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:
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."
