Jails: Revolving doors for the mentally ill

By Clifton Adcock
The Daily Record Newswire
 
OKLAHOMA CITY — Before he was locked up in the Tulsa County jail, James Alexander lived in a hole in the ground.

That hole was under Interstate 44 in east Tulsa, and there he slept, ate and stored his belongings, including food he had stolen from nearby stores.

He lived with depression related to bipiolar II disorder.

In jail for nearly two years since, Alexander, 30, now has a stable life. He is locked up 23 hours per day but gets steady meals. He is offered medication but refuses to take it.

His red beard is wiry and his fingernails long and yellowed.

“I’m on a good phase,” he says in a pleasant demeanor, though he talks in rambling non sequiturs at times.

For years it has been a truism that Oklahoma’s prisons have become de facto mental institutions, with about a third of inmates showing current signs of mental illness.

Less often mentioned are the mentally ill in jails – places that have fewer resources to treat people with mental disorders.

To the general public, jails can seem merely brief way-stops for people convicted of minor crimes and suspects awaiting trial on more serious charges. But jails also serve as regular, off-and-on destinations for hundreds of offenders each year who repeatedly commit nonviolent crimes such as trespassing, theft and public intoxication. Jail officers call them “boomerangs,” and many are mentally ill.

At the Tulsa jail, at least 200 inmates have mental illness at any one time, according to a 2014 report by the Oklahoma Department of Mental Health and Substance Abuse Services. The Oklahoma County Jail has as many as 500 mentally ill inmates, the report said.

Michael Brose, executive director of Mental Health Association Oklahoma, said relatively little treatment is given to jail inmates.

“In the smaller rural counties I think it would be almost nonexistent above a suicide watch,” Brose said. “When you talk about metro jails … it might be a little bit more than that, but not considerably. It’s minimal. That’s what we’re fighting.”

Alexander said he served in the U.S. Navy, where he was diagnosed with bipolar II disorder, which involves less severe mood swings than bipolar I but more pronounced depression. After being discharged, Alexander lived in Houston for a few years before returning to Oklahoma. Shortly after arriving, he became homeless.

It was early 2011 when he found the hole under the interstate, he said.

He would venture out at night to find food and supplies, taking care to not give away his shelter’s location to other homeless people.

“I was there by myself,” Alexander said. “I was completely outside of society.”

Then, in early August 2013, someone began breaking into businesses nearby, stealing mostly food, according to court records.

One night, police said they followed a trail of blood left after Alexander cut his foot trying to break in to one of the stores. Alexander was arrested and booked into the Tulsa County jail on Aug. 8, 2013.

Until the early 20th century, most mentally ill people were housed in jails and prisons, according to the Treatment Advocacy Center, a mental health group. Reform movements gave rise to large state-run institutions for the mentally ill, but in the 1950s deinstitutionalization and the emptying of the hospitals began.

The trend accelerated in the 1980s and 1990s.

“The mental health systems were told those (mental health) dollars will now be given to you to do community-based services,” said Terri White, commissioner of the state Mental Health Department. “But the dollars never made it.”

With fewer spaces available at state hospitals and underfunded services in the community, many of the mentally ill ended up in jail.

“If someone has impaired judgment, impaired executive functions, then they’re going to do something that goes against the laws on the books,” said Dr. Britta Ostermeyer, chair of psychiatry for the University of Oklahoma College of Medicine.

Ostermeyer said when she worked as a psychiatrist at the Harris County Jail in Houston, Texas, she could often get an idea of whether a person might be mentally ill just by looking at their criminal records.

“When I would see ‘trespassing, trespassing, trespassing,” I would say ‘we’re going to see a person with schizophrenia,’” Ostermeyer said.

The moment Robert Walker steps into the segregation unit at the Tulsa County jail, prisoners begin striking up conversations with him.

Walker, a former U.S. Army Ranger, worked as a detention officer in the jail before being appointed last year to the jail transition team for the sheriff’s office. Walker said one of his main duties was dealing with mentally ill inmates.

“I know all of them,” Walker said. “Right now, they’re on 23-hour lockdown. And it breaks your heart (because of the limited treatment options).”

At the jail, mentally ill prisoners are often placed in the medical unit or the segregation unit, from which they’re released for one hour a day for exercise.

“Typically, in a segregation unit, you would have people who need to be on close watch, either because of their charges, or their own safety, or because of their behavior,” Walker said. Referring to the justice system housing the mentally ill, he added, “We’ve gone overboard.”

Most inmates in the 42 segregation cells are mentally ill. Many are homeless, and many show up regularly in the jail, said detention officer Terry Childs.

“Unfortunately, we call these ‘the forgotten inmates’ because they live on the streets, they have no family to come visit,” Childs said. “We call them boomerangs, because they keep coming back.”

In general, jails are not properly set up to deal with severely mentally ill inmates, Oklahoma County Sheriff John Whetsel said. Although jailers receive training for how to deal with mentally ill inmates, they are not mental health professionals, he said.

“They (inmates) wind up in jail, in my opinion, a lot because of beds that have been closed in the state and funding being decreased for the mentally ill in the state.”

Most inmates with a mental illness are far more expensive to hold than other prisoners, said Ray McNair, executive director of the Oklahoma Sheriffs Association. The cost of medication, extra monitoring and often longer time behind bars contribute to the higher cost.

Alexander is an example.

After his 2013 arrest, Alexander was required to undergo competency evaluations at the Oklahoma Forensic Center in Vinita, court records show. Each time, the sheriff’s office transported him back and forth.

In September 2013, after he refused to eat for five days, a judge ordered him to be transported to a Tulsa hospital and placed on a feeding tube.

In January 2015, Alexander was sentenced to time served and released, court records show.

With no assistance or referrals to treat his mental health issues, “they let him walk out the front-(expletive)-door,” Walker said.

By March 17, Alexander was back in jail again on new charges of second-degree burglary. Police said that he had returned to living under the interstate and attempted to break into the same businesses he had broken into before.

After pleading no contest to three misdemeanor charges, Alexander was sentenced to three consecutive one-year sentences.

“That’s a $600,000 man sitting in there right now,” Walker said, estimating the cost of an expected five years in jail and the time in Vinita.

Thanks to a sales tax approved by voters in April 2014, Tulsa County is preparing to build a jail addition that will feature a new mental health unit.

The unit is to have two pods with close supervision and isolation cells, spaces for video court, an open dormitory area for higher-functioning prisoners and an outdoor area, Walker said. The addition is scheduled to open in 2016.

But “even when we get this and with our additional training, this is still not the best place for them,” Walker said, predicting the new beds will fill up.

Walker and others said they hope to bring together police, jail administrators, courts, prosecutors, public defenders and those in the mental health and homeless communities to develop a continuum of mental health care in Tulsa.

For example, jail employees could direct released inmates to mental-health organizations for treatment or help finding resources or housing.

“It’s been quite an effort to get all those players on board, but we’ve made good progress,” said Jill Young, chief program officer at Tulsa’s Family & Children’s Services.

The effort has been delayed by turnover in the sheriff’s, district attorney’s and public defender’s offices, as well as an investigation into the sheriff’s office after a former volunteer deputy fatally shot an unarmed man in April.

In Oklahoma County, a study committee and Whetsel, the sheriff, have recommended building a new jail with better mental-health facilities. The plan calls separate units for mental-health evaluations and for housing mentally ill inmates.

“Mental health has to be a huge part of any proposal that’s put together,” Whetsel said.

The committee recommended enacting a sales tax hike to pay for construction and operation of the jail and a juvenile facility. The chances of its passage are unclear. Under a consent decree with the U.S. Department of Justice, Whetsel’s office must address dozens of problems with jail operations.

As in Tulsa, Whetsel’s plan includes partnering with community mental health centers and other organizations to create a continuum of care.

“If we have no outside organization prepared to assist them when they get out, they will be right back here,” Whetsel said. “We haven’t done anything to address the real problem if we don’t do that.”