Court-ordered programs taking government funds have, in some cases, become part of the prison pipeline.
By Timothy Eric Ayers
I cannot be certain whether I started using drugs because of my mental health issues or whether my mental health deteriorated when I started using drugs. Either way, I've been in psychiatric wards more than 50 times in my 51 years. I've attempted suicide 11 times: twice by hanging, three times with a knife, and five times by intentional drug overdose. After my latest arrest, within the first month of incarceration, I tried hanging myself and free-fell off my bunk head first onto the concrete floor.
This history has led me to 25 inpatient programs and numerous halfway houses. Since my first exposure to the Alcoholics Anonymous and Narcotics Anonymous community at age 14, I’ve attended thousands of such meetings. In 2017, during a time of abstinence, I took classes and received a peer recovery specialist certificate. The aforementioned resume does not qualify me for much in this world, but it does give me the authority to speak on these topics.
My name is Timothy Eric Ayers, and I am a substance abuser in recovery. As I write this, I have been free of drugs and alcohol for just over 18 months. Since July 30, 2021, I’ve been living in a drug, alcohol, and mental health treatment facility called Gaudenzia Park Heights in Baltimore, Maryland. I was sent here by court order after breaching my probation. The hope was that by allowing me to get help with my addictions and mental health, I could avoid returning to prison.
Many of my fellow residents were also sent here as a “last chance” to avoid jail time. Centers like this one are largely government-funded by the state, Medicaid reimbursements, and federal grants (95.1 percent of Gaudenzia’s funding is state and federal money). In exchange, the center is tasked with overseeing our recovery. If we can be rehabilitated, the thinking goes, we will get out of the prison pipeline, breaking the cycle of incarceration.
On my first day at Gaudenzia, I was housed in a room with three other gentlemen, two of whom had been released from 12 years’ incarceration into this treatment program. Very quickly, I could tell that something wasn’t quite right. For one thing, every resident had a phone, though I had been told phones were not permitted until a later phase of our program. This may seem like a small matter, but it was a hint at how the coming weeks would dash my ambitions of receiving treatment.
Proper rehabilitation programs provide a rigorous schedule of therapy, groups, meetings, and one-on-one counseling. Life at Gaudenzia, on the other hand, is very loosely structured. The most important aspect of any day for the staff seems to be obtaining each resident's signature certifying participation in a “group session.” But approximately 85 percent of these sessions are nothing more than a social chat, with no staff present. Once in a while a discussion topic is set, or a movie played—most often, we are just left sitting in a room for 45 minutes. The center has counselors with various certificates and qualifications, but interactions with them are limited to a few superficial questions during a five-minute check-in.
For me and many others, AA and NA are the cornerstone of any recovery program, and during my first week here, I was anxious to attend a 12-step meeting. I had been clean for a year but knew I needed help to stay on track. To my surprise, Gaudenzia did not offer any 12-step meetings, which are normally standard at rehab centers. As this is a program for formerly incarcerated people with co-occurring disorders (both substance abuse and mental health issues), I had also assumed I’d be able to talk through my problems with a psychologist—but no. In more than six months inside these walls, I've yet to meet a psychologist employed by Gaudenzia. Many of the counselors are empathetic and kind, but they are overloaded with paperwork, leaving them very little time to focus on the people they are charged with helping.
The “care” provided by the center’s psychiatrists feels like the McDonalds of mental health. When a resident puts in a request to meet with one of them, that meeting will involve a few minutes of back-and-forth, and medication will be prescribed. Afterward, the patient is left largely to their own devices. My medications have run out three times, each time without my being told that the last dose had been issued. It wasn’t until I myself flagged that I needed a refill that a psychiatrist addressed it.
At other centers I have attended, therapy, counseling, and group sessions went deep into how each resident’s addiction had affected their family, criminality, and life. They helped us understand why we took drugs, and helped us manage our emotional state. We were held accountable when we broke rules. At Gaudenzia, by contrast, there is very little oversight of residents. One man told me he’d learned from a roommate how to cheat on a urinalysis test without getting caught, because no one pays attention to the sample’s chain of custody—one can simply pay another resident to urinate into the cup.
After a few days at Gaudenzia, I realized I was not in a rehabilitation center at all. I was in a glorified homeless shelter, unable to leave. The lack of treatment and support here began to generate a great sense of gratitude for what I had learned in past meetings, rehabs, halfway houses, and psychiatric hospitals. I would need to reflect on these experiences abundantly to make it through the months ahead. But many of my fellow residents have no such resources to draw on.
People are typically sent to centers like Gaudenzia for professional help to deal with their problems at the source, thereby breaking the cycle of addiction, mental illness, and prison. These centers are given a lot of government funding to carry out this mission, but with very little oversight or accountability. Much like the economics of the private prison industry, the less money a center puts toward staffing and resources, the more goes into company pockets. At “nonprofit” Gaudenzia, most executives make between $170,000-$200,000 per year; the CEO, $350,000. The overburdened counselors, on the other hand, make an average of $39,000 per year.
Meanwhile, drugs such as K2/Spice are all around me. At least one-third of the people living here are using crack cocaine. Many of these drugs get into the center because packages sent to residents are not checked, in breach of the rules. The program is understaffed. There are no repercussions for poor behavior. Those still inclined to criminal behavior take a mile for every inch they are permitted, and no one stops them.
I eventually began to interview my fellow residents to see whether I was alone in my sense that Gaudenzia was remiss in its duty to the court and those in its care. Not one person said they felt they got help with cognitive behavior. Not one said they got help with core beliefs they needed to address. Not one said they had hope instilled into them that they could re-enter society successfully.
For some, this was a first shot at treatment. Many of the people sitting rudderless in our group meetings had already spent upward of 15, 17, and 22 years in prison. There are men who have severe mental impairments receiving almost no mental health support, men with substance abuse issues who have no idea what AA or NA are.
Once a mentally ill or drug-dependent human being is locked up here, no one knows what goes on; we are put out of sight and out of mind. But what happens behind these closed doors—or more importantly, what doesn’t happen—is of great importance to the lives of the people who end up at this center, and to our neighborhoods, towns, and cities beyond.
For court-ordered programs intended to rehabilitate people and keep them out of jail, some kind of governmental oversight is crucial to ensure they are actually carrying out this taxpayer-funded duty. When a resident completes a program here on paper (and I can say firsthand that at Gaudenzia, it is on paper only), they are turned loose with a certificate declaring they have completed a treatment program. But as I see it, this paper is a lie. They instead return to society addicted to drugs, with untreated mental illness. What do you think will happen next?
There is little doubt that such a person, if they are lucky, will soon find themselves back in front of a judge who looks at their record and notes they were given a chance at rehabilitation and failed. Their only option will be imprisonment for longer and longer periods, where they’ll have even fewer resources to assist them in their quest to overcome their mental and substance difficulties. They will end up using again, committing crimes, overdosing, and most likely dying.
I'm writing this story for every man who agreed to be committed to this center and was promised an appropriate standard of treatment so he'd have a chance to change his life and learn how to re-enter society. Three out of every five prisoners have a substance abuse problem. At least half of incarcerated people have some mental health issue; 10-25 percent have serious illness such as schizophrenia or bipolar disorder. Locking up offenders in centers run by private entities with no accountability for the conditions within creates the illusion that we are changing our criminal justice system by diverting people from prison to get help. But in fact, this is just prison by another name—and just as ineffective.
Incarcerated people who attend rehabilitation programs that conform to principles of effective intervention are 25 percent less likely to reoffend than those who do not get such treatment. Government money—your money—is being sent to centers like this one across the country. Is anyone ensuring that this money is being directed appropriately? Is there any tracking to see whether people stay clean after attending this program—that it actually helps them? Gaudenzia, Inc., is one of the largest drug and alcohol treatment and recovery networks in the United States, with 51 facilities in Pennsylvania, Maryland, Delaware, and Washington. I don’t know whether Gaudenzia’s problems extend beyond this one center, but I suspect they do.
My stay here is coming to an end. I will go back to society, my family, my community, with a piece of paper that is in my opinion a falsehood, stating that I’ve been through a treatment program. Walking out of these doors, people like me will be assumed to have achieved something. But inside here, all we’ve done is time. Surely, there must be a way to hold these entities accountable to provide what they are paid for. I wish I had the power to do so, but I don’t, except to write this essay.
As of the time of publication, Gaudenzia did not reply to a request for comment.