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 Article of Interest - Mental Illness

Jail poses danger to mentally ill
Lack of staff training puts disturbed inmates at greater suicide risk
by Shawn D. Lewis, the Detroit News, January 12, 2003
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Ariel Perez Jr., 19, took a drastic step just 28 days into a 90-day Oakland County Jail term.

The Auburn Hills teen twisted a sheet around his neck and ended his brief life, becoming the jail's first suicide in a decade. He was in jail for violating probation on a home-invasion case. Perez had stolen a used punching bag and phone card from a friend.

A psychiatric patient being treated for schizophrenia, Perez posed the type of challenges local and state corrections officials expect to grapple with increasingly.

"I tried so many times to get help for my boy and asked his most recent psychiatrist to try to help him get his medication (Lithium) in the jail," said Ariel Perez Sr. after losing his son Nov. 25. "But nobody paid attention."

County sheriffs and jail administrators in Michigan and around the country acknowledge they are not trained or staffed to evaluate severely disturbed inmates. The patients already are stressed, experts say, and being jailed can add to their agitation or despair.

At issue is how to deal with the medication and counseling needs of patients who need specialized care.

"We weren't designed to deal with mental health issues. We weren't intended to deal with the mentally ill," said Terrence Jungel, executive director of the Michigan Sheriffs Association.

Nationwide, a greater number of lawbreakers with mental disturbances also are being incarcerated as a side effect of psychiatric hospital closings and the trend of community-based care, according to corrections officials and health specialists.

Michigan shut 10 state mental hospitals in the last decade, and the number of new state prison inmates reporting past mental health care rose from 6,169 (19 percent) a year in 1990 to 11,598 (23 percent) last year.

The number of mentally ill behind bars today is almost five times the number in state mental hospitals, according to federal figures. While serious mental illness afflicts 5.4 percent of U.S. adults, the mentally ill account for almost 16 percent of inmates, or more than 284,000 people, the U.S. Justice Department says.

"It's cheaper to treat the mentally ill in a jail or prison than in a mental hospital," said Dr. Elliot Luby, clinical professor of psychiatry and law at Wayne State University. "It is a cold calculation on the part of the budgeting people in charge."

Gov. Jennifer Granholm tends to agree, but sees no easy answers as she confronts a $1.8-million budget shortfall. "The governor feels jails are not the place for us to keep the mentally ill," said Mary Dettloff, her spokeswoman. "We've received a lot of information from mental health advocacy groups who want us to take a look at this."

But the ability to make suggested changes is limited, Dettloff added, explaining that the state would have to find no-cost or low-cost alternatives.

Suicides and attempts by mentally ill inmates across Michigan leave devastated families in their wake.

Patricia House, 38, of Clinton Township, diagnosed as bipolar and on the drug Depakote, now is paralyzed from the neck down after jumping from a second-floor balcony of the Macomb County Jail in 2001. Lawrence Hull, 41, of Flint, a schizophrenic who was taking Prozac, Depakote and other mood-stabilizers, committed suicide by hanging himself with his shirtsleeve inside a Flint police lockup that same year.

Suicide leads jail deaths

Suicide is the third-leading cause of death in prisons and the leading cause of death in jails. From 1984-93, according to the most recent U.S. Justice Department study, the national prison suicide rate was 20 per 100,000 -- 150 percent higher than that of the general population.

The suicides prompt lawsuits that cost Michigan taxpayers millions of dollars, said Mark Reinstein, president of the Mental Health Association in Michigan, an advocacy group in Southfield. More than 95 percent of those who take their lives behind bars have a treatable mental illness, according to the group.

On a more positive note, suicides are uncommon in Michigan's state prisons, which currently house nearly 50,000 inmates. The Department of Corrections recorded 45 suicides since 1995.

Similar figures for county jails are not compiled in a central database.

In Wayne County, eight inmates killed themselves since 1999, including two with previous mental health care. In Macomb County, there were six suicides between July 2000 and last April. Perez's recent hanging at Oakland's jail was the first in a decade.

Advocates seek answers

Gathering information on jail suicides has been challenging for prisoner advocates.

The Michigan Protection and Advocacy Service sued Wayne County's sheriff in December for refusing access to records of three inmates who committed suicide between 2000-2001 at the county jail. The group also cites problems getting suicide records from Macomb County.

"After months of negotiations, they finally released the medical records for the people who died and policies and procedures at the jail. But we really need to ... ask them questions about what we've found and what changes they've made," said Yvonne Fleener of the Lansing-based group.

The group suggests Macomb officials follow jail procedures in neighboring Oakland County, which "had zero suicides in their jail during the time Macomb had their rash of suicides," Fleener said.

Medical personnel at Macomb's jail in Mt. Clemens work for a private contractor. "Macomb is the only county to use (that arrangement) -- there's got to be something to that," Fleener said.

Each of the county jails employs psychiatrists: one in Macomb, four full-time psychiatrists and one part-timer at the Wayne County jail, and two part-timers covering 40 hours a week combined at Oakland's facility. Screening for suicide risks is part of each facility's intake procedures, and mental health professionals are on 24-hour call for emergencies.

"We have a failing mental health system," said Luby of Wayne State, who has a private practice in Farmington Hills. "The effects are felt at county jails. They don't have the funds, hospitals here have been closing and there are very few acute care facilities.

"So the hospital settings then become the prisons."

Toll is six in Macomb

In Macomb, five inmates hung themselves and a sixth died after jumping from a second-story balcony at the Macomb County Jail between July 2000 and April 2002. The jail houses 1,400 inmates.

"I told the police that she was supposed to be on her meds," said Miller, 65. A lawsuit against the county has been filed on behalf of House's 12-year-old son.

"I'm a fighter, and I'm not going to give up on my daughter," Miller said. "To be honest, we've been through hell, and it's not over."

Macomb County Sheriff Mark Hackel acknowledged suicidal inmates aren't always easy to spot or treat.

"Sometimes a corrections officer can see somebody who looks despondent, or upset. But unfortunately, you get people that get upset and jump off a two-story balcony because of a phone call," Hackel said. "We've had that happen. How do you prevent that?"

The Macomb County Jail has undergone changes since the suicides. Previously, Macomb prisoners on suicide watch were placed in cells with around-the-clock monitoring. They returned to the general population once the medical staff determined they were no longer threats to themselves.

"They weren't followed or monitored as closely or as often as they should have been," acknowledged Michelle Sanborn, who has run the jail in Mt. Clemens for nine years.

Now, a prisoner who leaves suicide watch goes to a unit with close supervision and mental health monitoring before he or she is sent back to the main cellblocks.

In Oakland County, Ariel Perez was the first suicide in a decade.

"This was an unfortunate incident," said Capt. Michael McCabe of the Oakland County Sheriff's Department shortly after the hanging. "This is the first suicide in over 10 years, so I think our record speaks for itself. Other than that, I can't comment."

But the Perez family remains inconsolable.

On Thanksgiving morning, Perez's parents and two sisters accompanied his casket back to Villalba, Puerto Rico.

His mother, Gladys Perez, has been so shaken that she returned to the island again after a brief stay in Auburn Hills following her son's burial.

His father, Ariel Perez Sr., a cook, and sisters Jennifer, 25, and Elda, 20, remain in Auburn Hills.

"Arielito" was diagnosed with attention deficit disorder as a child, his family says. Passed through the Pontiac School system without learning to read and write, he spent a troubled youth, eventually committing the crime leading to his fatal jail stay.

12 percent on drugs

The Oakland jail holds up to 1,800 inmates, with about 12 percent on psychotropic drugs.

Officials declined to say whether personnel knew of Perez's mental condition or whether he received correct medication. "We can't divulge confidential information," said George Miller, health division manager at the county jail.

The Auburn Hills teen was jailed last Oct. 28 for violating probation in the earlier home invasion case.

"He came from a good family," said attorney Frederick Toca of Pontiac, who represented Perez at the time. "He had severe learning disabilities. He had a deficit as far as his ability to understand. He was convicted in circuit court.

"One of the things we hoped was that he wouldn't do jail time because of his profound inability to understand. The calling card was worth about $6, and the punching bag was used. It was nothing major at all."

Case in Flint

In the Flint police lockup on Jan. 11, 2001, 41-year-old Lawrence Hull was "yelling, screaming and kicking the door, demanding his phone call and his medication," according to a police report.

Arrested hours earlier on a charge of hitting his sister, Lawanda Hull, the detainee was told by jail guard Ricardo Clemons that "there are people trying to sleep and you are making all this noise," the report says. "Hull would not calm down and continued to yell and scream and waving his arms. Clemons then went back to the intake area and continued to process the inmates."

Shortly thereafter, Hull was discovered hanging in his cell by a shirt sleeve.

The police report said Hull had been acting strangely for days. He was being treated for depression and schizophrenia at a Genesee County mental health facility, according to his sister, Patricia Jones.

"Police went to his house and took a bag filled with his medications after he committed suicide," said Jones. "It was too late then."

She reflected a moment and added, crying: "I feel so badly because I promised my mother before she died that I would be responsible for him. I feel like I failed."

Toca, the Pontiac lawyer who defended Perez as a youth now represents Lawrence Hull's family in a wrongful death lawsuit.

Problem remains

Experts familiar with these types of cases are pessimistic about improvements in the way jails handle the mentally ill.

"The situation is getting worse because society looks at (mental patients) like they shouldn't have gotten in trouble and gone to jail in the first place, " said Dan Manville of Ferndale, a civil rights attorney who has represented prisoners for more than 15 years. "And with all the cutbacks in jails and prisons because of the economy, and since the mentally ill are considered on the bottom anyway, they get the worse treatment inside the jails."

But the Michigan Sheriffs Association is working to help county jailers deal more effectively and safely with mentally ill inmates. Two training sessions will be held May 29-30, said executive director Terrence Jungel.

He acknowledged that mentally disturbed or emotionally unstable inmates are a tough problem for sheriff's departments.

"We're looking for better ways of diverting the mentally ill from county jails to treatment programs," Jungel said. "One of the problems is that there is really limited availability of regional treatment programs. It's a community problem that needs to be dealt with on a community-wide basis."

Detroit News staff writers Gary Heinlein, Tony Manolatos, Santiago Esparza and Mike Martindale contributed to this report.

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