LA County Struggles with Mentally Ill Inmates

Mentally ill inmates at Los Angeles County Jail watch television in a common room. They’re kept shackled to their tables so that they can’t harm themselves or others. Photo by Chris Richard

The inmate had stripped off his suicide-prevention gown.

Such garments are of heavy fabric, like moving blankets, so that inmates in the Los Angeles County Jail’s “high observation” wing can’t tear them up to make ropes and hang themselves.

This man had rolled his gown into a club. Standing naked, he bashed it again and again against the walls of his cell.

The air stank. The door to another cell nearby stood vacant, its walls splattered with dried feces. Inmates often do that, Sheriff’s Deputy William Hong explained as the tour of the jail’s mental health units continued, to dormitories where men deemed less dangerous to themselves or others sat shackled to tables, watching television. Then it was on to the hospital for the most seriously ill. There, the cells are larger than usual, so deputies can maneuver while holding down patients who resist medication.

On this day, nobody was fighting. In cell after cell, shapeless figures lay huddled under blankets.

One out of every five Los Angeles County Jail inmates has been diagnosed with a mental illness, a statistic that leads authorities to describe he jail system as the nation’s largest mental institution.

One county study found the vast majority of the system’s mentally ill are there for petty crimes related to homelessness, such as public urination or sleeping on the sidewalk. It warned such people are being incarcerated largely because there’s nowhere else to put them.

With a sane person, many “quality of life” offenses result in a warning or fine. But advocates say when a mentally ill person is challenged by a law enforcement officer, tensions can quickly escalate, with the ill person responding inappropriately. Further, such persons have often missed court summonses on previous citations, and the officer has grounds to take them custody. Legal competency evaluations and other complications can turn a trivial offense into weeks behind bars. In that time, some mentally ill jail inmates spin more and more out of control.

In June, citing sloppy supervision and a dramatic increase in jail suicides, the U.S. Department of Justice announced it was seeking court oversight of how mentally ill county inmates are treated. In a report, DOJ investigators describe jail cells as “dimly lit, vermin-infested, noisy, unsanitary, cramped and crowded,” conditions that worsen the unstable prisoners’ distress.

Meanwhile, county officials are moving forward with plans to develop their own “mental health jail.” As part of a plan to replace the aging Men’s Central Jail and ease chronic overcrowding, jail officials will seek to house mentally ill inmates in the proposed Consolidated Correctional Treatment Facility, which would offer more mental health services. Most other inmates would remain in the county’s other large jail next door, Twin Towers.

Still, as county supervisors consider plans for the new, $1.7 billion facility, officials are considering how to keep some mentally ill inmates out of the jail system altogether.

One leading advocate for change is Los Angeles’ District Attorney, Jackie Lacey.

In May, she convened a summit of law enforcement leaders and mental health workers to possible reforms in the county criminal justice system’s treatment of mentally ill offenders.

In collaboration with the federal government’s Gaines Center, Lacey is preparing recommendations on diverting mentally ill arrestees from the penal system. That report is due in September.

Addressing county supervisors recently, Lacey said training law enforcement, prosecutors and judges is crucial to identifying mentally ill offenders and directing them to alternatives to jail time where appropriate. Further, the county needs more housing and support services for the mentally ill, she said.

“People with mental illness are often dumped back into the street after being stabilized in medical facilities or jails,” Lacey said. “There’s a moral question at hand in this process. Are we punishing people for simply being sick? Public safety should have a priority, but justice should always come first.”

In late July, supervisors deferred action on a proposal to set aside some $20 million as initial funding for such programs, pending receipt of Lacey’s recommendations and their own budget planning sessions this fall. But in deferring the funding decision, several supervisors acknowledged the need for a new approach to the mentally ill.

“I think yes, $20 million is only a down payment,” Supervisor Gloria Molina said. “The problem is we don’t have a plan. That’s what we need.”

Peter Eliasberg, legal director at the American Civil Liberties Union of Southern California, said he was disappointed at the delay.

“I think there’s more than enough information to know this amount of money will be necessary, and having the money set aside will help things move quickly once the DA comes back with her report,” he said.

“On the flip side, there seemed to be unanimous commitment on this issue that diversion is a board priority and it needs to be done.”

In a joint report issued last month, Eliasberg’s organization and the Bazelon Center for Mental Health Law note that diversion programs including the Nathaniel Project in New York City, Thresholds in Chicago, and, in Florida, Miami-Dade County’s Criminal Mental Health Project have dramatically reduced recidivism rates among the mentally ill.

“We really do know how to do this correctly. There are experts in the field and research in the field now that didn’t exist 10 years ago,” said Mark Gale, criminal justice chairman for the Los Angeles Council of the National Alliance on Mental Illness.

“Before it was like, ‘Well, we’re really not sure what to do,’ and anybody trying something new, it’s so new it’s untested. We now have evidence-based practices. There are best practices. There are consultants who can literally map your system for you.”

Gale wants pre-booking diversion programs that let a law enforcement officer direct an apparently mentally ill person detained for a minor offense to a psychiatric emergency room or similar facility where he can be evaluated and offered treatment.

Gale also supports post-booking diversion for more serious misdemeanors and even some felonies. Typically, such programs operate in “behavioral courts,” where mental health caseworkers help defendants to receive housing, counseling, vocational training and other services. Participation, in lieu of time behind bars, is voluntary, and the crime must be linked to the client’s mental illness. People who fail to comply with the services offered them are incarcerated.

Currently, the federal government does not underwrite the cost of mental health treatment in jail, but it does subsidize community treatment programs outside the lockup.

Terri McDonald, assistant sheriff for custody, said a five-member sheriff’s department team has begun helping inmates apply for benefits under the Affordable Care Act and Medi-Cal, so they can receive treatment at a community facility rather than jail. Diversion programs could eventually assign up to 1,000 mentally ill inmates who do not pose a threat to others to such community-based centers, McDonald said.

The county’s commitment to such services can easily mean the difference between life and death, according to the mother of a 23-year-old man committed suicide in the county jail last year.

The woman, who agreed to be interviewed on condition that neither she nor her son be identified, said in a previous incarceration, her son had informed jail deputies that he wanted to kill himself, and they placed him on suicide watch. A judge ordered that the young man be transferred to a facility that treats mental illness and addiction. Instead, the jail released him in the middle of the night.

The young man’s mother said she and her husband were worried that their son, who was highly agitated following his release, might do himself harm. A detective advised her to swear out a new arrest warrant so the young man could be kept safely in custody until a bed in the treatment facility was available, the woman said.

This time, she said, even though her son’s fellow inmates told deputies of his threats to kill himself, he was given a bed sheet and placed alone in a cell. Deputies later found he’d used the sheet to hang himself.

In her grief, the woman has appealed personally to county supervisors to support diversion programs, she said.

“I don’t want to be doing what I’m doing, but there’s other people out there like my son,” she said. “If I did nothing at all, I would not be able to live with myself. My son did not deserve this, and these people that this is happening to did not deserve this.”

One organization that Lacey has cited as a possible model for community-based mental health services is Amistad de Los Angeles, the Los Angeles campus of Amity, a non-profit substance abuse treatment agency. With support from government contracts and private donations, Amity offers probationers, parolees and homeless people housing, counseling, substance-abuse therapy, job training and other “wraparound services.”

Peter Starks credits Amity with saving his life. For 15 years, Starks said, he tried to medicate himself with heroin for mental illness rooted in the domestic violence he witnessed as a child and his combat experiences in Vietnam. During that time, he was incarcerated repeatedly. In 2009, he came to Amity, and he’s been sober ever since. In May, the organization hired Starks to advise Amity clients struggling with similar addictions and mental illnesses.

Typically, when a mentally ill inmate is released from county jail, he walks straight onto Los Angeles’ Skid Row, where people immediately begin offering drugs, Starks said. His path to sanity started with the fact that an Amity worker picked him up immediately upon his release and drove him straight to Amistad, Starks said.

“That the county is even considering building another jail, a so-called ‘mental health jail,’ that’s insane,” he said. “They should be taking that money and putting it into mental health services.”

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