There is a caged outdoor area attached to the mental health infirmary at Coffee Creek Correctional Institution, and it represents progress.
A decade ago, the cage was half as large, with only enough room for one or two people to fit comfortably when going outside. The inmates in the infirmary are in crisis, and it isn’t safe to let them go into a traditional “yard” with large groups.
But then came Jana Russell. She had the cage doubled in size to allow women more space to move and urged the prison administration to allow potted plants to brighten it up.
The Department of Corrections hasn’t been the same since.
Inside the infirmary, a woman playing cards hears female chatter and Russell’s clicking footsteps on the linoleum. She looks up from her game, just as everyone does in this prison, where anything out of the ordinary is interesting.
“Jana!” the woman says, beyond interested now.
Karen is nearly coming out of her skin with joy. She gushes to Russell about her life at Coffee Creek, about the computer classes she is taking and the job she has. Karen remembers Jana’s upcoming December birthday and asks how old she will be. She looks down at her hands every time she’s thinking of an answer to Russell’s questions.
She has a square of white gauze on her throat, held in place by a dark blue bandage that wraps around her neck, protecting a wound.
It’s the reason Karen is in the mental health infirmary at Coffee Creek — her delusions have led her to harm herself many times.
Russell, 64, started working for the corrections department about 10 years ago at Coffee Creek. Today she works out of Salem and, as a behavioral health services administrator, creates and manages programs for the prison system that help inmates like Karen heal to a point where they are unlikely to hurt themselves and unlikely to commit another crime.
Oregon’s prisons have become the largest mental health care provider in the state. About half of all 14,700 inmates have some kind of mental illness, and about one-fifth of them have a mental illness that needs treatment.
There isn’t room for all of them at the Oregon State Hospital, nor is the hospital equipped to handle the most violent or criminally minded of the population.
The majority of OSH patients are there because they committed crimes, but they were found “guilty by reason of insanity,” and the hospital treats them strictly as patients.
Oregon has no forensic mental health facility — essentially a prison for the criminally insane, which can address both treatment and security needs – so its prisons must accommodate everyone from the stable to the psychotic.
Finding Coffee Creek
Prison is not inherently designed to treat people for mental health issues, but Russell has changed the treatment, housing arrangements and staff culture in Oregon’s prison system to the point that it can help some inmates manage and recover from mental illnesses.
She did not begin her career in prisons. She earned a psychiatric nursing degree from Gold West College in California and spent 17 years designing, implementing and managing community and hospital-based psychiatric programs in California, Texas and Oregon. She worked for Lutheran Social Services, Legal Aid and an advocacy group in California.
She moved to Oregon toward the end of her career, but didn’t feel ready to retire.
She saw an ad in the newspaper for Women and Community Services, seeking someone to work with the women at Coffee Creek, which opened in 2001, and it brought back a memory from decades before she moved to Oregon.
Russell’s daughter is mentally ill and struggles with addictions. Russell rarely hears from her, but one day, her daughter called from jail.
“You have to do something, Mom,” she said, crying. “All these women are here with so many problems and no mental health counselors.”
She went on to have her career and her daughter, a hair stylist, continued to struggle. She didn’t have health insurance but didn’t qualify for Medicaid and has never recovered.
“I do not know where she is,” Russell said. “Occasionally I get a message with enough information to know she is still alive. Knowing I have no control over her life is one of the most painful realities in my life.”
When she saw the Coffee Creek ad, she remembered that phone call.
“I thought, here is an opportunity,” she said. “I can do this.”
She started working for a nonprofit at Coffee Creek in 2002, and by 2004 she was working full-time for the corrections department. She became the behavioral health services administrator in 2007.
Before she worked in a prison, Russell had no idea how many inmates were mentally ill.
“I was so naive about prison,” she said.
Russell struggled when she first arrived at Coffee Creek. She was confronted with a facility whose staff didn’t understand mental health, whose security protocol she did not understand, and an infirmary with only 10 beds to care for the hundreds of mentally ill inmates.
Today, nearly 1,000 of the 1,272 inmates at Coffee Creek have some mental health problem.
Early on, she met Capt. Elizabeth LaCarney, an officer with the prison’s security staff, and the two formed a connection. LaCarney became her mentor and friend.
“That (friendship) was my greatest gift to myself,” Russell said. “It allowed us to teach each other. I was able to learn a language.”
LaCarney did as well. Each woman taught her staff the language of the other — what words to use, what questions to ask, what information to consider.
They married security concerns with mental health needs in how inmates were treated and how they lived.
One of their largest projects was the creation of a housing unit — where inmates eat, sleep, exercise and socialize — designed specifically for the mentally ill. The prison administration gave them the Delta housing unit, and the result worked so well in getting inmates appropriate treatment and keeping the prison running smoothly that it’s now used in every Oregon prison.
The inmates in Delta are not “in crisis.” They are not hurting themselves or anyone else, and they can manage their daily lives but still have serious mental illnesses and need special attention.
The legacy of Russell and LaCarney’s collaboration can be seen in how the staff on the Delta unit relate to the inmates. Officer Jamie Berringer has a smile for every woman. She understands the way they think well enough to whisper to a visitor that it’s bothering some women to see one of the visitor’s socks peeking above her boot without anyone feeling awkward.
Colorful posters hanging in the Delta unit classroom remind inmates of important life skills. “Ride da-urge,” one says, urging inmates to wait for emotions to run their course. Another offers the “shut up skill” — the ability to pause before speaking.
These skills are part of “dialectical behavior therapy,” a method used to treat people with behavioral and mood disorders. It teaches inmates how to manage their emotions and understand their own behaviors and motivations. It draws on Eastern philosophy, particularly the idea of mindfulness — being aware of one’s present emotional and physical state.
Russell first encountered it during a visit to Canada and brought it back to Coffee Creek. It, too, proved successful for inmates and staff and is now used statewide.
“When you’re trying to teach someone something, you have to teach it in a way they can hear,” she said, referring to the funny titles for DBT skills.
Russell said it’s effective in prison, partly because it does not rely heavily on group therapy, which can make inmates too vulnerable. (Sharing a story of childhood molestation, for example, can subject an inmate to attacks or serious bullying.)
Instead, it teaches inmates life skills.
The challenges of prison
Mental illnesses are not all the same. Where some may be treated successfully with medication, a mood or personality disorder — more common in prison — is a matter of the brain having developed incorrectly.
Those illnesses require people to relearn how to relate to themselves and the world. Medication may help, but it won’t solve the problem alone.
Most of the mentally ill in prison arrived there without having received the treatment they need. Some committed their crimes because they were ill; others simply happen to have a mental illness.
Many experienced trauma that altered their mental and emotional development. They found substances — often heroin — that took away their symptoms. Heroin is effective in eliminating the symptoms of psychosis — delusions, hallucinations — Russell said, so many with severe mental illness end up using it.
One of the most important skills taught in DBT, Russell said, is “distress tolerance,” or the ability to handle stress instead of trying to avoid it.
Prison winds everyone tight.
Russell said she has become hyper-vigilant since working in prisons, noticing every sound, every movement around her. She ends every day stressed.
To cope, she showers every day as soon as she returns home and changes into comfortable clothes. She makes a cup of her favorite black tea with ginger and other spices or pours herself a glass of wine and considers her day while she sips, before making dinner.
“I don’t gulp the tea down. I taste every element of the flavor. I can actually feel it going into my stomach. For me, it’s a little miracle,” she said. “If I could change the world, we would all be learning this in about the sixth grade.”
It’s a crucial skill for prison inmates.
Inmates are never alone. They have so little autonomy that they cannot even turn off the lights in their cells. They must socialize every day for most of the day. They follow strict rules and have closely monitored schedules. They cannot touch each other. They live their lives under harsh fluorescent lighting in rooms and hallways. Metal doors slide open and close constantly, clanging and rattling the air in the housing units. The only smell is packaged food from a microwave.
Many come in to this environment with serious illnesses — post-traumatic stress disorder, bipolar disorder, schizophrenia — that they are trying to recover from or manage.
Others have less intense problems — anxiety or depression — which sometimes get worse simply from being in prison.
Add to this panic attacks, hallucinations, disembodied voices, serious mood swings or developmental disorders like autism, and you have an environment nearly impossible for some inmates to cope with.
For some, however, the exposure to therapy and new skills helps thwart their mental illness.
Inmates cope with stress largely through activities: they draw, exercise, play games on Wii systems, crochet — “I have two big afghans made for me by inmates,” Russell said — or doing something kind and anonymous for someone else.
They also are allowed to make appointments at the prison salon (it’s run by inmates learning those skills) or do their own hair and makeup.
In fact, a woman sat in the infirmary common area straightening her long black hair during Russell’s entire conversation with Karen.
“We feel better when we look better,” Russell said. “If someone took away my makeup and my hair tools and put me in jeans and a T-shirt, I wouldn’t feel good about myself either.”
Many of the women Russell worked with during her time at Coffee Creek are still there. They greet her with hugs and effusive updates on their lives. Many tell her how much they miss her.
She seems at home and out of place in prison. Her ID badge hangs from a beaded chain interspersed with moons and stars, and her peep-toe pumps click loudly on the linoleum.
One inmate once recognized her by those heels, which are distinct among the boots or comfortable flat shoes worn by nearly all the staff.
Megan was one of many inmates Russell created a bond with.
Megan was sentenced to Coffee Creek for arson. She had been leading a successful life with a business she owned, a husband and a baby boy, but she had a psychotic breakdown and burned part of an apartment building and set herself on fire.
She lived largely as a recluse when she first came to the prison. She had frightening delusions and picked at her body all the time; there were scars and scabs everywhere.
“I hadn’t ever seen what your body looks like after you have third-degree burns all over your body,” Russell said. “It was hard for me to look at her at first, and I needed to.”
Russell and her staff eventually coaxed her out of her cell with a cup of coffee.
“She would do almost anything for a cup of coffee,” Russell said. “I came to love who she was so much.”
Megan’s best days were when she was allowed to visit the prison library for a new book, and she turned out to be a funny, joyful person, Russell said.
Russell cries a little bit when she remembers her, just as she cried when she talked about Karen’s delusions and about the many inmates she has known.
“I get so emotional about my patients,” she said. “How can I not?”
Some of those tears come from a place of joy, as in the memory of Megan’s improvements.
But others fall from sadness at the memory of the dark places mental illness can take people.
Russell’s programming was developed and started at Coffee Creek, but they now are applied across the prison system, which means men make up the vast majority of the population being served.
The programs have been adapted to work with men, which Russell said isn’t harder but simply different.
For example, suicide attempts are common among all the prisons’ mentally ill, she said. However, while women hurt themselves more frequently, it is the men who most often try suicide in earnest and hurt themselves the worst.
Russell has seen men who have pulled out their own intestines or hung themselves. She has seen men who have torn open surgical wounds and inserted objects inside.
Although men have a lower rate of mental illness than women, Russell suspects men under-report their conditions.
“(Mental illness) often isn’t visible,” she said. “You have to give it some time and as you get to know someone, it becomes apparent that, ‘OK — we have just gone to the land of Oz.’”
Men don’t tend to be forthright with stories about childhood trauma or the reasons behind their substance abuse, often used to mask a mental illness, Russell said.
“Men tend to hold things in,” she said. “They don’t want to be vulnerable. Women are much more open. They want to create support systems.”
That makes the therapy process slower for men.
“My way is to listen first to the story they want to tell me and then to show that their story matters to me,” she said.
Life after prison
For all the stories that end well, there are more that end in dark places. The stories of the mentally ill often sound like the story of Russell’s daughter, full of uncertain endings and people too fragile for even the strongest love to hold together.
Prison is only one or two chapters in most of their lives. The world is still out there, waiting for them when they leave.
Samantha came to Coffee Creek during Jana’s first year. She was psychotic, but responded to medication. She improved dramatically during the years she spent there.
Then she left prison on a bus to a distant county with nothing except a 30-day supply of medication and a troubled relationship with her grandmother, her only relative. They fought, and Samantha ended up living on the street.
One night she got a gun, walked into a restaurant in town and said, “Call the police, I need help. I need to go back to prison. I don’t have any medication.”
She went back to prison and the story repeated itself. She was released again, ended up homeless again and overdosed on heroin. She died.
“This was one of the lessons I had to learn,” Russell said, emphasizing that not everyone can be helped and that their lives go on after prison.
Samantha had no options and the county she lived in had no money for services to help her.
Other stories have better endings.
Megan, the arsonist, eventually was released to the Oregon State Hospital and now lives in an apartment of her own. Last time Russell checked, she was doing well.
Before she got out of prison, the staff found her son, who was no longer a baby. They told him about his mother and her illness, and the two started writing letters.
“He was there waiting when she got out,” Russell said.
“And that is why I do this work.”
Who is Jana Russell?
Family: Son, (45), daughter-in-law, two stepdaughters, (both 22), three grandchildren, several brothers and sisters, “an entire troupe” of nieces and nephews
Hometown: Suburbs of Boston (born into a big Scottish/Irish family)
Education: Bachelor’s, master’s degrees in theology, master’s in psychiatric nursing from Golden West College (1978), psychiatric nursing residency at Metropolitan State Hospital Forensic Unit in Norwalk, Calif., under Dr. Wally Ellerbroeck. Became the first female to work in the mentally disordered sex offender unit.
Interests: Taking classes (currently studying natural medicine, cultural expressions of spirituality, the art of foraging for food), cooking for friends, getting her hands dirty, her creative extended family
On having a second career: Cannot imagine not working. “I get to use my wild array of skills, creativity and talents for a positive purpose. The work is the same. The environment is new,” she said. “I am very curious and really love the challenge of learning new things and believed I could bring creative ideas and opportunities to the mental health delivery system in an environment not designed for this purpose. “
Sentencing the mentally ill
People who commit felonies in Oregon can go to one of two places: prison or the Oregon State Hospital. People found “guilty” go to prison; people found “not guilty by reason of insanity” go to the hospital.
Because the people who go the hospital are not found guilty of their crimes, they are considered patients of the hospital and are not under the jurisdiction of the Department of Corrections.
However, being mentally ill does not guarantee going to the hospital. Specific criteria must be met and the defendant’s lawyer must use a specific plea. Most mentally ill defendants end up in prison because they either didn’t plea “not guilty by reason of insanity” or the court did not decide their mental illness rendered them unresponsible for their crimes.
All female felons in Oregon go to Coffee Creek Correctional Institution in Wilsonville. Men go to one of Oregon’s seven prisons. However, inmates’ mental health needs are considered when placing them in a prison.
The female mentally ill are housed at Coffee Creek, but mentally ill males are housed around the state. The most severe go to Oregon State Penitentiary, which has specialized programming for the sickest or most violent mentally ill inmates.
Other prisons have specialized programming as well. For example, Snake River Correctional Institution has programming designed for people with developmental disabilities, so those inmates are often placed there.
Editor’s note: The names of inmates have been changed to protect their confidential medical information.