More threads by David Baxter PhD

David Baxter PhD

Late Founder
Locking Up the Mentally Ill
August 28, 2005
The Gazette

Colorado's prisons and jails have become the front line in the state's battle against mental illness. The number of beds has dropped at the two state mental hospitals. The Colorado Department of Corrections reports an increase in inmates diagnosed with serious mental illness. In 2004, Corrections cut funding for mental-health treatment.

Nearly one in four inmates at the El Paso County Criminal Justice Center probably doesn't belong there, Sheriff Terry Maketa says.

Those inmates are among Colorado's growing number of untreated mentally ill who have slipped through the cracks of a public mental- health system ravaged by budget cuts. They stay behind bars longer than other inmates and return more often, and many are eventually sent to prison -- usually for a string of relatively minor crimes.

Colorado's jails and prisons have, by default, become the front line of mental-health treatment in the state. Nearly onefifth of prison inmates, and onequarter of those in county jails, are diagnosed with moderate to severe mental illness.

"Jails were never designed to be long-term treatment and care. They were designed to be placement for pretrial offenders," said Maketa, who as sheriff runs the largest mental-health facility in El Paso County -- its jail. "But history has certainly shown to us it's a responsibility we're going to have to assume."

For mental-health advocates, the numbers aren't encouraging:
  • In 2004, the state cut funding for treatment of serious mental illness by 25 percent, which led to 14,000 fewer people receiving treatment.
  • At the two state mental hospitals, the number of beds has dropped from 552 at Pueblo and 220 at Fort Logan in 1999 to 438 and 173 this year. Thirty years ago, when the state's population was half what it is today, the two hospitals had more than 6,000 beds.
  • The percentage of Colorado Department of Corrections inmates diagnosed with a serious mental illness has increased from 3 percent in 1991 to 11 percent in 1999 to 18 percent -- 3,750 inmates -- in 2004.
  • The Corrections Department, from 2003 to 2004, cut funding for mental-health treatment by 17 percent, nearly $1 million. In the 2005-2006 fiscal year, just 0.8 percent of the department's budget is dedicated to mental-health treatment, half what it spends to run prison canteens.
  • The ratio of inmates to mental health professionals in prisons is about 1-to-360. [/list:u]
    Mental-health experts say the ramifications are deeper than poor treatment of inmates. It costs El Paso County taxpayers $55 more a day to keep a mentally ill person in jail than other inmates, because of medication, mental-health staff and extra deputies.

    It costs state taxpayers $27,825 a year to keep someone in prison -- and nearly triple that if the inmate requires treatment at the specialized mental-health facility and is lucky enough to be sent there.

    "It doesn't serve any of us to put people like this in jail," said Jeanne Rohner, executive director of the Mental Health Association of Colorado. "Treat the real problem."

    Experts trace the situation to the 1960s, when mental hospitals across the nation were shuttered in favor of outpatient mental- health care in the community. State funding was a key element of the new system. In 1970, 3.9 percent of the total state budget went to mental-health services. By 2000, just 1.4 percent of the state budget was going to mental health. When the economy turned sour in 2001 and state officials found themselves hemmed in by voter-approved spending limits in the state constitution, it was among the first programs to suffer.

    At Pikes Peak Mental Health in Colorado Springs, there was state funding in 2002 to treat 2,471 patients who lacked insurance. In the current fiscal year, the center received money for 470. In January, the facility lost $150,000 a year in federal funding to treat mentally ill homeless people. "We used to take anyone who knocked on our door, period. We don't do that anymore," said Sharon Raggio, senior vice president. " I've worked in this industry for 20 years, and it just breaks my heart to see it torn down." Raggio said Pikes Peak Mental Health has been able to make up some of the shortfall through fundraising and grants.

    Some of the uninsured who can't find mental-health treatment are relying on hospitals -- emergency room visits for mental health and substance abuse in Colorado increased 83 percent from 2000 to 2003. Many others, especially people without insurance, are finding no treatment at all, said Bob Holmes, executive director of Homeward Pikes Peak, an advocacy group for the homeless. "We do not have a functioning system of mental-health treatment for the homeless and uninsured people in Colorado Springs," he said.

    For Brian Bennett Sr., the three years trying to find some sort of treatment for his son was like a fulltime job. In 1998, Brian Bennett Jr., an athlete and college student, began to show signs of bipolar disorder. He was arrested after he grabbed at a police officer, then ran, in a Colorado Springs park. So began a spiral of self-destruction that ended three years later when Bennett Jr. hanged himself with his trousers in an El Paso County jail cell in November 2001. "I kept searching for a program or an environment that somebody with his set of disabilities could fit into, and they're just not out there," the father said. "Even if you could pay, they're just not out there." There were short stays at psychiatric facilities -- a few days at Cedar Springs, three months at the state hospital in Pueblo. But Bennett Jr. always left on his own or had to be released when the facility no longer had the space for him. Living on the streets, abusing drugs and alcohol, he inevitably wound up in jail -- for marijuana in March 2001 and again June 10; for harassment June 11; for carrying a concealed weapon June 15; for trespassing July 3; for theft and resisting arrest Aug. 6.

    Experts say this is how mentally ill people get caught up in the criminal-justice system. Many abuse drugs or alcohol or live on the streets. Their bizarre and erratic behavior often leads to arrests, and police have nowhere to take them but jail. When they get out, they miss court dates and appointments with probation officers, leading to more jail time.

    Bennett Jr. had trouble following the rules in jail. He refused to take his medicine and was put in lockdown for two weeks for assaulting another inmate. He was put on a waiting list for the state hospital. When he hanged himself, a Sheriff's Office report later concluded, the deputy watching the isolation cells didn't check on him every 15 minutes, as required by jail policies. His parents sued and eventually settled out of court.

    Bennett Sr. tries to remember his son as he was before the illness hit him "like a hammer." He was an avid golfer -- once ranked among the top 10 junior golfers in the state -- and an ambitious student, studying aeronautical engineering. "He wasn't a bad kid," Bennett Sr. said. "If somebody's mentally ill, things happen out there, and you have no idea what's going to happen next. There's very little a parent can do to change things."

    Eventually, because they commit a serious crime or their minor offenses mark them as a habitual offender, many of the mentally ill wind up in prison. Defense attorneys and mental health experts say prisons can be nightmarish and dangerous for people with mental illness. It's a world where the recommendations of judges and outside experts don't apply. "They are first and foremost a prison system. They don't really have a place for people who are chronically mentally ill," said Virginia Grady, a federal public defender in Denver. "They're not staffed to care for the mentally ill."

    In 2001, Shane Bailey, an inmate with bipolar disorder, was sentenced to 34 additional months in prison for helping his schizophrenic cellmate hang himself. A judge, saying the U.S. Bureau of Prisons had "failed in a shameful way" by allowing the two mentally ill inmates to live in the same cell, recommended that Bailey go to a mental-health facility. According to a lawsuit Bailey filed, he spent just two months in a prison medical center, where he engaged in a few 1- or 2- minute conversations with a psychologist, through his cell door. He was sent to the federal Supermax prison near Florence, where he was next to some of the most dangerous criminals in America and where inmates spend 23 hours a day in their cells.

    For many mentally ill inmates caught in the prison system, isolation becomes the daily reality. They often are labeled behavioral problems and spend weeks or months at a time in "special housing units" -- punitive segregation cells where, experts say, their mental illnesses fester.

    In 2002, also at the high-security federal prison near Florence, convicted bank robber Ernest Brown attacked a chaplain without warning. A regular troublemaker, he had been in and out of the special housing units of different prisons for years. After long periods of isolation, he told prison psychiatrists he was "losing my resiliency" and that his thinking "used to be more clear." A psychiatrist hired by his public defender concluded he suffered from an untreated bipolar disorder overlooked by numerous prison mental-health professionals over six years. Their opinion was that he had an anti-social personality disorder or that he was "malingering," according to court documents. Eight years were added to his sentence. In a letter to The Gazette, Brown wrote that he is still denied treatment, including medication.

    Medication is the main treatment for the 17 percent of federal inmates and 18 percent of state inmates diagnosed with mental illness. Critics say the newest medication often isn't provided because of its price. Instead, they say, inmates get older drugs with more severe side effects.

    Prisons also struggle to provide the therapy and counseling that experts say is essential. "There's just not enough money to treat them the way they need to be treated," said Sharlene Reynolds, chief trial deputy with the state Public Defender's Office. "They get their medications, but they're certainly not getting any kind of therapy."

    Defense attorneys say inmates often emerge from the prisons with a 30-day supply of pills, their mental illness untreated -- if they emerge at all. Many others, like Brown and Bailey, are convicted for crimes in prison and serve years beyond their original sentences.

    The Colorado Department of Corrections, feeling the pinch of the budget crisis, cut its mental-health budget by 17 percent -- about $1 million -- in 2003. About $500,000 of that has been restored.

    The San Carlos Correctional Facility, a specialized prison in Pueblo for the worst mental-illness cases, has room for only 255 inmates. Those sent there are stabilized and returned to regular prisons. The DOC has just 10 beds available at the state hospital in Pueblo. There are long waiting lists for both facilities.

    Across the system, the ratio of mental-health professionals to inmates is about 1-to-360, resulting in long waits to see a psychiatrist or counselor at some facilities, said Barry Pardus, the DOC's director of clinical services. He would like to see it closer to 1-to-250. There are no set standards for inmate ratios, but the San Carlos facility has a ratio of 1-to-17.

    Because of the shortfall in mental health funding, the department is forced to keep about 25 percent of its positions vacant. Many psychologists and psychiatrists won't work for what the department is budgeted to pay, so the DOC keeps some positions vacant to pay others and to contract service through the University of Colorado. Records show 15 of the 26 vacant positions in the department last month were for psychiatrists or psychologists. Pardus said the DOC is looking at ways to more efficiently give inmates counseling, such as one-on-one "tele- psychology" -- counseling via closed circuit television -- and more group sessions.

    The mass incarceration of Colorado's mentally ill didn't happen overnight, and experts agree the problem won't be solved quickly. A state legislative committee studying the issue has been meeting since 1999. Lawmakers, working with a 27-member task force, have come up with numerous recommendations for treatment alternatives, but little legislation.

    In fact, so lukewarm was the support from the General Assembly, in 2003 it voted to dissolve the committee. The group continued to meet informally and in 2004, the General Assembly voted to reinstate it. "Everybody nods their heads and says, 'This is a terrible problem. We've got to do something about it,'" said Steve White, a task-force member from Aurora, whose mentally ill son is serving eight years in a state prison. "But when it comes to actually getting funding to address the problem, it's very difficult."

    "The committee has done some exceptional work," said state Sen. Sue Windels, D-Arvada, the committee's vice-chair. "They have data that would blow the roof off the General Assembly if they had any money to implement some of the things they have researched." Windels pins her hopes on the upcoming Referendums C and D, which, if passed, would allow the state to keep more revenue than normally allowed by the state constitution. She hopes some of that could be put back into mental-health programs and alternatives to jail.

    Putting people behind bars, she said, "is a very expensive way to handle the mentally ill in your society."
"Putting people behind bars, she said, "is a very expensive way to handle the mentally ill in your society."

I agree with her comment, but according to this article, being behind bars doesn't equate mental illness treatment. Unreal. And so ironic, because many symptoms of mental illness are what landed many of those people there in the first place.

And regarding Ernest Brown in the high-security federal prison near Florence, "Eight years were added to his sentence. In a letter to The Gazette, Brown wrote that he is still denied treatment, including medication". Well-geeze. That'll really help him "get reformed".

Like Bennett Jr.'s dad, I tried a number of organizations, programs and individuals to help my sister before she took her life. The only suicide prevention organization was in a district that we didn't live in and thus they refused to see her. I'll never forget how absolutely frustrating that was. Additionally, she had been admitted to Emergency twice for cutting her arms so badly that she needed several stitches - both times she was under 19 and both times I wasn't called and my parents were not called (mind you, they lived on different continents at the time). Both times she was released hours later - by herself. However, when I was hospitalized after her death there was a girl in the psych ward with me who was admitted for taking less than a handful of aspirin. Anyway, I guess I just relate to desperately needing help, but not being able to access it.

There simply aren’t enough resources in either Canada or the U.S. to effectively treat the overwhelming number of people affected by mental illness. Sadly, and as mentioned above, tax payers are paying big bucks to keep many of them in tiny rooms with no treatment. Of course, this enables their illnesses to get even worse, which leads to more crime (including hurting themselves and others), which then leads to even MORE tax dollars needed.



Dear Healthbound,

I'm so sorry to hear about your struggle to get help for your sister before she died. Unfortunately this is not an uncommon problem.

As someone in the article noted; many people recognize that putting those with severe and persistent mental illnesses in jail instead of treatment is inhumane, but the issue is only given lip service.

Take care
afraid my will son end up in this situation

My son (26) was diagnosed with schydso-effective disorder 4 years ago. He's been off and on meds. He's been struggling with his illness and so have I and my wife. don't know how to help him anymore don't know who to turn to.
County hospital only provides him with meds which he doesn't take and when he did it just added more side effect problems to his health. most of the time he seems to be ok other than being on the down side he can manage to cope and so can we, but when he gets on the manic stage, that's when I'm afraid that he or I will end end up in jail. there's no psych-therapy through the county here. and we haven't been able to afford to take him to any other therapist. he does have medicare but i'm not sure how that works .I',m looking into it. please help. if anyone has any advice.I will greatly appreciate it. concerned dad. I don't know if it's ok to write my e-mail here. but this is my e-mail.
P.S. please forgive me for my misspelling and grammatical errors.
please let me know if there's any other places or links where I can get more advice or places where i can chat with someone about this problems, thank you all.


Hello Blueknight,

My son has been on and off medication for many years too. A high percentage of people with schizophrenia or schizoaffective disorder have very little to no insight into their illness. They are not able to "see" that they are ill and need medicaton. As you know medication is the most important step down recovery road for people with these illnesses.

If you can get him into a group where he learns about his illness and how to cope with it that will help. NAMI has great education programs and one of them is specifically for family members. It is called Family-To-Family and is here on the Texas site: You will find this program extremely helpful for yourself, wife and his other family members. There is no charge for this course.

I have met some wonderful NAMI people from Texas. It is also the state that developed the family education program for families with children and adolescents with mental illness (Visions for Tormorrow) I believe.

This Texas site also has online support~

Many of the Family-To-Family courses are starting this month so I hope you get into one right away.

Take care
Thanks to everyone for your help

Thanks to everyone who has replyed to my post, I greatly appreciate it.
I will look into the links that you all have provided.
following mesage for HeartArt:

My wife and I attended the NAMI two week course in the family to family
program when my son was diagnosed . It gave us a lot of
insight and understanding about my son's illness. at this point it's just that
we haven't been able to get him the counceling and therapy that I know
will help him a great deal. it's just that i 'm having a hard time finding him
the help. I know some nami members that have giving me the advice to get him therapy.
But so far I have not found any kind of therapy that we can
afford, though i'm still searching and i have faith that i will find something
somehow. Thank you so much for all your help and advice, to everyone.

P.S. If anyone has any further information that will help me ,will be greatly appreciated, Thanks.
Hi Blue Knight,

Here is another link for you.

I did my internship in Brownwood, TX and learned at that time how Texas did not have adult mental health with Medicaid. Texas had done away with it before I arrived. You might look into having your son evaluated for disability as this would be one avenue of obtaining the financial means to help pay for the care your son needs. I truly hope that you are able to find some assistance. Please keep us posted. I have a friend in Texas who is a psychologist and I will ask her for any suggestions. Best wishes,
Dr. Bill Dobson

Dr. Dobson, Thank you for your advice and link you've provided.
epmhmr is the place I mention on my first post, where my son has been seen by a psychiartrist ever since his condition was diagnosed and evaluated. They provide him with his monthly meds but no kind of therapy.I was told that i'd had to get him that somewhere else, which i'm trying so desperately to find out. Like I mentioned before, my son does have medicare part a and part b. Im trying to find out if mental illness is covered by medicare and how i can go about in getting it for him.
If you friend Psychologist knows anything about this, I would appreciate it greatly if you could ask her for me . thank you very much for your reply and your support.
Sincerely , BK

my e-mail:

You are welcome. I have tried to call my friend but have not received a return call. As soon as she calls me I will let you know what I find out. My understanding of Medicare is that many times they want Medicaid to be charged first, but I am not sure about this in TX. I wish I had better news. I would also suggest writing letters to your congressmen and representatives and see if you can obtain help. Many times they will help you as they usually have troubleshooters to help their constituents. (P.S. My psychologist friend in TX travels as part of her job so I imagine I will hear from her this weekend). Best wishes,
Medicare vs Medicaid

Hello Dr. Dobson

For some reason that I didn't really undersand my son did not quailify for medicaid benifits. As soon as my son was put on medicare ,i went to inquire about medicaid. I was told he did not qualify for some reason I'm not sure of (maybe cause he's on ss disability and not supplimental income). I'm plannihg to look into it again, hoping that maybe I can understand it better . I will keep in mind your advice about taking this matter to higher authorities if i can't find any answers at the local level. Thank you very much for taking your time in replying to my posts. sincerely,BK

You might also try university hospitals as they might be willing to work with you. Many times they have programs for situations much like your son's. I still have not heard back from friend in TX but I will let you know what I find out as soon as I reach her. I hope things work out for your son. I am sure this has to weigh heavy on your heart. Best wishes,

Thank you Dr. Dobson for your advice and support. I will certainly put that on my list to inquire into the local University. I 'll keep you informed if anything positve happens, Thanks . BK
You are welcome BK. I did get to talk to my friend in TX but she was expecting a phone call from her brother. We will speak on Friday or Saturday this week. Have you found out anything new? I will let you know as soon as I find out anything on this side. Take care,
Dr Dobsom

I have aquired a list of places where I may be able to get some help for my son. I am just contacting these places, hoping that I may get some positive results (none yet though) but I'will let you know if anything good
comes out of this. Thank you for your help and support,
Gratefully Yours, BK
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