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For the one in nine who is severely ill, prison can lead to violence, abuse and even death, experts say.
By ADAM C. SMITH
© St. Petersburg Times, published September 28, 1999
Donald Brenner, who sometimes saw little green men and often heard laughter in his head, spent the last days of his life bloodied and bruised from repeated fights with prison officers forcing him into shackles, leather restraints and handcuffs.
Sentenced to 13 months for assaulting a Florida corrections officer -- the guard was really a PLO agent, Brenner told a psychologist -- the burly paranoid schizophrenic spent his last night alive strapped naked to a bed for 14 hours. Officers escorted him on Sept. 24, 1998, to the infirmary at Union Correctional Institution with blood from a head wound streaming over his face and chest.
Less than two hours later, the 34-year-old Brenner was dead.
"Prolonged physical exertion" caused his heart to fail, the medical examiner concluded.
The Brenner case highlights the growing problem prisons face in dealing with severely mentally ill inmates. At least one in nine state prisoners in Florida suffers from severe mental illness, often making them unable or unwilling to cooperate with even the most routine orders. The situation, say mental health experts, is a recipe for violent confrontations.
The medical examiner chalked up Brenner's death to natural causes. But his family sees nothing natural about it; they think officers killed him.
They have autopsy photos showing his body dotted with injuries, his wrists and ankles deeply bruised and cut from cuffs and shackles. For nearly a year, they struggled to get records from prison administrators explaining precisely what happened.
"I just don't understand it," said Martha Gillespie, Brenner's mother in Tennessee. "He was handcuffed and had those things on his ankles -- shackles -- so I don't see how he could have been such a threat to be beat up like that. It was such a horrible way to die. Don was not a criminal. He was mentally ill."
John Burke, chief administrator of the prison health care system, said he reviewed Brenner's records and saw no evidence of anything but appropriate medical care.
"The question in my mind is whether this guy should have been put in prison in the first place," Burke said. "Once these guys are put in prison they've got to function in a structured environment -- a very structured environment -- and some of them can't. But that's not a correctional officer's fault."
The struggle to provide mental health care in a prison environment is not unique to Florida. With a shortage of state mental hospital beds, halfway houses and community treatment facilities, prisons and jails have become the nation's new mental hospitals, say mental health experts. Some 284,000 inmates -- 16 percent of the country's prison and jail population -- suffer from severe mental illness, according to a Justice Department study this year.
For some inmates, prison offers access to psychotropic drugs and treatment they wouldn't otherwise receive. For others, prison only intensifies their illnesses as they face officers ill-equipped to distinguish between mental problems and simple unruliness. The Justice Department found mentally ill inmates on average spend considerably longer behind bars, often because they are disciplined for behavior such as fights.
"A prison is absolutely the worst place for somebody with severe mental illness, and absolutely certain to exacerbate their symptoms," said Ron Honberg, legal director for the National Alliance for the Mentally Ill.
Inside prison walls, mental health staffers operate in an atmosphere where security is the top priority, and where guards and administrators often view mental health staff members as inmate coddlers who are too easily manipulated by prisoners.
Helen Cunningham, who quit in August as Baker Correctional Institution's senior psychologist, said she often had to wait days before corrections officers would bring in inmates requesting mental health care. If she wrote up reports on allegations that inmates had been abused, as she said she often did, guards would become even less cooperative.
"Mental health has to play ball with security," Cunningham said. "Often it's security who wants to make the call that inmates (feign mental health problems), so that it's okay not to provide treatment for them. There's an attitude that all inmates are (faking it)."
The Department of Corrections spends more than $46-million a year on mental health services, but those services are getting increasingly squeezed. The Corrections Department has cut at least 65 mental health positions in the last two years. With the mentally ill inmate population swelling and the costs of psychotropic and other drugs rising faster than the system's medical budget, prison administrators are trying to do more with less.
"It's being tightened down as tight as we can get it," said Burke, the prison's health services administrator. "(But) we think we're still providing care that meets the constitutional standard."
One of the most dramatic looming changes in mental health care involves closing the department's only mental health hospital facility, the Corrections Mental Health Institution in Chattahoochee. Within the next few weeks, more than 100 inpatient psychiatric inmates will be transferred to other facilities, most to Zephyrhills Correctional Institution, which currently houses no long-term psychiatric cases.
Burke maintains that Zephyrhills is better suited for such inmates, but some psychologists and prisoner advocates complain that the major shift in the department's mental health program has received little review.
"We still don't know at this point exactly how the inpatient acute psychiatric care is going to be provided if there is no CMHI," said Peter Sleasman, a legal aid lawyer in Gainesville. "This is a significant change, but it doesn't appear to be real well thought out from a legal or a treatment point of view. It appears to me more motivated by cutting costs."
Indeed, as the department struggles to trim its mental health costs, mental health professionals worry that prison administrators may be helping create even more volatile inmates who eventually wind up on the streets.
"As they cut mental health services, which is what they're doing, you are going to have more and more inmates who are unmanageable because of mental illness," said Connie Schenk, a former prison psychologist who quit in frustration last month. "The way Corrections deals with mentally ill inmates who can be problematic is just to put them into close management (confinement), where they don't get near the access to help that they used to."
The system's increasing reliance on confinement for difficult inmates has drawn a pending class action lawsuit, alleging among other things that mentally ill inmates are being deprived of necessary treatment.
Terry Kupers, a forensic psychologist from California, wrote a book on the devastating impact confinement can have on inmates. Left with little contact with others, prisoners often become psychotic and filled with rage, he said. Even outside confinement, the discipline problems of the mentally disturbed often get little sympathy from corrections officers.
"It becomes a vicious circle -- especially if the mentally ill inmate hurts an officer," Kupers said. "Rather than providing any therapeutic treatment, the guards can get more and more brutal, and then the inmate becomes even more violent and disruptive. It just escalates."
Donald Brenner, himself frequently in confinement, offers a case study.
Once a popular star athlete and solid A and B student, Brenner received a diagnosis of paranoid schizophrenia at age 17. When he stayed on his psychiatric medication, his brother and sister said, he was stable and charming. But periodically he would go off his medications, and problems arose
Late in 1993, Brenner was convicted of aggravated assault and battery after he slashed a Pensacola taxi driver who Brenner claimed was supposed to set him up with a prostitute. He spent less than a year behind bars, but three years later was sent back to Florida after violating probation with a drunken driving arrest in Alabama.
Family members kept receiving letters from Brenner about guards beating him at Apalachee Correctional Institution in the Panhandle. He complained about being unable to get his psychiatric drugs, though prison records say he often refused his medication.
"We'd call the prison to make sure he was getting his medication, and they'd just say, "Most of the people in here have problems and need medication, and we can't deal with every one of them,' " recalled Gerry Brenner, Donald's brother.
In January 1998, Brenner smacked an Apalachee corrections officer while waiting to be taken into the infirmary after a group of inmates had assaulted Brenner. He received another 13 months in prison.
Brenner's violent final days were spent at the North Florida Reception Center in Lake Butler. Records show that several inmates said they were concerned about Brenner's behavior and questioned whether he should be moved out of his general population wing.
On Sept. 22, officers said, the 235-pound Brenner refused to sit on his bunk for an inmate count. Brenner, reported Officer Daren Bivens, did not appear to understand what they were saying. His eyes were twitching and he seemed jumpy. Then, officers said, he punched a sergeant and had to be wrestled to the ground and handcuffed.
On the way to the infirmary to be checked for injuries, Brenner lunged into a window, breaking it and cutting his head, officers reported.
Two inmates gave a different account. They said they saw officers put Brenner face down on a sidewalk, kick him on his head and side, jump on his back and slam his head on the ground.
The officers denied it, and an investigator reported no physical evidence to back up the inmates' allegations.
Officers reported two more scuffles the next night when they moved Brenner to the "crisis stabilization unit" for psychiatric cases. Eight officers wrestled him into restraints, strapped him to a bed and cut off his clothes with scissors. A nurse injected him with Thorazine, and medical records indicate an "extremely agitated" Brenner remained strapped to a bed in leather restraints for the next 14 hours, though officers gave him a blanket after five hours.
On Sept. 24, officers moved Brenner from North Florida Reception Center to Union Correctional. Another struggle occurred as officers put Brenner in the transport van. He arrived at Union about 30 minutes later, with blood streaming from his head.
Officers took him to the Union Correctional clinic for treatment, but medical staff members said he continued to struggle as they sutured his wound. He went into distress during the procedure, they said, and died.
Dr. William Hamilton, the Gainesville area medical examiner who reviews scores of prison deaths in North Florida, ruled that Brenner's heart gave out "due to prolonged physical exertion."
His report notes numerous bruises, cuts and scrapes over Brenner's body from recent altercations but concludes that heart failure killed him. Though Brenner was only 34, Hamilton found hardening and narrowing of his arteries.
Hamilton declined to comment on the case.
Family members hired private investigator Bill Cunningham of Tampa, who thinks the family's suspicions are on target.
"If you take a tremendous beating and your heart stops, did the beating cause your heart to stop or did your heart just stop?" Cunningham asked. "I don't think there was any intention to beat Donald Brenner to death, but that's what happened."
The Brenner family sent Don's body to be examined by a forensic pathologist in Maryland, Dr. Rudiger Breitenecker, who reported additional injuries not noted by Hamilton: extensive bruising on Brenner's inner upper arms. The bruises suggested Brenner was trying to shield his head from injury, Breitenecker told the Times.
But Breitenecker concurred with Hamilton that heart failure, not trauma, killed Brenner.
"More likely than not it wouldn't have happened had there not been an altercation, but then maybe he started the altercation," Breitenecker said of Brenner's death. "It's so close, so questionable," Breitenecker said, that had he been the official medical examiner, he probably would have referred the case to the prosecutor's office to review.
The Department of Corrections' internal inspector general's report reaches no clear conclusion about how officers handled Brenner or whether anything should have been done differently. In an unusual move, though, they forwarded it to the state attorney's office, which declined to investigate further.
"His heart gave out," said Bo Bayer, assistant state attorney in Union County. "Until I hear anything different from the medical examiner I have nothing to prosecute."
In Tennessee, Brenner's mother said she struggles to understand her son's death, just as she struggles to understand how people with an illness wind up punished, instead of treated.
"He had a family that loved him so much, and tried to do everything we could to help him," Martha Gillespie said. "I don't know what's happened to our system when somebody gets in trouble because they're mentally ill and then gets put in jail. Don didn't need to be in prison. He needed psychiatric help."
-- Times staff writer Adam C. Smith can be reached at (727) 893-8241 or adam@sptimes.com.