It would be easy to haul off irresponsibly and start blaming anyone and everyone in the NC state prison system for its latest sad tragedy, that of an inmate reportedly dying of thirst apparently this past March 12, 2014 according to a story, September 27, 2014, in the Charlotte Observer in an Associated Press story likely in other major papers in the state. It was written by Michael Biesecker, long time reporter in NC who along with other reporters such as Lynn Bonner of Raleigh has written extensively on the long term painful changes the state, like so many other states, has gone through in its own version of mental health reform. For the complete story, follow this URL, http://www.charlotteobserver.com/2014/09/26/5201687/nc-inmate-died-of-thirst-after.html.

The story has just now emerged after one of the state’s coroners, Dr. Susan E. Venuti of the NC Medical Examiner’s Office released her report Thursday Sept. 27, and could only make the incomplete preliminary verdict of the cause of death as “indeterminate,” because of the lack of information of state documents she reviewed as part of her inquest. She stated in her report that, “The nature of the dehydration, whether as a result of fluids being withheld, or the decedent’s refusal of fluids, or other possible factors is unclear.”

Doubtless this case has many more complexities than have been fully determined in that he was a mentally ill inmate, was being transported by van from the state’s Alexander Correctional Facility in Taylorsville roughly in the mid North Carolina, to Raleigh, was reported to have  had schizophrenia, and to have been placed in “administrative segregation on Feb. 5, 2014 with his water cut off to his cell for an undetailed period of time which is usually done when inmates flood their cells.

Again, the correctional systems are shown to be dealing with extremely difficult psychiatric and behavioral dilemmas, trying to control destructive behaviors while maintaining safety and order, a nearly impossible balance of correctional and psychiatric/mental health approaches and philosophies. What is clear is that correctional facilities from local county/city jails to huge state and federal correctional facilities are facing management challenged perhaps never seen before. I am reminded that Harris County Jail of the county encompassing most of Houston, Texas is commonly touted somewhat tongue in cheek and sadly at the same time as “the largest psychiatric hospital in the country.” It has approximately 10,000 prisoners, and 2,400 mentally ill inmates/patients. Approximately a year or more ago, I recall reading many accounts as that media story made the rounds nationally, that Harris County had had to increase its number of consulting psychiatrists from 3 to 15 to begin to handle the load of treating a number of psychiatric inmates equivalent to a small town’s population.

And this current story in North Carolina, replicates the sad reality that all over the country, the last 10-15 years of cutting state and private funded psychiatric hospital beds has taken its toll and the chronically mentally ill are more and more ending up in the jails, in nursing homes, ill equipped group homes and on the streets.