Peering
through the chain link of a holding pen at the Cook County Jail, a man
wrapped in a navy varsity jacket leans toward clinical social worker
Elli Petacque Montgomery, his bulging eyes a clue that something's not
right.
"They say I got bipolar, that's all," he says.
"OK, are you taking your meds?" she asks.
"When I can get them," he answers.
"I'm down here every day," Montgomery says. "Every morning I hear this."
The
Chicago jail and many of its 3,300 counterparts across the country have
become treatment centers of last resort for people with serious mental
illnesses, most arrested for non-violent crimes. And like other jails,
it is awash in a tide of booking and releases that make it particularly
unsuited for the task.
U.S.
jails, most of whose 731,000 inmates are trying to make bail or awaiting
trial, hold roughly half the number in prisons. But last year, jails
booked in 11.7 million people — 19 times the number of new prison
inmates. The revolving door complicates the task of screening for mental
illness, managing medications, providing care and ensuring inmate
safety.
"Jails are churning
people," says Henry J. Steadman, a consultant to government agencies on
how courts and correctional facilities deal with people with mental
illnesses.
Experts have
pointed to rising numbers of inmates with mental illnesses since the
1970s, after states began closing psychiatric hospitals without
following through on promises to create and sustain comprehensive
community treatment programs.
But
as the number of those with serious mental illnesses surpasses 20
percent in some jails, many have struggled to keep up, sometimes putting
inmates in jeopardy.
The
Associated Press has reported that at least nine of the 11 suicides in
New York City jails over the past five years came after operators failed
to follow safeguards designed to prevent self-harm by inmates. The AP's
investigation into the deaths of two mentally ill inmates at the city's
Rikers Island complex — one who essentially baked to death in a
101-degree cell in February and the other who sexually mutilated himself
last fall — have prompted promises of reform.
Federal law protects the
rights of people in jails and other institutions. But in temporary
holding facilities, dealing with serious, long-term mental illnesses
requires operators to rethink what they do, Cook County Sheriff Thomas
J. Dart says.
"You're given a
court order by a judge to hold this person in the jail until you're
told not to," Dart says. "You're not supposed to do anything other than
feed him, give them a bed, make sure they don't harm anyone else or
themselves. ... You're not in there trying to cure people."
Many jails are dealing with similar dynamics, with sometimes disturbing results.
—In
June, federal officials cited "deplorable" conditions for mentally ill
inmates in the Los Angeles County jails as partly to blame for 15
suicides in 30 months. The L.A. system, the country's largest with
19,000 inmates, has been under federal supervision since 2002, but still
fails to adequately supervise inmates "with clearly demonstrated
needs," the Justice Department concluded.
—In
Pensacola, Florida, Justice officials last year issued a scathing
report about conditions at the Escambia County Jail. Records showed many
inmates who requested care were never seen by a mental health
professional. When inmates refused to take medications, the jail merely
removed them from its list of those with a mental illness.
—In
Columbus, Nebraska — seat of a county of 33,000 — six Platte County
Detention Center inmates attempted suicide early this year, as many as
in the previous 10 years combined. Jon Zavadil, the recently retired
sheriff, says about 80 percent of all inmates medicated for some type of
mental illness.
"Every
county jail in the state has the same problem," says Zavadil, who blames
Nebraska lawmakers for voting to close two of the state's three public
psychiatric hospitals over the past decade.
Researchers long warned mental illness was being "criminalized," as police arrested more people for low-level offenses.
In
the 1980s, researchers found about 6 percent of inmates showed signs of
serious mental illness. A survey published in 2009 found 17 percent of
jail inmates with serious mental illnesses. Individual jails report far
greater numbers.
Today, many of those jailed with mental illnesses have grown up in a system full of holes.
"Even
what we had when I started doing this work in 1988 was better than what
we have now," says Nancy Koenigsberg, legal director for Disability
Rights New Mexico, which helped bring suit against her state's Dona Ana
County Detention Center in 2010 for mistreating mentally ill inmates.
But
while the jail has since increased its mental health staff, New Mexico
cities and counties have continued closing drop-in centers and other
programs to that help maintain treatment. Many people wind up repeatedly
picked up for relatively minor crimes.
At
the Volusia County Detention Center in Daytona Beach, Florida,
administrators compiled a list of such "frequent flyers." The 19 worst
had been collectively jailed 894 times, mostly for minor offenses.
Nearly half had a history of mental illness.
"A
lot of their behavior was low level," says Marilyn Ford, the county's
corrections director. "So they cycle through in a fairly short period of
time and they never make it to prison."
Chicago's
jail can offer an island of stability for inmates with mental
illnesses, Dart says. In coming months, Dart plans to convert a former
boot camp into a transition center to help those with mental illnesses
after release.
But William, a
62-year-old inmate who says he's been jailed nine or 10 times for theft
to support a drug habit, is doubtful. Many judges dismiss mental
illness as a factor in crimes, says the inmate, diagnosed with
depression, anxiety and symptoms of bipolar disorder. Outside jail,
treatment is hard to get.
"Once we leave here," he says, "we're back on doom street."
Sandy
Allen was born in 1955, a normal-sized baby. But she grew, and grew,
and grew to be 7’ 7” by the time she was 20, when brain surgery to
remove a tumor on her pituitary gland stopped her growth. She was
diagnosed with the tumor as a pre-teen, but as her family was uninsured,
they could not afford it. If she’d had the surgery as a young girl, she
would have been just a tall woman. As it turned out, Sandy Allen
achieved the world record as the tallest woman in the world. But it came
with a price- Gigantism has a lot of physical effects besides height.
Doctors told her she’d be lucky to live past age 30.
