Friday, February 10, 2006


A Look At Mental Illness in Jail


[Editor’s Note: Their stories are not so well chronicled as that of Phil Wiggins
but those of others affected by North Carolina’s shearing of its capacity for
inpatient psychiatric treatment can also be found in the Henderson County Jail.]


By Joel Burgess

It was a normal day in the classification pod of the Henderson County Jail. Of
the dozen or so inmates, one was schizophrenic, two were from group homes, which
often treat those with developmental disabilities, one was on suicide watch and
a handful were withdrawing from alcohol, heroin or other drug addictions.

Of the 151 inmates in the jail that day, head nurse Karen Styles estimated 90
had some degree of mental illness and more than 100 had "alcohol or drug

"I would say there are probably 24 that have major mental health medications
that they are on," said Styles, an eight-year veteran of correctional medicine.

Considering what it has been like for the past year, this was just another day
for Styles.

"I call it little Broughton, without the medications," she said, referring to
the state hospital in Morganton where the jail sends inmates with extreme mental
illnesses. Or at least that was where the jail used to send such cases, she
said, before sweeping state mental health changes effectively cut off that
avenue of treatment.

Now the jail has become the "dumping ground," she said, for many of the
community's seriously mentally ill.

'The Archangel'

One such person was jailed two months ago after being picked up with a stolen
car in Henderson County. Styles cannot give out names of mentally ill inmates
because of medical confidentiality rules, but said before being incarcerated the
man had been staying with his sister in Buncombe County.

"He disappeared into the cold one night, and she took out commitment papers,
because she knew about his mental illness," Styles said.

The man, "Inmate A," told jail officers he was "the archangel" and was going to
kill himself and that he could take his eyeballs out.

Using the small length of cord on an inmate telephone he tried to hang himself.
An officer intervened and stopped him.

Though there have been many attempts, the jail has never had a suicide, due
largely, Styles said, to officers' diligence.

Officers took Inmate A's clothes and put him into a safety gown, a loose garment
that cannot be tied, burned or torn. They placed him into a small padded cell
absent of any furniture or fixtures except a light and a hole in the center of
the floor with a grate over it.

Styles, realizing the man needed more treatment than she or local facilities
could offer, got on the phone to try to get him committed to Broughton.

She found out about the commitment papers the sister had taken out and got in
touch with her.

"I learned that in Georgia he literally did pull his eyeball out because he
thought it was the end times," she said. Intensive surgery was required to save
his eye.

While on the phone Styles said she heard a "pop."

Inmate A had smashed his head against the padded wall and blood was now running
from a wound.

Officers took him from the room and transported him to Pardee Hospital. At the
hospital a psychiatric social worker evaluated him and said he was commitable to

The hospital has its own psychiatric ward, but it is not set up to handle

Broughton refused admission, saying the inmate could be kept safely in the jail.

"So we had a person that was truly psychotic, good and strong physically, that
had injured himself before, hanged himself in his cell, we moved him into the
rubber room and he bounced and hit the wall so hard that he lacerated his head,
and they won't take him," Styles said.

Inmate A's injury required further medical attention and he was transferred to
Mission Hospitals in Asheville, ending the jail's responsibility for him. Styles
has tried unsuccessfully to get in touch with his sister and has been unable to
find out what became of Inmate A.

Much Different

Before the overhaul of the mental health system, the situation would have played
out much differently, Styles said.

If an inmate was having a psychotic episode, Styles would call Trend Mental
Health, the public mental health care provider for Henderson and Transylvania

Officers would transport the inmate to Trend for an evaluation and if necessary
Trend would call Broughton. Broughton routinely accepted such patients.

That changed with the reforms.

With the stated goal of achieving parity in mental health services and providing
users with more choices, the state dismantled the existing system of small local
public providers.

County programs such as Trend no longer give direct care such as counseling or
drug prescriptions. Instead, private contractors are supposed to provide care
under the umbrella of a central administrative unit, or Local Management Entity.

For Henderson, Transylvania, Polk and five other counties, the LME is Western
Highlands, based in Asheville.

Meanwhile, state mental hospitals that in the past dealt with the most severe
cases are reducing the number of beds for mental patients and cutting the length
of stays. The idea is to force communities to play a greater role in caring for
mentally ill residents.

Broughton administrators question whether the problems experienced by the
Henderson County Jail are really part of the reform, saying they are more likely
due to the exploding population in the mountains.

Hospital Director Seth Hunt said at Broughton and the other three state
hospitals that specialize in mental illness the patient population has
"increased pretty dramatically."

"When you look at the 2000 census you see that the population has changed but
without any exponential increase in services," Hunt said. "That is not
necessarily a problem with reform."

Broughton serves 37 counties that contain 36.4 percent of the state's
population, he said.

The hospital does not have beds designated for mentally ill inmates, but takes
them on a case-by-case basis according to the degree of sickness and potential
danger they could present.

"I don't know that we're being any more strict, but we're having to make
adjustments," he said.

State cutbacks have taken Broughton from 500 beds to 339 with further reforms
set to reduce that number to between 278 and 290.

The situation has the potential to get better with the construction at Broughton
and at Butner in Eastern North Carolina of 50-bed forensics units designed to
handle inmates.

At Broughton the $6 million unit could be completed by the summer of 2007.

Broughton has about 20 to 30 inmate patients and after the completion of the
unit will likely take back 10 to 15 western inmates from Dorothea Dix Hospital
in Raleigh, leaving it with five to 10 beds "wiggle room," Hunt said.


Though Hunt sees no direct link, mental health providers in Henderson County say
that the reforms happened shortly before the jail began having difficulty
getting higher-level care for inmates.

"It's the trickle-down effect," said Barry Beavers, director of adult services
at Mountain Laurel Community Services. "As the state hospitals get further along
in their attempts to downsize they are having to get firmer with directives of
how to deal with clients that we would historically refer to them."

Mountain Laurel is a private nonprofit mental health organization that handles
many of the services formerly provided by Trend.

Beavers said emergency rooms are not equipped to deal with these people and he
thinks the new forensics unit at Broughton will help.

"But my perspective on mental health reform and what we need to do as a
community at this point is to move away from the idea that our state hospital
system is the answer to a lot of our ills and concerns," he said. "It's a lot
about our partnerships and what we can do here in our community."

Already Beavers has been working with Styles and other jail nurses to help the
inmates, going to the jail for assessments rather than making officers bring
them to Mountain Laurel.

The biggest problem in this type of work is a prohibition against billing for
services to incarcerated individuals. For this reason many of the new private
programs will be reluctant to pick up this area of last resort.

Though this puts a strain on Mountain Laurel's budget, Beavers said the service
is an important link in the chain of overall care.

"There are certain things we are just going to have to reach out and take care
of," he said.

Styles, meanwhile, said she is hoping for a change.

The increased number of severe mentally ill people in the jail has stretched
staff to the limits, she said, and left her with no time to sit down and work
through a solution.

She points to one inmate who she said had a "long violent history," and was put
in jail without the medication he needed for mental illness.

"He was constantly threatening to kill the officers and the other inmates. He
kicked the door every day and was just really violent," she said.

Styles tried to get him committed to Broughton but was refused. The inmate only
had a $400 bond. He was soon back on the streets.

As far as she knows there have been no incidents where inmates who needed mental
health treatment have left the jail and injured someone, she said, "but it

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