Sick and Mired

The percentage of the 20,000 inmates incarcerated in L.A. County’s jails who are mentally ill is about the same as it is nationwide. About 7 percent of the almost 10 million people annually booked into America’s jails have acute or serious mental illness, and more than 50 percent have other mental problems, such as anxiety and antisocial personality disorders.

The numbers in state prisons are even greater. According to the federally funded National GAINS Center (which specializes in finding ways to improve the treatment of inmates with mental-health and substance- abuse problems), "serious mental illness in prisons is twice that of the jail population, and three to five times that of the rates found in the [outside] community . . . 5 percent are schizophrenic, 6 percent have bipolar disorder and 9 percent have unipolar depression . . . while approximately 13 percent of the prison population has both a serious mental illness and a co-occurring substance-abuse disorder."

Through incompetence, inertia, apathy or simply not giving a damn, L.A. County Sheriff Sherman Block recognized none of this, as his jails became blights on the humanity of Los Angeles during the 1990s. In October 1997, for example, Bobb stated in a follow-up to his initial highly critical report that "a series of [his] recommendations" to the Sheriff’s Department and the Department of Mental Health (DMH) had been "largely ignored." Since then, however, as Bobb wrote last June, "Our reports and the Justice Department investigation have had the intended effect of galvanizing the department and others to take action.

"One improvement," Bobb recently pointed out, "and a very dramatic one, has been the transfer of the mentally ill from very substandard housing at Central Jail to good, clean, open housing with windows at Twin Towers jail." Among other changes, according to Bobb, have been the addition of more DMH personnel to the jails, "a more rapid identification of mentally ill at the in- take point in the jails, a more rapid referral of those people to psychologists or psychiatrists, a better distribution of medications" and the selection of Dr. Ellen Reitz, a professor at USC Medical School, to transform the jail’s mental-health program.

As a result, says Bobb, "There is now greater expertise and greater numbers of people dealing with the mentally ill in the jails. This has all happened within the last year or so.

"Some of these changes are fairly far along," Bobb continues. "But there remain very serious concerns about whether the increased funding for programs and staff promised by the Department of Mental Health will actually occur, and about the possibility of continued abuse of mentally ill inmates. But if you compare the treatment of the mentally ill in the jails today to 1996 — when the Justice Department and myself first began our investigations — there’s no denying that there’s been some real progress."

An official of the Civil Rights Division of the Justice Department agrees with much of Bobb’s assessment, but is not quite so upbeat. "There’s no question there have been improvements," notes the official. "Obviously, the Sheriff’s Department is not where it should be, or our investigation wouldn’t still be continuing. Most of the remaining deficiencies are along the same lines as we first noted — they’re simply not as bad. A lot of the problem remains inadequate staffing, which leads to inmates not getting out of their cells to receive treatment, and mistakes being made over things like medications." (Reached at USC, Reitz declined to comment for this story.) "And there’s still harassment by officers not trained to deal with the mentally ill, as they now have been in the Twin Towers jail. But it’s taken a lot of really intense focus to even get us to this point."

While Sherman Block had to be forced kicking and screaming into improving jail conditions, newly elected county Sheriff Lee Baca appears to have a far more open, affirmative attitude. And a special interest.

Raised by his grandparents, Baca helped them care for an uncle who was mentally ill from birth. "My grandparents and I," said Baca recently, "assumed the parental role for my uncle because he needed to be fed, bathed, shaved, dressed and taken to the bathroom. So for the first 22 years of my life, I was exposed to the most severe kind of mental-health problem.

"My uncle’s case might not be the exact fit for the people I’m responsible for in the jails, but it’s close for certain inmates. And what I want to do is change the culture in the jails. We had the Department of Justice inspection, and there have been changes since then. We now have a very nice physical environment to house mentally ill inmates. But I know that what looks to be clean and orderly doesn’t mean they’re getting better treatment. You can have a brand-new facility, but the fact of the matter is that they’re still locked in 8-foot-by-8-foot cells.

"My desire is not to place misdemeanor offenders in high-security lockups that resemble the most draconian mental hospitals of the past centuries. I want the priority to be an environment where it’s understood that the mentally ill are in need of medical attention, and are not criminals. When I went to the Twin Towers jail and inspected those mental-health cells, what I saw were places where murderers ought to be. These are places for . . . isolation of the worst criminals. We dispense 6,000 pills a day. But what good does it do to give a person psychotropic drugs and put him back in a cell where he’s locked up for 24 hours a day?