Mental Disorder

In 'no-man's land,' the mentally ill pile up in NC jails

cjarvis@newsobserver.comMay 4, 2013 

  • Read our 2008 series (PDF)

  • The story so far

    North Carolina has struggled with mental health reform since the U.S. Supreme Court ruled in 1999 that states had to treat people in less-restrictive settings. The state has reduced institutional beds, but it has largely failed at building a network of community treatment options, wasting hundreds of millions of dollars in the process, a News & Observer series showed in 2008.

    In 2007, two UNC studies looked at the mentally ill in North Carolina’s county jails and found broad problems with recognizing mental health problems in inmates, a failure to provide proper medication, and a lack of communication between jails and community treatment centers.

    As a result, the General Assembly enacted a law in 2008 requiring all county jails to screen inmates with a standardized mental health assessment, allow local mental health management entities to review the daily booking logs for patients they might know, and work with the local entities to make sure mentally ill inmates receive the right medications.

Second in an occasional series

All his mother wanted to do was get help for her son. If he resumed taking his medications for bipolar disorder, he could get back on track.

But the police, who she hoped would take James Franklin Taylor Jr. to a crisis treatment center, instead booked him into the Wake County jail on assault charges. He has now been there for more than three months, refusing to take his medications or to even talk to anyone as he deteriorates into incoherence with no clear path out of jail.

That’s not the way it’s supposed to work, but Taylor’s situation is not unique. North Carolina’s county jails hold thousands of mentally ill inmates, some of them waiting for weeks or months to be evaluated or treated.

This is not just a problem in North Carolina. Over the past several decades across the country, patients who were phased out of large institutions so they could be treated in their communities found there wasn’t enough help. Without treatment, many ran afoul of the law and then tumbled into a nightmare of compounding problems.

Nationally, studies estimate between 15 and 20 percent of jail and prison inmates have a serious mental illness.

In North Carolina, that translates to roughly 5,500 in prison and an estimated 3,400 people languishing in jails that were built to hold those charged with crimes for only a short time, all of them with schizophrenia, bipolar disorder and other illnesses. To compare, the state has 850 beds in its mental hospitals.

“This has become a very, very common occurrence,” said Adam Adams, a psychotherapist who evaluates jail inmates in Wake County. “They sit in jail for months, sometimes on a very minor offense. Jail has become the largest mental institution in the state.”

A messy arrest

In recent years, Taylor had stabilized his life against the turbulence of mental illness that had plagued him since his early 20s. He attended therapy sessions and was on good terms with his ex-wife and three children. He held many odd jobs over the years, and he saved up enough cash to buy a 2005 Nissan Sentra sedan, said his mother, Juanita Taylor.

Taylor, 46, was living with his parents in Raleigh on the condition that he stay on his medications. But last winter Taylor stopped taking them again, and his parents kicked him out. They hoped he would rent a room, but one day they saw him living in his car.

On a cold and rainy day in January, they came home to find him huddled on their front porch; they relented. By then he was increasingly delusional and unpredictable, and his parents bought locks for their bedroom door.

On Jan. 15 – the day his mother was granted temporary guardianship – his parents came home from court to find he had thrown out all their food and was cooking burgers on the stove with flames leaping dangerously high. When his father tried to turn down the stove, James shoved him and nearly knocked him down.

Desperate, his parents called police. Several officers showed up, including one trained in de-escalating confrontations with the mentally ill. But unable to persuade Taylor to come with them, they handcuffed him in a scuffle and took him to jail, charging him with assaulting his father and a police officer.

For the past two decades, police across the country have been learning special techniques in handling the mentally disturbed through a concept called crisis intervention team training. Raleigh police have embraced the concept and have trained about 150 officers. That’s 19 percent of the department; mental health advocates would like to see it closer to 25 percent.

Gerry Akland, president of the Wake County chapter of the National Alliance on Mental Illness, has trained police in that method. He said it’s difficult to second-guess how an officer handles a confrontation like that, and officers have broad discretion. But, he said, training needs to improve to give them a better sense of situations such as Taylor’s, where they have to decide whether to ignore a crime in order to divert someone from jail.

“So far, the training has not gone into that kind of depth,” Akland said. “Those are tough things for an officer to deal with.”

Rich Munger, a Buncombe County Department of Health and Human Services planner who is involved in statewide efforts to address the problem of the mentally ill in jail, says some states are going beyond the basic training by giving police more discretion not to arrest someone even, in fact, emphasizing a preference not to arrest.

But he said that requires a societal change recognizing that mental illness is a health issue just like cancer or strokes.

“It’s not that they’re pathological misfits – their brains have been damaged,” Munger said. “Lots of people – legislators, persons in the criminal justice system – don’t understand this. We’ve not turned that corner in this country at all. We’re not even close to it.”

Eddie Caldwell, executive vice president and general counsel for the N.C. Sheriffs’ Association, says the responsibilities and costs of incarcerating and transporting mentally ill inmates is a longstanding concern with jail administrators.

“If we took all the people out of jail who have mental health and substance abuse problems, we wouldn’t need near as many beds,” Caldwell said. “It’s an elusive issue, and the solution is beyond their control.”

A slow process

Two weeks after Taylor’s arrest, a judge ordered him to be evaluated by Adams, a therapist with Wake County Forensic Services. Adams can’t talk about the case because of patient confidentiality.

According to the court file, Adams tried to talk to Taylor but found him combative and unable to understand the charges. Taylor was so uncooperative that Adams couldn’t perform a complete evaluation, court records indicate.

On Feb. 20, more than a month after his arrest, the case came before another judge, who ordered Taylor evaluated at Central Regional Hospital in Butner to see if he had the capacity to proceed with the criminal charges against him.

But then nothing happened for the rest of February. And nothing happened in March, either.

The case was scheduled to be back in court by mid-April. But on that day, the judge was told Taylor was too disoriented to appear in court for the hearing, according to his mother, so the hearing did not proceed.

Melissa Floyd-Pickard, a UNC-Greensboro researcher who has studied mental illness in North Carolina’s jails, says counties are inconsistent in how they handle medications. Often, inmates are given a substitute for their normal drugs.

“It takes months and months – sometimes years – to get people’s medications right,” she said. “If you start messing with it, that can really send them into crisis.”

The judge wanted to delay Taylor’s case for another two months to allow enough time for him to be evaluated and back on his medications, but Juanita Taylor says she persuaded the judge to make it only one month.

Sometime after that, Juanita Taylor learned that two therapists from Butner had come to the Wake County jail to evaluate Taylor there – a very rare occurrence. He refused to talk to them, too.

Since James Taylor’s arrest, an increasingly frustrated Juanita Taylor, who owns a house-cleaning business, has been making almost daily phone calls to lawyers, therapists and state officials, and visiting judge’s offices to find out if anybody is doing anything to help her son.

“You cannot imagine what people put you through just to find out if your son is well,” she said.

It would have been so simple, she said, if he had just gone somewhere to be treated with proper medication for a few days, instead of jail.

No-man’s land

Cases such as Taylor’s are happening all across North Carolina and were compounded when the state closed Dorothea Dix Hospital last August, and transferred its patients to the smaller Central Regional Hospital in Butner. County jail inmates are spending more time in jail waiting for a bed at Butner to open up.

Inmates whose mental condition is suspect typically have to wait for an initial evaluation, then a more in-depth examination, and then for a room to open up at a treatment center. There are other delays along the way.

Inmates have to be driven from all over the state to Butner, where an evaluation can take weeks. Sometimes prosecutors might want a second opinion, and that adds to the wait. State officials say only 480 jail inmates were evaluated at Central Regional Hospital last year.

There is also a no-man’s land in which an inmate is found not to have the mental capacity for the criminal case against him to proceed, but in a separate process isn’t considered harmful to himself or others. In those cases, he can’t be involuntarily committed to an institution. So the inmate waits in jail until his condition improves or a bed in a treatment center opens up.

Last year, Mark Hazelrigg, director of outpatient evaluations at Butner, expressed concern about that no-man’s land to a legislative committee looking into the “incapacity to proceed” issue. He said the differing legal standards trap inmates in a cycle. He also said there is no law compelling psychiatric hospitals to treat a patient specifically so he gets well enough to proceed with his case.

Adams says three therapists and one case manager at Wake County’s two jails are swamped trying to get to every inmate who needs attention. He said his caseload used to average 15 to 20 inmates a day. Now, he said, all of the staff juggles more than 40 cases a day.

A new law to help

The legislature has started to act. Last year, a study committee recommended mental health training for law enforcement, attorneys and judges, and several steps to lessen the time people have to spend in jail while their case is unresolved. The chairwoman of that committee, now-Sen. Shirley Randleman, a Republican and retired court clerk in Wilkes County, put many of the proposals in a bill that Gov. Pat McCrory signed earlier this year.

The new law is meant to speed the process for placing someone in a mental health facility if they are judged to be without the capacity to proceed. Only those charged with felonies will have to be examined in Butner. Randleman says that will relieve the hospital of 20 percent of its examinations.

Subsequent competency examinations will be conducted at a state hospital closer to home, which will also lessen the workload at Butner, she said.

That would help mothers such as Juanita Taylor. Her son is still in the county jail, and she continues to make phone calls as she tries to find someone to get him out of limbo.

On Friday – after weeks of phone calls by her and recent inquiries by The News & Observer – she learned that Butner had finally completed its evaluation and would be sending it to her son’s attorney in time for a court hearing scheduled for Monday.

It’s something, anyway. And, she says, she knows her son stands a better chance than many of the other jail inmates who are disturbed.

“Some don’t have people who care about them like I do,” she said.

Jarvis: 919-829-4576

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