Mental illness isn't a crime, but the way we treat — or don't treat — the mentally ill is. Or should be. I wrote earlier that the Hillary's hostage taker was ordered to undergo evaluation, which led me to make the following joke.
In fact, if you need — really need — inpatient mental health care, you’re unlikely to be able to get it, or at least get enough of it, because whatever can’t be treated in 10 days or so, isn’t going to be treated period. Not unless you kill someone, or at least take a few hostages.
But it turns out that committing a crime isn't necessarily a ticket to getting mental health care. In fact, if you're incarcerated — probably as a result of untreated mental illness — it can be a virtual guarantee that you won't get the mental health care that you desperately need. In some cases, it can even be a death sentence.
The Los Angeles Times ran an article about one man whose story illustrates how hope of treatment dissolves when a mentally ill person commits a crime and enters the criminal justice system as a result.
Torrie Gonzales stood at the stove, laughing with her boyfriend as she fried him some eggs on his 23rd birthday. Then she felt him press a flimsy blade against her neck.
Struggling on the floor, she pried a paring knife from Reny Cabral's hand, leaving him curled up in a ball, sobbing and seemingly horrified.
"He said, 'I don't know what I'm doing. I'm so sorry,' " recalled Gonzales, now 25.
Twice more he attacked her, choking her until she passed out, then performed mouth-to-mouth resuscitation to revive her. Finally, he raised his arms with a look of panic and walked into the orchard adjacent to his parents' modest rural home.
A neighbor, hearing Gonzales' screams, dialed 911.
In the days leading up to the Jan. 6 attack, Cabral had been exhibiting symptoms of an emerging psychotic illness. He was held, briefly, in a psychiatric facility. But once Glenn County sheriff's deputies responded to the 911 call, he lost any chance of being treated in the mental health system. He would now be dealt with as a criminal, with catastrophic consequences.
The catastrophic consequences of Cabral entering a system in which inpatient mental health resources are diminishing even as the number of mentally ill people who are incarcerated increases, were pretty drastic. His behavior changed in fall of 2006, and landed him in psychiatric facility, which was the first time the mental health care system failed him.
On Jan. 3, Gonzales walked through the open door of the Chico apartment she shared with Cabral to find tufts of body hair on the living room floor.
Meanwhile,in the city's expansive Bidwell Park, police watched as Cabral bolted naked through traffic, dragging a roll of saran wrap behind him. Nearby, officers found 5 gallons of kerosene and his oil-drenched clothes.
A detached Cabral spoke of suicide to police and social workers and said he shaved his eyebrows for a "fresh start," records show. Police had him transported to a local emergency room, and from there he was sent to Butte County's 16-bed Psychiatric Health Facility on a 72-hour hold, police and county records show.
There, he was tentatively diagnosed with psychotic and depressive disorders, records show, and prescribed Risperdal, an antipsychotic drug most commonly used to treat schizophrenia.
Early chart entries described him as "suspicious" and "guarded." Entries at 2:45 a.m. and 6:15 a.m. found him restless.
But by 7:30 a.m., the tone of the entries had changed: Cabral promised he would not hurt himself. "I do need some help though," he said. "I cannot do it on my own." When, at 9:30 a.m., he said he needed "to spend time with my family," the facility obliged.
His diagnosis was changed to "major depressive disorder," and about 10:30 a.m. -- just 10 hours into his three-day hold -- Cabral was released.
This was after he experienced his first psychotic break. After attempting to strangle Gonzales, he was a taken to jail, where he was supposed to receive anti-psychotic medication, but didn't. The one jailhouse psychiatrist was on vacation, so when a social worker called jail, a deputy told him Cabral "seemed" OK.
When he acted out on his mental illness again, Cabral was moved to isolation, where things quickly went downhill.
Finally subdued at 3:50 a.m., Cabral was placed in a safety cell lined with a thin layer of hard rubber.
Paranoia raging, he believed he would be raped if he didn't escape, he recalled, and so rammed his head against the wall.
In checks through a slit in the door every 15 minutes, deputies noted his posture. The last entry to record him standing was at 4:31 a.m.
"Laying on floor," "Laying on stomach breathing," "Laying on stomach," subsequent entries in a jail log note. At 5:45 a.m., breakfast was pushed through the opening. Cabral did not rise.
Cabral claims he yelled for help steadily. "If they did answer, they said to 'get up,' " he said.
The first log entry to note Cabral's distress was at 10:11 a.m.: "Laying on stomach/yelling."
At 11:10 a.m.: "alleges paralysis -- 'broken neck.' " Without entering the cell to investigate, the deputy left a voicemail for a nurse, records show.
At noon, as Cabral pleaded for help, they served him lunch.
No one opened the door until the jail nurse arrived at 1:09 p.m. -- more than eight hours after Cabral was last reported standing.
Willows' tiny Glenn Medical Center concluded Cabral was quadriplegic. Three more hours passed before he was taken to Enloe Medical Center in Chico and given medication to reduce spinal cord swelling, according to a legal claim Cabral filed against Glenn County. The county rejected the claim, and Cabral's civil attorney said he is now preparing to file a lawsuit.
And Cabral's is not exactly an isolated case, the Boston Globe is running a series of articles about inmate suicides in which mental illness, and the lack of mental health care, is almost always a factor, including stories like what happens to Nelson Rodriguez.
By the time Nelson Rodriguez walked through the heavy metal doors of state prison in 2004, convicted in a stabbing case, he had long since been diagnosed as mentally retarded and mentally ill - a man unable to grasp even the most basic concepts.
But as an inmate, the 26-year-old Rodriguez was routinely punished for acting out in ways he could not control. Time and again, his jailers used the same blunt tools - isolation and loss of basic privileges - to deal with him.
The discipline never improved his behavior; in fact, he got worse. It ran directly against warnings by prison clinicians. But it kept coming - for him as for many of the mentally ill who have overwhelmed the prison system.
During 18 months in state custody, the young man with the lazy eye and troubled mind spent a quarter of his time - about 145 days - in solitary confinement.
On Dec. 20, 2005, five days after his last transfer into the forbidding Walpole prison unit known as 10-Block, Rodriguez's isolation was pressed to the extreme. Officers shut an outer solid door over the bars of his cell and walked away.
Sometime in the next four hours, Rodriguez tied a strip of bed sheet to the metal cover around his cell's smoke detector. He wrapped the other end around his neck, and hanged himself.
The stories of what happened to Nelson Rodriguez and Reny Cabral are extreme, but it's arguable that if if their mental health care needs had been properly addressed they might not have ended up in the criminal justice system. It's almost certain that had they received the mental health care they desperately needed, they'd still be alive today. But they're needs were barely even addressed, let alone met.
They probably represent the extremes of mental illness in America, with problems far more complicated than the other millions of Americans who experienced some degree of mental illness. If those who, essentially, among the most ill and in need of care can't get it, what hope is there for the rest of us?
Crossposted from the Republic of T.