How Southern California jails are changing the way they treat the mentally ill
How Southern California jails are changing the way they treat the mentally ill
by Nikie Johnson
Rusty the miniature donkey patiently moved from man to man in a circle of chairs around him.
Some eagerly reached out to pet his forehead or scratch behind his ears. Others engaged more cautiously.
Rusty’s effect on the group of seven severely mentally ill inmates at the West Valley Detention Center, San Bernardino County’s largest jail, was obvious.
As his handler, volunteer Janella Denney, moved him around the circle that November day, the inmates peppered Denney with questions.
Can kids ride him? (No, but he can pull a cart that weighs up to 500 pounds.) How much does he weigh? (225 pounds.) How much does he eat? (A lot of hay!) Does he have a girlfriend? (No.)
“How was that for you?” the mental health clinician asked one man who won’t touch the dogs that come to visit the jail, but apparently was unable to resist petting a mini donkey with drooping eyelids, perky ears and an orange vest.
He paused. Considered. “Really nice.”
Of all of the jail system’s programs for mentally ill inmates, nothing is more effective than animal therapy, said Terry Fillman, the San Bernardino County Sheriff’s Department’s health services administrator. Animals provide unconditional love — and a rare opportunity for physical contact. Opening up to interact with them can lead to a breakthrough with human therapists.
Rusty’s monthly visits are one example of how some of Southern California’s jails are trying to do a better job of treating mentally ill inmates, who pose one of the biggest challenges to jail health providers — and who face some of the worst conditions of all inmates, critics contend.
The consequences of failing to provide care can be severe. Untreated mental health or substance abuse issues are high risk factors that lead people to cycle in and out of jail. And in the worst cases, inmates in a mental health crisis can die from suicide if they’re not monitored and treated.
‘Deplorable’ situation
Correctional officials say that as mental health resources in the community have disappeared — an issue they trace back to changes 50 years ago in the state mental hospital system — county jails have become the de facto treatment centers.
No one, in or out of law enforcement, thinks that’s right, and advocates’ constant refrain is that communities should create other programs where mentally ill inmates can be diverted. Nonetheless, most jails have a high rate of mental illness.
In the overall U.S. population, statistics show just under 20% of U.S. adults will have a mental illness in a given year. In local jails, the percentage of inmates with identified issues range from about 25% in San Bernardino County to about 30% in Orange and Los Angeles Counties to as high as 45% in Riverside County, officials said.
“Jails are not the ideal place to treat them, but we’re going to do the best we can while we have them here,” said Jerry Gutierrez, executive officer for the San Bernardino County Sheriff’s Department, who previously worked in Riverside County.
But for too long, critics say, jails have not been doing the best they could. Lawsuits that the Department of Justice filed against Los Angeles County and that the nonprofit Prison Law Office filed against Riverside and San Bernardino counties in the past few years included horrific descriptions of conditions.
“Dimly lit, vermin-infested, noisy, unsanitary, cramped and crowded,” the Department of Justice wrote in a 2014 letter that said the conditions “present, rather than prevent, a risk of suicide.” The Prison Law Office called conditions “deplorable” and said cells for mental health patients often stank of urine and feces.
Common threads in complaints about mental health care are that inmates are kept severely isolated, aren’t supervised closely enough, don’t have access to needed therapy and are given inappropriate medication. All of that can contribute to increased suicidal behavior.
Fatal outcomes
The expert who evaluated the mental health services in Riverside County’s jails for the Prison Law Office lawsuit, psychiatrist Bruce C. Gage, reviewed several suicides.
In one, Gage wrote, a robbery suspect made suicidal statements multiple times while being arrested and booked. The man was put in a safety cell, then evaluated by a clinician, who said the man “fit the protocol” to be sent to the general population: He wasn’t making suicidal statements, and was smiling and making eye contact. But as he was being moved into his cell, the man told someone “he wished the deputy would have shot him.”
The next morning, he was found hanging in his cell just after 11 a.m. He appeared to have been dead for two or three hours. However, “the deputy on duty reported having completed a security check at (10:48 a.m.) … This incident is reportedly being investigated for employee misconduct.”
Riverside County sheriff’s officials said last week that they “thoroughly investigate all inmate deaths” but would not say whether anything came of this investigation.
In Los Angeles County jails — which had been operating under an agreement with the Department of Justice since 2002 to improve its mental health care — a spike in suicides in 2013 led to a new lawsuit that claimed the county hadn’t done enough.
Not only was the county failing to prevent inmates from becoming suicidal, but it wasn’t learning from its mistakes: “Fifteen suicides in 25 months produced almost no discernible change in the Jails’ custodial practices,” federal officials wrote.
One case the letter highlighted was an inmate who reported past suicide attempts when he was booked into jail in 2012. He was first sent to an in-patient program, then to a hospital, then back to Twin Towers. A psychiatrist wrote a few weeks later that the man was to be transferred to high-observation psychiatric housing. It never happened, and there was no explanation why. Within a week, he was dead — he strangled himself with a sheet that he should not have been given.
Changes having an effect
Since the lawsuits against the three counties were filed and settled, all three jail systems have begun making changes, though the experts monitoring their progress say all have a ways to go.
LA County has given deputies better training and removed suicide hazards from housing areas, according to that case’s federal monitor. Inmates in crisis when they arrive at jail are being seen faster. The number of suicides has dropped, from 10 in 2013 to between one and five in each year since. And suicides that do occur are being reviewed more thoroughly.
The county also plans to replace the decrepit Men’s Central Jail with a new facility focused on mental health; it will be staffed by deputies but run by the county health department. Orange County also just announced plans to build more capacity for inmates with mental health and substance abuse issues.
In San Bernardino County, the jails are providing more services to mentally ill inmates to try to “restore people to their maximum wellness,” as Fillman says — although the head of the Prison Law Office believes many inmates are still not getting the treatment they need. The jails are giving more training to deputies, as well.
In Riverside County, one inmate who’s been in and out of jail over the past decade and agreed to speak about his experience said he noticed a change for the better in mental health care during his most recent stint.
Benito Juarez, 45, of Perris, said he spent about six months at the Cois M. Byrd Detention Center near Murrieta. Court records show his most recent charges were for violating a restraining order.
He said he got a lot of psychological help this time, unlike he ever had before.
“The medical staff, I think they really stepped up,” Juarez said. They talked to him about addiction issues, asked what they could do to help and made sure he was released with a 30-day supply of medication.
“They’re really doing a good job to break the cycle that keeps guys coming back,” he said.
This article is part of a series on jail health care that was produced as a project for the Data Fellowship, a program of the USC Annenberg Center for Health Journalism.
All credit goes to Nikie Johnson Originally published on https://www.dailynews.com
