In prison, she has earned her barber’s license and is now cutting other inmates’ hair in the barber shop at the ACI.

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The Providence Journal / Mary Murphy

Ginger Collins is about five years old when the devil first appears. Only she can see him.

Sometimes, he’s in her closet. Sometimes, he’s at her window. The pretty little girl with the brown eyes and brown hair pulls the covers over her head, but terror persists –– the devil’s under her bed now, whispering.

You’re mine, he says, in a voice only she can hear. You’ll never get away from me.

When morning comes, Ginger tells her parents. They assume nightmares haunt their daughter and to reassure her, they fill her closet with stuffed animals, no space left for the devil to hide. They nail her window shut, on the improbable chance that someone might have climbed into her second-floor bedroom.

Night after night, the devil returns.

During the day, while riding her tricycle, Ginger sees dead people on the doorsteps of houses in her East Providence neighborhood. When Ginger’s grandmother dies, her parents do not take their daughter to the funeral or the cemetery –– but Ginger imagines she is there, watching as chopped-up pieces of her grandmother are thrown into a pit.

These are among the early symptoms of the mental illness that will torment Ginger Collins for years — an illness that, during times when she is not treated, causes her hallucinations, paranoia, depression, anxiety and eating disorders. It moves her to attempt suicide and helps ease her into the company of criminals.

Thirty-seven now, Collins has lived nearly her entire adult life at the Adult Correctional Institutions, where she is serving a 65-year sentence for her role in a 1994 murder. Two men who participated with her are incarcerated, too.

Medication now controls Collins’ illness, schizoaffective disorder. She is connected to the real world –– the devil is gone –– and her behavior is praised by prison staff. Having survived malignant breast cancer and the emotional distress that accompanied a radical mastectomy, she looks forward to this fall, when she could be paroled to a community residential facility. Her ACI caretakers point to this as evidence of the quality of treatment she has received during her long incarceration.

But others, most prominently state Mental Health Advocate H. Reed Cosper, say Collins should never have been sent to prison. He considers it a throwback to the days when the mentally ill were banished in chains to root cellars and attics. Cosper contends that Collins belonged in a psychiatric hospital, where she would have benefited from the treatment provided by a specialized staff.

And while Collins’ crime is extreme, Cosper regards her case as symbolic of the hundreds of other mentally ill Rhode Islanders who are behind bars –– the majority of them guilty of such nonviolent offenses as drug dealing and violating probation.

“We have forgotten a compact we made with mentally ill people,” Cosper says. “We’re now led by people who just don’t understand that we have a moral obligation, as civilized people, to protect mentally ill people from criminalization. We’re too focused on punishment and we’re too lacking in compassion.”

JOHN AND DONNA COLLINS assumed the second of their three children possessed only a vivid imagination, but their reassurances failed to convince Ginger that the devil in her room wasn’t real. There were other disturbing signs –– headaches, unusual shyness, unexplained panic. Thinking the cause was physical, they brought her to doctors. Tests were run.

“Everything kept coming back normal,” says Donna. “But I said, ‘there’s just something not right about her.’ ”

At times, Ginger herself suspected something was wrong in her head.

“I knew I had a problem,” she says during one of several interviews at the ACI. “I just didn’t know how to tell my parents.”

As Ginger entered adolescence, her behavior deteriorated. Once a quiet, if moody, middle-class child who liked reading and movies and wanted to be a veterinarian when she grew up, she began to use offensive language. She drank, smoked marijuana and snorted cocaine. She was not violent, but teachers labeled her a troublemaker.

John, an office-equipment salesman, thought she was “a troubled drug addict.” Donna, daughter of a Barrington policeman, viewed her as “a very rebellious child.”

They brought Ginger to a counselor and Narcotics Anonymous meetings, without result. In April 1987, Ginger, not yet 16, was seen at a mental-health center. Adjustment disorder with anxiety –– a mental imbalance following stress –– was diagnosed. Ginger would later recall being raped, although her recollection was, and remains, murky.

Ginger Collins graduated from North Providence High School in 1990. Her illness was intensifying.

She often lost her appetite. She saw and heard things. She blacked out. She overdosed on her prescription medications. She cut herself with razors. On May 13, 1992, she was admitted to Butler Hospital, in Providence. A doctor wrote: Mental Status: Bizarre, hallucinations, difficulty with attention/concentration, tangential, worthlessness, and general anxiety.

The Butler staff stabilized her, and she was discharged with instructions to stay on her medications and seek additional treatment at the mental-health center, now called Gateway Healthcare, in Johnston. She did receive treatment there but was rehospitalized at Butler, in March 1993.

BY THE END of 1993, Collins had fallen in with three young men whose fates –– along with hers –– would shift forever in a blood-spilled night.

Collins met James A. Wieneke, 21, a high school dropout from Florida, at a nightclub. By year’s end, she shared an apartment in Pawtucket with him and a second man, Michael J. Ruggieri, 22. Ruggieri made headlines in 1992, when he pleaded no contest to charges related to driving a car that tumbled over an embankment, killing a 15-year-old passenger. Ruggieri was drunk. He left the scene.

By early 1994, Collins, Wieneke and Ruggieri were working for Roger B. Oliver Jr., 22, owner of an escort service based in North Providence. Collins’ escort name was “Kelly.” She says she quit after a few weeks.

Having also quit her medication, she was again losing connection to reality. “Fake” is her description of how she observed the world outside her apartment.

“I stayed in my bed, in my room, and I’d look out the window and it just looked like a plastic model,” she says. “I was so sick that I didn’t realize what I was doing or where I was.” She wouldn’t take her medicine as prescribed –– but she deliberately swallowed handfuls of pills, hoping to die.

In the early hours of May 3, 1994, after a night of drinking, Collins and Wieneke returned to the apartment, where they found Ruggieri. In statements made to the police, Collins, then 22, and the men gave significantly different accounts of what happened next. But they agree on this: they all went to Oliver’s apartment on Morris Avenue on Providence’s East Side.They intended, perhaps, to rob the man. Or perhaps one or more of them intended to kill Oliver in a scheme to take over his business. The truth probably will never be known.

Oliver’s autopsy report disclosed stab wounds and head trauma. Forgoing their rights to trial, Collins, Wieneke and Ruggieri all pleaded guilty to second-degree murder, and the question of what role each played in the crime went unanswered. Collins says she stabbed Oliver, once or twice –– out of fear.

“I went to walk away, to leave, and then Mike followed me and brought me back to Roger and gave me the knife and said, ‘stab him.’ I was like, ‘no, I can’t.’ He said, ‘if you don’t stab him, I’ll kill you.’ ”

Collins says she wanted to die, but not at Ruggieri’s hands. After stabbing Oliver, she says, she hid in the bathroom. “I was so scared. I wanted to throw up, wanted to cry, but I didn’t want him to know that I was scared and wanted to cry and was sick. I wanted him to think that I had no feelings.”

Cosper believes Collins should have attempted an insanity defense.

“In a society that had rational policies toward mentally ill people and mentally ill offenders like Ginger,” says Cosper, “she would have been acquitted on grounds of insanity and she would have been institutionalized in the state mental hospital for a very significant period of time and then discharged very carefully to a step-down, secure facility in the community.”

A judge sent Collins to prison, the usual sentence for second-degree murder.

HISTORY IS rife with examples of inhumane treatment of people with psychiatric disorders. Americans by the mid-19th century no longer routinely stoned or burned the afflicted, but the insane remained at the bottom of the social order. Dorothea Dix, the Massachusetts woman who campaigned 150 years ago for better treatment, wrote:

“Were I to recount the 100th part of the shocking scenes of sorrow, suffering, abuse and degradation to which I have been witness –– searched out in jails, in poorhouses, in pens and block-houses, in caves, in cages and cells, in dungeons and cellars; men and women in chains, frantic, bruised, lacerated and debased –– your souls would grow sick at the horrid recital.

“Yet all these have been witnessed, and for successive years shocking facts have been patiently investigated. And why? In order to solicit and procure a remedy for such heart-rending troubles: the only remedy, the establishment of well-constructed, curative hospitals.”

She meant psychiatric hospitals. Many states heeded her call, including Rhode Island, which in 1870 opened the State Asylum for the Incurable Insane in Cranston. But by 1954, when the population of what was called the Institute of Mental Health, or IMH, peaked at 3,459 patients, abuse was common. Outrage led to deinstitutionalization, which shifted care to the community, a more humane environment, advocates maintained.

Rhode Island spent tens of millions of dollars in the 1970s and 1980s to build a system of care that included treatment centers, group homes and other programs –– a system that today needs improvement but still meets the needs of the majority of Rhode Island’s mentally ill, according to Craig Stenning, acting director of the state Department of Mental Health, Retardation and Hospitals. The IMH’s population declined, and in 1994, the asylum closed, with the remaining patients transferred to state-run Eleanor Slater Hospital. Slater today has approximately 125 psychiatric beds –– less than four percent of the IMH’s capacity of 50 years ago.

Stenning says Slater’s present capacity meets the needs of mentally ill Rhode Islanders. Critics say the pendulum has swung too far, to the detriment of some of the mentally ill, including some of those in prison.

Says Alan Feinstein, a former IMH psychologist who is now supervising clinical psychologist for the Department of Corrections:

“As more and more people were released from the state’s mental health facilities into the streets and more independent living, and the criteria for hospitalization became more restrictive, you saw what was not really deinstitutionalization but ‘trans-institutionalization’ –– instead of getting locked up in mental hospitals, getting locked up in prison.”

GINGER COLLINS believes that she would have been restored to sanity more quickly if she had been sent to a secure ward at a psychiatric hospital. Cosper agrees. Collins was depressed, confused and severely disoriented during her early days behind bars. At times, she thought she was on vacation in Spain.

On June 30, 1994, six weeks after her arrest for Oliver’s murder, Collins sent a letter to Weineke, who was also at the ACI:

“Sorry I haven’t written you. I was just waiting for my luggage. It got lost on the airplane. But I made it to Spane just fine. … American Country Club Inn, yes, this is where I’m at. It’s pretty nice here. Just looking out my back window there is a big lake with bushels of trees everywhere. The water is fresh and warm. You can go fishing out on a little bote…. I have a big room, wall to wall carpets, and a big king size water bed…”

As her prison sentence unfolded, Collins received medication and therapy and began to improve. She studied, took up art and poetry, and earned praise from the prison staff for model behavior. An Episcopal priest who visited frequently during the 1990s said Collins regretted her crime. “At no time in any facet or mood did she indicate anything except deep sorrow and remorse,” the Rev. Donald A. Lavallee wrote in May 2000 in support of Ginger’s eventual plan to seek parole. (Attempts to reach Roger Oliver’s parents were unsuccessful.)

Roberta Richman, warden of the Gloria McDonald Awaiting Trial & Medium Security unit during much of Collins’ imprisonment there, took a personal interest in her care. Now assistant director of rehabilitative services for the Department of Corrections, Richman says that, under the circumstances, Collins has received appropriate treatment at the ACI.

“Given the fact that she was incarcerated, that she got this sentence –– given all that — she probably got as good treatment here as I could have hoped for,” Richman says.

Cosper disagrees. In a suit filed last year to have Collins finish her confinement at Eleanor Slater, he accused the ACI of misdiagnosing and “under-treating” Collins and subjecting her to inappropriate isolation. Medications were changed and discontinued, he alleged, “often without any clinical explanation.” Record-keeping was so sloppy that were the ACI a mental-health provider, he said, it would lose its license.

“This standard of care does not meet any contemporary standard for psychiatric treatment,” Cosper wrote. “It probably does not even meet a 19th century standard for psychiatric treatment. The prison does not maintain any ‘therapeutic milieu’ anywhere within its walls that is minimally appropriate to treat a mentally ill population.”

Late in 2004, Collins was diagnosed with malignant breast cancer; in February 2005, surgeons removed a breast. Collins began chemotherapy but stopped taking medication for her mental illness. By January 2006, she was beginning to psychologically “decompensate” –– in lay terms, she was falling apart. In April 2006, the ACI took the rare step of transferring her to Eleanor Slater, where, benefiting from the ‘therapeutic milieu’ Cosper desired for her, she was restored to mental health, according to those who have charge of her care.

Cosper sued to have her kept there. He lost. On July 26, 2007, after 14 months at Slater, Collins was sent back to the ACI.

LONGTIME PSYCHIATRIC hospitalization would not be appropriate for many of the ACI’s approximately 400 mentally ill inmates, most of whom have committed lesser crimes and suffer from milder disorders than Collins, according to Cosper and Richman. For this larger group, even Corrections Department officials say the state should offer alternatives to prison.

“There will never be enough resources to do all of the rehabilitation work inside the prison that could be done,” says Richman. “That’s because of the nature of the beast. About 85 percent of the department’s budget goes to personnel, custody and control.”

Richman supports secure halfway houses for the convicted mentally ill –– what she calls “something in between” prison and freedom. Plans to open some failed, she says, in the face of opposition from correctional officers and communities.

“Rhode Island, unlike Connecticut and Massachusetts and many, many states around the country, has no intermediate sanctions,” Richman says. “So we wind up incarcerating everybody at a huge cost to the public.” (A handful of people judged criminally insane are kept at two forensic units at Eleanor Slater.)

Hopeful that she will be paroled this fall, Collins has been working with a community mental health center to find supervised housing and a job. Richman supports her ambitions. “You have the ability and the will to change,” she wrote to Collins in 2001, “and, when the time comes to leave prison, to reenter the community as a healthy and productive member of society.”

As she waits for her parole hearing, Collins preoccupies herself with drawing –– fairies are her favorite subject just now. She is taking computer and journalism classes, and she has a job cutting inmates’ hair. It pays $3 a day.

The devil is gone now. The future, she hopes, will finally favor her.

“I don’t want to live in the slums,” she says. “I don’t want to struggle eating. I want a roof over my head, plenty of clothes for work, a car. I want to be able to go on little road trips. Spend time outside, you know –– go out. Get a dog.

“I want a good life. I want to be happy.”

gwmiller@projo.com