Jason paces the Salt Lake City jail cell in cutoffs and slippers, shouting at the guards with the tone and vocabulary of a Shakespearean actor. He hits the walls with his fists and looks futilely for things to throw.
But a drug-screening test shows no evidence of illegal substances in his system, so he is released and ordered to go directly to pretrial services.By the time he reaches the street, the 28-year-old has forgotten his destination. He doesn't feel the cold October wind biting his bare legs as he walks to his apartment, and he is oblivious to the looks his strange appearance - and apparel - elicit. He has a mission.
He must turn his shabby North Temple apartment into a fortress, to protect himself from the man who lives in his basement. That man, Jason is certain, keeps demons and pigs.
Jason has just had his first brush with Utah's legal system. He is one of hundreds of mentally ill Utahns who each year run head-on into that system as a result of criminal activity.
That system may be as confused as the people it serves.
There are psychiatrists, law enforcement officials, social workers and mental-health advocates who believe that Utah does a good job of caring for mentally ill criminals. Just as many, including parents and program operators within that system, say it is at best deficient and at worst destructive. They call it a patently unjust way of treating people who may not be fully responsible for their actions because of mental illness.
"Mental health doesn't know what to do with its more violent, dangerous people. We're not taught to restrain and contain. Law enforcement and corrections haven't been taught to cure," said Kathy Reimherr, Valley Mental Health's program supervisor for the mentally ill offenders program at Orange Street Community Correctional Center in Salt Lake City.
"Part of being mentally ill is you just don't fit in any environment well," said Michele Parish-Pixler, director of Utah's American Civil Liberties Union and an outspoken critic of the penal system's treatment of mentally ill offenders. "One problem with being mentally ill is someone's very likely to act in inappropriate ways, which brings down the wrath of other inmates and guards. He's difficult to manage.
"It's hard to get out of the system, and it's hard to get help. We get many complaints about the mental and psychiatric delivery system."
A mentally ill individual who gets into a minor legal entanglement may be turned loose as "harmless" or "blameless" or "too much trouble." That's a mixed blessing, say parents who have a mentally ill son or daughter, because without mental-health care, criminal behavior often escalates into serious legal difficulties.
Offenders involved in more serious crimes find themselves entering a system even supporters call "arbitrary" and "peculiar.""It's a coin toss where a prisoner will end up," said Bob Verville, superintendent of the State Hospital in Provo. "Whether he goes to prison or a mental-health facility hinges on the judge's understanding of the system. Whether someone's even charged depends on the mental-health center, the judge, the police department. . . . It's very arbitrary."
Mental illness takes many forms, from depression and mild perceptual deficits to blatantly psychotic and delusional behavior. Nationwide, an estimated 15 percent of jail and prison inmates have a serious mental illness, including bipolar (manic-depressive) disorder, schizophrenia and psychosis. Up to a third may have some mental illness. In Utah, at least 300 and probably many more of those within the dominion of the criminal justice system suffer from clinically discernible mental illness.
The crimes that bring them into the system are as varied as their psychiatric maladies. Mentally ill offenders have been convicted of everything from harassment, petty theft and cultivating marijuana to sexual assault and serial murder.
Once in the system, mentally ill suspects step into a variety of worlds, from a clean, spartan hospital room, to a sunny billiard room in a supervised halfway house to a dimly lit cell with a hole in the floor for a toilet.
If the crime is serious, a mentally ill offender will usually end up at the Utah State Hospital in Provo or the Utah State Prison. At the hospital, the offender receives intensive psychiatric care and has more freedom than at the prison. At the prison, emphasis is on punishment rather than psychiatric care, but an inmate may be released sooner than he would be from the State Hospital.
"There's a lot of inconsistency in how we treat mentally ill offenders," said Dallas Earnshaw, forensic program director at the Utah State Hospital. "We've had a fellow at the State Hospital for 71/2 years for bad checks because of his mental illness. There are mentally ill people at the prison who have been violent but will be out sooner."
A cruel system?
The Legal Center for People With Disabilities, in cooperation with the ACLU, has filed a class-action suit in district court against the Department of Corrections and the Utah State Prison, charging that care for mentally ill offenders is inadequate and inhumane.
"Between 25 and 30 percent of the entire prison population is estimated to have some form of mental illness; however, only one psychiatrist works part-time to supervise the mental-health treatment of all inmates," the lawsuit says. "Inmates receive most mental-health counseling (when available at all) from social workers rather than psychologists or psychiatrists. These social workers have other obligations that conflict with their role as therapists."
The lawsuit charges that inmates seldom have immediate access to mental-health services; that there are too few mental-health beds, so mentally ill offenders are placed in the general prison population; that guards physically mistreat inmates who are suicidal or mentally ill; and that the prison fails to meet minimal federal guidelines like the American Correctional Association Standards for treatment of mentally ill prisoners.
"We believe that the inadequate mental-health treatment at the prison constitutes cruel and unusual punishment," said Mary Rudolph, coordinator for the legal center's Protection and Advocacy for the Mentally Ill. "I think there's also reason to be concerned there are abuses like verbal abuse and harassment that's greater with the mentally ill population."
Prison officials agree that there are serious problems in treatment of mentally ill offenders.
Lack of resources
Staffing is a big issue. At the state prison, a three-quarters-time psychiatrist, the equivalent of 51/2 full-time psychologists and a number of social work practitioners must take care of the mental-health needs of more than 300 prisoners who have mental illness. State Hospital staffers also provide some group therapy at the prison.
"There is a lack of resources," said Jeff Galli, director of program services for the Department of Corrections. "Numbers? It depends on who you're talking to, but about a third of the population would be mentally ill by someone's definition. In terms of `raging lunatics,' no. Those are likely screened out and put in the State Hospital. Right now, we contract nine beds there for the most severely mentally ill (in addition to the people committed directly to the hospital's forensics unit). Here, there aren't enough clinical people to really do anything. We know that if someone is released without mental-health treatment - and 95 percent of these folks will be released someday - it almost guarantees a failure. That problem, unfortunately, is rampant across the United States.
"The end result of not intervening in those lives in some meaningful way is more victims. We have elected in America to incapacitate offenders. It's financial. If something is left over after food, etc., then we do programming. This year, in the budget process, I asked for 30 new clinical staff. I'll be lucky to get one or two."
"It's not so bad," said Dale Schipaanboord, director of habilitative service for Corrections. "As people come in, we try to screen those with serious mental defects."
Many mentally ill offenders are housed in the Special Services Dorm at the state prison, where bunks are spread out in large open rooms, and it's a "little more relaxed," Schipaanboord said.
Compliance is a choice
Jails and prisons are hampered in efforts to treat mentally ill offenders, because they cannot force an inmate to take medication. In severe cases, officials can petition an administrative law judge for "forced treatment." But they won't prevail unless the inmate is a danger to himself or others, Schipaanboord said.
Corrections officials are planning a "track" system they believe will help make incarceration more rehabilitative. Incoming inmates will be given a battery of tests and then be diverted to one or more of eight tracks, including mental health, education, psychology and life skills.
Although the State Hospital is better-equipped to help people with serious mental illnesses, limited physical and financial resources prevent it from making more than a small dent in the legal system's mentally ill population.
"California has two forensic hospitals," said Earnshaw. The State Hospital has 66 of its 343 beds designated for criminal - or "forensic" - admissions. "We're swamped. We have more than 70 offenders now - we're equipped to handle 66.
A fine line
"It's a shame. If you put the mentally ill in a prison setting, the institutional life feeds into the mental illness. It's a balancing act to provide a secure facility where you can treat the mentally ill and protect the community. Society doesn't really have a facility to deal with criminal, mentally ill people," Earnshaw said.
"The forensics program at the State Hospital has for years been held up as a model program," Verville said. "It's humane. We're not using a prison atmosphere. Unlike some states, we don't have guards and towers and fences."
Lack of a "prison atmosphere" is a strength and a weakness, he said. Forensic patients at the hospital are seriously mentally ill and frequently dangerous. But it is not a secure facility. Efforts are being made to increase and upgrade the security staff. The Division of Mental Health, which oversees the hospital, would like to move the forensic unit to a more secure building and expand it.
Programming is difficult. Sex offender programs, for instance, have been largely underfunded and more cutbacks are expected. Earnshaw said about half of the patients in the hospital's forensics unit are sex offenders and a third of prison inmates are sex offenders. "There's a real lack of treatment."
No simple solution
While families, prison officials, mental-health experts, judges, counselors and citizens who may be victimized by mentally ill offenders argue and collaborate on how best to deal with this growing population, the program supervisor in a halfway house's mentally ill offenders program cautions against being too simplistic.
"Families want to think the offender is only criminal because he is mentally ill. In our population, by and large, are people with bad behaviors and mental illness. Without one, he might still be the other. There are mentally ill people who never commit a crime," said Reimherr. "Mental health and corrections have to work together. When the mental illness is cured, you may still have a criminal. Mental health's role is partly to predict when someone's going to get out of control so it can intervene. It's not enough to provide medical maintenance. He needs to be able to make a transition into the community.
"That's why the two areas have to build a marriage. And keep working at it."