the new insane asylums Los Angeles County, California
This was part of a two part series that ran in 1991, along with two sidebars and many charts. After it ran, the Los Angeles County Board of Supervisors voted to study the conditions of the mentally ill in its jail facilities and how police cope with the mentally ill. But little has changed.
When Jail Is a Mental Institution
Los Angeles County Jail has become a massive dumping ground for the emotionally disturbed. Police perform 'mercy bookings,' but treatment often falls short.
The largest mental institution in the United States rises from a bleak industrial sector of downtown Los Angeles, a maze of concrete walls and steel bars where more than 3,000 people with mental illnesses are crowded into dimly lit cells.
The "mental institution" is, in fact, Los Angeles County Jail. Built to house criminals, the jail has become a vast holding tank for people with serious emotional disorders, a "hospital of last resort" for psychotics and others cast adrift by the county's rapidly disappearing community mental health system.
On any given day, hundreds of cells in the Men's Central Jail might be filled by emotionally disordered men charged with trespassing, shoplifting or other petty crimes. For them, the monotony of days and nights in the windowless facility is broken only for meals and for "pill call," the dispensing of powerful, mood-altering psychotropic drugs.
A handful of the most acute cases inhabit "Suicide Row," round-the-clock observation cells. Some are strapped to cots with leather restraints in the jail infirmary.
All the mentally ill are known in the jailhouse lingo as "dings"--short for ding-a-lings.
"People who just a few years ago were in a county or state psychiatric hospital, now you'll find them here," said Manuel R. Mora, head of mental health programs in the Men's Central Jail. "They get sicker and sicker; they end up on the streets and then they end up in a jail cell."
A quarter century after mental hospitals in California and other states began to release hundreds of thousands of patients in response to an outcry for reform, the nation's jails have become a dumping ground for the mentally ill, according to interviews with county mental health workers, judges, public defenders, prosecutors and advocates for the mentally ill.
With the Los Angeles County mental health system in disarray after a decade of budget cuts, breaking the law has become the only way many people can receive treatment for chronic mental illnesses.
To keep psychotics off the streets, police officers and prosecutors repeatedly perform what they call "mercy bookings" and "mercy filings," charging the mentally ill with crimes so petty they might otherwise be ignored.
After completing their sentences in the County Jail system, the vast majority are released. Left to fend for themselves, many commit new crimes, returning to jail over and over again.
Although the scope of the problem is perhaps greatest in Los Angeles County, it is common to nearly every major city in the United States. In such places as Cook County Jail in Chicago and Rikers Island Jail in New York City, jail officials find themselves caring for more and more emotionally troubled and psychotic men and women every day.
There are now more people suffering from manic depression and schizophrenia incarcerated in the nation's jails and prisons (about 100,000) than are receiving treatment in public hospitals (68,000), according to a recent study by the National Alliance for the Mentally Ill.
In Los Angeles County, the number of inmates admitted to the jail system's mental health units has increased 66% since 1986. Mental health programs in the jail cost about $10 million a year.
Officials estimate that about 15% of the jail system's 24,000 inmates suffer from mental illnesses--there are thus more mentally ill inmates in the jail than there are patients in the nation's largest public mental hospital, Pilgrim State Hospital in New York.
Judges and public defenders have joined mental health advocates in arguing that the incarcerations of so many psychotic and emotionally troubled people marks the end of government efforts to provide compassionate treatment for the mentally ill. In effect, they maintain, American society is slowly recreating the "insane asylums" of an earlier, less-enlightened era.
"Three hundred years ago in this country what we did with schizophrenic people was we either banished them or we executed them," said Dave Meyer, second in command in the Los Angeles County public defender's office. "We simply eliminated them from our midst. . . . Haven't we progressed since then?"
Only a fraction of those with mental problems are even identified by jail officials. On any given day, there is space in the mental observation cells for barely one-fourth of the estimated 3,000 mentally ill inmates. The rest live with a wide variety of criminals in the general jail population. With the exception of a handful of inmates admitted to the jail infirmary, none will benefit from counseling or psychotherapy.
"We only see the most seriously ill people here," said Dieter J. Poiser, director of the jail's outpatient mental health unit. "You can easily speculate that there's a lot of mentally ill people we can't see."
Inside the color-coded jail, the mentally ill are assigned pale yellow uniforms that set them apart from other inmates, who wear blue, green and orange. At the Men's Central Jail, the yellow-clad men live in mental observation modules, collectively known to inmates and guards as "the ding tank."
The jail's largest mental-health unit is Module 4300, a collection of 50 iron-barred cages. About 245 men, crowded in groups of four to six, lie on thin mattresses covering steel bunks bolted to the walls. Their restless tossing is constantly monitored by two deputies seated in a glass-enclosed booth in the center of the module.
Two or three times a day, the inmates are rousted from their cells and taken in groups of 50 or more to a long hallway. They form a line ending at the "pill-call window," where they receive medications that help control their symptoms.
The drugs also carry side effects, including drowsiness and muscle spasms. Some somnolent inmates walk through jail passageways with an unsteady gait they call "the Thorazine shuffle."
Fifty men with acute mental illnesses are housed in Module 4500, where the single-person cells are so narrow that a tall man can stand in the center and touch both walls with the palms of his hands.
Module 4500 is dimly lit and grim. All but a few inmates are lying in their bunks as a group of county health workers troop through on a midmorning inspection. An inmate yells from his cell, grasping the iron bars with angry hands. He drops his yellow pants, exposing his genitals.
"He's fairly agitated and anxious," said Elsie Lu, director of forensic mental health services. "If you put him in a cell with another person, he would agitate the other person and get punched out."
A regular inhabitant of these cells is 33-year-old Michael Brewer. Arrested for 14 crimes ranging from drug possession to shoplifting, Brewer has spent much of the last five years in the County Jail system.
Brewer says doctors have diagnosed him as suffering from paranoid schizophrenia.
By now, the jail's concrete floors and iron bars are familiar surroundings where he can receive a warm meal, a place to sleep and medicines--all at a cost of at least $100 per day to the county taxpayers, three times what it costs to house other inmates. The jail is like a second home to him. In fact, it is his only home--when he is not in a cell, he lives on Skid Row streets.
This is not to say that Brewer likes jail.
"It's very small. People have lost their minds," he said recently after being released from custody.
"There's the criminally insane in there. Then you've got your weak ones. They get picked on. . . . (The deputies) beat them up. They won't get their treatment (medications). . . . The other prisoners will try to rape them."
Indeed, in its physical appearance and in the dangers it presents to its inmates, the mental units differ little from the rest of the jail.
Even in the mental health modules there are frequent lock-downs when weapons or drugs are discovered in the cells. Gang members have been known to infiltrate the units, preying on the vulnerable inmates for sex and drugs.
"If a gang member can work his way into one of the modules, he's going to have a field day," said Poiser.
During the jail inspection, Poiser and other jail workers step over dirty underwear littering the walkway. A recurring problem in the unit, one worker says, is that some inmates eat their own feces or throw the excrement at deputies and doctors.
Another corner of the many-chambered jail is inhabited by inmates considered suicidal or a danger to others. In the jail infirmary, a handful of men are strapped to beds in tiny cells behind heavy steel doors.
A man yells from one of the cells: "Get out of here! . . . Get out of here!"
His wrists and ankles are strapped to the bed with wool-lined leather restraints. Suddenly, he is quiet, pulling at his restraints. He opens his eyes wide in a psychotic stare.
After being strapped to a similar bed for six days, Carl Bruaw, a 49-year-old accountant, died in one of these cells in 1989. Unable to move, Bruaw slowly succumbed to a blood clot in his lungs.
County officials say more sick people are in jail because state budget cuts have decimated the community mental health system.
Since 1988, reductions in state funding have forced the county to close eight of 30 community clinics, eliminating services for 30,000 people. Last year, the Department of Mental Health lost $22 million in state funding.
Francis Dowling, the department's acting director, said he is certain that many people who were once treated in the defunct clinics are in jail.
"It becomes a vicious circle," Dowling said. "These people get out . . . (and) they get in trouble. They either wind up in jail or they wind up on the door of one of the county hospital psychiatric emergency rooms, which are backed up and closed half the time. They deteriorate even further."
At those clinics still operating, prospective patients may wait two months or longer for an appointment, according to health workers. In overcrowded county hospitals, severely mentally ill patients sometimes sit two or three days in a waiting room before a bed is free.
Even psychotics who have been arrested and ordered sent to a psychiatric hospital by a judge may wait for days or weeks in County Jail before being transferred to Metropolitan State Hospital in Norwalk.
"The waiting list is so long to get to Metro, they never even make it out there," said Alisa Dunn, director of the mental health department's court diversion program.
When all other alternatives fail, there is always the jail. The flood of disturbed people into the institution reached new heights in the late 1980s, culminating last year, when a record number of inmates were admitted to the mental observation units.
"I never thought we'd see this many mentally ill people in the jail," said Mora, a county mental health worker since 1972. "These are individuals who are coming into a facility that is not set up for treatment. And yet, sometimes this is the only treatment they will have."
Sheriff's deputies and mental health workers get their first look at the mentally ill at the inmate reception center, where deputies try to sort out psychotic and other disturbed inmates among the estimated 700 people who enter the jail each day.
Among the newly admitted are many who, like Brewer, have been arrested for petty crimes while homeless. Unable to care for themselves while living on the street, they are taken into custody suffering from malnutrition, with dirt-encrusted skin and hair or bleeding from open wounds.
"It's really, really pitiful," Poiser said. "You get people who are hallucinating, who haven't eaten for days. It's a massive cleanup effort. They get shelter, food, you get them back on their medications. . . . It's crisis intervention."
When a sheriff's deputy places bandages on their wounds and offers them a jailhouse shower, it might be the first time they have been treated compassionately by another human being in weeks or months.
Perhaps understandably, some inmates seem to have a certain attachment to their grim cells. Jail social workers have come to know intimately a few disturbed but persistent men who return to the mental health modules with predictable regularity.
Each time the inmates are released from custody they commit new crimes--usually misdemeanors. The crimes are not serious enough to require time in state prison, but do earn them a return to County Jail.
"A lot of times, you talk to these guys and they say this is home for them," Poiser said. "They know the doctors, the deputies. You think, how long can we keep them out of jail before they come back? Two weeks? Three weeks?"
Others respond much differently to their incarceration. Driven to despair, they try to kill themselves.
"You might feel you're going to be beat up by other inmates or gang raped or that the deputies are going to beat on you, any one of which could happen to anyone (in the jail) at any time," said Dr. Eugene Kunzman, the jail's chief psychiatrist. "They know that if they're not alive, they won't feel the pain."
To prevent suicides, jail workers often place the inmates in leather restraints or in one of 14 cells in the mental health modules collectively known as "Suicide Row," where deputies keep a 24-hour watch.
Another alternative is to place an inmate in a multiperson cell in the jail's mental-health units because, Kunzman said, "even among the mentally ill it's hard to stand by and watch a guy kill himself."
For each suicide, there are about 20 failed attempts, Kunzman said. Of the 65 County Jail inmates who have committed suicide since 1970, 71% had histories of mental illness or had been examined by jail mental health workers just before they killed themselves.
The last suicide in the mental health units occurred two years ago, when an inmate dismantled a plastic disposable razor and fashioned it into a crude spear, stabbing himself in the neck. The man bled to death in the middle of the night, as the others in his cell slept.
Susan Martino, 42, was alone in a cell last September when she killed herself at Sybil Brand Institute, the women's jail. According to a coroner's report, she had been diagnosed for more than 20 years as a paranoid schizophrenic. It was her second suicide attempt at the jail.
Martino, the daughter of LSD guru Timothy Leary, hanged herself with a shoestring attached to the iron bars of her cell.
"She was of the opinion that she had been in jail long enough," Kunzman said of Martino's suicide. "She was confused and angry about being in jail."
Officials of the Los Angeles County Sheriff's Department, which runs the jail, take a dim view of their newfound role as mental health administrators.
Cmdr. Robert Pash of the Sheriff's Department's Custody Division said the presence of a growing number of psychotic and emotionally troubled inmates is taxing the already overcrowded jail system.
Pash envisions a facility where the mentally ill could be housed in more humane conditions, perhaps bungalows in a minimum-security facility, where they will have space for outdoor recreation.
The Sheriff's Department has presented the county's chief administrative officer with plans to create such a facility, Pash said. "But those things take money, and the money is not available right now."
For the foreseeable future, the jail will remain a way station for thousands of mentally ill men and women, a temporary home for those suffering from schizophrenia and nearly every other conceivable psychosis.
After completing their sentences, the vast majority of mentally ill men are simply released to the streets around the Men's Central Jail on Bauchet Street, just north of the Civic Center.
County health workers say it is not uncommon for some to refuse to leave the jail grounds after they are set free. They sleep by the front door of the inmate reception center until a deputy arrives to hustle them away.
"They have some kind of bonding with the facility," said Mora, the mental health official. "They don't want to leave."
A few former inmates of the mental health modules are said to wander the industrial district neighboring the Central Jail. Disoriented and confused, they find food and shelter as best they can in and around the district's old warehouses and railroad tracks.
Others, like Brewer, find their way back to their old stomping grounds.
Brewer was back on Skid Row recently after being released from jail on a grand theft conviction--he allegedly took a $100 watch from a man on a downtown street.
Some days, Brewer said, he hears voices. Recently, his symptoms got so bad that he pounded his fist into a police call box.
After receiving an injection of psychotropic medication at a clinic, he described what his illness feels like when it isn't treated. "You get really disturbed mentally," he said. "You won't eat. You won't work. You might hit a brick wall."
Brewer has been homeless for five years, his mental illness tugging him from one downtown street corner to the next. Being homeless is "not so bad if you got Jesus," he said.
Still, he admitted that he is afraid of the police. If he got sick, he said, they could arrest him again at any time and send him back.
A few weeks later, Brewer was arrested for trespassing at the Bonaventure Hotel.
Police first held him in the holding tank at Parker Center, the downtown Police Department headquarters. Then he was transferred to the tiny cells of the Men's Central Jail, where he had to worry, once again, about hardened criminals trying to rape him.