By Kathleen Wilson
Sunday, October 11, 2009
Photo by James Glover IIMichael Jung says mental illness and drug abuse have landed him in the Ventura County Jail over and over again.
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Recidivism high among mentally ill inmates
RELATED STORIESMentally ill with bipolar disorder and fearing voices telling him he’s the devil, Michael Jung turns up over and over in Ventura County’s main jail.
He has been booked at least 15 times in the past 10 years, revolving from a cell to temporary lodgings to the street and back.
“I’ve gotten slightly institutionalized,” said the Camarillo man with a litany of drug and alcohol convictions, but no violent felonies. “I know this is where I have to be.”
Until his latest release in September, he was confined for six weeks in G Quad, the unit where psychiatric inmates stay in their cells for all but one hour of the day.
Jung said he’s been taken to what he calls “lower purgatory” many times, referring to the so-called rubber rooms where suicidal inmates stay until they calm down. Still, he calls his treatment in jail “pretty fair.”
He saw a psychiatrist, took his medications and a nurse stopped by his cell to help him fend off the voices, he said. But doctors and family members say the challenge is to keep inmates like Jung from coming back.
“The recidivism is amazingly high,” said jail psychiatrist Marvin Jung, no relation to Michael Jung. “In and out, in and out.”
Many of the hundreds of people who are jailed with mental illness each year in Ventura County struggle with serious brain disorders as well as substance abuse, low incomes and few family ties.
They began filling up jail cells after former Gov. Ronald Reagan closed many of California’s large state mental hospitals in the 1970s, a new study suggests. The trend continued as state leaders reduced bed space in the remaining hospitals, closing Camarillo State Hospital in the mid-90s. Free in the community but without adequate housing and treatment, some committed crimes that brought them to jail.
“Rather than deinstitutionalize people with mental illness, California has shifted many of them from one kind of institution — mental hospitals — to another — its jails and prisons,” says a newly released report from the California Corrections Standards Authority, which regulates jails.
‘Every effort’ urged
In recent months, the Standards Authority, the Ventura County Grand Jury and the county Mental Health Board have called for reforms to reduce their numbers.
Nationally, a recent study found that close to 17 percent of adult jail inmates have serious mental illness. The Ventura County Sheriff’s Department estimates the figure at 10-14 percent in the county’s jails, but members of the county Mental Health Board believe the figure is far higher.
In the state corrections report, a panel made up primarily of law enforcement officials advocated keeping as many out of jail as possible.
“Every effort that can be made should be made to divert mentally ill people from jail,” the panel said.
The group also recommends creating better conditions for those who must be in jails, from prompt treatment to safe housing to stocking adequate medications.
Ventura County sheriff’s officials say they’re delivering on virtually every recommendation made in the state report.
“This whole facility is very much a de facto mental health facility,” said Cmdr. Linda Oksner, who oversees the main jail, where most mental health services are quartered.
She said inmates at the main jail in Ventura and Todd Road jail near Santa Paula can see psychiatrists, get medication and referrals to community resources when they leave. An infirmary provides nursing care.
Two years ago, though, a survey team said it found reason for “significant concerns” about the quality of mental health care at the main jail and the Todd Road Jail.
Problems noted, addressed
The team issued a 90-day conditional accreditation instead of the normal two years. Inspectors found mentally ill inmates were being inadequately monitored, staffing was too thin, seriously ill inmates needed more social interaction, and it did not appear that inmates on psychotropic medications had been rechecked by a psychiatrist within 30 days.
The accreditation is voluntary, but Ventura is one of 22 counties in the state that seek the stamp of approval from the California Medical Association’s Institute for Medical Quality.
In a resurvey conducted in March 2008, the institute found jail officials had taken sufficient steps to fix the deficits, and it later issued a two-year accreditation. The award expired this month, but sheriff’s officials said they are seeking a new one. CMA spokesman Andrew Lamar said the same issues would be re-examined in the next survey.
As default mental hospitals, jails inherited the responsibility but often lack the resources to fully treat these inmates.
They have fewer medical staff members than hospitals, don’t stock as many medications, and usually are not licensed to force medication on uncooperative psychotic inmates. Prisoners found incompetent to stand trial can wait for months for a bed in already full state mental hospitals while the prisoners’ sanity deteriorates.
“It is not the facility for the purpose of treatment,” said Jean Farley, who oversees mental health clients for the county Public Defender’s Office. “It houses people to be punished.”
An eighth of the population
Sheriff’s officials estimate the mentally ill account for close to 200 of the 1,600 inmates in the county’s two major jails on an average day. About 50 wear yellow bands around their wrists, signifying they are seriously mentally ill.
Most of the others are housed with the general inmate population, whose members may be allowed out of their cells for up to eight hours. But the sickest ones are confined to the special unit where Jung stayed.
They’re incarcerated 23 hours a day for their own protection, because they’re dangerous or because they would create trouble in the general population, sheriff’s officials say.
Oksner said some of these inmates, paranoid and delusional, prefer the enclosed space. Nor is the practice unusual in the state’s jails, according to the California Medical Association.
But some question whether it’s humane.
Former inmate Susan Abril said the confinement made her hear voices for the first time.
“I didn’t sleep,” said Abril, who has bipolar disorder that is now being successfully treated. “I mentally went insane being locked down 23 hours of 24.”
Mental illness alone should not merit such confinement, said Ventura psychiatrist Ronald Thurston.
“That reflects on the system’s ability to handle the illness in a humane way,” he said.
A less costly option
Conservatively speaking, the Sheriff’s Department spends about $85,000 a month on care for mentally ill inmates, including monthly charges of roughly $25,000 for psychotropic drugs. The cost of a day in jail averages under $127, compared with the average of $1,345 at the county psychiatric unit.
But mental health advocates say the price tag for recycling of mentally ill people in and out of jail and prison is incalculable.
“In general, people with mental illness can recover when given the appropriate treatment rather than to be sent off to jail only to become more psychotic and come back and reoffend,” said Ratan Bhavnani, executive director of the Ventura County chapter of the National Alliance on Mental Illness.
Jail managers could not provide a breakdown of crime statistics for mentally ill inmates but said they run the gamut from public intoxication to murder. Many have long records of alcoholism and drug abuse. Even when their crimes are petty, some cannot be freed on their own recognizance because they have no home address or haven’t shown up for court appearances.
On the streets
The journey to jail often starts on the streets. In Ventura, Police Officer Bobby Lamborn figures half his calls are related to people disabled by mental illness, developmental disabilities and alcohol and drug use.
“A lot have self-medicated with alcohol, meth and heroin,” said the officer, who patrols downtown and the west side. “The drugs have become more controlling of their life than the illness itself.”
Easygoing yet imposing at 6-foot-3 and 260 pounds, Lamborn can usually get them to obey the law. But if they start assaulting each other and won’t stop, he takes them to jail.
Then it’s up to prosecutors to decide whether to charge the crimes. That depends on how serious it is and whether the person knew right from wrong, an official said.
“You can have a myriad of mental illnesses but still have the intent to commit the crime,” said Chief Deputy District Attorney Mike Frawley.
Inside the jail, deputies on the booking floor may be the first to figure out that an inmate is mentally ill. They administer a one-page survey designed to pick up any health problems, including psychiatric disorders.
Communication problems can arise, although all deputies and most civilian staff are undergoing training in how to deal with mentally ill prisoners.
“The hardest thing is, they don’t always understand what you want them to do,” said Deputy Edward LeClair. “You have to be gentle. Sometimes it seems like they’re resisting.”
Isolation in ‘safety cells’
Inmates found to be suicidal, drunk or high are placed inside “safety cells.” They’re a standard feature used to prevent suicides in jails, and managers consider them more humane than physical restraints.
Prisoners must take off all clothes and shoes, and wear nothing but padded smocks inside the cell. The space has no furniture and is equipped with a grate for urination. Because it has soft walls, inmates call it the rubber room.
Oksner said medical staff members are quickly notified, inmates are checked every 15 minutes and a video camera monitors the occupants constantly. Eight suicides have been reported in the jails since 2000, but officials knew of none in the safety cells.
Inmates are rarely kept there for more than 24 hours, said Cmdr. Brent Morris, who oversees the Todd Road Jail. They’re taken to a hospital if they are continuing to deteriorate and not able to take fluids after six hours, according to jail protocol.
But Michael Jung and another former inmate recall being in safety cells for up to three days.
“That’ll make you crazy right there,” said Sunday Alyse Fay Kaiser, 42, of Oxnard. “There’s a camera in there watching you be naked. There’s no getting out of it.”
Jung, 46, hopes such issues are behind him now. Out of jail for a month, he’s entered a diversion program and is staying at a sober-living home in Oxnard.
“I got into this alone, but I can’t get out of it alone,” he said. “The only way I can give myself the gift of time is to stay in recovery.”
Source: Ventura County Star
