Guilty of mental illness

MODESTO, Calif. -- An 18-year-old schizophrenic man pounds on the thick security glass of his single-man cell.

A woman lets out a long, guttural scream to nobody in particular to turn off the lights.

A 24-year-old man drags his mattress under his bunk, fearful of the voices telling him to hurt himself.

This is not the inside of a psychiatric hospital. It's the B-Mental Health Unit, one of two wings reserved for mentally ill inmates at the Stanislaus County Public Safety Center in Modesto.

Sheriff's deputy David Frost, who oversees the unit, says most of the inmates aren't difficult, just needy.

"They do want help," Frost said.

Stanislaus County is not unique. Experts say U.S. prisons and jails have become the country's largest mental health institutions, its new asylums.

Nearly four times more Californians with serious mental illnesses are housed in jails and prisons than in hospitals, according to a study released this year by the nonprofit Treatment Advocacy Center and the National Sheriff's Association.

Nationally, 16 percent to 20 percent of prisoners are mentally ill, said Harry K. Wexler, a psychologist specializing in crime and substance abuse.

"I think it's a national tragedy," Wexler said. "Prisons are the institutions of last resort. The mentally ill are generally socially undesirable, less employable, more likely to be homeless and get on that slippery slope of repeated involvement in the criminal justice system."

Those who staff prisons and jails are understandably ill-equipped to be psychiatric caretakers, and there are consequences, researchers say.

Frost agrees his role is an unexpected one: "I'm not a mental health technician," he said, although he does hold a psychology degree. "I'm a sworn law enforcement officer." He walks the halls on a recent day, asking inmates if they're taking their medications, how they're feeling and answering questions about upcoming court dates.

To compound the problem, 75 percent to 80 percent of the mentally ill inmates also struggle with substance abuse, Frost said.

Mentally ill offenders have higher recidivism rates than other inmates (they're called "frequent fliers" in the criminal justice world) because they receive little psychiatric care after their release, researchers say. They cost more to jail because of the cost of medications and psychiatric examinations, and they can cause security problems by their aggressive and destructive behavior in lockup.

Wexler said these inmates also are more likely to commit suicide. Because they're less capable of conforming to the rigid rules of a jailhouse, they can end up in isolation as punishment, Wexler said.

At 4:30 a.m. in the Modesto jail -- and again 12 hours later -- it's "pill pass time," when the medical staff hand out about a dozen types of medications. But they can't force inmates to take their prescriptions for bipolar disorder, major depression and substance abuse psychosis.

"You're making jailers our mental health treatment personnel," said Phil Trompetter, a Modesto police and forensic psychologist. "They're not trained to do that. ... This population is not getting what they need, and I think it's a lose-lose for everybody."

The movement to abandon state mental hospitals began in the mid-1950s, and California led the way.

It found support from both ends of the political spectrum: Fiscal conservatives wanted to save money, and civil rights advocates wanted to "liberate" patients.

When then-Gov. Ronald Reagan took office in the mid-1960s, the hospitals were half empty. Reagan vowed to close the hospitals.

Called deinstitutionalization, that policy made it difficult to find a bed for a seriously mentally ill person needing treatment, according to the report. In 1955, there was one psychiatric bed for every 300 Americans. In 2004, that ratio grew to one bed for every 3,000 Americans, the report said.

Trompetter said most of these psychiatric beds are filled by those ordered there by the courts, including sexually violent predators, those found incompetent to stand trial or those found not guilty by reason of insanity.

Because of the lack of hospital space, police often are forced to take the mentally ill who commit minor misdemeanors -- from petty thefts to urinating in public -- to jail instead, Trompetter said.

"We have too many untreated mentally ill people who are getting criminalized because of the absence of resources," Trompetter said.

One nationally recognized solution is called a mental health treatment court, which gives offenders the choice between going to jail or following a treatment plan -- including taking prescribed medications.

Stanislaus County launched such a program three years ago, and it was singled out statewide by the state Department of Corrections and Rehabilitation for its success in decreasing the recidivism rate among mentally ill offenders and helping smooth their transition back into society.

A team of experts works collaboratively within the county's mental health court. Those people include deputy Frost, a registered nurse, prosecutor, deputy public defender, probation officer and counselor.

But at the same time, the county lost $1 million in grant money because of the state's budget shortfall, Frost said. The court was forced to stop taking new offenders and cut its client enrollment by half. Four people are currently enrolled in the court's program, Frost said.

"We deal every day with this crisis of the mentally ill -- in jail or out on the street," Frost said. "We do need the funding for these types of programs."

What would be his solution in an ideal world?

"If they could print money for this," Frost smiles, "that would be great."