Mental Health Treatment in the County Jail System

Natty (not her real name), was diagnosed with bipolar disorder, manic-depression, when she was in her late twenties and began a series of different medications to help her control her extreme mood swings between super manic highs and suicidal depressed lows. Life was difficult for Natty as she tried to deal with her bipolar disorder and she began experimenting with drugs and became addicted to crack, heroin, and whatever drug was available that could get her high. She lost her job, her home, and her family. She stayed with whatever drug friend that still happened to have a place to live and even lived on the streets for awhile, gathering aluminum cans from the garbage to help support her drug habit. Her only friends were other substance abusers who all lived on the edges of society just as she did. Even on her medications, Natty wanted to die and was frequently trying to kill herself by daring others to shoot her, stab her, and just kill her already! Once she even started to jump off an overpass into the freeway oncoming traffic but backed out at the last minute when she had the thought that she might survive the fall. Natty hung out with the wrong people and was eventually arrested and charged with receiving stolen property and sentenced to six months in the county jail.

Once Natty was in the county jail system, she was never given a psychiatric evaluation upon admittance. She didn't get her bipolar meds for a full week; in fact, no one at the county jail even knew Natty had bipolar disorder because she'd had so much practice in hiding her mental illness. Natty hid her mental illness because she was afraid of being targeted for extra abuse by the other inmates and even the prison guards. Once Natty was finally given bipolar medications, she was given different meds than those she'd been taking because the county jail didn't dispense lithium to any of the inmates.

The county jail gave Natty, and many of the other mentally ill prisoners, the same medications: klonopin, celexa and seroquel. To get their meds, Natty and the other inmates, were required to stand in line at the same time each day to get the meds and then required to swallow them in front of the guard. If an inmate missed the meds time due to oversleeping, then they were unable to have meds that day and would have to wait for the following day. There was some abuse of the meds system where the inmates would quickly hold it under her tongue and leave, taking the pill out of her mouth later and selling it or trading it for different items. Natty soon found that the three medications, along with trazadone to help her sleep, were causing her to sleep all the time. Plus she was having a harder time controlling her bipolar symptoms which was something Natty was afraid of because of the risk of being beaten up or raped. So without authorization, Natty stopped taking the klonopin, instead holding it under her tongue as other inmates did and then trading it for different commissary items.

Once Natty served her sentence, she was released to a rehabilitation home for a year. Unfortunately when she was released, the county jail forgot to send her medications to the home with her so she was again without her bipolar meds for almost a week.

The story I have written here about my friend Natty, is only a small part of Natty's story and of her mental health treatment while in the county jail. Mental health treatment that is similar to the mental health treatment in the prison system.

Mental illness is an important issue in jails and prisons because so many of the inmates have mental illnesses. One report that I read at the Prison Policy Initiative website states that 16% of all prisoners are mentally ill but that this number only counts the inmates that have already been diagnosed. That's quite a large number of inmates who are mentally ill, in a jail and prison system that is intended to incarcerate and hopefully rehabilitate those guilty of various crimes. But what about the mentally ill inmate who doesn't even recognize or remember what he/she has done, should they be held in the same prison cell along with other prisoners? What if their behavior was a symptom of their mental illness? Is it even possible to rehabilitate someone by imprisoning them for whatever period of time their sentence is, but who is seriously mentally ill? I am not suggesting that the mentally ill should not be held accountable for their actions because I do not believe that. As I said in Natty's story, she lost everything and hung out with other drug people who most likely also had some form of mental illness. In that situation, going to jail was almost a given considering drugs are illegal and using drugs makes you do things you might not have done if you weren't high and bipolar disorder can cause you to make poor decisions which can include committing crimes or in Natty's case, hanging out with people who are committing crimes (which unfortunately makes you just as guilty by association).

By already knowing she was bipolar (for at least the last fifteen years), Natty was able to at least partially self-regulate her mental illness. She originally took all the meds that she was given in jail but she recognized her mood swings and realized that the meds were not helping her and that the side effects were instead causing her serious problems and possibly even endangering her life. Not all people with bipolar disorder are able to self-regulate, even on such a limited basis, like Natty did (and still does).

There are certainly some problems for the mentally ill who are in the prison system. Some of the different mental disorders will most certainly cause problems just because of the conditions in prison. You are locked up in a small cell with another person and your life is entirely regulated; wake up alarms and breakfast at 3:30AM; lunch at 10:30-11:00AM; dinner at 4PM, lights out and cells locked at 10PM. If you don't make it to meals at the specified time, then you go without until the next meal plus there are no in-between snacks offered. You go stand in line for your medications and you must take them right then even though like in Natty's case, the trazadone was to help her sleep at night and you are supposed to take it right before you go to bed with a small snack. That wasn't possible for Natty which is another reason she traded part of her meds for candy to eat with her trazadone at night. And if you missed standing in line for your meds, you didn't get them again until the next day when you had to stand in line and wait for them then.

There are many inmates in the prison system that probably belong in a mental hospital but there just aren't enough mental hospitals out there to hold them all so, the mentally ill must enter the jail and/or prison system. Where else can we put the dangerously mentally ill who have committed crimes? Some of our mentally ill roam the streets, a familiar sight in any town with a homeless population but then they will often end up in the jail and/or prison system too.

I know that there are problems with the mental health treatment that is given in the jail and prison system but I am not certain what can be done to bring about changes. Perhaps some of the many mentally ill in the prison system could be helped if the correct medications were given to them. One common side effect of the meds that Natty and many of her fellow mentally ill inmates were given is drowsiness and they were taking two and three meds with the same side effect! Natty said there were a lot of inmates who just slept most of the time which I'm sure made things easier for the prison guards but it certainly wasn't helping the mental illnesses that the inmates had. At least in Natty's case, there wasn't a lot of rehabilitating going on; instead it was a lot of sedating.

Resources:
About.com: Bipolar Disorder. Klonopin/Clonazepam Medication Profile by Kimberly Read & Marcia Purse.
A Clinician's Guide to Corrections By Anne Hanson, M.D.
Mental Health Primary Care in Prison.
National Center for State Courts (NCSC). Mental Health Resource Guide.
Prison Policy Initiative. Incarceration is not a solution to mental illness by Peter Wagner.
Treatment Advocacy Center Fact Sheet: Criminalization of individuals with severe psychiatric disorders.
Treatment Advocacy Center. Law enforcement and people with severe mental llnesses.
U.S. Courts. The System and Its Officers. Mental Health Treatment.