Care for the mentally ill falls to jails

Juvenal Hernandez Flores died on Christmas Day.

He hanged himself by his pants in the Pinellas County Jail. He was being held on $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 5-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 United States, 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 particular reason and who was starting to get vocal just then.

"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!"

In the Pinellas jail, some deputies spend their days watching up to six video screens showing suicidal inmates in their cells. They can stare at screens for hours and days without seeing anything of concern. The challenge, Deputy Doug Willis says, is "just making sure you're paying attention."

In Hillsborough, inmates considered suicidal lie on mattresses set at floor level. One officer sits inside a ward with up to four inmates. Prisoners are typically put in a "suicide prevention suit," a quilted outfit that is extremely hard to rip, so that no one could tear it into strips for a noose.

"How many have we actually saved?" responded Maj. Kirk Brunner, commander of the Pinellas County Jail, after a reporter asked about Flores' death.

Dealing with the mentally ill soaks up jail resources. One female inmate in the Pinellas jail recently broke off a piece of her wheelchair and began swinging it at anyone within reach, because she didn't want to go to the state mental hospital at Chattahoochee, in North Florida. Following a policy for dealing with aggressive inmates, the jail sent a sergeant, three transport officers and a nurse in two vans to take her to Chattahoochee.

Hillsborough deputies also took an inmate to Chattahoochee recently - only to discover the inmate had somehow injured himself, so the state hospital wouldn't admit him. They had to drive all the way back to Tampa, let him heal, and transport him back.

"We get a lot of very unstable people that we spend a fortune on, trying to keep them alive," said Col. David Parrish, who supervises Hillsborough's jails.

Even when inmates stay physically safe, jails can make them sicker mentally. Jails are not happy places for anyone, and they can be even more traumatic for people suffering from anxiety, depression and other illnesses.

Inmates don't always get medications because of restrictive formularies used in some jail pharmacies, said George Thomas, president of the Hillsborough County chapter of the National Alliance for the Mentally Ill. Jail officials say they work hard to provide medicine, but freely admit they can't provide the extensive counseling provided by actual treatment centers.

Mentally ill people do hurt others. Richard E. Henderson Jr., the 20-year-old Manatee County man accused of killing his parents, grandmother and brother on Thanksgiving Day, told the Bradenton Herald that he was bipolar and had not been taking his medicine since age 18.

But in a vast number of cases, jail officials, police and judges deal with mentally ill people who fall in a different category. They're the ones who are confused and delusional, doing disruptive but nonsensical things, like the man who was recently jailed in Pinellas for shoplifting. He was naked.

With people like that, "I think the key is to not bring them to jail," but to get them treatment, said Vicki Scotti, the Pinellas jail's program administrator for inmate health care.

But giving people treatment instead of jail time is easier said than done. Riggs said his northern Pinellas agency gives mental health services to twice as many people as it gets paid for, and still doesn't help everyone who needs it.

"The vast majority of America is uninsured or underinsured for mental health treatment," Riggs added.

Dillinger says that's why he will continue to champion a program that allows certain mentally ill inmates to leave the jail and stay in mental health treatment centers, with proper medication and counseling.

"This way, the people are in the community, they're not a threat to the community and they become productive," he said.

John Petrila, a professor at the Florida Mental Health Institute at the University of South Florida, says the issue of mental illness in jails is a complex problem not given to one single solution.

He said judges, mental health centers and others are forming community-based coalitions to deal with the issue. But it's not likely to go away any time soon.