Sunday, January 3, 2010

Decriminalizing mental illness

January 03, 2010 12:37 am

— By Jennifer Jacob Brown

Every day in the Lauderdale County Detention Facility, jail workers have to run more than just a prison for criminals. Though they lack the training and resources to do so, jail workers are forced to run a prison for the mentally ill as well.

Meanwhile, mentally ill patients are often in a state of terrified shock when they are thrown in jail because there are not enough beds in mental hospitals. As they await transfer, they are generally not seen by anyone with expertise in mental health.

The mentally ill that fill jail cells are not restricted to those awaiting beds at a mental hospital. Often, the mentally ill are in jail because they were charged with crimes their mental illness caused them to commit. With no form of mental health rehabilitation in jails, experts say their rate of recidivism is high.

But a local group of mental health workers and concerned citizens is working to change the laws and attitudes that contribute to the criminalization of mental illness. The group meets once a month, and this month they will be part of a seminar meant to educate the public and lawmakers about how criminalizing mental illness hurts both the mentally ill and the community in general.

The seminar "Treatment, Not Jail: Strategies to Prevent Criminalization of Individuals with Mental Illness", will be held Jan. 11 at the MSU-Meridian campus and is free and open to the public.

The seminar will cover both why its important to keep the mentally ill out of jail and how that can be accomplished.

One local official who's ready to see it accomplished is Sheriff Billy Sollie, whose responsibilities include running the county jail.

"The staff and facilities (at the Lauderdale County Detention Facility) were not designed, trained, or equipped deal with people who are suffering from mental illness issues, and it puts a strain on the employees and the facilities," he said.

At any given time, he said, the jail may have no mentally ill patients awaiting transfer to a mental hospital, or it might have as many as seven. "Only one," said Sollie, "creates a huge issue for the staff," and also takes up space
These numbers do not include mentally ill people who are convicted of minor crimes and sent to jail, rather than a mental health facility, over and over again. Sollie said one local person who is mentally ill has been arrested more than 30 times in the past two years, and another has been arrested 25 times during the same time period.
Sollie said getting the mentally ill out of jail and into hospitals isn't just about taking the strain off of jail workers, it's about treating people right.

"It would be providing care instead of incarceration... not hiding a problem by incarcerating it, but providing care for a resident," he said.

But keeping the mentally ill out of jail won't be as easy as 1,2,3 - Mississippi law will have to be changed.

Kristen Owen, a therapist at Weems Mental Health and president of the Meridian affiliate of the National Alliance for Mental Health - Mississippi, said that under current law, law enforcement officers don't have the authority to deem someone mentally ill and take them to an assessment facility. Their only alternative is to arrest mentally ill people who are causing a disturbance in the facility and take them to jail.

Last year, State Rep. Alyce Clarke (D-Hinds County) tried to change that, at least in Hinds County, by introducing a bill into the house that would have allowed Hinds County to create Crisis Intervention Teams - law enforcement officers trained to recognize and deal with the mentally ill and authorized to take them to an assessment facility.

The bill did not pass, but Bill Kehoe, director of NAMI Mississippi, said there is now more support for a CIT pilot program in Hinds County, including the support of the Mississippi Sheriff's Association, and NAMI is pushing to get a new bill through the legislature.

Rep. Clarke could not be reached for comment.

Owen said the Meridian affiliate of NAMI is hoping the bill will pass and will lead to legislation allowing the rest of Mississippi to use Crisis Intervention Teams or other jail diversion program as well.

The current system, Owen said, is downright inhumane. "We don't realize that these people are people," she said. "We don't lock granny's up that have Alzhiemer's, we give them treatment. But there's such a stigma associated with mental illness that we put them in jail."

"Many of our prisons," she added, "are the biggest state hospitals, and this problem of people being in jail gets worse when they close the state hospitals."
Recently, Governor Haley Barbour proposed closing some mental health facilities, including parts of East Mississippi State Hospital, to help ease the state's budget woes.

According to NAMI, a 1999 DOJ report showed that 16 percent of all inmates in state and federal prisons at that time suffered from severe mental illness. This, they said, means that there are approximately 283,000 people with severe mental illness in state and federal prisons at any given time.

Owen said trying to keep the mentally ill out of jails is not the same thing as being soft on crime. Getting treatment for the mentally ill, she said, is of benefit for the mentally ill themselves, the sheriff's departments that run the jails, and the community as a whole.

"We're not trying to get people out of punishment for their crimes," she said. "We're trying to identify people who are doing these things strictly because of their mental illness," she said. "We need to do what would get them better, and that's get them treatment."

If Mississippi allows Crisis Intervention Team programs, law enforcement agencies would partner with mental health agencies.

In incidents between law enforcement and a mentally ill person, a CIT trained officer would be able to take that person to the partnering mental health facility, and the mental health experts there would determine whether the person was severely mentally ill and have them admitted to a mental health facility.

Owen said she is hoping that a federal grant could help fund a CIT or jail diversion program, but that such a grant would likely require matching funds.

Owen said she hopes local governments will be on board because, "If it's affecting our citizens, it's affecting us as a whole... It's a cycle that continues and people just end up rotting in jail."
Want to go?

What: Seminar "Treatment, Not Jail: Strategies to Prevent Criminalization of
Individuals with Mental Illness" with speaker Margaret Severson, J.D., MSW
When: Monday, January 11, from 8 a.m. to 12 p.m.
Where: Kahlmus Auditorium, MSU Meridian, 1000 Hwy 19 N.
Admission: Free and open to the public
Registration: Required by calling Pace Cooke Emmons at (601)483-4821 or emailing by Friday, January 8.

Wednesday, December 16, 2009

NY prison system opens unit for mentally ill (update)

By MARY ESCH, Associated Press Writer
POSTED: December 15, 2009

ALBANY - The first inmates moved Tuesday into a new state prison unit for disruptive mentally ill prisoners that was created in response to a lawsuit filed by an advocacy group in 2002.

The 100-bed Residential Mental Health Unit at Marcy Correctional Facility in Oneida County was designed by the state corrections and mental health agencies under the terms of a 2007 settlement with Disability Advocates.

The nonprofit group sued to improve treatment of mentally ill prisoners and to stop putting inmates with serious mental illness and disciplinary issues in solitary confinement.

Inmates in the new unit will receive more mental health care, therapeutic programming and exercise.

Of the 58,690 inmates in New York state prisons, 7,844 are diagnosed with mental illness, including 2,359 with serious mental illness, said Erik Kriss, spokesman for the Department of Correctional Services.

Inmates designated as seriously mentally ill are those with schizophrenia, delusional disorder, psychotic disorder, major depression and bipolar disorder. The designation also includes suicidal inmates and those driven by psychosis or depression to harm themselves.

About 200 of those with serious mental illness have confinement sanctions for disciplinary violations, Kriss said. Traditionally, such inmates are moved to an S-block, a special housing unit with lockdown cells that reduce the need for security personnel.

The Disability Advocates lawsuit claimed that prisoners with mental illness throughout New York did not get adequate mental health treatment, and as a result, many of them were being punished with long sentences of solitary confinement, severe restrictions on property and visits, and no access to out-of-cell programming.

The lawsuit said isolation and idleness led to severe psychiatric deterioration in these isolation units, including acts of self-mutilation and even suicide.

The new mental health unit at Marcy has about 100 corrections employees and 26 Office of Mental Health employees, compared with 38 employees when it was an S-block, Kriss said.

Kriss said inmates in the new unit have constant access to both prison and mental health staff. Each inmate has at least four hours daily of programming and therapy.

''No other prison system to our knowledge affords the inmate patients the amount of time of out-of-cell programming and therapy, including group therapy and group interaction, as the RMHU,'' Kriss said.

Saturday, December 5, 2009

Texas executes man at centre of mental disability row

Defence attorneys for Bobby Wayne Woods argued for state to spare inmate following low scores on IQ tests

Chris McGreal in Washington, Friday 4 December 2009 15.28 GMT

Texas has executed a child killer at the centre of a bitter dispute over what defines legal mental impairment after several courts ruled that he could be put to death despite a low IQ.

Bobby Wayne Woods, 44, was killed by lethal injection for raping and murdering his girlfriend's 11-year-old daughter after the US supreme court denied a last minute appeal by lawyers who argued that the condemned man fell within a ruling by the same court in 2002 that the mentally impaired could not be sentenced to death.

After being told that the supreme court had refused to intervene, Woods' last words were: "Bye. I'm ready."

Tests on Woods in prison put his IQ as low as 68, below the widely accepted cut off for mental impairment of 70. However, in pursuing the death penalty, the state fell back on other tests conducted when he was a child that put his IQ as high as 86.

Maurie Levin, a University of Texas law professor who represented Woods, said that he is "transparently childlike and simple" and described the execution as "a travesty".

Despite the supreme court ruling seven years ago barring the death penalty for the mentally impaired, individual states are left to decide what defines severe learning disabilities. The court said that an IQ test of "around 70" was an indicator but did not set a specific test.

Recent studies have shown that men with IQ scores lower than 70 have been executed in several states, including Texas and Alabama.

Earlier this week, the Texas board of pardons and paroles, voted unanimously that Woods, who has been described as barely literate, should be executed. The Texas attorney general, Greg Abbott, argued to the supreme court that the IQ tests on Woods were unreliable.

"The only experts to ever conclude that Woods was mentally retarded did so after he had committed this murder and had motivation to underperform," he said.

Richard Hattox, who prosecuted Woods, defended the execution.

"Woods testified, and the jury watched him reason and think and debate with me and his own lawyers," he said. "If he was going to claim mental retardation, having him testify was a mistake, because that took away any doubt."

Woods raped and slit the throat of Sarah Patterson after abducting her with her brother, Cody. The boy was badly beaten but survived.

The children's mother, Schwana Patterson, was refused permission to watch the execution because she served a prison sentence for failing to protect her daughter from sexual abuse by Woods.

Woods was the 24th person executed by Texas this year.

Sunday, August 30, 2009

Florida failing to meet mental health responsibilities

State funding for mental health and addiction services continues to fall in a shortsighted policy that fails to tackle problems before they escalate into far more costly outcomes.

When legislators descend on Tallahassee in the coming weeks to lay the foundation for next year’s regular session, they should bear in mind that Florida ranks 48th in mental health funding and 35th in alcohol and drug treatment funding — both abysmal national marks for a state 15th in per capita wealth.

When families in crisis cannot secure behavioral health services, they often end up in emergency rooms, behind bars or out on the streets.

And when budget cuts force the closure of hundreds of treatment beds throughout the state — including 39 beds at Manatee Glens — the societal problem intensifies.

While medical costs soar — witness the impassioned national debate over universal health care — mental health care funding drops. The state of Florida has not adjusted funding to account for medical inflation in more than two decades, according to Manatee Glens CEO Mary Ruiz.

At what cost?

This summer, Manatee Glens, the county’s hospital for mental health and addiction treatment, closed the Adolescent Recovery Center, for teenagers with substance abuse and mental health problems. Juvenile clients of the center, a residential unit with 16 beds that provided care for six to nine months, must now find services at a center in Sarasota.

Several other Manatee Glens units, which provide a lifeline to thousands of clients, are threatened — including the Children’s Crisis Unit, for those who are a danger to themselves or others, and the Walk-In Center, which serves uninsured families.

Manatee Glens, a not-for-profit institution, does not survive on state funding alone — the county and private money provide a significant share. But, Ruiz says, the state’s portion of the hospital’s annual budget has plunged from 85 percent to 55 percent during her 20-year tenure. The current budget stands at $25 million.

Ironically, Florida’s lone mental hospital, G. Pierce Memorial Hospital in Arcadia, closed in 2002 over a lawsuit that accused the state of shortchanging patients with fatal results — at least 10 patient deaths and injuries to others blamed on underfunding.

Upon closure, those patients were dispatched to various community mental health providers, and Manatee Glens received 26 clients and a promise of state funding. That money has evaporated during legislative budget cuts, and those 26 beds have been lost.

The Pierce lesson has been lost on the Legislature, as has the funding pledge. Are we doomed to repeat the past, with deadly results?

As Florida ponders spending hundreds of millions of dollars on new prison construction as the inmate population surges past 100,000, that question becomes all the more critical.

Earlier this year the Legislature failed to remedy that situation by not passing the Community Mental Health and Substance Abuse Treatment and Crime Reduction Act. The reform bill would have established mental health courts, pre-arrest jail diversion programs and law enforcement crisis intervention teams, among other measures.

Proponents, including the judicial, law enforcement and mental health communities, vow a reintroduction of the bill in the 2010 session.

According to the state Department of Children and Families, Florida spends some $250 million annually to pay for 1,700 forensic hospital beds for inmates with mental illness, and that expenditure is expected to double over the next decade.

Far more significant, though, is the number of inmates with mental illness — 17,000, and that, too, is forecast to double in 10 years. The projected cost for additional prisons, beds and services for that unfortunate growth is a staggering $3.6 billion.

Community-based treatment is key to keeping the mentally ill out of the justice system, the kind that Manatee Glens provides. That’s a more prudent and thrifty way of dealing with this particular problem.

But lawmakers should also address the broader issue, the entire spectrum of mental health services. Children, teenagers and adults should not be denied treatment for want of funding, else they, too, get caught up in the legal system or otherwise become a burden on society — by overcrowding emergency rooms or roaming the streets.

Even now, too many Manatee families are falling through the cracks. Ruiz says Manatee Glens serves one out of 30 families here, but with appropriate funding could help one out of 10.

The Legislature’s shortsighted policies of the past must be abandoned in favor of a big-picture, humanitarian vision.

Sunday, July 19, 2009

New court ready for mentally-ill inmates

Program will seek to move prisoners into treatment plans and out of the jail.

By Suevon Lee
Staff writer

Published: Sunday, July 19, 2009 at 6:30 a.m.
After more than a year of planning, Marion County's first mental health court opens Monday.

Funded in part by a federal grant, the nascent court is strongly modeled after similar programs established around the state, including one in Gainesville.

These programs seek to steer non-violent misdemeanor defendants with mental illness toward treatment programs instead of jail cells.

The Marion version will serve as a division of the county court and, much like the special drug and DUI courts, will be presided over by a county judge who works with the State Attorney's Office, Public Defender's Office and representatives from agencies like The Centers.

"When I first started [as a judge] seven years ago, I saw some situations that just kind of cried out for attention," said County Judge Jim McCune, who spearheaded the plan. "Mentally ill people tend to stay in the jail longer. There's nothing going on to get them out."

The Marion County Mental Health Court, one of more than 200 already established in the United States, seemingly couldn't launch at a better time.

According to Marion County Sheriff's Office projections, in 2007 there were between 327 and 1,287 mentally ill inmates at the Marion County Jail. That range is expected to increase to 459 to 1,804 by 2012 and to 1,553 to 6,101 by 2030.

In Florida alone, it's estimated that 125,000 individuals with serious mental illness are booked into jails each year.

Bob Sharpe, CEO of the Tallahassee-based Florida Council for Community Mental Health, said mental health courts have proven to be a reliable arm of the criminal justice system.

"It's had the effect of reducing the number of individuals with mental illness placed in jail. It's helped connect them with the mental health system where they may not have had exposure to the system before," he said.

The potential cost savings cannot be overlooked, either.

"It's cheaper to provide recovery services outside of a jail setting. Many participants [would be] getting treatment through government providers for mental health services," said Diana Williams, president of the National Alliance on Mental Illness' Marion County chapter. "There's just a better place for them. I'm glad we're finally on board with that."

The way the court will work is this: Misdemeanor defendants with no pending felony or DUI charges will be referred to the program through a judge, prosecutor, public defender or law enforcement officer.

If the defendant agrees, treatment providers will work with the State Attorney's Office and judge to determine if the defendant is qualified.

Eligible participants must have a mental illness that is chronic and persistent, such as bipolar disorder, schizophrenia or a major depressive disorder.

If accepted, the defendant will undergo a 12-month treatment program that includes weekly appearances before the judge, regular meetings with a case manager, required attendance at therapy and rehabilitation sessions, and compliance with certain drug and alcohol regulations.

Successful completion could result in a dropped charge; violations could lead to sanctions ranging from community service to jail.

"We need to start small," said McCune, emphasizing that he wants no more than 25 participants enrolled at a time.

"We need to be careful as to how we load this, so we can space it out and get our dynamics clearly worked out. I want to be real careful who gets in the program, and how we time people getting into the program."

The nation's first mental health court was founded in Broward County in 1997. County Judge Ginger Lerner-Wren, who to this day presides over the docket, said her goal was a "pure diversionary court model."

"The main problem is that for decades, individuals with various types of mental disabilities were really, blindly almost, being trans-institutionalized from hospital settings into jail settings," she said. "The criminalization of persons with mental illness is a very profoundly tragic social phenomenon."

The Alachua County Mental Health Court in Gainesville, an 8-year-old program that Marion's is strongly modeled after, functions less like an official proceeding than an informal dialogue between judge and participant.

One day last week, in a regular, chestnut-brown paneled courtroom, participants were seated on benches as the judge entered. Garbed in a black robe, the judge nodded and greeted the individuals, then called each to the lectern, one by one.

Seated in the jury box were representatives from local treatment centers.

"It's nice to see you. You're doing well," County Judge Denise R. Ferrero said to one defendant. "I'm impressed that you're willing to work with the doctors and not just increase the medication yourself."

At one point, the judge asked the room to applaud the "Participant of the Week," a middle-aged man whose commitment to the program earned him a certificate. He left the room smiling.

Other participants did not fare as well.

"I see you had a setback this week," the judge said to a woman whose drug test did not come back clean. "I want you to be successful," she added before sanctioning her to eight hours of community service.

That type of tough encouragement is what keeps the mental health court successful, said Sherry Browne-Davis, who works in the Alachua County court. "We try to empower them to make better decisions. We try to encourage rebuilding the foundation they had before they came to us," she said. "Nobody fits into one box. We really do try to look at every individual individually as well as whatever the setback is and to try and get them back on track."

The first meeting with team members to discuss referrals to Marion County's mental health court is Monday; the first court session is not until early August. Officials are eager to start.

"There is a need for social services [like mental health court] in the community, especially with the population of individuals we have. We've run into people who have had mental health issues before," Marion County Assistant State Attorney Toby Hunt said. "We see them over and over again. We're not addressing their problem. We're addressing the criminal part of it."

To McCune, the court would not have been possible without cooperation from various agencies and investment from community leaders.

"The strength of our program is that we have taken the time to get all the stakeholders finally working together," he said. "We could have put a program together on paper and said, 'Here it is, we can launch,' but it would have been superficial at best. It would have had no meat, no staying power to it."

Above all, McCune added, the significance of the community's gradual awareness of mental illness can't be overstated.

"That takes something of a sea change," he said. "I think we're coming around."

Saturday, June 20, 2009

Artistic freedom

WUWF art exhibit features works by Escambia County Jail inmates

Rebecca Ross

Behind bars, art blooms.

In a small room at the Escambia County Jail, male inmates let their creativity run free. Using paint and pencils, some participants in the Captured Art program create idyllic scenes of bright skies and blue oceans. Others incorporate darker images —skulls and tombstones — to tell a story.

Several of those original works are now on display, through July 24, at Gallery 88, inside the WUWF Studios on University Parkway.

The Captured Art program began at the Escambia County Jail in 2007 with a volunteer teacher and donated supplies. According to Sybil Sahuque and Sharon Giraud, who began the program, its initial goal was to aid inmates with mental health issues.

"We're amazed at how far we've come since we started," said Sahuque, who serves as the program's sole art instructor. "Now there is a waiting list to get in."

"We never thought it would take off the way it did," Giraud said. "To think that we began with paper and mechanical pencils as only art supplies, we've certainly come a long way."

The popular program, funded mainly through donations of money, materials and the sale of participants' art work, is now open to inmates with exemplary behavior who pass an arts aptitude test. Because of space constraints, 10 or fewer men are accepted into the program at a time.

Sharon Gossett, a Sheriff's Department employee who works with the program, said that Captured Art brings about positive changes in participants.

"Their self-esteem has been encouraged, they want to further their education in art and maybe begin a career with what they have learned," she said. "And they have asked if they can invite the younger inmates into the program to try and mentor to them so that they do not make the same mistakes in life."

Former inmate Clarence Williams, 52, said he found self-worth through the program.

Recently released from jail, Williams was a guest of honor at the "Art from the Inside Out" opening reception Thursday.

"I always knew how to draw, but I never considered myself an artist until I got in the art group in prison," he said. "It helped me realize that I can do positive things with my life. It has made me want to do something with my art, now that I'm out."

Lynne Marshall, director of promotions & outreach at WUWF Public Media, said that the "Art from the Inside Out" exhibit is a perfect means to showcase the prison's unique art program.

"We've done several shows that highlight an issue or cause, such as hospice or breast cancer awareness," Marshall said. "When I heard about the Captured Art program and went to the jail and visited these men, I was just so moved by their stories and their work. I felt it was something that we needed to share with the community."

Susan Watson, regional director of the American Civil Liberties Union of Florida, hopes the exhibit will raise community awareness regarding the need for a mental health court.

"It's really important that we take a look at how to treat inmates with mental illness," Watson said. "The exhibit is also an opportunity to show the community some of the good things that are happening at the jail. This is a humane program that allows inmates to express themselves in a positive manner."

Sahuque, Giraud and Watson hope that the exhibit will inspire artistic volunteers to start a similar program for female inmates.

"Some wonderful things have come out of the Captured Art program," Watson said. "They should be shared."

Additional Facts
Want to go?
- WHAT: "Art from the Inside Out" exhibit.

- WHEN: On display through July 24.

- GALLERY HOURS: 8 a.m. to 5 p.m. Monday through Friday (excluding holidays).

- WHERE: Gallery 88, inside the WUWF Studios, 11000 University Parkway.

- COST: Admission is free.

- SPONSORS: National Council on Alcoholism and Drug Dependence, the Prison Book Project, Escambia County Jail Captured Art program, WUWF Public Media and the ACLU of Florida.

- DETAILS: 474-2787, or online at Those interested in viewing or purchasing additional art may contact Sharon Gossett at 436-9823.

Death of mentally-ill inmate raises question of care

01:00 AM EDT on Sunday, June 21, 2009
By Steve Peoples

Journal State House Bureau
He banged his head against the wall until his teeth were loose, says one investigator. He clawed at his chest to get the devil out.

So, prison officials moved James Davis-Reed to a special segregation cell within the “Super Max” unit of the Adult Correctional Institutions on March 27.

It is the safest place the prison offers mentally-ill inmates.

The six-cell “observation and stabilization” area is relatively quiet. Prisoners are held in isolation under 24-hour video surveillance. Psychiatrists visit three times a week.

It’s more common for staff to use restraints on suicidal inmates there, as was the case for Davis-Reed that Thursday morning.

His final hours are still under investigation.

Prison officials have confirmed he was locked in four-point restraints — bound to his bed at the wrists and ankles — “for a short period” in the morning. After the restraints were removed, 24-year-old Davis-Reed was left alone and naked — he had stripped off his gown — under motion-activated video surveillance, in a 7-foot by 10-foot cell.

A prison spokeswoman said that Davis-Reed “was on the highest level of observation.” She could not say, however, when guards realized he had stopped breathing.

Just one state official, Mental Health Advocate H. Reed Cosper, has been willing to publicly discuss the young man’s death in detail.

“He rolled himself up into a fetal kind of ball, which is kind of a regressive behavior for a really sick guy. And he managed to roll his head into a crevice between the bed and the wall, and he couldn’t get out,” said Cosper, among those investigating the incident. “He suffocated, kind of like being crucified. He didn’t suffocate in two minutes. He suffocated in 45 minutes, or 30, I don’t know.” It’s unclear if Davis-Reed was trying to kill himself.

The state police are investigating, as is the ACI. The medical examiner has ruled the death was the result of “positional asphyxia.”

No one disputes these basic facts: James Davis-Reed left the prison in an ambulance and was pronounced dead at Rhode Island Hospital on March 27. He died after spending 35 days at the ACI, transferred there after spending the previous 1,273 days in the forensic unit of the state hospital for mentally-ill prisoners.

“There are mentally-ill people for whom prison is toxic,” Cosper says. “This man was too fragile to be in prison.”

Department of Corrections Director A.T. Wall says his staff did the best it could.

“We can never say ‘no’ when a court sentences an offender to us. On any given day we have hundreds of mentally-ill offenders — diagnosed, in treatment, and on medication. The overwhelming majority adjust and are doing fine in the population,” Wall said. “Our staff worked very hard with James and the treating psychiatrist was distraught over his death, as were many of the staff that worked with him. They grieved when he died.”

JAMES DAVIS-REED had largely cooperated with the doctors after his arrest four years ago.

There was little doubt that he was a dangerous man.

He had traveled through the night of June 27, 2005, from Far Rockaway, N.Y., to Rhode Island to find his ex-girlfriend, Tiffany Joiner. He snuck in through her kitchen window at the Oxbow Farm housing complex in Middletown just after 9 a.m., and found a 10-inch kitchen knife in a drawer.

He first attacked Joiner’s 14-year-old brother, who was watching TV on the couch. Davis-Reed stabbed the boy several times in the neck, chest and back before chasing Joiner and her new boyfriend up the stairs.

The couple suffered minor stab wounds as they tried to barricade themselves in an upstairs bathroom.

The police arrived before anyone was killed.

They chased Davis-Reed through the apartment and out the back door before pinning him to the ground.

Middletown police officer Mark Minnella’s narrative described the moment immediately after the arrest: “The subject was crying and covered in blood. I asked the subject why he stabbed the other party, and his reply was, ‘I love ’em like a brother.’ ” Everyone survived the attack, including Joiner’s 5-year-old brother, who was taken to the hospital to be treated for shock.

The State of Rhode Island took custody of Davis-Reed later that day, June 28, 2005, when he was 20 years old.

His first stop was the state prison.

A judge ordered a mental competency exam less than two months later. On Aug. 26, Davis-Reed was deemed incompetent to stand trial and moved to the forensic unit of Eleanor Slater Hospital, the locked unit for mentally-ill criminals.

An incompetent defendant, according to state law, is someone who “is unable to understand the character and consequences of the proceedings against him or her and is unable to properly assist in his or her defense.”

The goal is to restore the defendant to competency through treatment, said Stacy P. Veroni, chief of the criminal division for the attorney general’s office. “Someone can be insane and competent to stand trial. … It doesn’t have to do with his mental state at the time he committed the offense. It has to do with whether the defendant can generally understand the court process.”

Davis-Reed’s public defender, Paul Tondreau, says all involved with the case agreed that his client was not fit for trial. Tondreau said the forensic unit was more appropriate for Davis-Reed. “He was getting treatment there in a setting that was preferable to the prison.”

He responded well in the small hospital unit, where he was medicated and received constant attention. After more than a year of treatment, he was reevaluated and on Dec. 4, 2007, he was deemed competent to stand trial, according to court records. Tondreau did not challenge the competency ruling, but requested that Davis-Reed be allowed to stay at the hospital until the case was resolved in court. The attorney general’s office did not object, and Davis-Reed would spend two more years in Eleanor Slater.

While still living in the mental hospital, Davis-Reed ultimately pleaded guilty to five felony counts and signed off, in September 2008, on a plea bargain that capped his prison time at 15 years.Tondreau did not raise the insanity defense, which might have kept Davis-Reed out of prison. “The client has the final say,” the public defender said recently. “It’s his decision.”

Superior Court Justice Melanie Wilk Thunberg accepted Davis-Reed’s plea bargain on Feb. 20, 2009, and ordered him to the ACI. Tondreau did not object. After more than three years in a state mental hospital, Davis-Reed was transferred to the prison that day.

Prison officials had less than 24 hours’ notice he was coming.

THE ADULT Correctional Institutions holds Rhode Island’s largest collection of the mentally ill.

One day in mid-May, at least 567 inmates, or 23 percent of the “sentenced male population,” were prescribed psychotropic medication for mental illness, according to figures provided by the Corrections Department. These do not include the intake center or the women’s unit. Of the 567 inmates, 213 were taking antipsychotic drugs for the most serious diagnoses, such as schizophrenia.

Despite the numbers, the prison’s clinical director, Frederic C. Friedman, said the ACI has “a small number of people with serious mental illness. The number of truly psychotic is small.”

It’s unclear if Davis-Reed was among the “truly psychotic.” State officials have refused to discuss his health, citing medical privacy laws. And court records relating to mental competency have been sealed.

After leaving the 20-bed mental hospital, he spent his first 34 days at the intake center — a chaotic, crowded environment that holds 1,148 inmates.

Friedman said Davis-Reed spoke to a “weekend psychiatrist within 24 hours” and visited a psychiatrist and social workers “several times” in the subsequent weeks, typical treatment for inmates.

Cosper, the mental health advocate, has suggested that ACI doctors may have changed Davis-Reed’s medications after the transfer. Citing medical privacy laws, prison officials refused to answer that question.

The ACI has partnered with the University of Rhode Island’s College of Pharmacy to control ballooning medication costs by switching to generic drugs in many cases, a collaboration that prompted a national award less than two weeks after Davis-Reed’s death.

Taxpayers spent $180,857 on antipsychotic medication for prisoners between February and April of this year, according to information Friedman provided.

He said he works to ensure that prison psychiatrists are aware of cheaper drug options, but says that specific prescription decisions are left to inmates’ psychiatrists.

“I’m concerned that in this area of fiscal restraints, the impression is being created that we sacrificed, sent somebody to the bottom line. It simply isn’t true,” said Wall. “The clinical staff was actively working with this guy and he was working with us.”

It’s unclear what triggered Davis-Reed’s deterioration. He went downhill relatively quickly at the ACI — after steadily improving over three years at Eleanor Slater Hospital.

“He had engaged in some self-injurious behavior which called upon us to place him in a smaller setting,” Wall said, declining to describe the behavior. It was Cosper who said that Davis-Reed had been knocking his head against the wall to the point of loosening his teeth, and clawing at his chest “to get the devil out.”

The smaller setting was the ACI’s observation and stabilization unit within maximum security, a special area established roughly three years ago for those with the most serious mental problems.

State law affords prison officials another option. In extreme cases, the corrections director or the director of the state Department of Mental Health, Retardation and Hospitals may file a court petition to have a mentally-ill prisoner transferred to Eleanor Slater Hospital.

Corrections officials could account for a handful of such petitions in recent years; MHRH couldn’t detail any.

The Department of Corrections did not file a petition in Davis-Reed’s case, though they acknowledge that the prisoner had become a danger to himself.

“He is by no means the only inmate who has been self-injurious in our setting. Sadly, we’re accustomed to seeing that behavior. It may not be routine, but it is not particularly rare,” Wall said. “And he had been with us for only five weeks. Lots of mentally-ill inmates have trouble settling down at first whenever there’s a change in circumstance.”

JAMES DAVIS-REED is among dozens of inmates who have died while in the care of Rhode Island’s prison system in recent years.

Altogether, 62 people died at the ACI since Jan. 1, 2000, according to data provided by the Department of Corrections. It’s difficult to say how many were mentally ill.

Davis-Reed is the only one listed as having died from “positional asphyxia.” But the prison details 13 suicides over that time, including 11 by hanging. Four inmates died from drug overdoses or acute drug withdrawal.

Rhode Island is hardly the only state in which prisoners die.

In 2006, 8 inmates died in the Ocean State, 39 died in the Massachusetts’ state prison system, 25 in Connecticut, 7 in Vermont, and 6 each in New Hampshire and Maine, according to U.S. Department of Justice statistics.

“I recognize that our job is, insofar as it’s possible, to keep everybody safe. It’s a very tall order,” Wall said. “Our record is very good. But we work with a very difficult population on a number of fronts, including mental health. Tragic outcomes can and do occur in all kinds of settings, correctional and hospital. I do not think it means that we, or I, am responsible for that outcome.”

Monday, June 15, 2009

Michael Goforth: Evidence mounts to make changes in mental health and jails

By Michael Goforth (Contact)
Monday, June 15, 2009

“We tend to use a criminal justice model for a disease and it just doesn’t work,” Judge Stephen Leifman told me in a telephone conference earlier this year. “We can’t afford to keep doing what we’re doing.”

Leifman, a special adviser on criminal justice and mental health for the Florida Supreme Court, was talking about the financial and social costs of housing the mentally ill in municipal, county and state jails.

Of an estimated 600,000 Floridians with mental illness, about 125,000 needing immediate treatment are booked into jails or prisons each year. The cost for a mentally healthy inmate is about $40,000 per year. For a person with mental illness in a state-operated psychiatric hospital, the annual cost is about $140,000

In addition, the numbers are increasing and it’s estimated that over the next decade, the state would have to build a new prison each year to keep up with the number of mentally ill inmates.

And, that doesn’t include the costs for expanding county jails for their mentally ill populations, which has been occurring on the Treasure Coast in recent years.

Speaking recently at a briefing on Capitol Hill, Leifman said, “Our criminal justice system was never intended to be the safety net for the public mental health system. Unfortunately, though, that is exactly what it has become. Too often, people land in jail for minor offenses directly related to symptoms of untreated mental illnesses because of inadequate system of community-based services and supports.

“Only through systemwide collaboration and partnerships can we begin to close the revolving door to the criminal justice system which, today, results in increased recidivism, devastation to our families and communities, wasteful government spending, and the shameful warehousing in jails and prisons of some of the most vulnerable and neglected members of our communities.”

Leifman was speaking in conjunction with release of the first significant study of mental health and jails in about two decades. That study by the Council of State Governments Justice Center and Policy Research Associates found that about 17 percent of inmates in the study suffered from “serious” mental illness.

That study, however, looked at only about 20,000 inmates at five jails. Using those figures, it was estimated that about 2 million seriously mentally ill persons are booked into jails in the United States each year.

But, it’s not just those with serious mental illness who are being housed in jails. Based on medications required, about a third of those booked into the St. Lucie County Jail each year suffer from some form of mental illness. The cost for a mentally ill person charged with a misdemeanor averages $35,000 per stay. The cost for a mentally ill person charged with a felony is about $64,000 per stay.

In March, U.S. Sen. Jim Webb, D-Va., introduced the National Criminal Justice Commission Act of 2009, which calls for a national commission to undertake an 18-month study of the impact of putting the mentally ill in jail and how the criminal justice system can be reformed to address the problem.

U.S. Sen. Pat Leahy, D-Vt., has been pushing for reauthorization of the Mentally Ill Offender Treatment and Crime Reduction Act, which would provide federal grants to state and local governments to create or expand mental health courts, offer treatment and training programs to provide support and services to reduce repeat offenders, and to train police in how to react to situations involving persons with mental illness.

In addressing the results of its study, the Council of State Governments Justice Center said, “Too often there are people incarcerated who have serious mental illnesses, oftentimes for minor offenses, who would be better served in the community. Though jails have a constitutional mandate to treat the mental illnesses of individuals under their supervision, they are ill-equipped to meet the needs of those with serious mental illness.

“Policies have relied on outdated data to determine the scope and nature of this problem. As state and local governments face significant budget shortfalls, grapple with growing jail populations, and slash spending for community-based mental health services, there has not been a more critical time for policymakers to consider the implications of this prevalence study.”

Study results are clear. Too many people with mental illness are in jails who should not be there. They can be better served and more cheaply served through community programs.

But, as time goes on without comprehensive actions, those will mentally illness and their families are abused and taxpayers are forced to pay far more than they should for far too little.

Monday, April 6, 2009

Early intervention works for mentally ill

OUR OPINION: They belong in treatment facilities, not in jails and prisons
You see them all the time: People who aimlessly wander the streets, obviously homeless and obviously in need of attention for their mental illnesses. Ever wonder what happens to them? Far too many end up in jail or prison, at great and unnecessary expense to taxpayers.

To keep just 1,700 of these people locked up, as Florida currently does, costs $250 million each year. When they are released from prison, as inevitably all of them are, their mental-health conditions have worsened.

There is a better way. Instead of warehousing these people in prisons, the state can diagnose and treat their illnesses. It can use supportive diversion programs in community-based facilities to put them on a path of recovery. This can be done at a fraction of the cost of locking them up.

This is what can be accomplished if state legislators approve HB 7103 and SB 2018. The legislation carries the ponderous title, Community Mental Health & Substance Abuse Treatment & Crime Reduction Act. Yet it represents years of work by a coalition of public and private leaders, including Gov. Charlie Crist, former Florida Chief Supreme Court Chief Judge R. Fred Lewis, Miami-Dade Circuit Court Judge Steve Leifman and others.

A Senate committee considers the bill this week and other committee hearings await before a floor vote is taken. The bills deserve the enthusiastic support of all lawmakers. If it becomes law, the proposal would achieve that legislative rarity of doing a public good while being revenue neutral (meaning it doesn't require new money) at the outset, and save the state hundreds of millions of dollars in the long term.

This would be possible because the state would begin to reverse its extraordinarily wasteful practice of putting mentally ill people who commit crimes in prison instead of treating their illnesses. Florida is not alone in doing this, but it would become the model for other states to emulate.

The law would allow Florida to use community-based mental-health resources to intervene with the mentally ill before they go to jail or prison. This is what typically happens:

A mentally ill person commits a minor offense, say being disorderly. A police officer arrives, and attempts to calm the situation. The person, under emotional duress, is unable to comply, becomes more disruptive and is arrested on a more-serious charge.

This is where the legal insanity begins. Because the mentally ill person is unable to understand the charges, he is sent to a criminal-forensic hospital where, with the help of medications, he is calmed enough to face trial. If convicted, he is sent to prison where there is no treatment for his mental illness. If exonerated, he is released, untreated, and certain to suffer another emotional episode, which starts the process anew.

The proposal would authorize pilot projects in Miami-Dade, Tampa-St. Petersburg, Leon County and the Pensacola area. The programs would use managed-care principles, using appropriate diagnosis and medication, trauma services, drug and alcohol intervention and rehabilitative services such as education and job training. The intervention will give the mentally ill the help they need to everyone's benefit.

Sunday, April 5, 2009

Prison nation

Friday, April 3
There are few industries more recession-proof than prisons, especially in this country.
The United States has the world's highest incarceration rate, with 2.3 million people behind bars. Despite having only 5 percent of the world's population, we have 25 percent of the world's reported prison population.

Ours is a nation that loves retribution. The flip side to "zero tolerance," mandatory sentencing laws and "get tough" policies on crime is that about 1 out of every 31 American adults is either in prison, jail or on supervised release. And all this costs us, as a nation, about $68 billion a year.

The picture is even worse in Vermont. According to data compiled by the Pew Center on the States, between 1996 and 2006,

Vermont's prison population doubled in size -- from 1,058 to 2,123 inmates -- and the corrections budget went up 129 percent -- from $48 million in fiscal year 1996 for $130 million in fiscal year 2006.

The percentage of the state budget devoted to corrections has risen from 4 percent of the general fund in 1990 to 10 percent of the general fund in 2008. Our state's incarceration rate has increased 80 percent over the past decade, compared to a national average of 18 percent.

At the current rate of growth, the state will either have to ship more prisoners to out-of-state facilities -- which would cost about $82 million -- or spend $206 million to build new prisons in Vermont.

In the ongoing budget battle, it has been more or less decided that more prisoners will be shipped out of state to corporate-run private prisons, since it is cheaper. But is that the real solution to the problem of an out-of-control corrections budget?
Vermont has the dubious distinction of being one of five states (Connecticut, Delaware, Michigan and Oregon are the others) that spend more on corrections than on their higher education systems. Is that the kind of state we want to be?

In Parade magazine this week, U.S. Sen. Jim Webb, D-Va., wrote about the urgent need to reform our nation's criminal justice system. With so many of our fellow citizens in jail, Webb wrote that "either we are home to the most evil people on earth or we are doing something different -- and vastly counterproductive. Obviously, the answer is the latter."

Webb believes one of the biggest problems is that we have swamped the criminal justice system with low-level drug offenders.

According to the U.S. Department of Justice, nearly 48 percent of all drug arrests in 2007 were for marijuana offenses and nearly 60 percent of all people in state prison serving sentences for drug offenses had no history of violence or of significant selling activity.

And while blacks comprise 12 percent of the U.S. population, they account for 37 percent of those arrested, 59 percent of those convicted and 74 percent of those sentenced on drug charges.

The other factor driving the increase in the prison population is mental health. The Department of Justice estimates 16 percent of adult inmates -- more than 350,000 -- suffer from mental illness, and the percentage is even higher among juveniles.

That is why Webb says he has introduced legislation to "create a national commission to look at every aspect of our criminal justice system with an eye toward reshaping the process from top to bottom."

He believes it's time for Americans to ask some hard questions. Why are so many of our citizens in jail compared to other nations? What is this costing us in tax dollars and lost opportunities? How can we change our nation's drug policies? How can we better diagnose and treat mental illness? How can we make our prisons a place for rehabilitation rather than violence and hate?

These are questions most politicians would rather not answer. It's easier to pass a gay marriage law in our legislature that it is to pass a law that would decriminalize marijuana possession. It's easier to advocate sending more people to jail for longer stretches in the name of public safety than to honestly deal with all the factors that make the United States the world's No. 1 jailer.

We need more lawmakers at every level of government who are brave enough to deal with a criminal justice system that is a national disgrace, to make the necessary changes and to come up with better ways to keep our nation safe.

Monday, March 30, 2009

Editorial: Mental Health

Better treatment

Court-ordered outpatient treatment for the mentally ill is effective for the individual and less expensive for the state. But in Pennsylvania, it's rarely used.
That's because the state's outdated 1976 mental-health law requires ill people to be a "clear and present danger" to themselves or others before a judge can order them to get treatment.

By the time people with mental illness deteriorate to that point, outpatient services are often not appropriate. They usually end up hospitalized.

If such people receive community-based treatment before they deteriorate too far, the results are positive. But people with mental illness often don't recognize they need help, and won't agree to treatment voluntarily.

Forty-two states have some form of assisted outpatient treatment for the mentally ill. And a bill pending in the state Senate would bring Pennsylvania up to date in providing round-the-clock outpatient services. (The New Jersey Senate is also considering similar legislation).

Sponsored by Sen. Stewart Greenleaf (R., Montgomery, Bucks), SB 251 would allow judges to order outpatient mental-health treatment for people involuntarily for up to six months. It would apply only to patients who have been hospitalized at least twice within the previous three years, or have been involved in a serious violent incident within the past four years.

The new standard would be a "likelihood" of danger for receiving treatment involuntarily. The bill provides for a court hearing and legal representation for the mentally ill person.

New York state implemented such a law in 1999. Five years later, a report showed that individuals in the program experienced 77 percent fewer psychiatric hospitalizations, 87 percent fewer incidents of incarceration, and 74 percent less homelessness.

Greenleaf said he's mindful of Pennsylvania's history with the mentally ill, in which too many people were institutionalized and forgotten. "We're not going back to the bad old days," he said.

Rather, mental-health advocates say, the problem now is that too many people don't receive treatment before coming into contact with the criminal-justice system. About 20 percent of prison inmates suffer from mental-health issues. Those who do end up in prison tend to stay in prison longer than other inmates, costing the state more money and denying themselves effective treatment.

Supporters estimate that court-ordered outpatient treatment would benefit about 500 people in Pennsylvania annually. They say the service network is already in place to help such people in most counties.

Greenleaf said the legislation would not cost the state more money because Medicaid pays for these services. That aspect needs to be explored more thoroughly. While the state could very well save money with fewer prisoners and fewer state hospital commitments, some county human-service agencies might face greater demand for their services.

The state Senate should move ahead with this legislation, the goal of which is more effective patient care, fewer hospitalizations, and fewer incarcerations.

Sunday, March 29, 2009

Mentally ill could benefit from bill


Published: Wednesday, March 25, 2009 at 1:00 a.m.

Responding to the growing problem of mentally ill Floridians ending up in jails and prisons, lawmakers are moving forward on a sweeping initiative that will help better identify and treat those residents. Proponents call it one of the most significant rewrites of the state mental health law since the Baker Act was passed in 1971, reforming the way the mentally ill are committed for treatment.

Although the program is ambitious, it will start off on a small scale, with three pilot projects and will not require new state funding.

But advocates say it has the potential to save the state billions of dollars in the long term by improving the treatment of the mentally ill and keeping them out of costly prison beds or forensic treatment centers.

"This bill will without a doubt ensure a more fair treatment of people with mental illness. It will not only add fairness but effectiveness to the system," said Rep. Yolly Roberson, D-Miami, as the proposal was endorsed by the House Criminal and Civil Justice Policy Council on Tuesday. "It's a win-win for all parties."

Miami-Dade Judge Steven Leifman, who has spearheaded the legislation as a special adviser to the state Supreme Court on criminal justice and mental health, said the proposal is designed to bring the state's handling of mentally ill citizens in line with new treatment systems that can help those residents avoid ending up in jails or prisons.

"We've pushed a lot of people into the criminal justice system that don't need to be there," Leifman said.

A 2007 report to the Supreme Court found on a daily basis there were about 70,000 Floridians with a serious mental illness who were in prisons or jails, or under some type of correctional supervision. The report said that annually more than 125,000 Floridians with mental illnesses were being booked into county jails.

"The vast majority of these individuals are charged with minor misdemeanor and low-level felony offenses that are a direct result of their psychiatric illnesses," the report found.

Leifman said the mentally ill prisoners were the fastest growing segment in the state prison system, saying a projection shows it could cost the state more than $3 billion over the next decade to build new prison space and maintain those beds for that population. The other escalating demand is being put on the state's forensic facilities -- where persons charged with a felony but deemed mentally incompetent are sent until they have recovered enough to stand trial.

Florida is now spending roughly $250 million a year on 1,700 forensic beds, which gives it the distinction of running one of the most costly systems in the country. At the same time, the state has been criticized by national mental health groups for being near the bottom when it comes to spending on mental health programs outside of the criminal justice system.

"We've deep-ended our system so poorly that there aren't enough resources to provide the level of services that we now know are required to keep people out of the criminal justice system," Leifman said.

The new bill aims to target people who can be diverted from the criminal justice system, while also providing better treatment for the approximately 6,000 inmates with serious mental illnesses who are released from prison each year.

About half of those inmates end up going back to prison, Leifman said. The measure has the support of key state agencies including the Department of Children and Families, the Department of Corrections and the Agency for Health Care Administration.

DCF Secretary George Sheldon, who oversees the forensic treatment centers, said the current system does not make sense in that many felons who are sent to the centers spend enough time there in recovery only to be released back into the community for "time served" once they are deemed competent to stand trial.

Under the proposal, state officials hope to use some of the money now slated for the forensic beds for the upfront treatment initiatives, thus saving the state money in the long run. "It's a much more sensible use of money," Sheldon said. "What we're doing right now is the true definition of insanity."

Leifman said another advantage of the plan is that the federal government will pay a majority of the program's costs -- through the Medicaid -- as long as the mentally ill are being treated in the community and are not being sent into the criminal justice system.

The measure calls for pilot programs to be established in South Florida, the Tampa Bay region and the Pensacola area.

A similar bill is sponsored by Sen. Mike Fasano, R-New Port Richey, in the Senate.

This story appeared in print on page BN1

Saturday, January 17, 2009

Many in U.S. Prisons Lack Good Health Care

Report finds high rate of chronic disease that often goes untreated
Posted January 16, 2009
By Amanda Gardner

HealthDay Reporter

FRIDAY, Jan. 16 (HealthDay News) -- The 2.3 million Americans currently being held in correctional facilities across the country suffer a much higher rate of serious and chronic illness than the general population does, a new report finds.

These individuals -- representing about 1 percent of the total U.S. population -- also have difficulty accessing care both inside and outside the correctional system, according to research published online Jan. 15 and set to appear in the April issue of the American Journal of Public Health.

It's the first such study to look at the health of all inmates nationwide at once, the researchers said.

"We largely ignore mental health in our society, and it's exacerbated here," said Craig Blakely, associate dean for academic affairs and professor of health policy and management at the Texas A&M Health Science Center School of Rural Public Health in College Station. "The findings suggest that health and mental health problems are linked to higher rates of arrest and incarceration."

"Devoting more resources to community mental health care could reduce crime rates and reduce incarceration," added study author Dr. Andrew P. Wilper, an instructor in medicine at the University of Washington School of Medicine.

Largely due to the war on drugs, the U.S. prison population has increased fourfold in the past 25 years, surpassing any other nation in the world in number of people incarcerated per capita, according to background information in the paper.

Prisoners have a constitutional right to health care via the Eighth Amendment concerning cruel and unusual punishment, yet such services are often sorely lacking, the report's authors contend.

Good data on the subject is also lacking, Wilper added. He said that he filed two federal government freedom-of-information requests -- both of which were denied -- to review copies of an U.S. Surgeon General's report on prison health care.

In their study, the authors analyzed responses contained in two Bureau of Justice Statistics surveys: the 2002 Survey of Inmates in Local Jails and the 2004 Survey of Inmates in State and Federal Correctional Facilities.

"Of these roughly 2 million inmates, about 800,000 suffered from a chronic condition that generally requires medical attention: diabetes, hypertension, a prior heart attack or a previously diagnosed cancer, among a few other diagnoses," Wilper said.

Compared to non-incarcerated citizens, inmates in state jails were 31 percent more likely to have asthma, 55 percent more prone to have diabetes, and 90 percent more likely to have suffered a heart attack.

In federal, state and local jails, 38.5 percent of inmates, 42.8 percent of inmates and 38.7 percent of inmates, respectively, had a chronic medical condition.

Among inmates with mental conditions that had been treated on the outside, 69.1 percent of federal prison inmates, 68.6 percent of those in state facilities, and 45.5 percent of those in local jails were not taking their medication at the time of their arrest. The treatment rate for mental health woes tripled after incarceration.

Fourteen percent of those in federal prisons, 20 percent of state prison inmates and 68.4 percent of those in local jails had not yet seen a health-care provider since their incarceration, despite persistent health problems, the report found.

"There's some alarming data that suggests that those [inmates] with chronic conditions don't get the care they need when incarcerated and that's Eighth-Amendment illegal," Blakely said. "The whole war on drugs has made a disaster of our judicial system and created a nightmare we can't control."

"Given the huge cost of incarceration, we're foolish not to ensure that inmates get the basic care that would allow them to have a better chance of rehabilitation," he continued. "This suggests the need for universal access to health care."

More information

Visit the U.S. National Commission on Correctional Health Care for more on this issue.

Gassing mentally ill inmates is out

A judge rules that it qualifies as cruel and unusual punishment.

By Paul Pinkham Story updated at 2:33 AM on Wednesday, Jan. 14, 2009

Two mentally ill inmates suffered unconstitutional cruel and unusual punishment at the hands of Florida State Prison officials who disciplined them with pepper spray, tear gas and other chemical agents, a judge has ruled.

But the same punishment was appropriate for four other prisoners who sued the Department of Corrections on similar grounds, U.S. District Judge Timothy Corrigan of Jacksonville wrote in a lengthy order finalized Monday after a five-day bench trial in September.

Corrigan made the distinction based on the mental condition of the individual inmates at the time they were disciplined. The order means the department can no longer use chemical agents on prisoners who lack the capacity to follow orders or control their behavior, said Jacksonville attorney Buddy Schulz, who represented the inmates.

"It's significant because it's the first time a federal judge has found this type of use of force unconstitutional as it relates to seriously mentally ill inmates who are incapable of conforming to the rules of the prisons," Schulz said.

Corrigan gave lawyers for the state until Feb. 10 to come up with terms of an injunction and Schulz's team until Feb. 24 to voice objections. He directed both sides to work together, and Schulz said he's hopeful for a dialogue for reform with Corrections Secretary Walter McNeil, who has shown interest in prison mental-health issues.

Lawyers for the prison system didn't return phone calls Tuesday.

Constitutionality was the only issue at trial. Individual claims by the prisoners had been resolved previously.

Corrigan found that the use of chemical agents against recalcitrant prisoners isn't by itself unconstitutional. But he wrote that such force loses its disciplinary purpose and "becomes brutality" when inmates are gassed who cannot control their actions because of mental illness.

Former Florida State Prison Warden Ron McAndrew, now a corrections consultant, called the ruling a vindication of mental-health policies he had in place in the 1990s.

"It's a great success for the people of Florida in terms of reducing the torture of inmates in Florida's prisons, especially those that are mentally disturbed," McAndrew said.

He testified at trial that his policies were abandoned when he was replaced in 1999 by James Crosby, leading to hundreds more gassings. Crosby later became corrections secretary, then went to prison himself for taking kickbacks., (904) 359-4107

State Lawmakers Look at Death Penalty Change

Thursday, January 15 2009
One state defense attorney is asking legislators to guarantee justice and fairness by banning the execution of death row inmates who suffer from severe mental illness.

Attorney Kimberly Stevens spoke to a legislative committee on Thursday asking them to remove the death penalty as a sentencing option for some suspects accused of first-degree murder.

According to the Associated Press, the new legislation would allow a judge to declare a suspect to have a severe mental disability. If convicted, the person would face a maximum sentence of life in prison without parole.

State law already bars a death sentence for the mentally retarded and North Carolina juries also can find a defendant not guilty by reason of insanity.

The bill could be considered after the Legislature meets later this month.

Saturday, July 19, 2008

European states treat mental illness before it becomes prison problem


Tennessee Voices

If, upon arriving in Maastricht, Netherlands, on July 2 I had shut my eyes, I may have thought I had not left Nashville.

The temperature was in the high 80s with humidity to match, very "un-Holland"-like. But with my eyes open, I knew I was in an old European city.

I attended the 18th Conference of the European Association of Psychology and Law (EAPL), representing the Davidson County Mental Health Court over which I preside as a General Sessions judge. Also participating from Nashville were Dr. Roland Gray, representing the Davidson County Drug Court Residential Treatment Program, and Dr. David Patzer, a psychiatrist who works with both court programs.

At the invitation of EAPL, I presented a symposium with Gray and Patzer about the Mental Health Drug courts and a unique collaborative effort that will provide residential intensive drug therapy and mental health treatment for individuals in the criminal justice system who suffer from both serious mental illness and drug addiction. This program just received a federal grant for implementation. It appears to be the only type of program in the United States where separate courts are working together on these issues.

Seth Norman, judge of Davidson County Criminal Court Division IV, who founded and presides over the Drug Court Residential Treatment Program, was not able to attend the conference but provided a video presentation used at the symposium.

I am proud to report that the conference participants with whom I spoke, mostly European psychologists, university professors and students and some law enforcement personnel, were interested and impressed with the programs. However, a few people were curious as to why so many mentally ill people were in the U.S. criminal justice system.

It appears that a much higher percentage of people incarcerated in the United States suffer from serious mental illness than in some European countries. For example, I learned in one seminar that fewer than 5 percent of people arrested for crimes in The Netherlands suffered from schizophrenia. Yet, according to a 2006 U.S. Justice Department study, 24 percent of local jail inmates reported symptoms of a psychotic disorder.

Why this discrepancy? Certainly, there are many reasons. However, one reason may be access to health care. European countries have universal health-care plans; perhaps because of this access to treatment and medication, fewer people have mental health issues that deteriorate to a level where the police and courts have to become involved.

The Europeans may be attacking this issue on the front end, thus resulting in fewer people with mental illness winding up in jails. Just something to think about.

Tuesday, July 8, 2008

Mentally ill need treatment, not jail

By Darlene Linville, Guest Columnist

Published Sunday, July 6, 2008 5:17 PM


"Treatment not jail'' is the battle cry for Partners in Crisis, a statewide advocacy organization whose members support prevention and early treatment programs designed to keep people with mental illness out of the criminal justice system and get them into treatment. Each year as many as 125,000 people with mental illnesses requiring immediate treatment are arrested and booked into Florida jails.

The National Alliance on Mental Illness in Florida theoretically chose the same battle cry, "treatment not jail," when members statewide chose initiatives for 2007, setting as No. 1 to advocate for more funding for the mental health care system, and No. 2, to work toward improving programs to keep people with mental illness from being involved with the criminal justice system. Florida's jails and prisons house more than 10 times the number of people with mental illness as the number being treated in mental health facilities.

NAMI Hernando shouted that same battle cry in 2007 with a community education seminar titled "Taking Action … Let the Dialogue Begin," at which Judge Ginger Lerner-Wren spoke about her involvement as presiding judge in the establishment of the nation's first Mental Health Court in Broward County. She talked long and hard about how the Mental Health Court in her county saved taxpayer dollars while preserving the human dignity of those living with a treatable mental illness. Treatment not jail!

Hernando County was listening. A task force was formed and with the help of Karen Nicolai, clerk of court, Jean Rags, director of Health and Human Services and Kathleen Lonergan, coordinator for the Drug Court, that same battle cry was soon picked up by others in our county. Many people gathered to discuss the need and the possibilities; from the judges to the jail warden to the State Attorney's Office, to the hospital administrators, all were in agreement: A Mental Health Court was desperately needed.

Too many people with treatable mental illnesses were spending time in a very expensive jail when their crimes were not violent, but rather were directly related to nontreatment of their mental illness. The 2006 Hernando County health needs assessment shows that Baker Act initiations are substantially higher in Hernando County than Florida's average, and have been increasing since 2000.

I am amazed at how quickly our county officials, judges, attorneys and jail personnel came together to make it all happen. The mental health court has begun hearing cases, in Judge Richard Tombrink's courtroom.

Everyone agrees a mental health court is not the final answer, but only a beginning. "Treatment not jail" includes finding the treatment necessary to keep people on essential medication and involved with adequate psychiatric care. The Harbor Behavioral Health Care Institute will do all that it can, but in these troubled times of reduced spending for necessary programs it can only do what current funding levels allow.

"Continuing the Dialogue … Decriminalizing Mental Illness" was the theme for NAMI's most recent community education seminar on May 31 at Nativity Lutheran Church. Approximately 70 people heard a panel of experts discuss the why's and how's of a mental health court. County Commissioner Chris Kingsley read the county proclamation for Mental Health Month.

Sheriff Richard Nugent and several members of the Hernando County Sheriff's Office attended the event, at which the recently graduated members of the Crisis Intervention Team were recognized. These officers form a unique group, a group that has learned through special training to recognize mental health issues and the techniques necessary to de-escalate potentially explosive situations, thus preserving human dignity and community safety. We now have 18 trained members of the Crisis Intervention Team. Once again, "treatment not jail".

The first full week of October will find NAMI on a national level observing Mental Illness Awareness Week. NAMI Hernando will be continuing the dialogue and shouting the battle cry "treatment not jail." Watch for more information in the months ahead.

Thank you for listening, Hernando County. We look forward to continuing this partnership and our fight for adequate care for the mentally ill.

Darlene Linville is president of the board of directors of NAMI Hernando. Guest columnists write their own views on subjects they choose, which do not necessarily reflect the opinions of this newspaper.

Saturday, July 5, 2008


"The death penalty is about revenge and hate, and revenge and hate is why my daughter and those 167 other people are dead today."

Bud Welch, father of Julie Marie Welch,
victim in the Oklahoma City bombing

"I have come to believe that the death penalty is not what will help me heal. Responding to one killing with another killing does not honor my daughter, nor does it help create the kind of society I want to live in, where human life and human rights are valued. I know that an execution creates another grieving family, and causing pain to another family does not lessen my own pain."

MVFHR board member, Vicki Schieber, testifying to the Subcommittee on the Constitution,
Civil Rights and Property Rights; Committee on the Judiciary; US Senate, February 2006

Thursday, May 29, 2008

Mentally incompetent defendants on rise

By Kevin Johnson and Andrew Seaman, USA TODAY
WASHINGTON — The number of accused felons declared mentally incompetent to stand trial is rising in 10 of the nation's 12 largest states, delaying local prosecutions and swamping state mental health and prison systems, a USA TODAY review finds.
These defendants cost hundreds of millions of dollars to treat and house as local governments tighten their budgets because of a slowing economy.

Legal analysts attribute the increase to a lack of mental health care, judges' increased openness to such claims and legal strategies by defendants to try to avoid harsh punishment.

"It's a huge problem," says Joshua Marquis, a vice president of the National District Attorneys Association. "It's equally bad for the accused and the victims" because cases linger.

Criminal defendants who do not understand the legal proceedings against them are generally declared by judges to be incompetent for trial. Most are referred to mental health facilities and treated. The length of treatment varies from an average of three weeks in Virginia to more than nine months in Tennessee before they are deemed fit for trial or mental health experts determine they cannot be successfully treated, the USA TODAY review found.

There is wide variation in how states track thousands of incompetency rulings, and some do not track them at all. Of the 12 most populous states, Texas reported a decline last year and New Jersey did not provide data.

Among states reporting increases:

• Florida: State policy analysts reported in March that incompetent defendants there doubled from 1,061 to 2,123 in the past five years. Florida Supreme Court Chief Justice R. Fred Lewis says that reflects a lack of access to treatment even before the accused enter the criminal justice system. Florida officials spend about $250 million yearly on treatment aimed at restoring mental fitness. The state projects the cost will double in the next seven years.

• Ohio: About 32% of 1,050 state mental hospital patients have been charged with crimes but declared unfit for trial. Most are accused felons, and that number has risen recently, says Howard Sokolov, Ohio's medical director for forensic services.

• California: Mentally incompetent defendants treated by state mental health providers increased in four of the past five years. Accused and convicted offenders now occupy 4,500 of the state's 5,000 mental hospital beds, up from 500 more than a decade ago, says the state Department of Mental Health.

Ken Murray, chairman of the National Association of Criminal Defense Lawyers' mental health committee, says competency claims are gaining acceptance among judges, prosecutors and defense lawyers in part because of growing efforts to identify the wrongfully convicted. "Some of these people who made false confessions" — and were convicted based on those statements — "had competence problems to start with," says Murray, a federal public defender in Phoenix.

Sokolov says incompetency caseloads for Ohio's mental health assessors have risen 22% in the past five years. "There is an increasing amount of people who are finding it difficult to obtain (mental health) services," he says, "and they tend to get in trouble with the law."

Contributing: Katharine Lackey

Monday, May 26, 2008

Lacking treatment options, mentally ill go to jail


SANDPOINT - In Idaho, as in Bonner County, the fastest way to land in jail without committing a crime is to suffer from mental illness.

And it's not because of any shortcomings on the part of local law enforcement officials - they already go above and beyond the call of duty when responding to situations where a mentally ill person is “in crisis.”

Where the system falls apart is after the event takes place - particularly in rural communities with limited resources. Faced with a severe lack of secure facilities, law enforcement personnel often have no choice but to incarcerate the individual, further exacerbating a shortage of space needed to house those people who actually have committed a crime.

The same holds true for the Idaho prison system, which has a markedly higher percentage of inmates with mental illness - 44 percent for juveniles; 28 percent for adults, according to the Partnership for Safety and Justice - than the national average for adults of 16 percent.

“Many people with mental illness are in the state's correctional system,” said Dr. Ann Wimberley, president of NAMI Far North - the regional chapter for the National Alliance on Mental Illness. “Some of them are there because they actually committed a crime, but some are there because of a lack of resources in their own community.”

The gap is not surprising, since Idaho ranks 49th in the nation for spending on mental health, earning the state a grade of “F” for mental health services from NAMI's national office. Although Kootenai County has a 10-bed facility that provides a temporary solution, as many as eight of those beds are used by the state at any given time, Wimberley said, which leaves Kootenai County with a shortage of its own.

“Having a safe place to take a person who's having a crisis is a big problem for law enforcement,” she added. “This is a situation that needs to be addressed by leaders of the community.”

With that in mind, NAMI Far North hosted a luncheon in Sandpoint on May 21, bringing together about 70 people representing the mental health

See NAMI, Page 3

and medical communities, elected officials from the city and county, law enforcement, the judicial system and the state Legislature. The speaker at that gathering, District Judge John Mitchell, highlighted a program that shows promise in those cases where crimes have taken place - a Mental Health Drug Court.

“In my courtroom, I began seeing a correlation between crimes of addiction and mental illness,” Mitchell said. “And if you talk to any district judge in the state, they would tell you the same thing.

“There are 5,000 inmates in the Idaho prison system and about 70 percent of that population is there for a crime of addiction,” he continued. “Almost half of them - about 1,750 people - also have a mental illness.”

Started about four years ago, the Mental Health Drug Court program in North Idaho began with five participants and has climbed to nearly 40.

“Most of our participants come to us when they are close to rock bottom - they're homeless, they're jobless,” Mitchell said. “We have saved more than a quarter-million dollars in jail costs and about $129,000 in hospital costs.”

Those figures are calculated by summing up how much these same individuals - most of whom were “return customers” to the judicial system, according to Mitchell - racked up in emergency room fees and jail time during the previous year, compared with their financial impact after joining the program. Routing people with mental illness into this group provides a network of support, education and treatment, the judge pointed out.

“This is a system-wide problem,” he said. “We have had a tendency to simply incarcerate and think that's going to solve the problem. But you need treatment.”

Mitchell also introduced a course called Crisis Intervention Training (CIT), which started in Memphis in 1988, after the fatal shooting of a mentally ill person during a response call by law enforcement.

“The program is in use in all but 10 states - and we're one of them where it isn't,” the judge said. “I'm here to start that dialog.

“Quite simply, what CIT involves is law enforcement walking a mile in health care's shoes and the other way around,” he added. “That way, when you're at somebody's house and they're unstable, you have a lot better idea of what you're getting into and a lot more options to work with, based on the knowledge the CIT program can give.”

Local law enforcement officials are on board regarding the need for training, but express frustration that they are often placed in the role of first responder to incidents that might be avoided or, at the very least, defused, before their help is needed.

“Law enforcement is ill-equipped to deal with this and we have zero options,” said Sandpoint Police Chief Mark Lockwood. “I think the hospitals look at us and say, ‘They've got the handcuffs and they take people into custody all the time,' so we get the calls. The biggest issue is that we lack facilities and a way to get these individuals the help they need.”

Lockwood applauds NAMI Far North's efforts to pull the community together in search of solutions for an issue that, by all accounts, has no easy answers.

“As a coalition - working together with NAMI, law enforcement and the judicial system - we can lobby the legislature for funds to build regional treatment facilities,” the police chief said.

“That's something we talk about every year with our lawmakers,” said Bonner County Sheriff Elaine Savage, “but this year, the legislature was not kind to North Idaho as far as treatment facilities. We have people in jail who shouldn't be there. These people don't need to be incarcerated, they need help.”

Wimberley said the Idaho Legislature already has approved funding a secure, 300-bed facility in a former warehouse on state prison property, with about 250 beds set aside for people with mental illness who have been sentenced for a crime. The other 50 beds at that prison facility, however, will be used to hold mentally ill individuals who have not committed an offense.

Like the sheriff and the police chief, the NAMI Far North president believes handling the matter at the local level would be a better direction.

“It's the right thing to do,” Wimberley said. “Rather than placing people in the correctional system, it's not only more humane to treat them in the community, it's also more cost-effective.”

NAMI Far North provides support, education and advocacy for people with mental illness, their families and friends. The group meets on the third Wednesday of every month from 6-8 p.m. at the Bonner General Hospital classroom.


Saturday, May 17, 2008

Nobody's Fault

The anatomy of a suicide in the Humboldt County Jail

By the HSU Journalism Department's Investigative Reporting class


In January, journalism students from HSU, as part of an investigative reporting class taught by Assistant Professor Marcy Burstiner, set out to understand the intersection of the mental health and criminal justice systems in Humboldt County by investigating the death of one man: James Lee Peters, a Hoopa resident who committed suicide in the Humboldt County Jail last August. Over three months they intended to interview people who knew him as well as people who work in mental health and criminal justice. They were met with a wall of silence: Many people did not respond to repeated requests for information. People in the mental health field who did respond said they could not discuss his case because of privacy protections required under federal law. His lawyers argued that attorney-client privilege survives the death of a client. The Hoopa community, unused to anything but negative news, did not feel comfortable talking about Peters to the press.

The mental health system in Humboldt and across the state turned out to be a labyrinth they couldn't penetrate; instead of answering basic questions about standard procedures one agency after another bounced them from office to office. A public information officer at Atascadero State Hospital forced them to file a California Public Records Request just to find out how its trial competency program works.

So the students poured through records: Court minutes and files that are open to public inspection; birth, death and autopsy reports; court transcripts, case files released from the district attorney's office in response to another public records request and procedural reports and data from Atascadero. Their conclusion based on the records and interviews: The untimely death of James Lee Peters was both entirely preventable and inevitable. It reflected the inability of our mental health system to help people until it is too late, and the failure of the criminal justice system to handle the people who end up in the jails as a result.

The students involved in the project were: Chris Hoff, Karina Gonzalez, Matthew Barry, Matthew Hawk, Marc Kozachenko, Tatiana Cummings, Cassandra Hoisington, Melinda Spencer, Deunn Willis, Nicole Willens, Adrian Emery and Meghannraye Sutton.

James Lee Peters spent his 25th birthday last August behind the walls of the Humboldt County Jail, waiting to be taken to a state mental hospital. He spent his previous birthday much the same way. He wouldn't live to see the next. Instead, 10 days after he turned 25, Peters took the sheet off his bed, tore it into strips, tied them together and hanged himself. He would be on life support for eight days at St. Joseph Hospital before he would die of asphyxiation.

If Peters understood what he was doing when he ended his life, it might have been the only time he fully understood his actions. Complications at birth gave him learning disabilities and a low IQ. Throughout his life he needed mental health counseling but received little. He tended to lash out when he was angry and that repeatedly put him in trouble with the law. What began as small outbursts became increasingly violent, until the criminal justice system could no longer overlook the threat he represented. Instead, as his criminal record piled up, the Humboldt County Superior Court bounced him between a variety of mental health facilities, but only to make him competent enough to stand trial.

But this story doesn't stop with Peters. Because the tragedy is that we fill our jail, and jails across the state and country, with people just like him. There are alternatives, but not in Humboldt County.

"This community treats dogs better then the mentally ill," said District Attorney Paul Gallegos. "My hope is that we [would] treat our mentally ill better than we treat a dog."

What little we know about James Lee Peters plays out through documents obtained under the California Public Records Act. Everyone he interacted with, from teachers, police officers, lawyers, doctors, counselors, probation officers and jail guards refused to speak about him or his particular case for this story. Neither would members of his family, who still grieve over his death and who intend to file suit against any party they can find responsible. As of yet, no lawsuit has been filed.

Here's what we do know. James Lee Peters, nicknamed Hans, was a Yurok Indian from Hoopa who entered the world much the same way he would leave it: gasping for air.

At birth Peters was without oxygen for several minutes. That manifested into developmental and cognitive problems. Jamie Lynn Solano gave birth to Peters at age 16; he was the first of her three children. His biological father did not acknowledge him and the first years of his life weren't easy. He suffered physical abuse and several members of his family battled with drug and alcohol problems. Sometime in his childhood Peters saw a counselor briefly in Hoopa but stopped because the family feared he would be taken from his mother. Around age five, social workers took him from his mother and he went to live with his grandmother Joyce Croix, whom Peters credited with raising him

If you drive east on Highway 299 and head north on Highway 96 through dense redwood forests, you will descend into the Hoopa Valley. Here a Ray's Food and the Lucky Bear Casino stand against a backdrop of jagged mountains. Nearby, the Trinity River flows past grounds where Hoopa residents still hold ancient healing and renewal ceremonies, such as the sacred Jump Dance and Boat Dance.

With about 2,600 people on 144 square miles, Hoopa is at once the state's largest Indian reservation and a small town where everyone knows everyone. The sovereign nation is separated from the rest of the county by both distance and culture. The tribal government administers health services on the reservation, including some drug, alcohol and mental health treatment, but offers no residential treatment facility. It educates students in conjunction with the Klamath-Trinity Joint Union School District.

Peters had a difficult time learning, so he was put in special education classes at Hoopa Valley Elementary. His fourth-grade yearbook picture shows a dark-haired boy with a big smile. The picture of him in fifth grade shows an 11-year-old boy standing straight and looking proud. (Few of the people who knew Peters at that age were willing to speak of him on the record. Most of what follows comes from reports written later by officials and psychologists who interacted with him at various stages in his journey through the criminal justice system.)

In the ninth grade, his grandmother died. Peters later said that that period in his life was emotionally difficult for him, and as a result he had trouble in school. He was involved in three physical fights, was caught with marijuana, and was expelled.

At 14, psychological evaluations determined that his verbal comprehension was "particularly impaired." He continued his education at Captain John Continuation High School in Hoopa, and was shuffled between the homes of various members of his extended family. But he lacked a primary guardian.

The lack of guidance took its toll. At 16, he picked up a rock and threw it at a teacher's car, cracking the windshield. Police charged him with battery of a school employee and he served 60 days in Juvenile Hall. In throwing that rock he threw himself into the Humboldt County criminal justice system and he would never climb out of it.

The Hoopa Valley Tribal Police station has no holding cell. Each time a suspect is arrested police drive him 60 miles to the county jail in Eureka. Taking someone that far for relatively minor crimes adds a "traumatic element" to an already traumatic situation, said Graham Hill, chief of the Rio Dell police department. While Rio Dell sits at the opposite end of the county, his department also lacks a holding cell. The drive from Rio Dell to Eureka is just 25 miles, but that extra trauma, he said, can do more harm in the long run for prisoners who are mentally ill. The geographic distance also makes it difficult for family to visit prisoners in the county jail.

Peters soon added two more infractions — criminal threat of assault and battery and assault with a deadly weapon — to his juvenile record. About that time, he landed his first and only job, that of a choker setter for Three Star Logging Company, a typical entry level job in the logging business.

As a choker setter, he would likely have trudged up hillsides machines could not access, to wrap a cable under and around a log, forming a noose so that they could be pulled up to a place where they can be put on a truck. It is not an easy job, said Robert VanNatta, part owner of a 30-year-old logging business in Apiary, Ore.

While VanNatta didn't employ Peters or know of him, he could explain the type of work Peters likely had. "You cannot exaggerate the difficulty and danger of choker setting," VanNatta said. After securing the noose, the choker setter must quickly get away or risk getting crushed from rolling logs. Peters liked manual labor, but quit after he was denied a $1.25 an hour raise. That marked the end of his employment and education.

Unable to control his anger or impulses, his offenses became increasingly serious. As an adult numerous evaluations found that he suffered from Paranoid Personality Disorder, mild mental retardation and schizophrenia. At 24, his IQ was 67, which is the equivalent to that of an average 11-year-old child. Only 2.3 percent of the population possess IQs lower than 70.

His trouble deepened in 2001. Between October of that year and August 2002, he would be arrested five times. In two of those cases he assaulted women. In one he threatened a woman with great bodily injury. As a result of those arrests, he was sentenced to a 52-week batterer's program that he would never complete, and three years probation. When released, he became a statistic.

Megan Gotcher was Hans Peters' probation officer and is now a senior officer for the Humboldt County Probation Department. There are more than 50 officers in the county, but each officer is responsible for 60-100 probationers at a time.

"If you have a hundred cases, it is hard," Gotcher said. "You deal with searches, subpoenas and home contracts. Sometimes you just have to put out the fire." Probation officers work closely with Hoopa Human Services, but are not trained in mental health services.

The Humboldt County Superior Court questioned Peters' mental health in Dec. 2001 and placed him on two years of conditional release under a program run by the county's Department of Health and Family Services. It was responsible for providing Peters with treatment and supervision while he lived in his community.

But whatever supervision it gave him wasn't enough. In Aug. 2003, police arrested him for pushing his mother and assaulting a friend of hers with a shovel, sending him to the hospital. Around that time a car accident left him with major injuries. Peters would later tell a probation officer that after the accident, he more easily lost his temper and experienced suicidal feelings.

That January, police arrested him for trespassing and vandalism. A month later, they arrested him again for attacking a man with an iron. He was sentenced to three more years probation, but this time the court ordered him to enroll with the Redwood Coast Regional Center, a private, non-profit referral agency for the treatment of people with developmental disabilities, and to participate in a counseling program run by psychologist Karl Fisher through the Hoopa Valley Tribe's Division of Human Services. While waiting for the regional center to evaluate him, he attacked an inmate and in another incident was charged with attacking a custodial officer.

Finally, in April 2004, Eureka clinical psychologist Otto Vanoni evaluated Peters and suggested that his problem was medical rather than criminal and that he belonged in a medical facility rather than a jail.

Peters was housed in isolation during the time of the evaluation, which worsened his condition, Vanoni wrote. "A failure to move him from solitary confinement and a continuation of jailing will only lead to further decomposition of functioning," Vanoni wrote. Vanoni described Peters at the time as having short brown hair, brown eyes, a mustache and "a fuzzy chin beard." At five feet, eleven inches, he weighed 155 pounds. Most important for the court, Vanoni deemed Peters mentally incapable of assisting in his own defense.

Five residential treatment facilities in California specifically treat people with developmental disabilities, but as a criminal, Peters needed to be put into a secured facility. So the Redwood Coast Regional Center sent him to the only secured facility — Porterville Developmental Center, in Tulare County, 520 miles from Hoopa.

After six months, doctors at Porterville deemed him competent and sent him to a "licensed board and care facility," according to court records. (The records don't identify the facility.) In June 2005, the regional center asked the court to terminate his commitment and release him. It argued that Peters was no longer eligible for its services as he was not developmentally disabled. In doing so it contradicted Vanoni's report a year earlier and its own subsequent finding that Peters was eligible for its services based on his diagnoses of mild mental retardation.

"It is believed now that Mr. Peters' mental status at that time of RCRC's psychological evaluation while he was incarcerated affected the results of that testing," wrote Wendy Stout, an intensive services specialist for the regional center at that time. Plus, Stout noted, Peters had not caused trouble in the eight months he'd spent in residential treatment. In layman's terms, being in jail had made Hans Peters crazy, and that tainted the psychological evaluation.

In an interview this month, San Francisco forensic psychologist Paul Good said mental retardation is a "static condition" that doesn't change and can't be cured. And as far as the courts are concerned, a competent person understands the legal process, the roles of courtroom players, legal strategies and can work with an attorney in an effective way. A person can be competent in understanding the law, but that doesn't mean they are mentally healthy.

Five months after his release, however, his anger got the best of him again. In Nov. 2005, he went to a house to talk to a woman he'd been dating. When she said she didn't want to see him, he refused to leave. Her family tried to force him out and Peters reacted by pushing a 13-year-old boy. The boy fell and injured his back against a stool. Police issued an arrest warrant, charging Peters with misdemeanor cruelty to a child.

Back in jail, things got worse. In January 2006, correctional officer Steve Christian opened the door to Peters cell to get some janitorial items and Peters punched him in the face. When officers asked him why he did it he said, "Leave me the fuck alone. Dealing with the voices in the back of my head is hard enough, I don't need to listen to you as well."

Peters later expressed remorse and apologized for his sudden outburst at Christian. "A lot of things were messin' with my head," he said. "I feel bad. No one deserves to get punched."

Again, his lawyers questioned Peters' competency and Judge Christopher Wilson ordered another evaluation. During the two years that preceded his death, Peters, whom doctors said was mentally unable to assist in his own defense, appeared in court 25 times. Five different defense attorneys represented him and he faced 10 different deputy district attorneys and three different judges. It seemed as if Peters was the hat that everyone would pass but no one would wear.

The inability to get Peters the help he so obviously needed frustrated Judge Wilson. Over the next 18 months, Wilson would repeatedly order Peter's attorneys to get him into a local treatment program or a state hospital only to be told that no place would take him. For almost three months in the beginning of 2006, Peters sat in jail while Wilson waited for the California Department of Mental Health to determine if he qualified for conditional release. In February, Eureka clinical psychologist Michael M. Ramirez determined that Peters' was still incompetent to stand trial.

But in March, the Redwood Coast Regional Center again found Peters ineligible for their services. Meanwhile Atascadero rebuffed Wilson's order and refused to take Peters.

On Nov. 6 the court acknowledged that Peters was there too long. "I'd like to know when Napa's going to come get Mr. Peters," Wilson said in court. "They said they're going to reject him because he's mentally disabled. We sent him back to the regional center. They said he's not disabled. They're just playing games with us."

Finally on Dec. 4, 2006, almost a year after his arrest, Peters was transferred to Napa State Hospital. But again, the goal was only to make him competent enough to assist in his own defense, not to silence the voices in his head. He would spend two months there and when doctors deemed him competent, he was back in the jail.

The delays Peters went through are common for the mentally ill prisoners who fill the jail, said Humboldt County Deputy District Attorney Wesley Keat, Jr. in an interview in April of this year. "Those in jail have some kind of mental illness and jailers say the jail is a mental health facility," he said. " There are a lot of people in the County Jail waiting to be transferred to a mental health facility."

The problem is that the jail is not equipped to handle such problematic prisoners, said Brenda Godsey, public information officer for the Humboldt County Sheriffs Office. "We are not a mental health facility," she said.

Humboldt County isn't the only place with this problem. One study published in 2006 estimated that jails across the country house more than 94,000 people with severe mental illness. The Los Angeles Daily News reported in April that the psychiatric patients who fill most of the 1,000 beds in Los Angeles County's Twin Towers jail facilities have turned the jail into the largest mental institution west of the Mississippi. It cited data that show that statewide, California has just 6,285 beds for mentally ill patients or 17 for every 100,000 residents. Researchers said the state needs at least 12,200 more.

The U.S. House of Representatives passed the Mentally Ill Offender Treatment and Crime Reduction Reauthorization and Improvement Act of 2008. If passed by the Senate, it would provide grants for diversion programs and increase cooperation between the criminal justice and mental health systems.

At least 13 counties in California rely on special courts for mentally ill prisoners to ease the burden. These courts only accept criminal offenders with severe mental problems and dismiss charges after the offender commits to and completes an individualized program designed for their illness, most often one that involves a residential treatment facility. After a year of sobriety and being crime-free, the defendant attends a trial and the case is dismissed. They are then given job training and GED exam preparation.

In Gainesville, Ga., a mental health court entitled HELP (an acronym for Health, Empowerment, Linkage and Possibilities.) puts prisoners on a plan for success, which includes, among other things, getting a job and taking medications. According to an article in the Gainesville Times, prosecutors, defense attorneys, case managers, treatment providers and judges work together to ensure that the prisoners stay on the right path. They review each case in weekly meetings, and determine which ones progress and which ones seem to regress.

California voters tried to address the problem back in 2004 when they passed Proposition 63, also known as the Mental Health Services Act. The statute raised an additional 1 percent tax on the 30,000 state residents (1 percent of the state population) that make an annual income of over $1 million. By 2006, the statute generated about $730 million for mental health services in California. But the law did not specifically fund mental health courts. Mental health providers across the state, and in Humboldt County in particular, complain that much more funding is needed.

A new program known as STAR (Supervised Treatment After Release) started in Humboldt County on April 1, 2007. The goal of the program is to provide evidence-based treatment in treating seriously mentally ill offenders by coordinating mental health service providers, corrections, probation, the district attorney's office, defense attorneys and community/family advocates.

The STAR program only serves 25 offenders at a time, according to its website. Regardless, Peters may have been ineligible, as it does not take inmates considered a public safety threat.

Julie Ohnemus, mental health director of the Open Door Community Health Centers said that in the past five years she has seen a jump in the number of mentally ill patients. The Arcata clinic alone sees 4,000 such patients a month, and that means that counselors can see each patient for only about 15 minutes each. That's not enough time for a doctor to properly monitor a patient. But resources are limited. The Open Door network has a total of eight counselors for both Humboldt and Del Norte counties. That's forced family practitioners to act as psychological counselors.

Hans Peters did not go to an Open Door clinic. But Ohnemus said that the clinics see people like Peters every day, released from the jail and bound to return. That's because the jail releases prisoners who suffer from severe mental conditions without any medication, and without medication they are in no condition to get themselves the help they need. "That's wrong," she said. "There's no reason not to follow up," she said.

Robynne Lute has worked as a behavior health consultant at the Humboldt Open Door since 2004. She sees about 10 patients every day. They suffer from depression, anxiety, substance abuse and chronic pain. She has lost five patients to suicide and several others to drug overdoses. One female patient hanged herself while on a waiting list for county psychiatric services.

"People are not getting what they need," she said. The county has an intensive treatment program but it only has 12 beds for three counties. There is also an emergency treatment program that can keep someone under surveillance for 72 hours. But after that it refers them to other facilities and leaves it to the patient to follow through. Meanwhile, the shortage of beds means that only people who are very sick are admitted into the two programs. "We don't have a lot of services for people that fall in between."

Perhaps Hans Peters was doomed from the start. Although suicide is taboo in the Hoopa Valley Tribe as well as many Native American cultures, rates are high and rising. The Centers for Disease Control reported in 2005 that that among American Indians/Alaska Natives ages 15 to 34 years old, suicide is the second leading cause of death and the per capita rate of 21.4 per 100,000 people is 1.9 times higher than the national average for that age group. Native Americans are disproportionately represented in the Humboldt jail. On the day Peters hanged himself, the jail housed 47 Native American men accounting for 16 percent of the total jail population. Native Americans account for just six percent of the total population in Humboldt County according to a 2006 U.S. Census estimate.

If he could have been steered to an alternate fate, it would likely have had to happen early on. But deputy public defender Christina Allbright described current California law regarding minors and mental incompetency as a "huge black hole." She noted that Humboldt County has no facility to treat mentally incompetent juvenile offenders.

Some in the U.S. Congress are trying to bolster resources for Native Americans. The U.S. Senate passed the Indian Health Care Improvement Act in February. If passed by the House it would fund greater mental health services for tribes and could address the need for in-patient mental health treatment in Hoopa.

Hans Peters wanted to get treated. After Napa released him in March 2007 he told Judge Wilson that he hoped for a normal life. "I just want to go to my programs and take my medication and do good in life and get me a job, sir," he said.

His defense attorney, David Lee, argued that Peters deserved a chance at freedom. "He's served far more time in custody on all of these charges probably than anybody would have gotten at the onset," Lee told Wilson. "It's nobody's fault he was not able to handle the criminal proceedings for many, many, many, many months based on his mitigating mental condition."

Wilson was reluctant to allow Hans Peters to be released without adequate supervision. "If there's some form of decomposition, we're back to where we were," he said in court. "And that just cost Mr. Peters two years of his life."

The process took so long that Wilson released him three times during the two years to take care of personal business: Once to visit his brother, once to cash some checks and once to go to a dentist for a root canal.

In May 2007, Peters spent two days in Sempervirens Psychiatric Health Facility in Eureka, the only inpatient care facility in Humboldt County, while waiting for acceptance into a drug treatment program.

It's not clear exactly how long Peters spent outside confinement on the last go-around, but he was back in jail June 22, this time charged with false imprisonment and two counts of battery. Yet again, the court questioned his mental capability, ordered another psychological evaluation by Dr. Michael M. Ramirez, waited for a report from the mental conditional release program and ordered Peters recommitted to Napa State Hospital for recovery of trial competency.

According to a report from Deputy Coroner Charles Van Buskirk, Hans Peters did not want to return to Napa. Instead, in an attempt to prove mental competence, he had stopped taking his court-ordered medications. At 3:15 p.m. on Aug. 29, 2007, Peters fashioned a noose out of his bed sheet. Two officers found him hanging in his 7 1/2-by-11 foot jail cell. He had pushed the ends of the cloth strips through the small holes in a ventilation grate over his toilet, using a tool he had made by chewing on a spoon.

The officers tried to resuscitate him, but it is unclear if they were able to get a response from the body. At St. Joseph Hospital, doctors put him on life support but he never regained consciousness.

In ending his life, Peters put a stop to what had become an endless cycle: Arrest, temporary treatment, release and re-arrest. The problem is that the system expects mentally ill people like Peters, a man with the mentality of an 11-year-old boy, who suffered from paranoia and who was incapable of controlling his emotions, to get themselves the help they need.

Rebecca Porteous, a licensed clinical social worker, said she sees people come in and out of jail with recurring mental issues. When the jail releases mentally ill inmates, it instructs them to see a mental health professional. If they do that within the first two weeks, they will continue their medication. But not all do.

"It is still America," she said. "And people have free will."