Two years ago, the North Carolina prison system promised change after blaming staff shortfalls for the problem of mentally ill prisoners left isolated in cells splattered with human waste.
Now, mental health advocates say they are still waiting for prison officials to deliver on that promise.
New numbers obtained by the INDY show that North Carolina prisons continue to operate with dozens of vacant positions for mental health workers. In some positions, the state's staffing has improved, while in others, it has worsened.
Nearly a third of 98 positions for prison psychologists, charged with treating mentally ill prisoners, were vacant as of Monday, said N.C. Department of Public Safety spokeswoman Pam Walker.
Sixty percent of senior psychologist positions were open. Of the prisons' 1,314 nursing positions—vital for providing day-to-day checkups—22 percent, or 289—are vacant.
In 2012, when DPS asked consulting psychiatrists to examine the besieged prison system's mental health care, consultants reported staff shortfalls had a "very negative impact" on care. Furthermore, they questioned whether prisons could improve their care without a significant increase in personnel.
Terri Catlett, deputy director of health services for the state's prisons, acknowledged vacancies remain a problem for psychologists and nursing positions. But she noted some improvements for state prisons, pointing out additional hiring of social workers and senior psychologists.
State statutes require psychologists to be licensed by the N.C. Psychology Board, which slow the hiring process, she said, noting neighboring states such as Virginia and South Carolina do not have that requirement.
However, Catlett said mentally ill prisoners in North Carolina are not in any additional danger because of the staff vacancies.
"We have dedicated folks, not only in mental health but in medical, who can provide those services," she said.
Based on diagnoses, an estimated 5,513 inmates—equal to 14.6 percent—in North Carolina were severely mentally ill in 2006, according to a 2010 report by the Wake County chapter of the National Alliance on Mental Illness.
Nationwide, 16 percent of inmates in jails and prisons suffer from mental illness.
The state Department of Correction reported that there has been a steady increase in the number of inmates with mental disorders, as many as 400 more inmates per year than would be expected by population growth alone.
There would need to be a significant increase in staffing to accommodate the growing number of mentally ill inmates.
Vicki Smith, executive director of the nonprofit Disability Rights N.C., said she believes the prison system's persistent staff shortfalls played a part in the death of 53-year-old Michael Kerr.
As the INDY reported in April, Kerr, who had been diagnosed with mental illness, died of dehydration following a month-long stay in solitary confinement. Kerr had been left unmedicated, reportedly covered in his own feces, in a Taylorsville prison before dying during his transfer in a prison vehicle to Raleigh's Central Prison on March 12.
Kerr's death, and the resulting media coverage, prompted state and federal investigations, nine dismissals, two resignations and numerous reassignments, including the transfer of the Taylorsville prison's top administrator.
"In any facility where you find a high rate of vacancy, you have a lot of workers putting in overtime," Smith said. "If you have people working a lot of overtime, they're not getting down time. Poorly trained, overworked staff always contribute to abuse and neglect."
Disability Rights N.C. opened an independent investigation into Kerr's death and found "severe deficiencies" in the care for mentally ill prisoners. The group asked Gov. Pat McCrory to declare a hiring emergency in North Carolina prisons and to authorize an expedited hiring system to fill the vacancies.
"Staff vacancies are a fundamental and crucial barrier to the Department'ssuccess," Smith said. "Currently the bureaucratic and protected hiring process cripples its ability to adequately care for prisoners with mental illness."
Hiring a state worker, even if it is expedited, could take more than three months because of reporting and interview requirements, Smith said.
At the conclusion of its investigation into Kerr's death, Disability Rights N.C. recommended prison officials prohibit mentally ill inmates from being placed in solitary confinement, improve conditions in solitary confinement for all inmates and step up screening of prisoners for mental health issues.
Smith said McCrory's office never formally responded to their requests. "We still believe this is an emergency," she said. "Typically, when the governor responds to known emergencies, he does it publicly. There has been no public response to this critical situation."
Reached Monday, a spokesman for McCrory pointed out the governor's office did issue a press release following the Disability Rights probe. In the statement, McCrory's office credited the governor for immediately ordering an investigation after Kerr died.
"Changes are being implemented to ensure that a previous broken culture is eliminated and our prisons are safe, accountable and appropriately staffed with trained employees," McCrory said in the statement.
However, DPS officials, not the governor, announced internal and independent investigations in late March, after the INDY began asking questions about Kerr's death.
McCrory's office did not provide specifics on reforms in the prison system. But DPS leaders have said they will create a task force to study the use of solitary confinement on prisoners with mental illness.
DPS said it is also ordering crisis training for prison workers and requiring prisoners undergo a mental health assessment before being placed in solitary confinement.
Prisons nationwide have been under criticism for their use of solitary confinement on mentally ill prisoners, with many researchers saying the method may only exacerbate illness.
This article appeared in print with the headline "Help wanted"