PORTLAND, Maine — Shortly after a 16-year-old transgender boy hanged himself while on suicide watch at the Long Creek Youth Development Center last October, a girl at the juvenile prison also tried to take her own life, strangling herself before being rushed to the hospital, according to a citizen group that monitors the prison.

Charles Maisie Knowles was the first person in at least 20 years to die while being held at Long Creek, according to the Maine Department of Corrections. But the pair of suicide attempts — one of which resulted in a death — are part of a persistent pattern of self-harm among inmates at Long Creek, according to the South Portland prison’s Board of Visitors, a five-member body appointed by the governor and empowered by law to inspect and review the corrections facility.

Long Creek increasingly is being used to house young people with severe mental illnesses, even though the prison is ill-equipped to treat them and struggles to keep them safe, the group said.

“To date, several youth continue to self-harm, have made attempts or threats to strangulate themselves, and require unsustainable levels of constant observation,” the Board of Visitors wrote in its 2016 annual report.

Tonya DiMillo, a trained social worker and chair of the board, said the report was based on visits to Long Creek and ongoing discussions with the facility’s staff and administration.

[MORE: Transgender teen’s suicide raises concerns about Maine youth corrections center]

The findings reflect a trend in recent decades when Maine prisons and jails increasingly house mentally ill inmates who cannot find care in the state’s scarce and limited psychiatric facilities. In 2015, more than one-third of adult inmates and nearly half of juveniles were prescribed psychiatric medications, a Bangor Daily News investigation found.

In Long Creek, the rate of mental illness is even higher, according to a Department of Corrections report on the 79 youth who were committed to the facility as of July 1, 2016. Nearly 85 percent of inmates arrived at the youth prison with three or more mental health diagnoses, 42 percent had previously been treated in a residential treatment program — and 30 percent came directly to the prison from such a facility, the report found.

[tableau server=”public.tableausoftware.com” workbook=”Longcreekdiagnosisstats” view=”Diagnoses?:showVizHome=no” tabs=”no” toolbar=”yes” revert=”” refresh=”” linktarget=”” width=”100%” height=”485px”][/tableau]

[tableau server=”public.tableausoftware.com” workbook=”Longcreekdiagnosisstats” view=”Statusdash?:showVizHome=no” tabs=”no” toolbar=”yes” revert=”” refresh=”” linktarget=”” width=”100%” height=”385px”][/tableau]

Department of Corrections Commissioner Dr. Joseph Fitzpatrick acknowledged that “there are some kids coming in with significant mental health issues that are beyond the training of the corrections staff.” But in a brief interview he referred the question on why this is happening to the Maine Department of Health and Human Services.

“I don’t oversee that part of the system,” Fitzpatrick said.

The Department of Health and Human Services does not place people in Long Creek, according to spokeswoman Samantha Edwards. “Only a judge can make a decision of whether to transition a youth or anybody from a treatment setting to a correctional setting and vice-versa,” Edwards said.

At a joint meeting of the Criminal Justice and Public Safety and Appropriations and Financial Affairs committees on Feb. 15, DiMillo urged lawmakers to start asking why mentally ill youth are being moved from psychiatric facilities to prison.

“What is going on in the mental health system?” she said.

Knowles hanged himself from the inside door of the isolation room where he was on suicide watch. An investigation by the Maine attorney general’s office found nothing criminally suspicious. An outside expert hired to review the prison’s suicide prevention policy is expected to submit a report soon, though it is unclear whether that will be made public.

The Board of Visitors, however, suggested that the suicide was a predictable outcome of putting severely mentally ill adolescents behind bars.

Without the resources to treat the uptick of youth with severe mental illnesses, Long Creek can only try to keep them safe, according to the Board of Visitors report.

Attempts to stop young people cutting and strangling themselves include the use of “mechanical restraints,” around-the-clock observation and specialized clothing that cannot be torn to make a noose, DiMillo told legislators earlier this month. But the constant efforts are overextending prison staff and “another tragedy could be around the corner,” she warned.

“These youth need to be moved out of the facility or we are going to have another incident,” DiMillo said in testimony before two legislative committees. “I need to be clear: We will have another incident.”

Many months before Knowles succumbed to his self-inflicted injuries on Nov. 1, the Board of Visitors raised the alarm about imprisoning “youth in acute mental health crisis” at a facility that “is not medically equipped to deal with” them, the report states.

Knowles suffered from anxiety, depression, borderline personality disorder and possibly schizophrenia, according to his mother. After her son’s death, Michelle Knowles said he wasn’t getting the mental health care he needed because he was being detained at Long Creek awaiting trial, rather than being a committed prisoner.

Fitzpatrick challenged this assertion at the time saying that detainees and committed prisoners receive the same “ comprehensive treatment services” from the prison’s team of psychiatrists, psychologists, social workers and the commercial medical contractor Correct Care Solutions.

Despite the hard work of the prison’s “talented, gifted” staff, they just don’t have resources or training to treat young people with severe mental illness, DiMillo said.

Fitzpatrick put it bluntly: “We’re a correctional facility, not a treatment facility.”

The “unsustainable” efforts to protect mentally ill youth who cannot be treated at Long Creek is also taking a toll on the prison’s staff, according to the Board of Visitors. The group says it is driving “staff turnover, burnout, or the inability of staff to build positive relationships with all youth residents.” It also interferes with the staff’s ability to help rehabilitate other young prisoners and detainees, the board said.

On Monday, Fitzpatrick acknowledged that Long Creek inmates’ severe mental health issues are putting pressure on its staff.

“The stress at the facility … is related to the acuity of the population,” he said.

These concerns are becoming public even as Long Creek is looking at cutting staff at its school.

As part of Gov. Paul LePage’s proposed budget, the Department of Corrections would to cut 11 positions from the school operated at Long Creek. Although three of the posts were unoccupied when the budget was drafted, cutting 10 of the school’s 22 teaching positions, and its assistant principal, might endanger the school’s accreditation, corrections officials said.

The cuts would eliminate more than $1 million in annual personnel costs from the facility’s overall budget of close to $17 million. Fitzpatrick said that a contractual seniority system shapes which teachers could be cut and that the Department of Corrections is working with the Maine Department of Education to find a way to keep the school accredited if the cuts go through.

“I’m absolutely committed to not losing the school,” he said Monday.

Fitzpatrick said his department is working closely with the Department of Health and Human Services to try to solve the problems at Long Creek. DiMillo, who worked in child services for about 20 years, said that part of the problem is that there aren’t as many Maine facilities to care for the mentally ill as there used to be.

“If there was a place for these young people to go, I think that Long Creek would be working very hard to place them there,” she said.

This story was updated to include comment from the Department of Health and Human Services.