIO program has received national recognition for the innovative approaches to these challenging patients,” a December 2019 Fact Book from the Texas Tech University Health Sciences Center says, in a section touting the university’s care for incarcerated people. A TDCJ policy document outlining the scope of the program says the purpose of the program is to “provide a structured cognitive-behavioral program for aggressive mentally ill inmates in Restrictive Housing (Administrative Segregation) and G5 custody in order to achieve a less restrictive housing assignment.”

The document describes PAMIO as a program offered to prisoners with “history of aggressive and/or disruptive behavior.” The program is designed to provide an environment for mental health care, including group therapy, to some of the offenders that TDCJ has deemed most “aggressive.” After completing the program, those detained in PAMIO are supposed to be evaluated for a less restrictive housing assignment.

But according to letters sent by prisoners over four months, the conditions seemed to be the exact opposite of the helpful, rehabilitative area TDCJ claims to provide. Prisoners, their family members, and former staff members described the PAMIO program as a shadowy purgatory, where those detained sit in their cells for days and weeks on end without treatment, showers, or recreation time.

A TDCJ spokesperson wrote in an email that in April 2022, the program time was cut from 18 months to one year. But actual completion of PAMIO can take much longer than the previously scheduled 1.5 years if those incarcerated suffer setbacks to their treatment. Phone access is scant, leaving the incarcerated even more cut off from possible connections to the outside world. Even once they opt out of the program, they may sit in their solitary cells for months, awaiting transfer to other facilities.

“You have to take a bath in the sink with a rag and a cup. And they bring your meals to the cell and they open this little slot in the door,” Davis told The Appeal. “I’m in my 60s, they were destroying me. Since I’ve been out my health is starting to improve,” she added.

Tens of thousands of people are held in solitary confinement each day in U.S. prisons, and on any particular day, between 55,000 and 62,500 people have spent more than two weeks in isolation, according to a 2020 report. Research has found that people placed in solitary confinement suffer myriad health consequences and, according to one study, are even 24 percent more likely to die in their first year after release from prison. A disproportionate number of people who spend time in solitary have a serious mental illness.

The PAMIO program, which a TDCJ spokesperson said currently has 33 medical staff and a capacity to treat 246 people, is just one of many of the programs across the country that gets tax dollars to assist those with mental illness yet, according to those enrolled, it exacerbates their conditions. Across the country, these programs often resemble unregulated limbos, shielded from oversight, where incarcerated people with mental illness suffer continued abuse.

Of the 10 lawmakers contacted by The Appeal for this story, none agreed to an interview. The chief of staff of one member of the House Corrections Committee did not even know what the PAMIO program was.

Craig Haney, a psychology professor at the University of California Santa Cruz, told The Appeal that programs like PAMIO, which isolate prisoners, are more likely to aggravate mental illness. When the program was described to him, he noted that “prisons, in general, are perhaps the worst place on earth to try to provide effective mental health care.”

“Nobody’s innately violent,” he added. “People are violent for reasons and they’re not uniformly or constantly violent. They react to certain kinds of settings and situations and provocations. And when they’re mentally ill, oftentimes those reactions are directly tied to their mental illness, that makes them more challenging, but it doesn’t mean you lock them up in a cell and leave them there.”

During the more than 1.5 years that Taylor Goldston worked in the PAMIO program, she tried to ameliorate the monotony that the incarcerated people experienced. Goldston, a former mental health clinician medical worker who worked in the PAMIO program from August 2019 to May 2021, told The Appeal that she would bring incarcerated people pencils, and books even though her supervisor said doing so was prohibited.

Goldston and another former medical provider, who asked to remain anonymous due to fear of retaliation, confirmed that prisoners can go weeks without showers or recreation time.

Goldston told The Appeal that any behavioral slip-up could impact a prisoners’ progression through the program and that some corrections officers looked for reasons to demote incarcerated people.

Kenzie Haywood volunteered to enter the program, rather than be housed in “administrative segregation” in another unit. Haywood wrote to The Appeal that psychology departments in other TDCJ facilities advertise PAMIO as a more permissive environment in which to receive treatment than that offered in other facilities.

“The reason why PAMIO attracts offenders to it is due to the activities that are ‘supposed’ to take place once you are accepted,” Haywood wrote. He thought he would be receiving regular individual and group counseling sessions, arts and crafts, and group recreation.

When he arrived, he found a vastly different situation.

“Some of the cells that offenders are assigned to are plastered with feces, blood, urine, semen, food and all types of other unidentifiable gunk,” Haywood wrote in a letter to The Appeal.

Some in the program alleged that even their basic medical needs were not being met.

“I have rashes and sores all over my body from not being able to shower/bathe properly,” Edee Davis wrote, adding that she lost 35 pounds between June 2021, when she entered the program, and March 2022. Davis, who identifies as transgender, said she received no access to LGBTQ mental-health treatment.

Attempts to file grievances are often unsuccessful according to Davis and Marco Lee, an imprisoned person who is enrolled in a different mental health program held in the Clements Unit.

“Numerous inmates have exhausted their administrative review and directly contacted outside agencies,” Lee wrote in a June letter to The Appeal.

“In addition to the grievance process, inmates are able to submit inquiries to the Office of the Independent Ombudsman,” a TDCJ spokesperson wrote in an email.

When the pandemic hit, group counseling sessions were replaced by time in individual cells and worksheets. Healthcare providers then had to visit each prisoner’s cell and walk each person through the lesson, a time-consuming process that added further strain to the medical staff.

“It’s not very efficient,” the former medical provider who requested anonymity for fear of retaliation said.

That medical worker and another who worked in Clements, but not in PAMIO, and also requested anonymity, said when they requested more resources, they received directives to increase productivity. A spokesperson for Texas Tech University Health Sciences Center wrote in an email to The Appeal that PAMIO did not have a required staff-to-program participant ratio.

TDCJ has long faced staffing shortages that have plagued operations; as far back as 2005, the staff turnover rate was above 20 percent. Corrections officers had a turnover rate of 40.3 percent – representing a nearly 7 percent increase from 2020 to 2021, according to a study released in March by the state auditor’s office.

Even before the pandemic hit, staff shortages impeded the medical workers’ ability to provide the level of services advertised by the program. The pandemic further exacerbated such issues, TDCJ has previously said to other media outlets.

A study released in February from the University of Texas at Austin’s Prison and Jail Innovation Lab found that as of January 2022, Texas prison staff had the highest rate of deaths from COVID among prison systems in the U.S., and Texas prison staff had the 2nd highest number of COVID infections in the country.

In September, TDCJ increased the pay of corrections officers at maximum security units, including Clements, by 3 percent. Hoping to reduce CO vacancies, the agency raised the salaries for them as well as food service workers and laundry managers at all TDCJ facilities by 15 percent in April. Under the updated pay scale, the newest COs will earn an annual salary of $41,674.

TDCJ declined records requests The Appeal filed related to staffing numbers in the PAMIO program. The agency claimed the information was confidential due to a state statute barring disclosure of information “collected, assembled, or maintained by or for a governmental entity for the purpose of preventing, detecting, or investigating an act of terrorism or related criminal activity.”

Alycia Welch, the Associate Director of the Prison and Jail Innovation Lab at the University of Texas at Austin, told The Appeal that the conditions of the job, combined with a stressful environment, make staff retention difficult.

“Working at a fast food chain, for instance, may pay very similarly to a frontline corrections officer position,” Welch said. But prisons are crowded and hard places to work and staff are working with people who are “potentially not receiving the services and resources that they need. And so, you know, conditions where people are getting aggressive, and you’re having to sort of argue with people. I mean, that’s tough conditions to be working in.”

The former PAMIO worker said that the approaches of both TDCJ and medical supervisors exacerbated the difficult work environment.

“The problem here is very complicated,” the medical worker wrote in a text. “Between the triangle of the inmates, TDCJ, and Tech, there isn’t solely one to blame. All three contribute to varying degrees. The reality is the population comes with significant challenges to work with, which seems to be a factor in staffing issues.”

“[Assaults on] staff members and other inmates still happen,” the worker continued. “Not to mention the sexual harassment/violating acts toward other staff members. Some do not take any accountability for their actions, which is a main reason why they are incarcerated.”

But the complaints vocalized by the prisoners and their families cannot be explained by being short-staffed alone.

Haywood alleged that corrections officers would concoct “bogus” offender reports if they heard a prisoner complaining. Davis alleged that those who wrote to The Appeal were punished.

Goldston said that after a prisoner attempted suicide during her time at the program, a superior quipped to the man that maybe he would “get it right next time.” (A spokesperson for Texas Tech University Health Sciences Center wrote in an email that “we are unaware of any such occurrence.”)

The other medical provider who spoke to The Appeal for this article confirmed hearing about the incident but didn’t feel that remark is emblematic of the program’s current culture.

A TDCJ spokesperson wrote in an email to The Appeal that PAMIO is volunteer based and participants can opt out. But those who finish the program or attempt to opt out may face lengthy waits before receiving a transfer. A spokesperson for Texas Tech University Health Sciences Center wrote in an email that “if an inmate desires to be released from the program, TDCJ is notified. TDCJ is then responsible to transfer the inmate to another facility.”

In September 2021, Savannah Eldrige emailed Carrie Culpepper, the Chief Nursing and Quality Officer for TTUHSC. Eldrige, who is a nurse and member of the Texas Center for Justice and Equity’s Statewide Leadership Council, asked why her stepson, Ernest, was still being held in the housing unit designated for PAMIO while not receiving care.

“[He’s] saying that the conditions and environment in building 12 are making it hard for him to cope due to the consistent disruptive behavior, mistreatment and tossing of feces by some of the more severe patients,” Eldrige wrote in the email, which was viewed by The Appeal. In May, Eldrige sent another email, stating that she had not yet received a response to her inquiry.

Eldrige, an advocate who communicates with a number of incarcerated people, said that TDCJ regularly stymies her attempts to learn more about the incarceration programs, and she’s often forced to file records requests.

“I just feel like there should be more transparency and working with family members who are trying to help their loved ones who I always say are the first responders in this fight,” she said. “Because many people come out to the family, we need to know how to help them. And we can’t if we don’t know what’s going on,” Eldrige told The Appeal.

Around the time Eldrige sent her follow-up email, guards also abruptly told Ernest he would be transferred. Eldrige said the men were prevented from bringing personal items, such as legal documents and hygiene items, to their new units.

This lack of transparency links to a broader oversight problem related to how the program is managed, Welch said.

“We don’t have any correction oversight here in Texas, and so there’s no external body who’s looking at these types of programs,” Welch said, naming PAMIO. “There’s no external body asking, ‘What are they doing,’ ‘What data is coming out from them,’ ‘What are the outcomes that we’re seeing,’ which really keeps the public in the dark about what’s going on inside of these facilities.”