Jails, prisons, and preventable tragedies

Approximately 218,000 individuals with severe psychiatric disorders are incarcerated in the nation’s jails and prisons at any given time. That means, sadly, stories like the one below are not as uncommon as we might think.

In Auburn, California near Sacramento, 46-year -old Herman "Tim" Van Bragt, fatally stabbed his mother’s friend earlier this week.

Van Bragt had dreamed his mother’s friend Robert Haggquist was going to kill his mother. When Van Bragt was home alone with Haggquist he fatally stabbed the 72-year-old.

Van Bragt’s mother said he had stopped taking medication for bipolar disorder:

She said her son subsequently stopped taking medication for his bipolar condition and crashed his vehicle.

"I'll never get over it. My son is very sick with bipolar disorder."

"If he had been on his medication..."

33 year-old Lakane Murphy was sentenced to life in prison today for killing Malachi Lofton. Murphy's attorney said he had struggled with bipolar disorder.

"The sad thing is had he been on his medication ... Mr. (Malachi) Lofton would be here," Pope said.

Imprisoned because of psychosis

After stealing a car in 1995 and violating parole by making harassing phone calls in 1998, Carl Scherer was sent to prison for seven years. Not surprisingly, the symptoms of his paranoid schizophrenia worsened while in prison.

His records indicate that the medications were constantly being adjusted or changed, such that at no time was he stable for any lengthy period of time," Gottlieb wrote. He also reported that Carl often refused his medication, which led to repeated cycles of psychotic behavior.

Just before Carl was released on parole in 2001 he became so ill he was sent to Cresson State Correctional Institute. Shortly after, Carl’s parole was revoked. Carl was to be kept in prison- a place never meant as a treatment facility- to get treatment for his schizophrenia.

"They took away his only opportunity to get the care he needed and left him in there, not because he didn't meet the criteria for being paroled, but because he has a mental illness. I mean, it's outrageous in my mind. …

"That's not the point of the correctional institutions — to house individuals with mental illness."

Shortly after Carl was returned to the general prison population, he was killed by his roommate.

Carl Scherer was apparently too ill to be paroled, but not sick enough to be kept in treatment.

Why are we relying on prisons to provide psychiatric care? Better yet - Why wasn’t Carl getting treatment long before he was entangled in the Pennsylvania prison system in the first place?

Citizens being warehoused in jails

It is estimated that 16 percent of our jail population is seriously mentally ill. On any given day in the Roanoke Valley, there are about 162 citizens with a serious mental illness being warehoused in our jails. And because they won't be treated by the mental health system, they become the responsibility of the criminal justice system. It is cost shifting of the most cynical kind. It is a return to the 19th-century method of care for our mentally ill citizens.

As a taxpayer, I am outraged at the fraud of this cost-shifting from the mental health system to the criminal justice system. As both a criminal justice and a mental health professional, I am ashamed.

- Roanoke Times op-ed by Isaac T. Van Patten, chairman of the Department of Criminal Justice at Radford University and the principal investigator for a federally funded CIT program and a jail diversion program for the mentally ill

The only place that can't refuse to take you

“Prior to 2000, the Alabama Department of Corrections didn’t consider mental-health treatment part of our mission,” [said Corrections Commissioner Richard] Allen

Yet now that is a primary responsibility. The results have been pretty horrible.

Allen noted something stunning in his presentation to a legislative committee. Of the 25,000 people in Alabama's state prisons, 20% (5,000 people) need treatment. Yet

"4,400 of those people would be considered outpatients were they not also
convicted of crimes."

So if Alabama were using outpatient treatment to intervene BEFORE these people committed crimes, the number of people needing treatment behind bars would be reduced dramatically … to less than 3% of the prison population instead of 20%.

That would save not only lives, but money.

Allen said the state prison system budget will fall short by $31 million this
year, and the cost of treating mental illness has contributed to that.

How can my loved one get inpatient care?

The above question is commonly raised by families seeking treatment for someone they love. Unfortunately, the reality of treatment in the United States is that care too often only comes once they’ve committed a crime.

A recent study in the journal of Psychiatric Services looked at the psychiatric and criminal histories of individuals in a large urban county jail and what psychiatric services they received while incarcerated. Their conclusion? One that is not at all surprising – a large percentage of persons with a severe mental illness receive their acute inpatient treatment in the criminal justice system rather than in the mental health system.

The study’s specifics are sadly familiar: 75% of the random sample were diagnosed as having a severe mental illness; 92% had a history of nonadherence to medications before their arrest; 95% had prior arrests.

These terrible statistics bring to mind the comments of the Bazelon Center’s Michael Allen, who recently pondered whether it was worse for a person with a severe mental illness to be in a psychiatric hospital or in prison.

Re-institutionalization?

In the waves of deinstitutionalization of the 1950s and 1960s the number of people with severe mental illnesses in public inpatient psychiatric facilities dropped dramatically.

In 1955, 558,239 patients were in public psychiatric hospitals. By the
mid-1990s, the number had dropped to fewer than 72,000. By 2002, the total had fallen below 50,000.

Where did they all go? Too many ended up on our streets, in homeless shelters, in emergency rooms, and in jails and prisons.

In Colorado, the director of the department of corrections is requesting nearly $60 million to double the size of a 250- bed correctional facility to house mentally ill inmates.

Colorado isn’t alone. In Maine, Governor John Baldacci announced a plan to have the state assume control of all 15 county jails. Some jails, according to the plan, will be turned into “specialty facilities for people with mental illness.”

Almost 50 years after the first push for deinstitutionalization it seems we’re still housing people with severe mental illnesses in institutions. Now we require them to commit crimes to get there.

An exercise in futility

The title of a recent editorial in the Tallahassee Democrat says it all: "Incarerating mentally ill is futile."

"The cost in human suffering by the ill person, by his or her family and any victims is no doubt equaled by the cost to the state when it uses self-defeating systems. Even on county levels, authorities such as Leon County's Sheriff Larry Campbell decry the current system as ineffective, with no end of costs in sight, but no real improvements either."

This is the one place that can't say no

The Richmond Times Dispatch has been conducting an extensive expose on the suffering of the mentally ill in Virginia’s corrections system. But as the Times Dispatch’s editorial board laments, for many, it may seem “almost old news.” The most severely ill are increasingly being abandoned by a mental health system all too willing to shift the burden onto law enforcement and corrections. And so Richmond will be forced to invest even more resources for mental health care in its jails, while the mental health system continues to pick and choose who it will treat -a mental health system that cannot even be bothered to know what their treatment laws say.

Does this pattern sound familiar? You call for help for your loved one in crisis, only to be told that nothing can be done until they’re dangerous. So you wait. And worry. And hope that nothing terrible happens. Finally, there’s an incident and you call back, only to be told, “call the police, we don’t come when people are dangerous.”

Most would call that absurd. But for Virginia’s mental health system, it’s business as usual.

Strain on jails and prisons continues

It’s likely not a coincidence that the jails and prisons are experiencing strain and overcrowding as inpatient psychiatric beds close. According to the Chronicle Telegram in Ohio:

Ohio had a 16 percent decrease in the number of private hospital psychiatric beds from 1997 to 2002, as well as a 21 percent decrease in state hospital beds over the same period. Thirteen private psychiatric units were also closed during those years.

These are not statistics the forensic community is not excited about in Ohio.

Jail administrator Ken Kochevar:

“If we had intensive treatment services in the community, then we wouldn’t be forced to operate a mental hospital here. We’re a jail. … Don’t ask us to do all these specialized services.”

Debbie Nixon- Hughes, chief of mental health services for Ohio prisons:

“Unfortunately, we’re probably one of the larger mental health providers in the state.” And that isn’t exactly what our mission was intended to be.”

Mental health treatment in prison

On May 22 in the LA County Jail a man strangled his roommate to death. Kurt Karcher has bipolar disorder and was being held in the LA County jail because he was facing trial for a similar slaying that had occurred in the state prison.

In a report regarding this case, released on June 29, the grand jury recommended, in part:

“…developing a program to better train mental health professionals who provide jail services.”

As reports continue to call for increased mental health staff and services for the criminal justice system, there is little doubt jails and prisions are acting as our country's de facto mental health system. Is it really prudent to wait until someone has committed a crime to provide treatment, and is prison really the best place to be getting it?

New book: Crazy in America

GUEST BLOG:

Written by Mary Beth Pfeiffer, author of “Crazy in America: The Hidden Tragedy of Our Criminalized Mentally Ill”.

"Children wait in emergency rooms for psychiatric beds, sometimes for days."
--- June 1, 2007, Hartford Courant editorial.

We all know that America had better than a half-million psychiatric hospital beds 50 years ago, beds that were whittled down in a great, silent wave of untethered humanity called deinstitutionalization. But few realize that deinstitutionalization is continuing, and so is the failure of community care to pick up the slack.

The children referred to in the quotation above, who suffer while waiting for psychiatric beds in Connecticut, are just one group of victims. Add to them the homeless, the incarcerated, the two-thirds of Americans with mental illness who go untreated.

From 1990 to 2000, long after deinstitutionalization was believed over, the nation lost an additional 57,000 psychiatric beds, bringing the total to 86,000. But the bloodletting didn’t stop there: Harrisburg State Hospital closed in Pennsylvania last year and with it 260 beds. In Florida, 36 private psychiatric hospitals have closed in since 1992 – taking 4,400 beds. In Iowa, 600 general-hospital psychiatric beds were shuttered from 1998 to 2002 -- nearly half the state’s total. Connecticut had three sprawling public mental hospitals in the 1950s, serving 9,000; with additional cuts in recent years it is down to about 600.

America’s system of mental health care is broken. Emergency rooms, which saw psychiatric cases rise by 56 percent from 1992 to 2003, take the brunt in this severely strained system. And jails and prisons act as de facto mental institutions where there is always a bed – and where at least 330,000 mentally ill people now reside.

America needs leadership on mental health care. We need leaders who are willing to equate the needs of people with mental illness with those who suffer from cancer and heart disease. We need legislators willing to provide funding for housing, clinics and subsidized insurance. We need a media willing to explore the ills of a forgotten and under-funded system.

This isn’t too much to ask.
---Mary Beth Pfeiffer

***
Visit Mary Beth Pfeiffer’s web site at www.crazyinamerica.com to see photographs of her profile subjects and get other information. To buy the book, go to http://www.amazon.com/Crazy-America-Tragedy-Criminalized-Mentally/dp/0786717459/ref=pd_nr_b_8/103-2156816-0667067?ie=UTF8&s=books.

The opinions expressed by guest bloggers are their own and not necessarily that of the Treatment Advocacy Center.

Want to be a guest blogger? Tell us why at info@treatmentadvocacycenter.org.

An overloaded criminal justice system

A news article in the Eagle Tribune in Massachusetts describes the current situation in the Rockingham County Jail in which an estimated 15 percent of the jail population has a severe mental illness. Jail superintendent Al Wright says it feels like he’s running a psychiatric ward rather than a forensic facility. “I tell people I’m the superintendent of Rockingham County jail, the biggest provider of services for the mentally ill in the county.”

The article continues:

Also, there is a shortage of psychiatric beds at the state hospital — down from 3,000 beds in the 1960s to 300 today. This leaves police little choice but to transport mentally ill suspects to jail.

There is no doubt the criminal justice system is overloaded with patients who should have received psychiatric treatment long before they landed in jail.

Ken Braiterman, coordinator with the National Alliance for Mental Illness in New Hampshire, hit the nail on the head when he said:

Treatment has never been better for mental illness, but it has never been harder or those in need to get it.

How many tragedies will it take?

Joel Seidel’s tragic death spurred reforms in Camden County’s jails, new diversion programs by police departments, and a federal lawsuit that was recently settled for $4 million. The one area that has yet to enact reforms? New Jersey’s mental health system.

New Jersey is still one of only eight states without the ability to order AOT for individuals who are unable to maintain their treatment in the community. Individuals like Joel Seidel, who according to news reports, had repeatedly refused to take medication for schizophrenia and had failed to complete outpatient treatment programs. An attorney for Seidel’s family explained that they hadn’t posed the $150 bail that would have released him because they were hoping he would be involuntarily committed to get the help he needed. Sadly, he never got that chance. His lifeless body was found about an hour before his scheduled court hearing on his involuntary commitment.

AB 2304, a bill that would finally provide New Jersey the opportunity to help those like Joel Seidel, sits in a committee awaiting action. It should be passed before the next senseless tragedy occurs.

It's time for treatment before the crime

An op-ed by Jeff Gerritt at the Detroit Free Press calls for treatment rather than incarceration for those with severe mental illnesses who have committed a crime. Before suggesting a solution, Gerritt delves into the sad history of abandoning the mentally ill. As he so explains:

A solution is long overdue. When Michigan closed most of its mental hospitals in the 1990s, the mentally ill didn't just disappear. They ended up on the street, in homeless shelters, and, increasingly, in jails and prisons. One sheriff called the state's jails and prisons the new asylums. Today, nearly 25% of Michigan's 51,000 prison inmates are mentally ill.

No doubt, putting mentally ill people in a freer, less costly setting was a good idea. But as institutions closed, the state failed to invest in community mental health programs. People with severe mental and emotional problems went untreated.

The op-ed goes on to support the creation of mental-health courts to steer people with mental illnesses who have committed a crime into treatment rather than jail or prison. This is a good step for those already in the forensic system.

An even better step? Using Michigan’s assisted outpatient treatment law – known as Kevin’s law- to get treatment BEFORE a crime is committed.

California's three strikes law: schizophrenia + 2 bottles of booze = 25 to life

The Treatment Advocacy Center receives thousands of calls and e-mails each year from people desperately striving to help loved ones at risk because of the symptoms of severe mental illnesses. Although we were not formed to be a help organization, these pleas we cannot refuse. We inquire about the person’s condition and situation, and then offer advice, information, and referrals.

If the caller is from California, we ask one more question than with most other states: “How many strikes?” That is because California has one of the toughest “three strikes” laws in the country. In that state, a person can earn their first two strikes for serious or violent felonies. A psychotic phone call deemed by a court to be a terroristic threat is sufficient. The eligibility threshold lessens even more for the third strike: any felony will do. And a third strike means 25 years to life.

Three strikes laws are designed to keep habitual criminals off the streets; they are also vastly wide and deep pitfalls for people in crisis because of acute psychiatric disorders. The results are as sad as they can be absurd.

The Ninth U.S. Circuit Court of Appeals in San Francisco recently considered the appeal of a man with schizophrenia who had stolen $68 of liquor from a market. It had gotten him a third strike and a 25-year to life sentence. One of the justices on the appellate panel called the sentence "barbarous.'' The other two disagreed and the sentence was confirmed.

If the phrase “cruel and unusual punishment” comes to mind, don’t look for help from the U.S. Supreme Court. The nation’s high court upheld two similar, excessively punitive sentences ordered pursuant to the same California law in 2003. Both third strikes were also for theft. One man stole three golf clubs and the other two videotapes.

Kendra's Law- more important than ever

A recent investigative report by WABC TV in New York showed in the past 15 years, the number of inmates with mental illnesses in New York state prisons has grown by 71 percent, and that many of these prisoners have spent months, even years in total isolation, with virtually no therapy. According to Jack Beck, an attorney for a prison watchdog group:

"Often people with mental illness start their Southport Correctional Intuition sentence not because they've done some terrible act, but they've done some smaller act," Beck said. "But then, once they’re in this environment, that is so difficult for them to cope with, they start yelling and screaming and just being non-cooperative."

"Instead of having mental health beds, we have prisons and jails for the mentally ill. And that is the story."

Meanwhile, Kendra’s Law in New York has had stunningly successful results- For those in the AOT program: 77 percent fewer experienced psychiatric hospitalization; 83 percent fewer experienced arrest; and 87 percent fewer experienced incarceration.

The continued use of Kendra’s Law – a proactive approach to get treatment for people with severe mental illness before they deteriorate and commit a crime- is more important than ever.

Long road to treatment for Vitali Davydov

At least Vitali A. Davydov won’t be going to prison.

Davydov, 20, pled guilty this week to murdering Dr. Wayne Fenton, a psychiatrist who, as we’ve said before, was the exception in a mental health system that is geared almost exclusively to patients who are able to seek treatment voluntarily. Dr. Fenton embraced the most difficult cases and never turned people away who were really suffering, including Davydov.

"The average psychiatrist in the Washington area is on Connecticut Avenue and he's seeing . . . some executive who got passed over for a promotion and is having a midlife crisis," said Fuller Torrey, a local psychiatrist who often referred severe cases to Fenton. "Wayne was one of the few out here seeing the severely mentally ill. He was strongly committed to providing care and promoting research for the sickest people."

Davydov will be committed to a Maryland psychiatric facility until he is no longer considered dangerous. Hopefully, that means he will finally receive the treatment Dr. Fenton was trying to get him the day he was murdered.

Too late for Seidel, NJ could still save others

Joel Seidel, a frail 65-year-old retired stockbroker with schizophrenia, was stomped to death in 2004 in a Camden County, New Jersey, jail.

His cellmate, accused of the murder, was so violent he had been sent to jail from a psychiatric hospital after he raped another patient. Jail procedures in New Jersey have since been reformed to prevent vulnerable inmates from being housed with violent ones. Seidel’s family hopes those procedures will be made permanent in a settlement of a lawsuit against the county.

But what has been done to prevent people like Seidel ending up in jail in the first place?

Seidel “repeatedly refused to take medication for schizophrenia and had failed to complete outpatient treatment programs.” His family did not bail him out of jail because they believed that he “could only get help if he was involuntarily committed to a county psychiatric hospital” from the jail.

If his family had had some other way to ensure he would participate in treatment in the community rather than getting treatment via jail, he might be alive today. But the family’s hands were tied because New Jersey is one of only 8 states whose archaic law prevents court-ordered community treatment. Community treatment programs were available for Mr. Seidel – he was just too sick to realize he needed treatment. A court order might have saved his life.

A bill (S1093) that will help prevent other New Jersey families from facing the Seidel family’s dilemma and tragic loss passed the New Jersey Senate unanimously nearly a year ago. But it is still not law because the Assembly Human Services Committee has not even scheduled a hearing for the bill (A2304).

New Jersey must act now to make community services available to people like Joel Seidel who are too sick to participate voluntarily.

Simple logic

Prison = bad.
Prison + mental illness = very very bad.

Get it?

"States can institute policies to keep mentally ill inmates out of segregation or wait for litigation to force them to do so. They can improve the quantity and quality of mental health services they provide. But even those necessary steps fail to confront the larger question - should prisons be de facto mental institutions? If not, then the country must reduce the number of mentally ill people who are incarcerated. "