UPDATE: The article below was published in March 2014. On May 23, an emotionally-disturbed student attending the University of California, Santa Barbara in Isla Vista, California, killed six UCSB students and injured 13 people before taking his own life. Police visited 22-year-old Elliot Rodger at his apartment in late April and found him calm and polite, offering them no indication that he or anyone else were in danger. Hidden in his room were three guns… Four days later, on May 27, a patient at high-security Atascadero State Hospital was allegedly killed by another patient, and an employee was injured, in a hospital dorm room. An inmate, 34, was booked into San Luis Obispo County Jail the next day on suspicion of murder. The suspect had a history of assault and destructive behavior…
America’s jails and prisons have become our mental hospitals, according to a 2010 study by the National Sheriffs’ Association and Treatment Advocacy Center, and almost five years later, “The way we do business, the pure volume alone, has become alarming to everybody at this point,” said San Luis Obispo County Sheriff Ian Parkinson.
“That’s what makes it urgent that we are finally starting to realize that we’ve got a problem,” he recently told The ROCK.
The “problem” in 2014 is defined by a complex mix of laws, regulations, policies and budgetary restrictions, where state and local government bear the brunt of responsibility for treatment of the mentally ill. Finding effective patient care may depend on where someone lives in the state or county. A modern, capsule, historical overview of America’s care, and lack of it, for the mentally ill can be illustrated by the old balloon theory—push in one side and it pops out the other. Empty the psychiatric hospitals—and today there are more than three times more seriously mentally ill people in U.S. jails and prisons than in hospitals.
At least 16% of inmates in U.S. jails and prisons have a serious mental illness. In 1983 the percentage was 6.4%. So in less than three decades the percentage of seriously mentally ill prisoners has almost tripled, according to 2006 Bureau of Justice Statistics.
There is a direct and persistent connection between the lack of treatment for mental illness and the commission of crimes, petty and violent. There are the headline-stealing mass killings that are impossible to ignore, yet continue: the Aurora, Colorado movie theater shooting; the Navy shipyard killings in Washington, D.C.; the mass killings at Sandy Hook Elementary School; and even the Gus Deeds attack and suicide in Virginia, though not a mass killing—for want of one psychiatric bed. Each individual was in a psychiatric crisis and didn’t receive the help they desperately needed when they needed it, before tragedy struck.
Sheriff Parkinson, along with other sheriffs in the California State Sheriffs’ Association, recently discussed the impact of the mentally ill on law enforcement with Governor Brown. “He wants to solve problems,” Parkinson said. “He recognizes the problem. It’s been around and continues to be an issue.”
Atascadero State Hospital
San Luis Obispo County is unusual from a law enforcement perspective because it is the location of Atascadero State Hospital, one of five state hospitals. Atascadero State “provides inpatient forensic services for adult males who are court committed from throughout the State of California,” according to its web site. “The majority of the patient population (capacity 1,275 beds) consists of: mentally ill inmates; mentally disordered offenders; patients who have been found incompetent to stand trial; and patients who have been found not guilty by reason of insanity.” Patients need to be stabilized with medication. They often pose a threat to themselves and others.
A standing shortage of psychiatrists and a staff spread thin have resulted in fewer patients admitted to the facility. Still, with reduced capabilities and a full patient load, working at Atascadero State has occasionally proved dangerous to doctors, staff and inmates.
For Parkinson, who has been dealing with Atascadero State for some time, it’s an all too familiar pattern: Patients are sent there because they’ve been deemed incompetent to stand trial or be prosecuted for a crime because of their mental illness. Then, Parkinson said, they commit another crime by assaulting a staff member, and because Atascadero State doesn’t have an inside lockdown facility, that person is brought to county jail and booked for a crime.
“Which is really ironic,” he said, “considering they’re already in there (at Atascadero State) because they’re not [legally] capable of committing a crime, now they’ve just been booked for committing another crime that they’re not capable of.”
The ironies begin to pile up, one on top of the other. At Atascadero State, if patients are not taking medication voluntarily, they can be force-medicated to stabilize them. That’s not the case in county jail.
“They come down to a facility that is not really set up for the mentally ill, especially that level, and then we can’t force-medicate them,” Parkinson said. “We can only provide voluntary medication. So if they don’t take their medication, they continue to degrade.
“It’s just a vicious loop, and it’s frustrating because it is no solution for the problem.”
Parkinson has been working directly with Governor Brown’s office to deal with the impacts of Atascadero State on the county jail system, and they’ve been helpful, he said.
“We’ve gone from—at times we’ve had in the tens to upwards of almost 20 in custody from Atascadero State—down to a very few. I think at the last count I asked for a couple of weeks ago, we had one from Atascadero State in the (jail) hospital. So that’s a unique problem to us in this county. Couple that with the local problem that everybody’s experiencing, and it’s just a issue.”
Parkinson is candid about the state of America’s mental illness treatment capabilities. He believes the vicious loop has a momentum that is difficult to stop with legislation and lockup alone.
“I personally believe that our mental health situation throughout the country has been getting worse. We have some obvious indicators of that.
“A while back (in February 2013) I sent a letter (to Vice President Joe Biden) regarding gun control. Obviously, people could interpret that letter the way they want. My problem, not to roll this into a gun-control issue by any means, was the fact that we look for a simple solution to a complex problem, and when you talk about the school shootings that have occurred, those people have been mentally ill, and yet we are trying to regulate our way out of it, and that was the issue I had.”
The extreme cases of school shootings are deeply emotional to everyone, and the typical reaction, Parkinson said, is to attempt “to solve this with regulation, and it’s no resolution to the problem. They’ll never regulate their way out of a situation involving the mentally ill. They have to take a multi-tiered approach.”
Nationally, the high rate of mental illness in jails reflects their role in the criminal justice system. According to the National Sheriffs Association study, jails are a hub. They receive offenders after an arrest and hold them for a short period of time (usually less than a year) pending arraignment, trial, conviction or sentencing, and hold mentally ill persons pending a move to an appropriate mental health facility. State and Federal prisoners typically serve more than one year.
Dealing with the mentally ill in the public sector, on the street on a daily basis, is also a serious concern for local law enforcement. Parkinson said a typical situation starts with someone constantly trespassing because he or she is sleeping on the steps of a closed business and the police are called. If that person doesn’t leave the premises, they are arrested for trespassing and end up in county jail.
“They’re kind of the other extreme. It’s a quality of life, petty crime, but because of their mental illness they end up in county jail. And again,” he emphasizes, “we’re regulating something that we’re never going to get a handle on by arresting our way out of it or regulating our way out of it, and we just don’t seem to get it.
“It’s a point of frustration with all the sheriffs because no matter what size your jail is, you have a percentage of your jail that is mentally ill, and they require special treatment, special care and special security; because in some cases they’re extremely violent and require two staff members to move them when they come out of their cell.
“In some cases they are at the point where they’re rubbing feces all over of the jail and themselves, so we have to get them out, clean them up, clean their cell out, put them back, and they repeat the same behavior. So they’re obviously suffering from severe mental illness, and none of our jails are really built to deal with it.”
No full-time psychiatrist
SLO County Jail holds a daily average of about 750 prisoners, men and women, some with various degrees of mental disabilities. A new, expanded women’s jail for 200 female inmates, which should relieve the overcrowding that existed in the old women’s jail, is under construction and expected to be operational in late 2016. However, generally speaking, rolling out current statistical trends through the second half of the decade predetermines that the prospects for significantly lowering the actual numbers of mentally ill that pass through our jails and prisons remain dim, unless the focus sharpens on solutions that are implemented and begin to chip away at the problem, Parkinson said.
“First, it starts with recognizing that we have an issue and not reacting emotionally with simple solutions to a more difficult problem. Second, we’ve got to realize that in many cases these people are patients, not necessarily inmates. So how do you treat a patient? Obviously by getting him in an environment that’s conducive to them improving their mental illness, in some cases (receiving) medication.”
County jail doesn’t have a psychiatrist on staff at all times, so patients can’t be force-medicated, even when it’s best for them. Medicating them doesn’t mean placing them in a vegetative state; it means they’re behaving, and “that helps improve their understanding of the situation they’re in and their ability to make decisions on their own,” Parkinson said.
“That requires money. You’ve got to have a full-time psychiatrist in the jail, and that’s expensive. We have limited visits from a psychiatrist. We have four full-time mental health therapists in the jail, and we’re challenged by that.”
California courts recognize this challenge, since it is a judge that determines if a person is incapable as a result of mental illness, where they need to go next, and for how long. They could be sent to the 1,287-patient-capacity Patton State Hospital in San Bernadino, a major psychiatric institution, or back to mental health for focused treatment. Yet neither the 14- or 16-bed mental health facility, nor Patton, has the room to house them, said Parkinson.
“So we’re on this waiting list and, of course, the (patients) are longer and longer in jail and deteriorating.
“Then the defense attorney says that the sheriff has not moved this person from the jail, and the judge says (to me), ‘why haven’t you moved this person out of jail into a facility?’ and I say, ‘because I don’t get to force my way into these facilities and drop him off on the doorstep.’ If there’s no room and they’re not going to accept him, I’ve got no choice but to continue to house them.
“It’s a huge challenge, and that’s kind of what we presented to the Governor; that we have to come up with other solutions.”
Complex local situation
Located practically across Highway 1 from the County Sheriff’s Department and jail, three miles north of San Luis Obispo, is the CMC, the California Men’s Colony, a sprawling state prison where a new 50-bed mental health center opened in August 2013. [As of February 18, 2014, CMC’s mental health outpatient population was 1,416 and inpatient 48. On February 7, CMC had 42.5 psychologists, 20 social workers and 18.25 psychiatrists.] The CMC facility would seem to be a natural option for the county’s mentally ill inmates, but Parkinson explains that despite the close proximity that’s not how it works out in reality.
“The problem is with the prison count,” he said. “Three federal judges are watching the numbers going into the institutions. Now when something happens at Atascadero State, the easiest solution is you don’t bring them to our facility, you bring them to CMC, into their lockdown mental health facility.
“(But) that means you’re adding numbers to CMC’s count, which is really counter to what the judges are prescribing to the state. So it creates a real dilemma for them as well. We don’t have enough mental health hospital beds, either at the local or state level. We have a growing issue and we’re not prepared to treat it.”
Meanwhile, on the street on SLO, where 90% of the homeless are unsheltered, the mentally ill homeless continue to impact local law enforcement, generating calls to police because citizens either feel threatened by their behavior, or believe the person in question really needs help.
“We go out there (when called),” Parkinson said, “and they don’t qualify as somebody that can be taken to mental health; because they’re definitely suffering from mental illness, but they can take care of themselves to some degree as prescribed by law, and we can’t take people and say, ‘you really need help and we’re locking you down.’ In many cases they are camping out. A lot of them are trespassing type offenses, or they’re walking out in the middle of traffic, not trying to hurt themselves, but just because of their mental illness.”
While most mentally ill people are not dangerous, thousands are institutionalized by court order because they are a danger to themselves and others, and about 10% of homicides and countless suicides can be attributed to individuals suffering from serious mental illness, including the commission of shocking crimes that devastate our society.
“Putting it in perspective, we have a little of both,” Parkinson said. “We have the high-end ones illustrated by the school shootings. Sandy Hook is a great example. [Adam Lanza] was diagnosed with mental illness and decides he’s going to go out and commit the ultimate crime and kill people. He’s not concerned with whether or not he can have a loaded gun in public or even have a gun, and one certainly could argue that his mother probably never should have had guns in the house. Not a good combination.
“But the reality is that’s an extreme case of mental illness that is repeating itself throughout our society, and most or our school shootings and/or mass shootings involve mental illness. So I think we have both extremes, and we certainly have something in the middle.”
When working in jail with mentally ill inmates, the risk of violence is real. A few weeks earlier, one of Parkinson’s deputies was assaulted, a female deputy by a female inmate, leaving scratches all over her face. “It’s not uncommon to have issues like that,” he said. “In that case it’s not a trespassing charge per se now. Now it’s raised the bar to combative and violent, and we’re tasked with caring for these people.”
Parkinson makes a case for the effectiveness of outpatient treatment. The Sheriff’s Department works with outside mental health facilities to relieve pressure on a crowded jail system not built to provide for the mentally ill, and to get patients the focused treatment they need.
“We work as closely with them as possible,” he said, citing the success they’ve had with San Luis Obispo-based nonprofit, Transitions-Mental Health Association, which offers programs at more than 35 locations in San Luis Obispo and North Santa Barbara counties.
Transitions-Mental Health recently held a class in jail, and about 37% of those that went through the class have since been released from custody and made contact with Transitions for treatment, “which is a huge step,” Parkinson said. “They’re getting the mental health programming in the jail, and now they transition out of custody, and actually made contact, which is ultimately what we really push them to do.
“We also have a half-time deputy that does nothing but work in partnership with mental health in the field. Her job is to identify the people out on the street, try to get them into outpatient treatment, and see if they can get treated out in the field so they don’t end up in custody. For the ones in custody, she works directly with our mental health therapist inside to transition them when they come out in getting them to mental health treatment on the outside.
“Our goal is to manage them when they get out and not just say, ‘okay, you’re done, now go out.’ We really want to hand them off to our mental health people when they get out of jail to get them to continue to take medications, in some cases get them into housing when we can, and obviously treatment.”
Sheriff Parkinson, a law enforcement officer for almost 30 years, clearly recognizes the enormity of the challenge, which is why he stresses the urgency to address it and address it correctly. He sees the gaps in the system widening.
“It’s urgent because we are at capacity in the sense that we’re running out of the means to provide them with treatment as a patient. It’s always been present; we’ve always had mentally ill in jail. That’s not unusual. At some point in time that’s always going to happen, and it’s always going to happen to a percentage. That’s because they’re outside and maybe not popping up on the radar per se. Then they commit a crime that lands them in here.
“I think the way we do business, the pure volume alone, has become alarming to everybody at this point, and so that’s what makes it urgent, that we are finally starting to realize that we’ve got a problem.”
Despite the perils of his department’s task and the ongoing frustrations in trying to manage the diverse mental health needs of inmates, Parkinson believes that good communications with Governor Brown’s office will eventually lead to real solutions.
“I’m optimistic, and I only say that because of the dealings that I’ve had with his office regarding Atascadero State. We put together conference call meetings, we discussed the issues. They did take actions, and it really significantly reduced the number of people that came from Atascadero State.”
Parkinson wants to make it clear that they are not trying to pass along the problem, in this case the patient, when the patient shouldn’t be in jail.
“We’re not trying kiss off our problem on to somebody else. What trying to provide what’s in the best interests of the patient. We do that by not putting them in a facility that’s not set up and capable of providing for their health and welfare.
“The Governor responded to that, and I was very optimistic that they get it. So we’re taking some steps. When we had that discussion with the Governor a couple of weeks ago, and all the sheriffs were there—out of 58 there were probably 45 at the meeting—we all gave him the same message, and I think he heard it. Whether your jail typically houses 50 people, or is in the thousands like L.A., it’s the same problem. It’s all relative to the size of your jail.
“So the message was very clear to the Governor,” Parkinson said, “and he took it very seriously that we’ve got to do something. We’ve got to figure out a plan to solve this. We just simply cannot regulate our way out of this issue.”
SAN LUIS OBISPO COUNTY JAIL, CAPACITY AND MENTALLY ILL PERSONS SNAPSHOT SUMMARY, MARCH 11, 2014
Board-Rated Capacity: 646 (includes Men’s and Women’s Honor Farm)
Self-Rated Capacity: 797 (includes Men’s and Women’s Honor Farm)
As of 6:00 a.m. 768 inmates were in custody. Although the number does not exceed the Self-Rated Capacity, just because there are 797 beds available does not mean someone can be placed in each bed. Depending on the classification of the inmate, it may not be possible to place a certain inmate in the same cell with other inmates, which means that a double-bunked cell may only have one inmate. In addition, only one of the buildings (40 beds) is used for beds at the female honor farm. The second is used for programming (subtract 40 beds from total). A more telling number would be that the in-custody population this morning was 768 with 35 male inmates and 8 female inmates not having a bed and required to sleep on the floor on a floor bed with mattress.
Total mental health contacts with inmates by mental health staff:
2012, approximately 6,700 contacts
2013, approximately 7,000 contacts
(Source: Undersheriff Tim Olivas, San Luis Obispo County Sheriff’s Department)
THE MENTALLY ILL IN U.S. JAILS AND PRISONS – BY THE NUMBERS
• U.S. prisons and jails house 10 times as many people with severe mental illness than psychiatric hospitals.
• At midyear 2005 more than half of all prison and jail inmates had a mental health problem, including 705,600 inmates in State prisons, 78,800 in Federal prisons, and 479,900 in local jails. These estimates represented 56% of State prisoners, 45% of Federal prisoners, and 64% of jail inmates.
• Jail inmates had the highest rate of symptoms of a mental health disorder (60%), followed by State (49%), and Federal prisoners (40%).
• Around 40% of individuals with severe mental illness have been in prison at some time in their lives. Nearly a quarter of both State prisoners and jail inmates who had a mental health problem, compared to a fifth of those without, had served three or more prior incarcerations.
• In 1955 there was one psychiatric bed for every 300 Americans. In 2005 there was one psychiatric bed for every 3,000 Americans—the majority of which are filled by court-ordered forensic cases and thus are not really available.
• Female inmates had higher rates of mental health problems than male inmates (State prisons: 73% of females and 55% of males; local jails: 75% of females and 63% of males).
• State prisoners who had a mental health problem were twice as likely as those without to have been homeless in the year before their arrest (13% compared to 6%).
• Jail inmates who had a mental health problem (24%) were three times as likely as jail inmates without (8%) to report being physically or sexually abused in the past.
• The number of doctors on staff at Atascadero State Hospital has dropped about 33% since September 2012, according to an October 2013 Tribune article. The hospital, which treats mentally ill, violent offenders, has about 22.5 psychiatrists on staff, down from 33.7% in September 2012. The facility is licensed for 1,275 patients.
• Over 1 in 3 State prisoners and 1 in 6 jail inmates who had a mental health problem had received treatment since admission.
(Source: Bureau of Justice Statistics, September 2006 Special Report: “Mental Health Problems of Prison and Jail Inmates” and Treatment Advocacy Center, 2004-2005 data)