Saturday, January 06, 2007

Behind Bars, Without Treatment in Jeb Bush's Florida

Despite Florida's law requiring prompt attention for inmates deemed mentally ill, they often are left to languish in county jails, struggling without the help they need.

A mentally ill inmate shakes the bars of his cell and yells at guards in Delta ward of the Pinellas County Jail. The Department of Children and Families has recently come under fire for not transferring mentally ill inmates into hospitals quickly enough.

David sits cross-legged behind the bars of his jail cell, talking nonsense and singing The Lion Sleeps Tonight. He tries to hang himself nearly every day.

Donald yells gibberish, spits at the staff and exposes himself. "Donald, eat your food," a jail deputy tells him at lunch time. "And pull up your pants."

And there is Brian. How long has he been in jail? "About 2,000 years," he says. He thinks he's a space commander. His eyes are vacant. He talks in a whisper. But he can turn violent fast, like the time he bashed in a fellow inmate's head with a pencil sharpener.

These three mentally disturbed men - and nearly 30 more like them - live in single cells at the Pinellas County Jail.

County jails across the state are crammed with people like David, Donald and Brian.

After days and sometimes weeks in jail, many of these inmates are declared too disturbed to participate in their own defense. At that point, the Department of Children and Families is supposed to transfer them to state mental hospitals within 15 days of an incompetency order. But the agency hasn't had the hospital space or funding to follow that law.

That has led to a showdown between the agency and some judges, including a Pinellas judge who threatened to jail former DCF Secretary Lucy Hadi if she didn't follow the 15-day law.

The dispute, which gained nationwide attention, prompted lawmakers to schedule an emergency budget meeting next week to approve $16.6-million for more hospital beds.

So what's so important about getting the mentally ill out of the state's jails?

Everyone who works at county jails statewide - guards, doctors, psychiatrists - agrees that jail is not the place for them. Without adequate treatment, they often become worse. They tax the staff with suicide attempts and violence.

But because mental hospitals nationwide have been shuttered over the years, the disturbed are landing in jail more often. And staying longer.

"The jails have become a dumping ground for the mentally ill," said Maj. Kirk Brunner, commander of the Pinellas jail.

The St. Petersburg Times visited three county jails - in Pinellas, Hillsborough and Broward counties - to get a glimpse of the problem.

* * *

At Hillsborough's Orient Road Jail, the most troubled mentally ill inmates typically end up in 6 Charlie, a block of 16 individual cells. For at least 22 hours a day, the men are locked behind heavy metal doors.

Suicide attempts, inmates talking to people who aren't there - Deputy Charles Miller, 32, has seen it all here.

Miller walks back and forth in front of the cells, eyeing each of the inmates every 15 minutes. When someone makes a mess on himself or smears feces on the cell walls, Miller cleans it up.

"It's outside the scope of the job, but you got to do it," he says, adding that he prefers working with mentally ill inmates over others.

"They have more of a reason to act the way they do," he explains. "And here you can actually help somebody."

Ana Mourer, supervisor of psychiatric nurses, watches Miller make his rounds. She shakes her head.

"A lot of these inmates shouldn't be here," she says. "They're charged with misdemeanors. They just have nowhere else to go."

* * *

Broward County this week has 59 jail inmates waiting for mental hospital beds - twice as many as any other Florida county.

The county jail has a mental health unit with about 375 beds. Only the sickest get a spot in that unit; the rest - some 600 other inmates who regularly take psychotropic drugs - end up in the general population.

"We have to make difficult decisions on who is able to leave the unit so we can accommodate the new arrivals," says Tim Ludwig, the jail's mental health coordinator since 2002.

"This is how we cared for the mentally ill in the 1700s," he says.

Ludwig says staffers try to make the jail feel less like jail. Metal tables and stools have been replaced with plastic couches. Deputies wear polo shirts rather than starched uniforms. They have also experimented with different paint colors to make it more soothing. They hope to add more natural light and figure out ways to reduce noise.

"Jails aren't conducive to treatment," he says. "It is a stark environment. Loud, industrial."

Even so, jail programs help inmates learn about mental illness and manage their medications.

In a jail, you have to celebrate small victories, says Ludwig. He points to an inmate washing windows in the infirmary. He is smiling broadly, clearly happy to have something to do. Last week, he was cutting himself.

"We take it for now, but know that his condition might change in an hour," Ludwig says.

* * *

At the overcrowded Pinellas jail, which has had as many as 30 inmates awaiting mental hospital beds, conditions are much darker.

The wings where many of the mentally ill men are kept echo with the sounds of their barks and shouts. It smells of human waste.

Some of these inmates will stand at their cells and masturbate for hours. Others will sling their feces at the deputies or splash in puddles of their urine. Or they'll plug their toilets and flood their cells.

They play poker with ghosts, climb the bars like bats or dump their lunch trays into the toilet and eat the food like soup.

They will slam their heads against the wall, slice themselves with razors or plunge head-first off their bunks onto the concrete floor.

"There's so many of them with the state hospitals closed down," said Deputy Caroline Broad, who watched over 16 of the inmates one day last week. "We don't have room for them all."

Those who attempt suicide must be watched constantly with videocameras. Others cannot receive anything in their cells but their uniforms and foam feeding trays.

"They are here for everything from trespassing to murder," says Deputy Gary Paxson, an 11-year veteran assigned to watch them on a recent morning.

Paxson says he does his best to soothe the troubled men, but he feels ill-equipped to contend with them.

"People go to school to deal with these kinds of people," he says. "We have no experience as far as mental health is concerned. It's extremely frustrating. You're damn stressed. It's unfortunate that county jails have to make up for the state dropping the ball."

* * *

The DCF for years has been unable to follow the 15-day rule. But the problem has worsened greatly in the last two years. A waiting list for beds has grown at times to more than 300. The waiting period has spiked to an average of three months.

Brian, the Pinellas inmate who said he had been in jail 2,000 years, waited nearly three months after his incompetency order before a hospital bed opened up for him Tuesday.

The bed costs the state about $100,000 per year. Brian's crime? He was arrested in June for trespassing and having a trace amount of cocaine in his pocket.

During the wait period, the costs for housing and treating those inmates is paid by the counties. Pinellas recently paid more than $100,000 to treat a single inmate in the time he waited for a state hospital bed, said Dr. Timothy Bailey, the facility's doctor.

Jail staffers cannot force inmates to take medications unless it's an emergency. Counseling is either unavailable or limited. That environment causes the inmates to deteriorate.

One inmate at the Pinellas jail gouged out an eye last year. Another in a South Florida jail carved out both.

"I've seen people come in here and they're pretty congenial," says Paxson. "And by the time they leave, they're ... zombies."

By the numbers:

Mentally incompetent inmates statewide awaiting mental hospital beds: 295.

Those waiting more than the 15-day limit: 251.

Men waiting more than 15 days: 200.

Women waiting more than 15 days: 51

Counties with the most mentally ill inmates waiting more than 15 days for a hospital bed:

1. Broward: 52

2. Dade: 22

3. Orange: 18

4. Duval: 17

5. Hillsborough: 16

6. Polk: 13

7. Leon: 10

8. Alachua: 9

9. Palm Beach: 8

10. Pinellas: 8