Prison Mental Health Orig_00012103.jpg
A fresh approach to mental health in prison
02:33 - Source: CNN

Story highlights

Pennsylvania prisons trained staff and inmates in Mental Health First Aid

"I felt that I could help myself and help others," one inmate counselor said

Bellefonte, Pennsylvania CNN  — 

The man was about to snap. He had just lost a child.

“I couldn’t really relate to that,” Peter Robinson said of his fellow inmate. “I know what loss feels like, though.”

Like the other prisoner, Robinson struggles with mental illness; he has bipolar disorder and depression. The men talked for a long time. They came to focus on the message of the Serenity Prayer: God grant me the serenity to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference.

“The things I can’t, you’ve just got to let it go,” Robinson recalled.

The two remain friends now at State Correctional Institution-Benner Township, a medium-security men’s prison with about 2,000 inmates. The concrete collection of buildings stands starkly against the rolling green farmlands of central Pennsylvania.

That moment, when Robinson talked his friend through a mental health crisis, “it’s something I’m proud of,” he said.

It’s part of Pennsylvania’s innovative new approach to mental health care in prisons. Inmates and staff alike train to reach a mutual understanding about how to deal with the myriad issues surrounding mental health.

It’s an approach born from necessity, after a scathing government investigation into the state’s prison practices.

‘A huge amount of scrutiny’

The investigation began after a lawsuit was filed by the Disability Rights Network against the Pennsylvania Department of Corrections. The Department of Justice launched it in May 2013 in one prison and then expanded it to the entire Pennsylvania prison system. It focused on the treatment of inmates with mental illness and the use of solitary confinement.

“It put our system under a huge amount of scrutiny,” Pennsylvania Department of Corrections Secretary John Wetzel said.

According to Wetzel, about a quarter of the inmates in the Pennsylvania corrections system struggle with some kind mental illness. Nationally, more than half of inmates suffer from some kind of mental illness, according to 2006 Bureau of Justice statistics (PDF), the most recent available.

Before the investigation, individuals with mental illness could be sent into solitary confinement. Over the course of a year, more than 1,000 mentally ill inmates were held in solitary confinement for more than 90 days, according to the Department of Justice’s initial letter to the Department of Corrections.

That practice resulted in “serious harm” to inmates. That year, 206 of 288 documented suicide attempts took place in the isolation units.

The investigation, which was closed in April, resulted in an overhaul of the department’s approach to mental health care.

“The improvements we have seen since our February 2014 findings, together with [the department of corrections’] commitment to sustainable reform, give us confidence that the same pattern of practice of violations we found early in our investigation does not exist today,” the final report read.

Inmates with mental illness are no longer held in solitary confinement. Additionally, all staff members – 15,000 to 16,000 people, according to Wetzel – are trained in Mental Health First Aid. The full staff was trained in just a year, according to Wetzel.

The program, which started in Australia, has expanded into the United States. Some law enforcement agencies, like the Albuquerque Police Department, are implementing the training with their staff members. According to the organization, Pennsylvania is one of a few state-wide prison systems to use this program so broadly.

It’s an eight-hour course often compared to CPR training or basic first aid training. Trainees learn how to identify warning signs of a suicide attempt, for example, and how to intervene when someone is experiencing delusions. They are also educated on the various symptoms of different mental illnesses.

But staff aren’t the only individuals with access to the training: Inmates themselves can participate in the training to become peer-to-peer counselors for others behind bars.

Helping themselves and others

For a long time, Anthony Formisano turned to drugs as a way to connect with others and to self-medicate. He’d been in and out of prison, and he struggles with depression.

“It took away a lot of void,” he said. “I believed I had more friends that way, and I wasn’t as depressed, so I thought. But as I came down from the drugs I was using, I’d be more depressed in the end.”

Behind bars, he got involved in another program that counsels other inmates struggling with substance abuse. One day, a brochure for the mental health peer-to-peer counseling team caught his eye.

“I wanted to get involved in more programs, learn more about my depression, other things people were struggling with,” he said.

“As much as I was helping the people over there with their drug addiction and other issues they had, I felt that I could help myself and help others with other things.”

Inmates are trained for 75 hours, which includes the Mental Health First Aid training. They emerge from the training as certified peer specialists, a paying job in the prison. It’s also a real-world accreditation that can lead to jobs.

“Just right here at this prison, we recently released five peer-to-peer specialists. Three of them are now working as peer specialists in the community,” Wetzel said.

‘I’m just doing my job’

A map of the H Unit lights up a computer screen in front of Brian George, one of the corrections officers. It’s his responsibility to make sure all 41 inmates who reside here are accounted for at all times.

There are the heavy, sliding cell doors you might expect in a prison, but you may not expect the under-the-sea mural on the wall or the cheery coloring pages that dot the tables in the common space.

This is where many of SCI Benner’s most seriously mentally ill inmates live. Schizophrenia, bipolar disorder, major depressive disorder, delusions and myriad other issues manifest in the inmates here, according to the unit’s manager.

“In the past, you just had a problematic inmate and you really didn’t know, and you didn’t know what staff to contact,” George said.

After the mental health training George received, he feels more capable of handling challenging situations with mentally ill inmates. Now, he engages directly with inmates to learn what their problems might be when they’re acting out or upset.

“Certain inmates talk about, thinking about suicide, suicidal thoughts,” George said. “I like to pull them out. That way, I have a constant observation and speak to them.

“I’m not a healer, by no means. I’m just doing my job.”

The inmates notice a difference, too.

Some of the corrections officers took a while to adjust to the new approach to mental health, but there is a new level of respect among all, said James Weitzel, an inmate in the peer-to-peer counseling program.

“A lot of the [corrections officers] here, they really are buying into this,” said Weitzel, who is nearing the end of his 12½-year sentence for bank robbery. “Some are being drug in kicking and screaming, but they’re really giving it the effort. When I see someone trying to help somebody, I can appreciate it.”

Rather than becoming nemeses, it seems the inmates and corrections officers at SCI Benner are coming to a new level of mutual understanding.

“They didn’t put me here, bottom line,” Weitzel said. “They didn’t put me here, and they’re human beings just trying to feed their families, and they chose a career, and this is it.”

Beyond the prison walls

When peer-to-peer counselor Al Sherik Moate leaves prison, he wants to return to culinary school.

Follow CNN Health on Facebook and Twitter

  • See the latest news and share your comments with CNN Health on Facebook and Twitter.

    “I just finished my cookbook,” he said. “I want to try different things. I want something better now for me and my family. For them to be happy, I’ve got to be happy myself.”

    Moate says that before his training, he couldn’t talk to anyone. But he’s come out of his shell now.

    “This is about bettering the self,” he said. “I lost so many opportunities and doors closed behind me because this wasn’t my lifestyle.

    “I know now how to reopen it and make myself better now.”

    Data don’t yet to track the program’s progress, but Wetzel is optimistic about the results.

    “You have an individual who comes to a prison mentally ill, not only gets in recovery but learns to help others and then gets out and helps others,” he said. “That’s great stuff.”

    Video by CNN’s Brian Vitagliano, Bryce Urbany and Sarah Jorgensen.