View Full Version : Prison Hospital questions

03-02-2016, 04:50 AM

Is there anyone here who has knowledge of state run hospitals for the criminally insane? I'm not even sure what the accepted term is. I want it to be the location of my next novel, but I can't seem to get a tour of the one near my home (go figure). I would have quite a few questions, from layout to procedural items. If you fit the description (either voluntarily or not) and are ok with sharing, can you please pm me?


03-02-2016, 04:59 AM
You can probably get a lot of your questions answered by the reality TV show Lock Up. They cover all kinds of prisons and units within prisons. It's MSNBC on cable TV. Good luck.

03-02-2016, 05:18 AM
I'll check it out! Thanks for the tip.

03-02-2016, 05:24 AM
Most of them are fairly modern. A lot are called "secure psychiatric unit" or "SPU" for short. No way in hell are you going to get a tour of one beyond the visitor's area. Physical layout is fairly prison like and a lot less therapeutic. Patient confidentiality applies and many of the inmates are on various drugs.

Here's a newspaper article on NH-SPU -- http://www.nashuatelegraph.com/news/913586-196/secure-psych-unit-described.html

And for a letter to the editor against NH-SPU -- http://www.concordmonitor.com/home/21242253-95/my-turn-the-trouble-with-new-hampshires-secure-psychiatric-unit

There are pictures of NH-SPU on line.

I have been in NH-SPU for a fairly decent tour, much beyond what normally happens. I also represented several individuals who were in there for varying periods.

We try to share information publicly on this forum. This way others can use the information. I'm willing to answer questions, but prefer the public forum.

Best of luck,

Jim Clark-DAwe

03-02-2016, 05:52 AM
Thanks Jim,

I'll read through those articles and do some research based on what I find. If I have any further questions, I'll post them to this thread.


03-02-2016, 06:53 AM
A lot of individuals with mental illness end up in the general population, unfortunately.

The American Nurse Project interviewed several prison nurses and posted them on their website. There's a link below and the prison nurses are in the second row, second from the end on the right hand side, and then the fifth row, fifth from the left. I can't imagine there are a lot of procedural details, but it will probably give you some background and flavor.


03-02-2016, 06:55 AM
You all are awesome! Thanks so much.

03-02-2016, 07:31 AM
I think there are a couple of different ideas getting mixed together here. Just for the sake of clarity there are, at least:

- Medical units in a regular prison: where regular prisoners get treated for temporary injury/illness
- Prisons that are, themselves, hospitals: where regular prisoners with long-term illnesses are housed (like FMC Lexington (https://en.wikipedia.org/wiki/Federal_Medical_Center,_Lexington))
- Prisons that specialize in inmates with mental issues (like FMC Butner (https://en.wikipedia.org/wiki/Federal_Medical_Center,_Butner))

What kind of facility does your story need?

03-02-2016, 07:40 AM
The last one. I haven't had time to delve into the specifics of the research offered yet, but I'm just at the brainstorming stages, so anything is helpful.

03-02-2016, 08:00 AM
MDSchafer -- Nice videos.

Both nurses are from Angola in Louisiana. Once a very bad prison, it's now doing many things right. Connected to the hospice program is the fact that there is an inmate who makes caskets for any inmate who dies there. (Nearly all Angola inmates will die there from old age.) These are quality caskets.

Unclaimed bodies are buried on the prison grounds. Here's a picture of an inmate being transported to the cemetery. https://encrypted-tbn3.gstatic.com/images?q=tbn:ANd9GcRyJDANcmCIBqqoEFg-_ZPsWzWtj88t8hsVTPvr4oMhSQep5_U_

Angola is not, to the best of my knowledge, a psychiatric prison. This doesn't mean that some inmates don't have serious mental health issues, and may take some heavy duty drugs, but that inmates whose mental health issues interfere with their ability to be safe in prison are not sent there. Inmates in a SPU are severe mental health patients, a danger to themselves and others. Holmes, from the Colorado theater shootings, is in a SPU. Also within them are people who are deemed not competent to stand trial.

Many prison inmates have significant intelligence issues. I had one defendant who required over an hour and a half to do a simple plea and sentencing. I'd warned the judge and clerk that this defendant never made it beyond middle school for education. I spent three hours prior to the hearing going over his rights and he still couldn't follow what was happening and what he needed to say. But the plea was a good deal (court ordered probation, no alcohol, and had to be with his brother or his brother's wife) that was the only good idea anyone could come up with. Stupid, drunk, and big is not a good combination and was this guy's problem. Someone had said the wrong thing to him when he was drunk and he beat the crap out of the guy.

But the process of pleaing him was painful. A defendant has to knowingly enter into a plea, and he couldn't keep any of his rights clear, and couldn't remember all the terms and conditions of his sentence. On the bright side, it's been over 20 years, he's still with his brother, and hasn't had a drink in that time (neither has the brother -- the brother is a freaking saint).

best of luck,

Jim Clark-Dawe

03-02-2016, 08:43 AM
There are also prisons that hold only specific populations of offenders, and offer psychological care.

Mostly, what you're talking about is likely a ward in an existing hospital, but not always.

You're not getting a tour, so research is your friend.

Siri Kirpal
03-02-2016, 09:00 AM
Sat Nam! (Literally "Truth Name"--a Sikh greeting)

Okay, so I haven't been in the sort of facility you're talking about, but I did time in the 1980s teaching yoga to convicted male felons at a maximum security facility. It had a special lock up unit for the criminally insane. I was never inside, but...keep going.

One of the inmates I taught was clearly out of his gourd and would wander around the classroom looking at things while I taught. He was in the general populace.

Another one I didn't teach appeared to be okay mentally. But...

The way we got into and out of the prison involved a series of barred doors controlled in different ways, by different people. Between two of these doors was the stairway leading to the lock up insane unit. One evening, we were waiting for the huge guy who controlled the door out of the -- well, it was sort of a quad leading to different sections of the prison. Before the huge guard let us out though, he let this one inmate out. We (the evening teachers) were all shocked. Why was this guy going down that pathway that led out of the prison? "Because he lives there" was what the guard told us. IE in the lock up unit.

Oh, and the prison I was at looked lovely and bucolic on the outside: a stream with lots of ducks flowed by. But it was about as drab as you can imagine inside.

Teachers were not allowed to wear denim. When one of the teachers showed up with a blue skirt, our supervisor chided her. "But it's not denim!" she said. "The guards can shoot anyone in blue," said our supervisor. "Now do you understand the dress code?"


Siri Kirpal

04-09-2016, 06:03 PM
I think what you might need to do is break down your research into two angles--the prison side and the mental health facility side. I have no knowledge of the prison system, or how it is applied to the hospitals. But I did work extensively in residential mental health during college (psych major). So I can give you the therapeutic perspective, and maybe someone else can chime in with how the prison aspect changes things.

Residential mental health facilities live and die by schedules. The idea is to maintain as much routine as is humanly possible, and to keep the residents productively engaged. So there is always a big group schedule prominently posted with start and end times for meals, group therapy, arts and crafts, medication distribution (usually 3x/day, not all residents get meds at every distribution), even personal hygiene times. Then each individual client also gets a personal schedule (individual therapy, phone calls, doctor appointments, personal goals). Naturally, most residents aren't too good at keeping up with times and following schedules on their own, so a large part of the average mental health tech's day is taken up with corralling people to the next thing on the agenda. But routines help them feel safe and help keep them calm, so they're absolutely vital.

In regular residential mental health, the overarching therapeutic goal for each resident is stabilization, with the goal of returning to the community as soon as possible. Obviously this is different for a prison hospital, and I don't really know what the overarching therapeutic goal would be, since they're not returning to the community anytime soon.

Rewards rather than punishments are the preferred method of behavior control, at least in regular residential facilities. Pretty much anything you can imagine could be a reward--TV time, extra phone calls, participation in an evening group activity. Different levels of rewards call for different amounts of good behavior--a resident might get a half hour of TV time for following the day's schedule without complaint, but might need to actively participate in group therapy all week to join in a Saturday afternoon game. It's all very individualized to the resident.

In mental health as a whole, a good therapeutic environment is stressed--pretty colors, green spaces, plenty of exercise...but again, I know this is the polar opposite of thinking in the prison system, so I don't know how it translates.

Anything can be a weapon, so staff are always cognizant of that possibility. You haven't lived till you've been stabbed repeatedly in the arms and legs by a 9 year old with a pencil. Accordingly, residents tend to have everything potentially sharp or dangerous taken away when they come in, and very gradually earn the privilege of using pencils, shoelaces, etc. Just because someone earned the privilege doesn't make it "safe," however, and doesn't mean they won't snap--had a guy in a transitional facility, just about to be released, decide to stop taking his meds, steal a knife from the kitchen, cut himself up, and then go after a few of us. It was back to the hospital for him. The constant struggle for staff is finding the balance between building therapeutic relationships and keeping a guard up at all times.

Every resident goes through an intake process--you get their file, search them for contraband, give an orientation tour, assign a bed, give them a packet of information, and help them get settled. It usually happens as soon as they come in, though it may be abbreviated if they come in during the night, and finished the next morning. They see a psychiatrist within 24 hours, at least in my experience, and get assigned to a therapist in about the same time period.

Again, all of this is based on residential mental health that is not associated with the prison system. But hopefully it at least gives you a starting point. I'm happy to answer questions as well.

10-23-2016, 05:57 AM
I think there are a couple of different ideas getting mixed together here. Just for the sake of clarity...

Agreed. This was the point I was going to make. I've got some anecdotal info for at least two of these just mentioned by raelvw; but yeah if there's TV shows now (I don't follow TV) definitely look to them first. They can tell you better than I can as they're more up-to-date.

T Robinson
10-23-2016, 09:12 AM
Millidgeville was a true mental health asylum, but was considered a prison by the public when it was operational. Depends on what you need.


10-31-2016, 03:13 AM
I toured one in med school. We had a couple classes there during our psychiatry rotations. It felt much more like a prison than a hospital. There were different wings with varying degrees of seclusion and guards