Tue, Jan 03, 2006 - Page 16 News List

Care for those who cannot care for themselves

US penitentiaries are taking over the role of hospitals in treating the mentally ill

By Curtis Krueger  /  NY TIMES NEWS SERVICE , NEW YORK

Acutely mentally ill inmates in the Delta 1 wing of the Pinellas County Jail are observed and behavior is documented every 15 minutes by the observing deputy.

PHOTO: NY TIMES

He hanged himself by his pants in the Pinellas County Jail. He was being held on US$513 bail for failing to appear in court on a charge of driving without a valid license. How a man with mental problems ended up in jail on a minor charge is a stark reflection of a new reality.

"Jails are not hospitals and they were not designed to be hospitals," said Pinellas-Pasco Public Defender Bob Dillinger. But, "They are now the largest mental health facilities in every county in the state."

On Dec. 23, Flores had flagged down a Clearwater police officer and told him he was being followed. The officer thought Flores was acting erratically and was contemplating having him hospitalized under the state's Baker Act when he discovered an outstanding warrant for his arrest on the five-year-old traffic charge.

At the jail, a nurse put Flores on a round-the-clock suicide watch. Later, a psychiatrist concluded he could be taken off constant surveillance and checked on every 15 minutes.

Out of sight, Flores, 28, killed himself. His death underscores the dilemma that the mentally ill pose for jails. In the Tampa Bay area and across the US, jails house thousands of mentally ill inmates. More than 10 percent of the 8,000 inmates of the county jails in Hillsborough and Pinellas are taking psychotropic medication, indicating some kind of a mental diagnosis.

Attempted suicide is such a fact of life that Pinellas jail deputies carry what are known as "911 tools," knives with curved blades specifically designed to quickly cut down inmates who are hanging themselves.

Advocates for the mentally ill have long said it doesn't make sense to incarcerate people like Flores who commit minor, nonviolent crimes and who would likely stay law-abiding if they were getting proper treatment for their mental ailments.

"With the closure of hospitals and the limitations due to managed care and due to state funding cutbacks ... some people would say that the jails have become the new mental institutions," said Thomas Riggs, chief executive officer of Directions for Mental Health in Pinellas County. "I think that's a really sad commentary."

Inside Hillsborough County's Orient Road Jail, Deputy Wayne Moon works 12-hour shifts in a two-story cellblock called a "pod," where every inmate has been diagnosed with a mental illness.

Because of the way the sheriff's office runs the jail, Moon works inside an open area, right with the inmates. He's not separated by bars.

Moon, a 19-year veteran, likes the challenge of working there, of getting to know the inmates and their peculiarities. During a reporter's visit, he nodded toward one big inmate, who shouts a lot for no reason.

"You don't stay quiet, I'm going to take the batteries out of the radio," Moon said. The inmate, who was wearing earphones, stopped shouting and smiled.

Across Tampa Bay, Pinellas Deputy Michael Smith spends eight-hour shifts staring into two rows of eight cells, one on top of the other, that house inmates who need to be checked every 15 minutes. Each inmate has a sink and toilet in his cell, but needs to be escorted out individually for showers.

Toothbrushes are contraband -- they could be fashioned into weapons -- so they stay outside the cell.

As a reporter came in to interview Smith one day last month, before the death of Flores, the inmates got louder. "I need some counseling!" one yelled. "I need some help!"

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