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Recent death renews concerns about conditions at NH Secure Psychiatric Unit: 'This is a prison. This is not a hospital.'

The Secure Psychiatric Unit at the New Hampshire Department of Corrections.
Paige Sutherland
The Secure Psychiatric Unit at the New Hampshire Department of Corrections.

Officials have shared little about what happened leading up to Jason Rothe’s death at New Hampshire’s Secure Psychiatric Unit on April 29, except that he died after a “physical altercation” with six correctional officers, who remain on leave pending further investigation.

Rothe is one of at least three people who have died at a Department of Corrections psychiatric facility in the last decade. And for some advocates, the latest incident has underscored their longstanding concerns about how the state is caring for these high-risk patients.

“The fundamental problem here is: This is a prison. This is not a hospital,” said Beatrice Coulter, one of the founders of Advocates for Ethical Mental Health Treatment, a leading voice calling for reform. She said she briefly worked as a nurse at the Secure Psychiatric Unit in 2015 and was shocked to learn it housed civilly committed patients alongside people serving sentences.

The Secure Psychiatric Unit, sometimes called the “SPU,” is run by the New Hampshire Department of Corrections on the grounds of the state prison in Concord. It houses people serving prison sentences who require psychiatric care, but also mental health patients who have not been convicted of a crime.

A 2021 report from the New Hampshire Advisory Committee to the U.S. Commission on Civil Rights described the facility as a 'highly controlled, solitary-confinement environment, where security concerns must take precedent to clinical decisions.'

New Hampshire Hospital, the state’s main psychiatric facility, doesn’t have a secure unit. Because of that, some civilly committed patients who are deemed safety risks are transferred to the Secure Psychiatric Unit. As of May 3, the unit held 39 people — 17 of whom were there under the civil involuntary admissions process, according to the Department of Corrections.

The state is moving forward with plans to build a new forensic psychiatric hospital to treat those patients, but it’s not expected to open for another two years.

Mental health advocates say the problem has been decades in the making.

Coulter and other advocates say people who need treatment for a serious mental illness belong in a therapeutic setting — not a place with corrections officers, rigid regulations and the look and feel of a prison. Wanda Duryea, another co-founder of Advocates for Ethical Mental Health Treatment, said she speaks regularly with people held at the facility and their family members.

They monitor their phones,” Duryea said. “They open all of their mail. They shake down their cells. They strip search them.”

A Department of Corrections spokesperson did not respond to questions from NHPR about the Secure Psychiatric Facility’s practices and environment.

A 2021 report from the New Hampshire Advisory Committee to the U.S. Commission on Civil Rights said that kind of environment can be “dehumanizing” and detrimental to treatment, describing the Secure Psychiatric Unit as a “highly controlled, solitary-confinement environment, where security concerns must take precedent to clinical decisions.”

Francesca Broderick is a staff attorney and investigations coordinator at the Disability Rights Center-New Hampshire, which is empowered under federal law to investigate potential abuse or neglect at facilities caring for people with mental illness. She's concerned people at the Secure Psychiatric Unit aren't getting the mental health care they need.

Broderick said her organization has received complaints alleging some staff don’t recognize behaviors as symptoms of mental illness, instead treating them as disciplinary problems. Some spend up to 23 hours per day isolated in their cells, she said. (The advisory committee report described that as “a form of solitary confinement on psychiatric patients.”) She said the facility also has “cages” to confine potentially aggressive patients during counseling sessions.

“What should be a treatment unit is first and foremost correctional in nature,” Broderick said. “I think those two things do not go well together.”

Many questions, few answers

An autopsy conducted on Rothe, who was 50 years old, was “inconclusive” on the cause and manner of his death, according to the New Hampshire Department of Justice. The agency said corrections officers, after an altercation involving Rothe, noticed he was “not responsive and attempted CPR”; he was later pronounced dead at a local hospital.

The state has released few other details. Citing the ongoing investigation, a Department of Justice spokesperson declined to answer questions about what kind of force the officers used or when exactly they noticed Rothe was unresponsive.

'The details that have been provided are pretty sparse, but raise a lot of concerns.'
Francesca Broderick, Disability Rights Center - New Hampshire

Broderick, with the Disability Rights Center, said her organization is exploring “whether, or what avenues, we’re going to pursue in terms of looking into what happened.”

“The details that have been provided are pretty sparse, but raise a lot of concerns,” Broderick said.

It’s unclear why Rothe was at the Secure Psychiatric Unit in the first place. Officials with the New Hampshire Department of Justice and Department of Corrections would not say whether he was serving a sentence or had been civilly committed. NHPR attempted to contact members of his family for more details but was not able to reach them.

“The Department of Corrections strives to provide adequate and appropriate care to all residents regardless of their history,” the agency said in a statement Monday. “Any death of a resident under the care and custody of the Department is a tragedy and the Department extends its sympathy to the family of Mr. Rothe.”

In the last decade, New Hampshire has faced at least two wrongful death lawsuits brought by the families of other people who died at a Department of Corrections psychiatric facility.

In 2015, 47-year-old Charles Mealer fatally overdosed on medication at the Secure Psychiatric Unit, in what the medical examiner ruled a suicide, according to court documents. The state settled a wrongful-death lawsuit from his family alleging negligence in 2018.

In 2017, a 34-year-old man named Phillip Borcuk, who had a history of mental illness, died after corrections officers shocked him multiple times with a Taser and restrained him in a prone position with his hands cuffed behind his back, according to records from a New Hampshire State Police investigation into the death.

Borcuk was housed at the Residential Treatment Unit, which is in the same building as the SPU at the State Prison complex in Concord. A wrongful-death lawsuit brought by his family is still pending.

Future plans for a facility outside of the Department of Corrections

Meanwhile, the state’s plans to build a new forensic psychiatric hospital are moving forward — with a delay.

The 24-bed facility, next to New Hampshire Hospital in Concord, will be run by the Department of Health and Human Services, rather than the Department of Corrections. It will be able to treat patients who are found not guilty by reason of insanity, are incompetent to stand trial or are civilly committed, but considered too dangerous for a conventional hospital.

The state health department originally said the facility was slated to open by the end of 2023, but that’s now been pushed back to June 2025. Department spokesperson Jake Leon said site tests revealed the need for additional work, and extra foundation work was also required to make sure New Hampshire Hospital can stay open during construction. Building costs and supply chain delays are also a factor, he said.

'We have an obligation to ensure that everyone's loved ones receive the right care at the right time.'
Susan Stearns, executive director of NAMI New Hampshire

Susan Stearns, the executive director of the National Alliance on Mental Illness’ New Hampshire chapter, said the new hospital will be a major improvement in caring for people who need mental health treatment in a secure setting.

“Every one of them is someone's child, someone's parents, someone's brother, someone's sister,” she said. “They have someone who loves them. And we have an obligation to ensure that everyone's loved ones receive the right care at the right time.”

Coulter, with Advocates for Ethical Mental Health Treatment, also said it will be a big step forward. But in the meantime, she’d also like to see greater independent oversight of the Secure Psychiatric Unit and its transfer to the state health department. She says the laws should also change so that the state is barred from transferring civilly committed patients into the Department of Corrections’ custody.

“You're not supposed to lose your life when you are in the custody and care of the state,” Coulter said. “These are vulnerable individuals.”

Paul Cuno-Booth covers health and equity for NHPR. He previously worked as a reporter and editor for The Keene Sentinel, where he wrote about police accountability, local government and a range of other topics. He can be reached at pcuno-booth@nhpr.org.

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