American Psychosis (24 page)

Mentally ill inmates are also major management problems because of their impaired thought processes.

• In an Oklahoma prison, “screams, moans and chanting are normal. The noise level rises as the sun goes down. . . . One inmate believes he is in a prisoner of war camp in Vietnam while another screams that communists are taking over the facility.”

• A deputy at Mississippi’s Hinds County Detention Center said: “They howl all night long. If you’re not used to it, you end up crazy yourself.” One inmate in this jail was described as having “tore up a damn padded cell that’s indestructible, and he ate
the cover of the damn padded cell. We took his clothes and gave him a paper suit to wear, and he ate that. When they fed him food in a Styrofoam container, he ate that. We had his stomach pumped six times, and he’s been operated on twice.”

• Many other mentally ill inmates are quiet. In an Oklahoma prison, “one resident of the acute-care unit sculpted figurines out of his feces.” In California an inmate in San Mateo County Jail’s maximum security wing “lies curled up naked in a pool of urine.”

• Mentally ill prisoners are also victimized much more frequently than nonmentally ill prisoners. According to a 2007 prison survey, “approximately one in 12 inmates with a mental disorder reported at least one incident of sexual victimization by another inmate over a six-month period, compared with one in 33 male inmates without a mental disorder.” Among female mentally ill inmates, this difference was three times higher than among male mentally ill inmates.
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Not surprisingly, mentally ill inmates cost significantly more than nonmentally ill inmates. In Florida’s Broward County Jail in 2007, the difference was $130 versus $80 per day. In Texas prisons in 2003, mentally ill prisoners cost $30,000 to $50,000 per year, compared to $22,000 for other prisoners. In Washington State prisons in 2009, the most seriously mentally ill prisoners cost $101,653 each, compared to approximately $30,000 per year for other prisoners. And these costs do not include the costs of lawsuits being increasingly brought against county jails, such as the suit brought in New Jersey in 2006 by the family of a “65-year-old mentally ill stockbroker [who was] stomped to death in the Camden County Jail.”
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Sheriffs, however, originally applied for their jobs as law enforcement officials, not as custodial mental health workers, and in many counties they have begun to fight back. In Chicago, Cook County sheriff Tom Dart announced in 2011 that he was considering filing a lawsuit against the county for “allowing the jail to essentially become a dumping ground for people with serious mental health problems.” In Summit County, Ohio, Sheriff Drew Alexander took it one step further in 2012 when he announced that “the county jail no longer will accept violent mentally ill and mentally disabled people arrested by area police.” “We’re not going to be a dumping ground anymore for these people,” he said.
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The degree to which jails and prisons have become the nation’s new psychiatric inpatient units can also be measured by bricks and mortar. It is now common—almost routine—for jails and prisons to have special sections set aside for mentally ill inmates. These units are readily identifiable by their nicknames, such as “Fantasy Island” in an Oklahoma prison. Like psychiatric hospitals, some jails and prisons have their own pharmacies; in Cleveland, the Cuyahoga County Sheriff’s Department expected “to save more than $100,000” a year by opening its own pharmacy.
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In Maine in 2007, the governor proposed that some county jails be transformed into “specialty facilities for people with mental illnesses.” That same year saw proposals in Florida’s Dade and Broward Counties to provide funding for “the first county jails ever to be built specifically for inmates with chronic and severe mental illness.” Also in 2007, the warden of Montana State Prison proposed “opening a special prison for the mentally ill who are now housed in the regular prison.” In Raleigh, North Carolina, they are already doing this; a new, five-story hospital for 216 mentally ill prison inmates was built as part of Central Prison and opened in 2012. It sits directly across the street from Dorothea Dix State Hospital, which was simultaneously closed.
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But perhaps the most revealing development that illustrates how jails and prisons have become the new psychiatric inpatient system is proposals to take over closed state psychiatric hospitals and then turn them over to the Department of Corrections to become psychiatric hospitals for prisoners. In Pennsylvania the state legislature in 2010 was said to be “looking into the possibility of moving prisoners with mental illnesses into state hospitals” that were being closed. In New York State, Marcy State Psychiatric Hospital was closed many years ago and turned over to the State Department of Corrections to become the Marcy Correctional Facility. Then, in December 2009, it was announced that the Marcy Correctional Facility would open a 100-bed Residential Mental Health Unit for inmates with serious mental illness. Thus, seriously mentally ill individuals who were once treated in the psychiatric hospital may end up being treated in exactly the same building, except now it is called a prison. Office of Mental Health Commissioner Michael Hogan lauded the special unit as “a collaborative and innovative approach that to our knowledge is the first of its kind anywhere.” Governor David Paterson characterized the new unit as “government at its best.” Such thinking would have given Jonathan Swift much material for his satires.
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SHERIFFS, POLICE, AND COURTS AS THE NEW PSYCHIATRIC OUTPATIENT SYSTEM

Just as jails and prisons have become America’s new psychiatric inpatient system, the sheriffs, police, and courts have become the new psychiatric outpatient system. As a consequence of having discharged hundreds of thousands of seriously mentally ill individuals from hospitals to live in the community without adequate medications or support, psychiatric crises occur frequently. The people who respond to these crises are mostly law enforcement officials, and for many officials such calls have become a significant part of their jobs. In California’s San Diego County, for example, sheriff’s calls related to mentally ill individuals approximately doubled between 2009 and 2011. In 2011 police in Medford, Oregon, were dealing with “an alarming spike in the number of mentally ill people coming in contact with the police on an almost daily basis,” the
number of contacts having doubled since 2010. Many of the police calls were repeats, such as the 88 calls made between 2000 and 2006 by the West Des Moines, Iowa, police to the home of Joe Martens. Martens, who periodically stops taking medication for bipolar disorder, becomes violent and threatening to his neighbors. When police respond to a Martens call, “they bring two units; a third helps if things are slow.”
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Many calls to law enforcement are to transport mentally ill people to hospitals. In Corvallis, Oregon, for example, the police handled 30 “police officer custody” cases in 2001, 58 in 2002, 113 in 2003, 140 in 2004, and 162 in 2005. In North Carolina, where state law makes county sheriffs responsible for such transport, the shortage of beds caused by the closing of state psychiatric hospitals has put an intolerable burden on the sheriffs. In 2010, 100 sheriff’s departments “reported more than 32,000 trips last year to transport psychiatric patients for involuntary commitments. . . . Fourteen sheriff’s offices reported having a deputy wait with a patient for five days or more until a bed in a psychiatric unit came open.” On March 25, 2010, Burke County sheriff’s deputies had been with a patient in a hospital emergency room for 9 days “waiting for a bed at a mental health facility to open up.” The total time spent on such tasks in North Carolina in 2009 was estimated to be 228,000 hours—time, of course, that is lost for more traditional law enforcement duties.
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Given the psychotic thinking and behavior of many recipients of law enforcement calls, and given the lack of mental health training of many law enforcement officers, it is inevitable that some of these encounters will turn out badly. In 2007 California’s Ventura County sheriff’s deputies used Taser guns to subdue people 107 times; “the majority of those shot by deputies were mentally ill.” In 2008 in West Warwick, Rhode Island, a city of 29,000 people, 5 persons “described as having mental health issues” died in “police-related” incidents in a 6-month period. In California’s Santa Clara County, “of the 22 officer-related shootings from 2004 to 2009 in the county, 10 involved people who were mentally ill. . . . Many of them had numerous contacts with police before the crisis that ended in their death.” In 2011 in Syracuse, three of five officer-related shootings involved “emotionally disturbed people,” and in New Hampshire four of six officer-related shootings involved “mental health issues.” In Albuquerque between 2010 and 2012, 11 of 24 officer-related shootings were of people with “a history of either mental illness, substance abuse or both.” Although there are no national figures on such incidents, it would appear that at least one-third, and perhaps as many as one-half, of all officer-related shootings result from the failed mental illness treatment system.
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In 2010, in response to the numerous officer-related shootings of mentally ill people, Santa Clara County created a special task force to find ways to decrease such incidents. One member of the task force, an officer who had had 26 years’ experience on the Palo Alto police force, noted that police were being repeatedly “called to the same
home or situation” and said: “We want law enforcement to start looking for remedies.” Significantly, the officer did not call for the local mental health center to start looking for remedies but rather the police department, which has become
de facto
the new mental health center. This reality was reflected by a conference of county sheriffs in Colorado who agreed that individuals with mental illness were “the top problem facing sheriff’s departments statewide.” As the Pueblo County sheriff summarized it: “By default, we’ve become the mental health agencies for the individual counties.”
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There are other indicators of this ongoing shift in responsibility for seriously mentally ill individuals from traditional mental health agencies to law enforcement agencies. An increasing number of police and sheriff’s departments offer specialized mental health training, usually as part of a 40-hour training course originally developed by the Memphis Police Department in 1988. The training creates Crisis Intervention Teams (CIT) of law enforcement officers who are trained to respond to crises associated with mentally ill individuals. CIT teams have spread widely; in 2011 a bill was even introduced in the New Mexico state legislature to make CIT training mandatory “for every certified police officer in New Mexico.”
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Another indicator of the increasing responsibility for psychiatric services being assumed by law enforcement agencies is the hiring of mental health professionals by police departments. For example, in 2010 the Seattle Police Department created a new position for a mental health professional. According to the acting police chief, “the professional can conduct ‘street-level assessments’ and may be able to defuse threatening situations. He or she can also direct people in distress to appropriate social services.” In 2012 the Burbank, California, police department hired a psychiatric social worker because their mental illness–related calls had doubled since 2009.
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Several law enforcement agencies are already providing social services to mentally ill individuals. In 2010 California’s Ventura County Sheriff’s Department began a program in which “some mentally ill inmates will be given medicine and immediate rides to their first appointments at treatment facilities upon their release from jail.” A similar program in Hillsborough County, Florida, led to “a dramatic drop in recidivism.” A police officer who is also a psychologist set up a program in San Rafael, California, in which the police department works jointly with the local mental health center to provide social services to mentally ill persons. Such services include having a police officer drive mentally ill persons to doctor’s appointments. According to the initial evaluation of the program, “in three years, San Rafael police have closed 39 of 61 cases [and] almost a third have been moved into permanent housing.” Such activities led the president of the Los Angeles County Police Chief’s Association to observe: “Our local police forces have become armed social workers.”
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Perhaps the ultimate measure of law enforcement’s progressive assumption of responsibility for outpatient mental health services was the May 2011 offer by Sheriff
Ken Stolle of Virginia Beach, Virginia. City officials had voted to cut $121,596 in mental health funds from the Department of Human Services, so Stolle offered to transfer that amount of money from his jail reserve fund to cover the mental health program. He said that “the money being cut would dramatically impact the people coming into my jail with mental illness. . . . This is money well-spent, and it will decrease the money I’d spend housing them.” By spending Department of Corrections funds on outpatient mental health services, Sheriff Stolle expects to save money in the long term. Similarly, in Tuscaloosa, Alabama, in 2012, Sheriff Ted Sexton contributed $28,000 of his department’s money to help fund a mental health court.
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