The Real Cost of Prisons Weblog

Besides trying to keep them safe, clean and fed, there's not much deputies say they can do for the mentally ill. "They get worse here," Woody said. "They don't get better."

At the back of the Richmond City Jail's A wing, Shane F. sits naked in a strip cell. Just him, concrete walls, a hole in the floor where a toilet would go, except this cell is for people who could try to drown themselves in a toilet. He is standing by the bars, crying. Saying he wants to die. Gnawing at his wrist, trying to open a vein.

The deputy watching the five strip cells worries the distraught man will soon draw blood. He watches, ready to radio for a nurse to come and bandage the inmate if needed.

Mental-health care in jail is this:
# A deputy walks past the strip cells every 15 minutes, on suicide watch. # A twice-a-day pill line rolls though. Nurses from the jail clinic trundle their cart past the cellblocks and inmates may, or may not, line up for their medications. # Inmates -- sometimes -- make sure the mentally ill are fed and bathed. Sometimes they steal from them.

Roughly a quarter -- maybe 350 to 400 -- of the 1,500 men and women in the jail are ill enough to need psychiatric medication. Only about 120 get it. An additional 50 could, but they refuse. Deputies can't make them.

The rest just do time.

The jail, which has run over budget on medical expenses for years, has stopped using some of the newer and costlier medications its consulting psychiatrist formerly prescribed. The jail's medical director, a geriatrics specialist who now prescribes medications, says cost isn't the issue. He says the old medicines are effective.

If inmates are not too ill -- if they seem to manage to keep fed, stay relatively clean and not get beaten up too obviously -- they'll spend time in one of the big cages that were designed for 50 but can hold as many as 150 inmates, with dozens sleeping on the floor.

For about 20 men who jail officials fear would be beaten up in the main cages, there's a quiet space in the back of the jail's school tier. The students and inmate-tutors in the school program, with ill grace, clean up when the disturbed go to the bathroom in the aisles between the beds.

Some men and women stay in some of the roughly 50 single-bed cells where the jail houses inmates who are sick or need to be put in solitary.

For up to five of the most troubled men, there are the strip cells.

. .
Leon Anderson is slumped on the concrete floor, huddled in his blanket, back pressed against the rear wall of his cell. There's no bed. He has blocked the drain in the floor that is a strip-cell toilet. The air is thick with the fetid, musty smell of a man who hasn't washed in days.

Calm for now.

But a few minutes later, something snaps. He explodes. When his yells bring a deputy scrambling, Anderson throws filth from the drain at him. A radio call brings a team of 10 deputies and officers to subdue him. They fire a tear-gas cartridge into his cell, but even the acrid gas won't quiet Anderson. He bellows a gospel song, yells that the deputies don't scare him -- even as they wrestle him out of the cell, into handcuffs and then into a shower down the corridor to clean the filth off him. No one can beat him down, Anderson says a few days later. No one can make him take medications. In fact, no one can make anyone in jail, no matter how ill, take medication.

No one runs a therapy group, a psychosocial education class. There's little counseling, mainly what inmates offer one another.

They don't offer much.

"Hey, Irv!" inmate Sherod Jones calls. "Dingle-dangle." David Irving flops out of his bed in the back of the school tier, the space reserved for the mentally ill. Standing in the narrow space between bunk beds, he lifts his arms over his head, does a few shuffle-steps and a hip wiggle. "Hey Irv," Jones calls. "Coffee."

A broad grin cracks Irving's face. The marionette dance stops, and he lopes over to the table where Jones and a couple of other inmates from the front of the tier are skipping class. The table is supposed to be set aside for the tier's mentally ill to use -- for what, no one quite knows. Irving, voice badly slurred, grinning broadly, tells a complicated story about a man and woman at the place he had worked who thought he stole money. He didn't, he mutters when Jones asks. Court records show he's here for trespassing and possession of drugs. He was arrested two months ago and is awaiting trial. His next hearing is more than six months away. "I had a girlfriend, I had a girl," he says, when another inmate teases. "I had a girlfriend when I was 29, 32, 38, 35." A pause. "I'm 44." Where does he live when he's not in jail? A boardinghouse, he says. Then, shouts. Grins: "Larry's place, Larry's place. Ha ha ha."

. . .

Patty Brooks had been screaming and singing for most of the past three days, down on the ground floor of A wing, when deputies called the crisis line at the Richmond Behavioral Health Authority, the city's mental-health agency. The social worker made it out at about 4 in the afternoon, shift-change time. It wouldn't take long to fill in the standard assessment form -- Brooks was agitated, delusional. It should have made note of her February arrest on a charge of malicious wounding, since she was due for a preliminary court hearing the next day, as well as a half-dozen assault, property-damage and drug-possession arrests over the past few years. The social worker agreed with jail medical staff that Brooks met the test for a trip to Central State Hospital near Petersburg, the state mental hospital. They believed she was at imminent risk of killing herself or hurting someone else. Imminent, in their eyes, means within the next 48 hours.

Although it's not an official part of the process, RBHA checked in with Central State's admissions staff to see if it felt Brooks belonged there. The psychiatrist on duty said he was pretty sure she did and would expect to see her there in the morning. By the next morning, Central State's admission's director called back to ask where Brooks was. By noon, she was on her way. But when she arrived, there was no paperwork authorizing her stay. Somewhere between RBHA and the jail and Central State, no one checked to be sure a magistrate saw the assessment to issue the detention order. Everyone thought someone else was doing that.

. . .

A3R, a line of 12 single-man cells, shadowy on all but the sunniest days, is where inmates deemed mentally unfit to stand trial wait. Most are there on misdemeanors -- drunk in public or trespassing. Something in their manner led a district court judge to order the state to restore them to competency. That's the legal term that means you are well enough to understand your charges and can help your lawyer defend yourself. In one cell, a young man has wrapped himself, shroudlike, in his gray blanket. His legs twitch, uncontrollably, endlessly. In the next cell, an older, balding man mutters an endless stream of curses on kings and communists.

Next to him, a silent man, gray-haired with a neat gray goatee, perches sideways, motionless, on his metal toilet. He is staring at the rusted metal shelf where a mattress should go -- if the deputies weren't afraid he'd rip up yet another one and maybe try to hang himself. He spends much of the day staring like that, said jail psychologist Bill Rhoades. The man has been like that for weeks now.

Normally in Virginia, it is up to a mental hospital to restore people arrested for a crime. But Central State's decadelong effort to close units -- to save money and improve care -- sometimes means beds aren't available right away.Those reductions have freed funds that, among other things, pay for a team of mental-health workers to visit the jail, where part of their work is to help restore inmates. Someone is usually at the jail several times a week. But unlike Central State, the jail can't force inmates to take medications, Rhoades said. It often isn't until they've waited a few months and a bed comes free at Central State that they get the medications that restore a bit of reality.

By the time that happens and they arrive in court, they'll have spent enough time waiting in jail that their sentence will amount to time already spent behind bars. Often, they are back in jail within a month or two, Rhoades said. "This is the one place that can't say no," he said.

. The first time he attempted to end his life, a few months ago, Gordon Salmon tried hanging himself. A month or so later, he took a razor to both wrists -- most of the dozen purple scars didn't go deep, but he needed nine stitches to close the big one on his left arm, six for the one just across his right wrist and five staples for another on his forearm.

"I don't like hurting people," he says. "I'd rather hurt myself." He's 27, in jail because he stopped going to the probation office last year to check in after a 2003 cocaine-possession charge. Salmon doesn't talk much about the dark feelings, the waves of depression that have overwhelmed him since he saw his best friend die eight years ago. Mostly, there's no one to talk to. Most of the mentally ill inmates he lives with in the rear of the jail's school tier spend their days huddled in bed, blankets pulled over their heads.

They spend the nights wandering -- other inmates complain about waking up in the middle of the night and seeing a mentally ill inmate looming over them and about the messes of feces and urine they may leave on the floor.Salmon tries to open up a little to the man who sleeps a foot and a half away from his bed. And to the tall, soft-spoken concrete contractor who tutors Spanish-speaking inmates in English in the front of the school tier.The nurses who pass out his lithium at the daily pill line don't pay much attention -- they don't see how he palms the pills, which he detests because they make him sleepy, and throws them out. Mostly, jail is long and empty hours. Hours without an end.

Epilogue

A Times-Dispatch series on the city jail last year brought calls for change and a vow from Mayor L. Douglas Wilder to build a new jail. Wilder and Sheriff C.T. Woody said it's time to think about whether everyone who goes to jail, including the hundreds of mentally ill people there, really needs to be behind bars.

The city is looking at joining with other localities and possibly the federal government to build a new facility. So far, though, a half-year after Wilder's commitment, no firm plan is in place. Meanwhile, the jail still averages 1,500 men and women in a space designed for 882. And some of them don't even know where they are.

Solutions?
Here are some approaches Richmond jail and mental-health officials think could make a difference: More hospital beds: "We've lost hundreds of beds in the area. . . . Where do you think those people went?" says the jail's medical director, Dr. Stanley Furman. More community care: There are waiting lists for many basic services, such as a regular check-in with a social worker or case manager. New points of access: Steering a just-arrested small-time offender to a treatment program, or offering mental-health services in lieu of jail after conviction, could be a way to reach the mentally ill. Support in daily life: Housing and job programs for people whose illness or disability means they can't cope with day-to-day challenges might help keep them out of trouble with the law.
Tolerance: Many mentally ill people are in jail on misdemeanor charges because they acted in alarming ways but did not harm others. In Richmond, police officers often are able to stop that behavior at the time without arrest and jailing.

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Posted October 08, 2007 @ 08:54 AM by JustCause
This truly a moving piece. Artisitically, it is beautiful and invoking. Content-wise it reveals a true area of our society - local and abroad - that needs addressing. To bring it to light in such a power demeanor brings across the weight of such an issue.

Posted October 07, 2007 @ 08:03 PM by Anonymous
This is so sad. What is the saying "Any society,nation is judged on the basis of how it treats its weakest members-the last,the least and the littest"(Cardinal Roger Mahony).

Posted October 07, 2007 @ 06:09 PM by unionman
Folks, it's not just Richmond that has this problem. Prisons and jails all across the Comonwealth and the United States have a substantial number of seriously mentally ill tying up bed space and receiving mediocre treatment. It's my understanding that the largest mental health facility in the U.S. is the LA county jail. How we treat the least of us tells much about this country. We should all be ashamed.

Posted October 07, 2007 @ 04:29 PM by Anonymous II
This was really a very sad and depressing article to read. I have no answers, but I pray to merciful God that I am never arrested in Richmond for anything.

Posted October 07, 2007 @ 02:59 PM by Anonymous
After spending time in several psychiatric units around Richmond (am a student), I have gained much insight to many mental illnesses, one of which is the level at which they can communicate if they have received therapy/medication & counseling/groups. I have to say I don't think jail is any place for the mentally ill, especially if there is no group therapy or structured activity for them. This is not something they asked for. I invite anyone willing & able to help these individuals to do so.

Posted October 07, 2007 @ 02:51 PM by tip of the iceberg
Kudos to RTD for the frank reporting. And praise for Sheriff Woody pushing against impossible odds. Jail in Richmond for the mentally ill is no better than an 18th century madhouse. SHAME on us all for allowing such horrors to exist in 21st century Richmond. We wouldn't dream of not providing insulin to a diabetic inmate. But the city 'can't afford' the medications for THESE sick inmates? The stigma of mental illness is florishing in Richmond. What are we going to do about ??

Posted October 07, 2007 @ 02:22 PM by Anonymous
This is rediculous. Keep stories like this in the headlines.

Posted October 07, 2007 @ 12:48 PM by Anonymous
What year are we living in?? What the hell is the mayor doing? It seems like he has plenty of time to kick out the school board but the citizens of the city "his city" lay in their own fecal matter while trying to kill themselves. If he can not take care of his own people he needs to be kicked out of office. Let him stay a night or two at the jail and see if he does something about it. And what about the people who have to work there? This is madness!

http://www.inrich.com/cva/ric/news.apx.-content-articles-RTD-2007-10-07-0134.html