The New ‘Asylum’: When Jails Become Mental Health Facilities

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Michael Lawrence Martinez Jr. sits behind plexiglass at the Fabian Dale Dominguez State Jail during an interview.  Photo by Ana Ramirez/Victoria Advocate

Michael Lawrence Martinez Jr. sits behind plexiglass at the Fabian Dale Dominguez State Jail during an interview. Photo by Ana Ramirez/Victoria Advocate

 

In a white [prison] jump suit, Michael Martinez Jr., clung to a phone and rattled off all the things he wished he would have said to his mother.

Her boyfriend killed her in 2012 before taking his own life. Martinez says he was there when his brothers kicked in her door [of their home in Victoria, Tx] and made the grisly discovery; and he has been using drugs and alcohol to cope ever since.

Martinez, 29, who is serving a sentence in the Victoria County Jail, will be a free man later this month; but like most other mentally ill inmates, he’ll have only a bus ticket and his best intentions to guide him. He most likely will be back behind bars.

“They said I broke the law … but they don’t tell you how to deal with seeing your mother’s throat cut ear to ear,” Martinez said.

State prisons and jails in the U.S. now hold 10 times more mentally ill people than psychiatric hospitals. The same people are coming back to prisons and jails more often. And they are worse off there, according to a recent study by Public Citizen and the Treatment Advocacy Center.

That’s because only about a third of jails provide psychiatric care to inmates and even less offer any support system for them when they are released.

The Problem ‘Will Get Worse’

Ominously, the study’s authors concluded, unless the fractured mental health care system becomes a priority and is healed, “this problem will only get worse.”

Another study done in Arkansas found that the cost to prosecute and incarcerate a mentally ill person over a year was 20 times more than the cost to just treat them.

Hank Steadman, the president of Policy Research Associates, has studied mental health for decades. He said people don’t see the issue as their problem.

For taxpayers, though, it is.

“This is incredibly wasteful,” Steadman said. “They need to be linking these people to community-based treatment, not just temporarily recycling them through the jail.”

Martinez returned to Victoria from Houston earlier this year to rekindle a relationship with the mother of his child. But then, she dumped him. He felt like he was losing another family member.

Martinez was arrested [after a police officer] found him…staggering on the wrong side of the road early on the morning of April 3. He slurred as he gave inconsistent statements about where he was coming from.The officer allowed Martinez to knock on his brother’s door, but when no one answered, he was deemed a danger to himself or others and taken to jail, where meth was found in his pocket.

There, he received medication, but no counseling. He was at an emotional standstill.

The ‘Sandra Bland’ Effect

[The case of Sandra Bland, which received national attention last year, spotlighted why jails can’t ignore mentally ill inmates. The 28-year-old African-American women was detained after an argument with an officer in Hempstead, Tx, 60 miles northwest of Houston, who stopped her for making an illegal turn.]

Held in the Waller County jail, Bland died by suicide even though she indicated to the jailers when questioned that she had thought of suicide before. That should have triggered a call to the local mental health authority or at least more frequent checks of her, but did not.

Since then, the regulatory agency for jails in Texas revised the questions asked of inmates, as well as the form filled out when they are booked. The idea was the form needed to be more comprehensive for jailers, who are not mental health professionals.

For example, if inmates indicate they have thought of suicide, the form explicitly instructs jailers to refer them to a magistrate to determine competency to stand trial or to the local mental health authority.

It was during this process that the Victoria County Jail learned Martinez was a patient of the local mental health authority, the Gulf Bend Center.

Martinez said the jail filled at least three prescriptions for him within a few days. The prescriptions came from Gulf Bend’s psychiatrist, Dr. James Dotter. They were Depakote, which treats bipolar disorder; Trazodone, an antidepressant; and Hydroxyine, which treats anxiety, he said.

But he said the jail offered no counseling, which he wanted, desperately.

Martinez is better off than some.

If inmates are not already Gulf Bend patients or displaying symptoms of a mental illness that are obvious to jailers, they have almost no hope of getting treatment.

….Some Crossroads county jails report that when inmates have requested to see someone from Gulf Bend in the past, the wait time has varied between two weeks to four months.

Lane Johnson, Gulf Bend’s chief of clinical services, said the center’s response varies depending on many factors. He said Gulf Bend has limited manpower to offer counseling in the jails.

But Calhoun County Jail Administrator Michelle Velasquez thinks counseling could be helpful.

“I’ve got inmates who have been in here months. They are fine most of the time, but then they get frustrated with the court system or whatever is going on with their families on the outside, and they start getting depressed and sometimes suicidal,” Velasquez said.

Martinez said he filled out three request forms because he wanted Dotter to adjust his medication, which he felt wasn’t working.

When Martinez never heard back, he refused to take the medication for two weeks. He thought that by doing so, he’d force Gulf Bend’s hand.

Instead, his nerves frayed and he got into two fist fights.

For Martinez, his punishment was 24 hours in solitary. For others, the consequences of going without treatment while held in a jail are more severe.

In June, a Calhoun County Jail inmate tried to hang himself with a nylon thread he ripped out of a shower curtain in his cell. When the jailers noticed him standing on his sink with the thread around his neck, they tried to get him down. He elbowed, kicked, punched and spit on them. He is now charged with assaulting a public servant, a third-degree felony for which he could face a maximum of 10 years in prison.

He’s been on suicide watch for at least three months, requiring jailers to check on him once every 10 minutes.

Those familiar with the gaps mentally ill inmates fall into locally want to make a change, but cost…is their biggest hurdle.

Victoria County is considering signing a $1 million annual contract with the University of Texas Medical Branch (UTMB).

Signing this contract gives the county access to UTMB’s network of specialized doctors, which could cut down on how often inmates must be driven elsewhere for care, leading to some savings, County Judge Ben Zeller said.

UTMB also would provide a psychiatrist, who would be available via tele-video conferencing, Zeller said.

Gulf Bend’s psychiatrist is available to jails in the same way already, Johnson said.

But that same psychiatrist, Dotter, oversees Gulf Bend’s outpatient clinic five days a week. He sees an average of 18 patients daily.

“Our next step is to figure out a way to pay for it,” Zeller said of the UTMB contract.

Victoria County, which just grappled with budget shortfall amounting to about a million dollars, is on track to spend $1.13 million providing medical care at its jail this year, an increase over the previous two years…

Another Solution

The Gulf Bend Community Collaborative, a group of concerned residents led by Leo Rios, of the Victoria County Sheriff’s Office, has been working for almost a year on ways to divert the mentally ill from jail.

The Collaborative has come up with a plan that could help someone like Martinez, Johnson said.

The plan calls for case workers and deputies trained in mental health to meet inmates while they’re in the jail and follow up with them when they’re released. They also would try to establish a rapport with the mentally ill people in the community before they face a crisis.

During those meetings in and out of the jail, they’ll help a mentally ill inmate find a place to live and a job.

“Part of the role of those individuals in the Collaborative’s plan is to begin to put in place those basic human survival needs, which means they are less apt to get in trouble again,” Johnson said. “The major gap right now for us is when someone is released from the jail. What then? What happens over the next 24-48 hours is critical.”

The Collaborative is pitching the plan to legislators now. The cost is estimated at $11 million over four years.

But the plan is landing on legislators’ laps right as they’re contending with a cooling economy and other crises, such as the need for 550 more Child Protective Services caseworkers.

Endless Cycle

….Martinez missed his daughter’s first birthday. The only present he could afford was one of the four sheets of paper provided by the jail every week. On the lined sheet of paper, he drew her a portrait in pencil and mailed it to her home in Bloomington.

“I don’t know if she forgot about me. I hope not. I miss her every day,” Martinez said.

From April to November, Martinez passed the time at the jail working out his feelings about his mother’s death, not with a counselor, but by writing poems.

He also bartered with other inmates, a haircut for a tube of toothpaste he couldn’t afford at the commissary.

It sparked in him a desire to become a barber, but his future looks bleak.

In November, he was transferred to a prison about 30 miles from San Antonio to serve the remainder of his sentence.

“I get out on [December] 29th. I’m trying to get all excited about it and I am because I get to see my daughter, but I know what I’m going out there to – nothing. I don’t have anywhere to go,” Martinez said.

Jessica Priest, a court reporter for The Victoria Advocate, is a 2015-2016 John Jay/Langeloth Mental Health Reporting Fellow, This is an abridged version of a story published this month as part of a continuing series, “Minds That Matter, produced as part of her Fellowship reporting project. The full version of the story, and other parts of the series, are available here. Jessica welcomes readers’ comments.

 

One thought on “The New ‘Asylum’: When Jails Become Mental Health Facilities

  1. In Cook County (Chicago), the jail is the largest in the country holding an average of 12,000 inmates per day. Of those 12,000, Sheriff Thomas Dart says 3,000 of those individuals suffer from mental illness making the Cook County Jail the largest mental health institution in the country. Dart has done an amazing job addressing the problem, but simply can’t enact the needed changes to get these individuals treated. The state legislature refuses to fund meaningful reform. Never mind most of the mentally ill in Cook County are there for misdemeanors. They often shoplift candy bars so they can go to jail to get meds and decent treatment.

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