He’s in a prison cell, with no criminal conviction. Idaho put him there for mental health care.

BOISE (Idaho Capital Sun) — In the sagebrush steppe south of Boise is a prison compound. In that compound is a maximum security prison for up to 549 inmates, surrounded by a double-perimeter fence with razor wire and alarms. And in that prison is Ben, a man from a rural North Idaho county who isn’t serving a sentence or even facing criminal charges.

Ben, who is in his 30s, is in a prison cell because he has a mental illness, and Idaho has no other safe place for him.

There are nine cells at the Idaho Maximum Security Institution for men like him, and one cell at a prison in East Idaho for women like him — deemed “dangerously mentally ill” — even though they haven’t been convicted of a crime. Those beds are “usually full,” as patients stay for four to six months on average, according to Idaho’s chief psychiatrist for corrections.

Some of these Idahoans were charged with crimes but their psychiatric disease is so severe that they can’t stand trial without treatment. Others are facing no charges; a court placed them under an involuntary mental health commitment because their psychiatric disease makes them a danger to themselves or others.

Idaho Department of Correction spokesperson Jeff Ray said in an email that referrals of patients to the prison program have increased.

“Because the number of beds is capped at nine, admittance to the program is reserved for the most severe cases,” and patients with less severe cases have to be sent elsewhere, he said.

Idaho Gov. Brad Little this year asked the Idaho Legislature to fund a project that would house these Idahoans in a secure environment, not in a prison, while they receive treatment.

The Republican governor recommends that legislators approve $24 million for the Idaho Department of Health and Welfare to use for a “secure, forensic 26-bed mental health facility to care for patients committed and determined dangerously mentally ill by Idaho courts,” and additional funding to pay for improvements to state-run mental health facilities in Southwest and East Idaho.

The Joint Finance-Appropriations Committee planned to take up that budget item last week. It has delayed its consideration amid a prolonged budget-setting schedule.

Where Idaho puts ‘dangerously mentally ill’ patients

The Idaho Maximum Security Institution opened in 1989 “to confine Idaho’s most disruptive male residents,” according to IDOC.

That doesn’t usually describe Ben, said his mother, Diane. The Idaho Capital Sun has chosen to use their first names only to protect Ben’s medical privacy.

When he is not hospitalized, Ben lives with his mother in the house where he grew up. He enjoys playing golf. He mountain bikes, kayaks and snowboards. He and his mother take long road trips. He is “a joy” to live with when he’s healthy, she said.

“He tried to go to college. Several times. He got straight A’s, but, you know, the illness …” his mother said.

Ben was diagnosed with schizoaffective disorder almost 20 years ago, she said. His doctors have prescribed him a variety of medication regimens over the years, but they do not always work. He has been hospitalized many times in state psychiatric hospitals and non-state run hospitals.

Some medications “make him agitated, aggressive, assaultive, suicidal, all those kinds of things, instead of sedating him and (helping) with psychosis,” Diane said. But psychiatric providers often try those medications with predictably bad results, she said.

Instead of getting better, Ben lashes out.

“Any time Ben is in a psychotic state, and he sees anyone that looks like a policeman, he gets really afraid,” and that’s also how he responds to restraints or a needle, Diane said.

His defensive reactions can be violent, and as a result, he was shipped for the first time to the Boise prison in 2017, to be housed with other “dangerously mentally ill” men. He is now several months into his latest stay at the prison, and Diane does not know when, or if, he will leave.

“It makes me sick to think that he could end up dying there in a prison cell,” she said.

His mother is not surprised that a man with psychosis would be defensive and aggressive against people in police-like uniforms while he is locked in a prison cell.

The uniforms are just one of the weak spots in the invisible line the program attempts to walk between “convicted” and “committed.”

Medical records are on a prison template with, for example, “Inmate Name” instead of “Patient.”

The Idaho Department of Correction confirmed that, when the cells are not occupied by people who are there for mental health treatment, they are occupied by prison inmates. The other people housed in that part of the prison are on death row.

Medical records provided to the Sun by Ben’s mother show he was admitted last September, after “allegedly assaulting a nursing staff member about 10 days ago” at a state-run psychiatric hospital.

“I must reiterate (and I have done so by phone several times) to Health and Welfare that this is an inappropriate place for this patient to be treated because it lacks the level of care that he requires,” Ben’s psychiatrist at the prison wrote Sept. 6, in a medical record from Ben’s arrival at the prison. “Although it is more secure than the (state hospital), this patient required more intensive treatment than is available here.”

The record said Ben arrived at the prison believing, among other things, that “he had been kidnapped and sent to prison illegally …“

The staff who write up Ben’s progress notes refer to him as a patient, or by his first name.

“I introduced myself as ‘Amy’ and called him ‘Ben’ in an effort to build rapport (and he is not an inmate,” said a medical record from mid-October, written by a mental health clinician at the prison. At the time, he was lucid and could carry a conversation.

But over time, the records have become less about Ben the person, and more about Ben the confined aggressor.

Psychiatrist: ‘no doubt that Ben is struggling’ in Idaho prison setting

Ben’s condition has deteriorated since last fall.

The most recent medical records provided to the Sun describe Ben refusing to take medication, “laughing hysterically,” yelling, spitting on the glass window of his cell — in other words, showing symptoms of an untreated disease.

In late October, Ben was out of his cell for recreation time, when he began to swing his arms as if to hit someone, his medical records said.

He was ordered back into his cell and complied, but then became aggressive, kicking the door and yelling.

Those behaviors cost him the privilege of a daily cup of coffee and moved him to a “tier” that allows less free movement. Not understanding what he did to deserve punishment, Ben retreated, Diane said. He hasn’t left his cell since then except to shower, often hides in his cell and has attempted suicide there, she said.

Diane wrote letters to Gov. Little and others over the past few months.

Her goal is to advocate for her son’s well being, she said.

“My son (Ben) has been warehoused in the Idaho Security Medical Program in solitary confinement twenty one out of the last twenty eight months, without being convicted of a crime,” she wrote in a message to Little earlier this year. “I’m gravely concerned for my son’s health, welfare and safety. He is progressively getting worse from the effects of the prison environment.”

Dr. Walter Campbell, the chief psychiatrist for Idaho Department of Correction, said in a response to her email in early February that IDOC is “well aware” of Diane’s concerns.

There is “no doubt that Ben is struggling in the (prison) environment in spite of our best efforts,” he wrote. “That being said, he has presented with security concerns that cannot be safely managed in the Idaho state hospitals, although they have attempted to manage his behaviors on several occasions.”

Campbell said IDOC would be “very happy to discharge him to a more therapeutic environment, should the court agree to order such a placement,” but the state department that operates behavioral health care “does not have the capability to manage him in their current hospital settings and I am unaware of any alternative plans they may be developing.”