Mentally ill inmates languish in local jails
Taken into custody for petty crimes such as trespassing, damaging property or resisting an officer, some end up trapped in a revolving door of arrest and release
By Steve Visser
The Atlanta Journal-Constitution
ATLANTA — Detention Officer Terroyanne Harris considers the inmates she oversees on 3 North as much patient as prisoner. They suffer from schizophrenia, bipolar disorder, post-traumatic stress and other mental illnesses. Some walk aimlessly around their cell block. Some are lost in hallucinations.
Most are in the Fulton County jail because they are more of a nuisance than a danger in the free world.
Taken into custody for petty crimes such as trespassing, damaging property or resisting an officer, some end up trapped in a revolving door of arrest and release. Others languish behind bars for years as they wait to be declared competent enough to stand trial.
Fulton County is not an aberration. The same is true in DeKalb, Cobb and Gwinnett counties, as well as some rural counties in the state.
Jails have become the new asylums. In Georgia, more mentally ill people are locked away than are treated in all the state psychiatric hospitals combined.
And it's costing county taxpayers millions.
"The county taxpayers are paying for something the state should be covering," said Fulton County Sheriff Ted Jackson. "Locking up people because they are mentally disturbed is unfair to them and to the county taxpayers who are footing the bill. It just isn't right."
Harris couldn't agree more. "Most of these people should never have ended up in jail," she said.
Fifty years ago, the U.S. had roughly 600,000 state hospital beds for people suffering from mental illness. Today, that number has plunged to 40,000.
It used to be the nation took an out-of-sight, out-of-mind approach, and people were basically warehoused. A reform movement in the 1960s and '70s discredited that policy. Though community treatment became the ideal, it was never adequately funded. Mentally ill people often found themselves homeless.
With more mentally ill people on the streets, more have run-ins with the law. A Supreme Court decision in the mid-70s made it harder to involuntarily commit those with mental illnesses. Jail is where many land.
Georgia sheriffs contend that the jailing of the mentally ill is bad policy. While some are accused of serious crimes and should be locked away, many are arrested for nuisance offenses. Their incarceration puts a tremendous strain on jail staffs, which usually are poorly equipped to deal with people with serious mental illnesses. It wastes county tax dollars that could be put to other uses. And the jailing does nothing to solve the problem.
The mentally ill are released from the jail back onto the street, where they fall off their medications and often are rearrested, a vicious cycle that is neither fair to them, the public purse, nor the neighborhoods that have become gathering places for the homeless and afflicted, law enforcement officials say.
"We call them frequent fliers," said William Brickhouse, medical director at the DeKalb jail. "You get on a first-name basis with them. It is kind of poignant."
Nowhere is the problem more acute than in Fulton County, which spent $4 million last year treating mentally ill prisoners.
Roughly 460 of the 2,300 inmates in the Fulton County Jail are on psychotropic drugs. That number doesn't come close to the real number of mentally ill in the facility because it doesn't take into account those who are unmedicated, authorities say.
Jackson said his first visit to the mental health ward in the jail, one of the few county facilities to have such a wing, shocked him. The retired FBI agent said he had no idea that such sick people, many of whom appeared incoherent, were taking up premium jail space.
"I am no expert on mental illness, but when I go in there and see somebody just staring ahead, nodding, with mucous coming out of his nose, I know that is not right," Jackson said.
Some reported their illness when booked into jail. Others were referred to jail doctors by guards after they or other inmates noticed unusual behavior. Jail medical staffs determine who is mentally ill and who needs to be medicated for "serious mental illness," determined by duration and level of dysfunction.
Jail officials in Cobb, DeKalb, Clayton and Gwinnett report that the diagnosed mentally ill make up between 20 and 33 percent of their jail populations. Cobb reported spending more than $1 million a year on roughly 600 inmates who have psychiatric disorders. DeKalb officials said $2.2 million was spent in 2010 on an average of 662 inmates.
Cobb's costs surge
Taxpayers in Fulton —- or any regional hub, really —- "fork over more than their fair share because many of the mentally ill are drawn to downtown soup kitchens and homeless shelters and eventually end up in jail, officials argue.
Cobb County has seen its mental health personnel costs more than double since 2002. The county jail's statistics show the mental health staff had 10,000 visits with mentally ill inmates in 2008. It had 15,000 in 2010.
The dramatic increase has prompted Cobb to make plans for a mental health wing similar to the ones in Fulton and DeKalb, but the funding has yet to be secured, said Col. Don Bartlett, who heads administrative services for the Cobb sheriff.
"What we have seen over time with inmates is a trending toward more serious mental illness," Bartlett said. "That small subset that is seriously mentally ill —- a person who ends up eating feces or smearing feces, or tries to eat metal objects —- is what is real difficult for the jail staff to deal with because they are not trained to deal with that."
In Fulton County, the jail is, by default, "the largest mental health facility in the state, and we are the worst place for treating them," said George Herron, director of health services for the jail. "Mentally ill patients should be treated in the least restrictive environment and jail is the most restrictive. It is not a health care facility. It is not designed for medical personnel and counseling. It is designed for security personnel."
The money spent on housing nonviolent, mentally ill inmates could be better spent on hiring more deputies or buying better equipment, Walton County Sheriff Joe Chapman said.
Other officials noted that the money spent could go to providing better services in the community so those who are mentally ill don't wind up in jail. In the past decade, 16 mental health courts —- which try to divert the mentally ill into treatment —- have been created across the state. The Legislature also is funding 19 assertive community treatment teams to assess and treat the mentally ill on the streets, in parks or in shelters. The hope is that intervention will keep them from committing offenses that put them behind bars.
They end up in the jail for a multitude of reasons.
Last April, Willie Williamson said he ran out of his antipsychotic medication while living on the street. He said he got arrested for armed robbery after telling a woman "to give me $10 or $20."
"I threatened her and she got paranoid," Williamson said. "I didn't have a weapon."
Many of the homeless mentally ill are routinely arrested by police officers on charges such as urinating in public, making terrorist threats, loitering or being in a known drug area —- largely because they are a nuisance to property owners, businesses and residents.
Fulton Chief Jailer Mark Adger said, until recently, it was common for released inmates to get arrested while waiting on prescriptions outside Grady Memorial Hospital. "Atlanta police were scooping them up at Grady while they were waiting for their appointments," he said. "They got locked up on loitering and disorderly conduct charges."
The Grady sweeps have largely stopped under Atlanta police Chief George Turner, Adger said. But Emily McIver, director of disability services for Crossroads Community Ministries, said officers still often put charges on the mentally ill that would drive a sane person crazy. One of her clients, A.J. Jackson, got a ticket that stated that he was arrested for "darting out into traffic," McIver said.
"That is why he spent 30 days in the Fulton County jail —- he stepped off the curb and he stepped back," she said. "If you are walking across a parking lot and you don't have a car there, they will charge you with trespassing. If you are sitting down on private property at night, they will charge you with criminal trespass. That is 30 days in jail."
Adger said he understands why officers tend to arrest many of the mentally ill on petty offenses. The cops have few options for dealing with a population that often can be difficult and combative.
"My experience on the street was we were locking them up because they were crazy," he said. "I didn't think anything about getting them treatment until I got here. I said, 'Let the jail worry about it.'"
The Atlanta Police Department works hard to deal with the mentally ill in an effective way, spokesman Carlos Campos said. More than 300 of its officers have been trained to recognize mental disorders. A key component of the training is teaching officers to look for alternatives to arrest, calling on a wide range of public and private organizations, according to Lt. Brent Schierbaum, commander of the department's Community Liaison Unit. APD also has a team that responds to mental health emergencies.
Once in jail, even on petty charges, some inmates get caught in limbo either because they slip through the cracks or aren't mentally competent enough to enter a plea or stand trial.
"People being here for more than a year on misdemeanors happens," said Brickhouse, the medical director at the DeKalb County jail. "I have a patient who got arrested for no driver's license and no insurance —- two misdemeanors —- and she has been here more than a month. The jail offered her a signature bond, but she refused to sign the bond. She refused to go to court, so she ended up being held in contempt of court. She doesn't think she has a mental illness. I have to figure out how to get her out legally. She is not competent to go to trial. You can begin to see how this thing mushrooms."
Last month, Fulton had 43 inmates awaiting transfer to Georgia Regional Hospital at Atlanta to be "restored to competency" —- a legal term meaning the patient understands the judicial process and is able to assist his or her lawyer —- through a regimen of medication and therapy.
It can take months to get them into Georgia Regional Hospital.
Danny Entrekin occupied cell 111 in the mental health dorm of the Fulton County Jail for 14 months before he was shipped in late summer to Georgia Regional Hospital, where doctors will try to restore him to competency. He is accused of fraudulent use of credit cards. Entrekin, meanwhile, believes he is the heir to two fortunes, including one from oil tycoon J. Paul Getty.
"Every time I get a pocketful of money, they lock me up on some charge," Entrekin told the AJC. "I'm here to get my inheritance. I want out."
At least four times in the past three years, the 44-year-old has found himself in jail in Fulton County, usually on charges of criminal trespass or criminal damage to property. He also has been locked up in DeKalb, Cobb, Gwinnett and Clayton counties.
Competency issues are one of the main legal impasses that keep mentally ill inmates from resolving their issues in court and either going free or to prison where, from the sheriff's perspective, they can enter long-term treatment at the expense of a larger pool —- the state rather than the county taxpayers.
The inmate-patients don't have to comply with treatment, and some don't, either because they dislike the side effects of the medications or they don't believe they are mentally ill.
The state can't forcibly medicate a free citizen or a jail inmate who has not been convicted of any charge unless the person can be shown to be suicidal or a danger to others. "It is your right in America to be crazy," Brickhouse said.
Gwinnett County Jail commander, Lt. Col. Don Pinkard, cited several examples of people with schizophrenia currently in the jail who are in legal limbo because they refuse treatment, including a 32-year-old woman who has been in jail for more than a year on a misdemeanor assault, her sixth arrest since 2007, and a 46-year-old woman with schizo-affective disorder, who was booked with aggravated stalking in 2009 —- her third arrest since 2006.
In Fulton County, Howard Tate was arrested in December 2005. He has bounced back and forth between the Fulton jail and the state hospital after refusing to comply with treatment so he could be tried on a robbery charge, according to court records.
State psychiatrists were able to forcibly medicate him after Tate reputedly charged a nurse. He was declared competent in March 2010, but is still awaiting trial.
"I'm on my meds now, but I'm going to quit taking them when I get out," he recently told The Atlanta Journal-Constitution. "They have me diagnosed as a paranoid schizophrenic, but there is nothing wrong with me."
Supreme Court ruling
Jails across the nation began filling with the mentally ill following a 1975 U.S. Supreme Court decision that said people could not be civilly committed to mental institutions unless they were a danger to themselves or others.
The decision was grounded in the failure of many state mental institutions to care for the committed. Investigations found state institutions often overmedicated the mentally ill and warehoused them rather than trying to improve their lives. Nurse Mildred Ratched in the 1975 film "One Flew Over the Cuckoo's Nest" became the face of the oppressive state.
At the time, and today, mental health advocates argued the state had an obligation to treat the mentally ill in community-based programs that would allow them to live fuller, freer lives. But plans for community programs either weren't widely implemented or they were too underfunded to serve as a safety net for the hospital patients who were hitting the pavement.
By the 1990s, the mentally ill were overloading the homeless shelters and stacking up in the jails as police cracked down on quality-of-life crimes and minor felonies. A 1999 Supreme Court case determined that mental illness is a form of disability and that institutional isolation of a person with a disability constituted discrimination under the American with Disabilities Act.
"If you look at demographics, you will see a direct correlation between the discharge rate from state hospitals and the incarceration rate in jails and prisons for the mentally ill," Brickhouse said.
Fulton's Sheriff Jackson and his counterparts contend the state has shirked its duties by underfunding mental health treatment for decades.
The issue has turned many sheriffs into advocates of reform.
"These people shouldn't be in jail. It's not humane," he said. "They need to be in a hospital or someplace they can get proper treatment. That is better than us just being a pill factory."
Walton County's Chapman said the state has always been long on lip service and short on action. He has tried to find housing for 74-year-old Curtis Vinson, who was arrested in December on charges he tried to stab his sister.
The state mental hospital refused to take him because they concluded Vinson suffered from dementia, which made him the responsibility of the state Division of Aging Services. That division refused to house him on safety grounds, citing the arrest for aggravated assault. Chapman noted Vinson barely has the use of his two hands because of physical deformities.
"Everybody says he is somebody else's problem," Chapman said, "and he just sits in a cell by himself."
Copyright 2011 The Atlanta Journal-Constitution