At Hawai'i Community Correctional Center in Hilo, for instance, as many as three inmates believed to be a danger to themselves or others have been kept on suicide or safety watch for long periods in the same tiny holding room, a potentially volatile mix that is tolerated only because of a lack of space, two of the employees said. The room is so small that when three mattresses are laid on the floor, almost the entire area is covered. Sometimes, the room is used to temporarily house as many as five regular inmates because the staff has nowhere else to put them.

"If this was a dog kennel, the Health Department would have shut us down years ago," said a Hilo prison worker who asked not to be named for fear of retribution. "We treat animals better than this."

"It is far from ideal," Patel agreed, but he said staff limitations provide no alternatives.

While these pre-trial detainees are sitting in jail, "they're getting nothing" in terms of treatment, said Gary Smith, president of the center.

Dr. John Purtzer, a psychiatrist who worked three days a week for DPS from 2003 to 2006, said he talked with patients in hallways and other areas at the Maui and Hilo prisons whenever the offices he otherwise would use were busy.

'IT'S A SHAME'

The findings underscore what many advocates say has been a steady deterioration of conditions in recent years within the DPS network, which has eight facilities and early this month housed nearly 3,700 inmates.

"All of the prisons are a mess," said Lois Perrin, legal director for the ACLU of Hawai'i. "I don't know of a facility that is in compliance with constitutional standards. ... It's a shame."

David Fathi, senior staff counsel for the ACLU's prison project, the only national litigation program on behalf of prisoners, said the conditions described by The Advertiser were "overwhelmingly likely" to violate the inmates' constitutional rights.

One or a few of the conditions exist at prisons around the country, but "the combination of all of them in one system is somewhat unusual and certainly cause for concern," Fathi said.

The DPS professionals and support staff who work with Hawai'i's mentally ill prison population generally are praised by prisoner advocates and others as hard-working and dedicated, doing the best they can under trying circumstances. But they have so little to work with that their patients suffer, the advocates and professionals say.

"A lot of this happens by default, not by design," said Patel, the agency's chief psychiatrist for the past four years.

Still, the effect is the same, advocates say.

"We're nowhere near the minimum standard of care, and that's what's scary," said Kat Brady, coordinator of the Community Alliance on Prisons. "People who enter prisons with mental-health problems are going to become way more damaged than when they came in."

Federal concerns about the quality of prison mental-health care surfaced in mid-2005 when the Justice Department notified Gov. Linda Lingle that it was investigating such services at OCCC, considered at the time one of the better DPS facilities for dealing with the mentally ill because of improvements made during the court oversight.

What three medical experts found there during their October 2005 site inspection was disturbing.

Many seriously mentally ill inmates were being harmed because of a lack of adequate care, according to the November 2005 report the experts wrote. Some women detainees who needed psychiatric hospitalization because of severe psychotic symptoms, for instance, were instead kept at OCCC and placed in restraints or secluded, worsening their conditions, the experts noted. One severely psychotic woman was released from the jail to the streets without adequate assessment of suicide risk and stabilization of her psychosis.

The report, not publicly released but recently obtained by The Advertiser, detailed widespread and systemic problems with mental-health treatment at the facility, which had been under court supervision from 1985 to 1999 partly because of deficiencies in its mental-health care.

That supervision ended once the court determined the facility was in compliance with a consent decree between the state and the ACLU, which had filed a class action lawsuit in 1984 over prison conditions at OCCC and the women's facility on O'ahu.

Yet six years after the court oversight ended, the three experts found some of the same or similar conditions facing OCCC's mentally ill population. The deficiencies they documented were similar to problems critics say plague the rest of the prison system today. Together, the assessments depict a system largely failing a group with no political voice and few advocates, partly explaining how conditions have been allowed to deteriorate.

LOCKDOWNS CRITICIZED

The experts' report is not the official findings of the Justice Department. A spokeswoman said the investigation is continuing and an official findings letter will be issued later, though she couldn't say when.

The experts found much that was lacking with OCCC's quality of care.

Detainees not on suicide watch or therapeutic lockdowns had no therapies outside of medication, no individualized treatment plans, no organized counseling and no group activities, the experts said.

"Inmates are locked down more than not and there is little to no opportunity for therapeutic intervention of the most rudimentary kind," they wrote.

The experts also found significant problems with the prison's use of therapeutic lockdowns, suicide watch and restraints.

Therapeutic lockdowns, which were triggered by disruptive or threatening behavior and could last days or weeks, meant secluding prisoners and giving them no privileges, such as reading materials, personal visits or phone calls, cigarettes or social interaction.

Reach Rob Perez at rperez@honoluluadvertiser.com.