Washington Post
November 25, 2001
Mentally Ill Need Care, Find Prison
By William Branigin and Leef Smith
Leon was 14 when he started dipping into his mother's drugs to escape his aching depression. Curled up on the sofa, he'd smoke dope while watching old movies -- Hollywood's fantasies a happy distraction from his own life of poverty, beatings by his mother and longings for a father who wanted no part of him.
Dropping out of middle school, the one-time honor student began a cycle of drug addiction, incarceration and recovery that has repeated itself six times, culminating in two suicide attempts, once by drinking a bleach-and-Ajax cocktail. Only last year did doctors finally diagnose his condition as bipolar disorder, or manic-depressive illness.
Over the years, jailers tried to manage Leon's depression, prescribing Prozac and other drugs to stanch the mental breakdowns that left him crying on his bunk. But whenever he returned to the outside world, where he found little help for his condition and long waits for what programs did exist, he'd stop taking his antidepressants. Without ongoing counseling and help transitioning back into the community, he would inevitably relapse into illegal drugs and trouble. Then back to jail.
"The drugs were just a symptom of my problem," said Leon, 31, who is serving time on a parole violation and spoke on the condition that his last name not be published. "I needed mental health counseling. But I was lost in the system," he said, his gentle voice almost inaudible inside the cavernous Fairfax County jail.
Thousands of mentally ill people and their relatives confront this dilemma every day in the United States, where prisons and jails are increasingly substituting as mental hospitals, say patient advocates, jail administrators and government officials.
The number of mentally ill behind bars today is nearly five times the number in state mental hospitals, government figures show. And though serious mental illness afflicts 5.4 percent of U.S. adults, the mentally ill account for nearly 16 percent of all inmates -- about 284,000 people -- according to federal surveys.
People "shouldn't have to feel they have to go through the criminal justice system to get [mental health] treatment," said Collie Brown, director of the criminal justice program at the National Mental Health Association in Alexandria.
On any given day in Fairfax, as many as 200 people with serious mental illness are in the county jail -- some charged with violent crimes that might have been prevented with proper treatment, advocates say, and at least half there because of minor offenses, such as trespassing or loitering, that stemmed from their illness.
"They're there for being sick," said Bob Simon, who heads the Northern Virginia chapter of the National Alliance for the Mentally Ill. While the Fairfax jail provides significant mental health services, including a 12-member forensic unit to monitor inmates' conditions and administer antipsychotic drugs, jails are not the place to provide such treatment, he said.
"A lot of people with mental illness are charged with minor crimes as a way to get them off the streets," said Frank Feibelman, president of the alliance in Virginia.
High incarceration rates among the mentally ill reflect the failure of deinstitutionalization, a policy of hospital closures that began in the mid-1950s, Feibelman and other advocates say. Supporters of the process argued that thousands of Americans were being warehoused in state mental institutions and would receive better care in their communities.
But the promise underlying the closures has not been kept, critics say, citing insufficient resources for community-based programs.
"The woeful failure to provide appropriate treatment and ongoing follow-up care has sent many individuals spinning through an endless revolving door of hospital admissions and readmissions, jails and public shelters," said Mary Zdanowicz, director of the Treatment Advocacy Center, an Arlington-based nonprofit. "America's jails and prisons are now surrogate psychiatric hospitals."
At their peak in 1955, the nation's public mental hospitals held 558,922 patients, according to the U.S. Department of Health and Human Services. By 1998, the number was 57,151, even though the nation's population had grown by nearly two-thirds.
Since 1955, the District has lost 92 percent of its public mental hospital beds; Maryland has lost 86 percent and Virginia 84 percent.
Although private facilities and other centers have absorbed some of the caseload, there are fewer than 98 beds per 100,000 people available for the mentally ill today, compared with 264 beds in 1970, HHS reports.
Arthur M. Wallenstein, director of corrections and rehabilitation in Montgomery County, said he has seen "an enormous increase in the number of mentally ill coming into the correctional system." Using Justice Department figures, he estimates that 1.6 million Americans with serious mental illness enter or leave county jails each year. Most go back into the community, often with no medication or rehab program, he said.
Anne Minarik, a 24-year-old Annandale resident, has been to jail five times in recent years for minor offenses -- including unauthorized use of a relative's car -- that she said she committed in a compulsive, manic state. Like Leon, Minarik has bipolar disorder, which causes unusual shifts in mood, energy and ability to function, and post-traumatic stress disorder.
Minarik said she has repeatedly attempted suicide and battles addictions to drugs and alcohol. "A lot of people with mental illness become dependent on substances in order to level out," she said.
Nancy Rome says that is what happened to her son, Jesse, who has spent much of the past eight years in prisons and mental institutions and whose ordeal illustrates what families might experience when trying to access treatment.
Rome -- who did not want her son, who has a different surname, fully identified because of the nature of his crime -- said Jesse was in his late teens when he began hearing voices in his head. At Virginia Tech, which he attended on a scholarship, his drug- and alcohol-abuse problems worsened, and he flunked out.
Back home at 20, he was angry and depressed, his mother said. In May 1993, he checked into Fairfax Hospital, reporting visual and auditory hallucinations and admitting using cocaine, LSD, marijuana and alcohol, according to court records. A family history of schizophrenia prompted a doctor to put him on antipsychotic medication.
That November, as Rome searched unsuccessfully for a psychiatric rehab program for her son, Jesse overdosed on LSD and assaulted a family member. At trial, court officials dismissed his mental condition, according to his mother. He was sentenced to 15 years in prison.
Though increasingly psychotic, Jesse refused to take medication, Rome said. He feared it would leave him vulnerable to other inmates, he later told her. After two suicide attempts, including slitting his throat with a piece of glass, Jesse was transferred to a psychiatric prison, where he was diagnosed as schizophrenic, medicated and supervised.
In 1999, he was paroled and committed to the Northern Virginia Mental Health Institute, a 127-bed hospital in Falls Church. Then, this May, he was released to a halfway house for drug abusers, a placement his family thought inappropriate because he was still complaining of internal "demons" telling him to hurt people.
Five days later, the 28-year-old violated his parole by fleeing the halfway house, saying he was afraid he might hurt someone there.
An employee of the Woodburn Center for Community Mental Health who met with Rome and her son summed up the family's dilemma: For Jesse to be hospitalized, "somebody has to be in imminent danger," psychologist Abby May told them. An alternative, she said, could be the county jail, where Jesse might get an emergency treatment order and be sent to a hospital.
After his May evaluation, Jesse was told that he could stay one week in the psychiatric ward at Inova Mount Vernon Hospital -- a placement that eventually stretched to a month as his mother searched for a way to keep him from being returned to jail.
"I don't think that because I had a mental breakdown, I should have to go back," Jesse said.
That prospect was averted by the propitiously timed opening of a four-person group home in Leesburg, where Jesse now lives. But "if we hadn't been extremely persistent, Jesse's circumstances could very easily have landed him in jail," Rome said.
Today in that jail, Leon is nearing completion of a one-year sentence for violating parole on a 1998 conviction of embezzling from his employer, a Papa John's where he was an assistant manager. Leon said he was desperate for crack cocaine when he stole $415 from the pizza restaurant but then turned himself in.
"I was so depressed and miserable I wanted to be caught," Leon said a few days ago, his green jail-issue jumpsuit hanging baggy on his medium frame.
He was sentenced to five years in prison, with three years suspended. As a condition of his release, he was sent to a long-term treatment program for substance abusers in Alexandria. But Leon said his mental health issues were largely being overlooked and his medication hadn't stabilized. As a result, program officials found his behavior too erratic, he said. He was discharged, a violation of his parole.
After going back before the judge, Leon was transferred to the Fairfax jail and placed in a program that offers mental health as well as substance-abuse counseling -- what Leon describes as "a blessing" in disguise. Now, for the first time, he thinks he has a handle on his addiction and depression. Soon he will be released, this time on three years' probation. He has applied for financial aid to attend Northern Virginia Community College and wants to become a drug counselor.
Because there is a waiting list for supervised apartments, Leon will be living with his mother again, at least initially. That worries him, but he says he plans to attend mandatory therapy at a community mental health center and to take the medication he needs to stay focused and out of trouble.
"If I had gotten into this [jail treatment] program in the beginning, things could have been different," he said. "I always wanted to excel, to do something good. I have a lot of shame. I made a lot of bad choices, and I don't like the way my life has turned out, but I have the option to be someone."
He will be out of jail Dec. 22.
Copyright © 2001, Washington Post Company. All rights reserved.
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