by Art Levine
The seventh floor of the LA County Jail’s Twin Towers building is a phantasmagoria of mental illness and human torment. In one of the sixteen single-occupant cells in this section—or pod—a naked black man, his Afro disheveled, stands behind a locked brown door howling in a deranged rage. Of the 17,000 inmates in the LA County Jail, roughly one in five suffer from a serious mental illness, such as bipolar disorder or schizophrenia. Remember, these numbers make the county jail system arguably the largest de facto psychiatric facility in the country. On the fifth floor, the men are jammed into dorm-like pods that include not only sixteen two-person cells, but also a common area where fourteen people are forced to sleep on bunk beds. Psychologist Sarah Hough and other department leaders contend that the county jail’s seriously mentally ill inmates have access to medications and therapy, with roughly four hundred DMH staffers in the jail—including more than seventy psychiatrists and psychologists. (Hough left her leadership posts in the men’s jail and, later, the women’s jail by the end of 2015, but still works for DMH.)
Yet the department’s role in contributing to the jail’s well-documented culture of neglect and abuse has received little attention. Mental health officials defend the quality of care and seemingly ignore widespread brutality at the notorious county jail that victimizes mentally ill prisoners most of all. Yet Hough denies any mistreatment or brutality. “In the fifteen years I’ve been here, I’ve never been informed of it,” from either mental health staff or any inmates, she said. (One stunned Justice Department official scoffed: “That’s ludicrous on its face.”)
The Pollyannaish views of Hough and other Department of Mental Health leaders contrast with ACLU reports, the successful class-action lawsuit over widespread deputy violence that the city government agreed to settle in December 2014, and the sweeping Department of Justice agreement designed to end inmate abuse and improve treatment of the mentally ill.
The newest round of reform efforts was triggered when the ACLU of Southern California released a report in 2011 with eyewitness accounts from a civilian chaplain and an ACLU observer of violent deputy attacks, supplemented by dozens of inmate affidavits.
After over twenty years of failing to carry out court orders and independent commissions’ recommendations for change, the department, starting in December 2014, made a brand new series of promises it may or may not keep. The ACLU reformers remained hopeful real change would occur. Following the sweeping, court-enforced Justice Department settlement in August 2015, as Peter Eliasberg, the then-legal director of the ACLU of Southern California and Margaret Winter, director of the National Prison Project put it: “The reign of terror ends at LA County Jails.” Yet Eliasberg remained cautious about the prospects for change in the jail: “It’s better now, but it still needs a significant amount of work,” he told The Los Angeles Times.
Change may take a while. By 2014, the Los Angeles County Sheriff’s Department reported an 11 percent uptick in deputy “use of force” incidents against inmates in the jail system through September. The figure contrasts with a 36 percent rise in the women’s jail in Lynwood and a 40 percent jump at the North County Correctional Facility in Castaic compared to the same period in 2013, when “reforms” began. And, as a reminder, those are their officially reported uses of violence—not the beatings done out of the range of cameras chronicled in ACLU reports over the years. Until about five years ago, the ACLU received roughly 4,500 complaints a year of all kinds from inmates.
In fact, the public pressure and investigations have contributed to a two-thirds decline in brutality complaints to the local ACLU since the end of 2012; those complaints are also less likely to involve broken bones and deputies piling on with savage head strikes. Yet significant problems continue: The LASD’s own figures show a 167 percent annual increase to over 1,800 “use of force” jail incidents in 2016, with 314 of them resulting in injuries.
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WHILE IGNORING DECADES OF VIOLENCE, DEPARTMENT OF MENTAL Health officials failed to acknowledge major problems with their care. They said they provide high-quality, regular services and screening to the mentally ill male inmates housed largely in Twin Towers and to the women in the Lynwood jail.
Indeed, the department’s then-director, Marvin Southard, said the mental health staff in scandal-plagued Twin Towers delivers exemplary care. “The Department of Justice is happy with the level of service we provide mentally ill people in the jail, given the limitations of the facility,” he told me in an interview shortly before the Department of Justice released a stinging report to the contrary in June 2014. The report denounced mental health care in the jail as an “unconstitutional” violation of inmate rights. Although the thirty-six-page letter acknowledged improvements in services, the Justice Department took steps to impose court oversight of the jail, which were finally put in place with the settlement in August 2015, providing a potential roadmap for reform.
But it’s not clear how much the underlying culture in the jail will change. At the top, sheriff McDonnell welcomed the settlement as a “comprehensive approach to reform” that he and other leaders will “fully embrace,” starting with beefed-up training, restrictions on the use of force and the hiring of hundreds of additional staffers to increase safety checks of inmates. Yet after the 2015 settlement, the department was sued again by former inmates for allegedly dumping mentally ill inmates back on the street—paving the way for a return to jail—without any hands-on transfers to new services. The county’s Inspector General reported in 2016 that LASD guards used restraints to tether some near-naked, emotionally disturbed inmates to toilets, chairs and cell doors for as long as thirty-two hours, leading to two deaths in 2015, part of the twenty-one people who died in jail that year. Four jail deaths in just nine days in March 2017 then led to angry protests. “You don’t magically change a culture overnight,” says Witness LA editor Celeste Fremon.
What’s clearly unresolved is the deputies’ long-standing, undisguised scorn towards mentally ill inmates, and that’s shown few signs of changing. Routinely, deputies refer to mentally ill inmates as “dings.” In 2014, even after Department of Mental Health and sheriff’s department officials claimed that they had made so much progress that federal court oversight wasn’t necessary, deputies in the women’s jail still responded to a delusionary, untreated woman standing on a table talking to herself by laughing and hooting at her, according to a former inmate, Tina Middlebrooks. In the world of the LA County Jail, the mentally ill at least are good for laughs from law-enforcement and clinical staffers.
The lack of decent care has been especially evident in the women’s jail in Lynwood because of the absence of meaningful outside monitoring. County officials estimate that of the roughly 1,900 inmates there now, one-quarter have a serious mental illness. (The inmate population in Lynwood dipped following a statewide referendum in 2015 reducing certain non-violent crimes to misdemeanors.) Still, only 330 health beds are set aside for them. Abuse and neglect are common, according to Kristina Ronnquist, but DMH clinicians are too scared to say anything.
Ronnquist’s views were confirmed by a shocking August 2015 report by the advocacy group Dignity and Power Now (DPN), “Breaking the Silence,” that chronicled the degrading experiences of several women there. The most harrowing was the story of “Nina,” a forty-seven-year-old African-American woman diagnosed with bipolar disorder, schizophrenia and depression. After two weeks at the Lynwood jail, where she was allegedly denied access both to medical professionals and the medications she needed to “quiet the voices” in her head, Nina attempted suicide in September 2014 by jumping off a second-story balcony.
In addition to such neglect, untrained deputies have reportedly assaulted mentally ill inmates and even some patients who’ve attempted suicide for unruly conduct or slight infractions. As Ronnquist, now a volunteer with DPN, told the Board of Supervisors in May 2014, “One of my teenage clients just recently made a very serious attempt at suicide and one day later was taunted by a sheriff
’s deputy, who slammed her fingers in the door after she refused to move them, causing serious injury.” County officials insisted they couldn’t confirm her allegations after months of refusing to answer Ronnquist’s follow-up inquiries. Before closing the investigation without taking action, an LASD spokesperson said in a written statement, “We remain committed to the appropriate treatment of all inmates, including the mentally ill.” Yet many who have witnessed conditions there disagree.
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FROM 2012 TO MID-2014, THE NUMBER OF “PREVENTABLE” SUICIDES IN THE LA County Jail system rose sharply, to fifteen. (Nationally, the suicide rate has risen steadily in jails, now the leading cause of death there.) As a result, the Justice Department moved to strengthen its ongoing monitoring of the LA County Jail’s “deplorable,” “vermin-infested” conditions. The federal government concluded that the poorly supervised mentally ill prisoners “are housed in conditions that present, rather than prevent, a risk of suicide.” (Recent figures show that the number of jail suicides in LA County declined to as few as one in 2015 from ten in 2013. That change was spurred in part by another wrongful death lawsuit, which resulted in a $1.6 million settlement in September 2015 for transferring a hallucinating, clearly suicidal twenty-three-year-old man to an isolation cell where he hanged himself. The sheriff’s department has since realized that putting suicidal and depressed patients in solitary cells is a bad idea.)
All these conditions in the LA County Jail reinforce that we’re facing a nationwide crisis of mentally ill people being abused and neglected in the nation’s jails and prisons.
Some counties, such as Miami-Dade in Florida, arrange community-based treatment programs and “supportive housing” as alternatives to jail for mentally ill offenders who commit non-violent crimes. (In contrast, Florida’s state-run prison system, with a facility in the county’s south end, has a sordid history of killing and torturing some mentally ill inmates.) The Florida county’s programs have helped slash recidivism rates for even felony offers to as little as 6 percent. By contrast, 75 percent of offenders with mental illness in the Los Angeles County jails commit crimes again.
If mentally ill people can somehow navigate obstacles in the county’s mental health system, they are better off getting those services in the community and staying out of jail. The Department of Mental Health’s seeming indifference to aiding mentally ill inmates contrasts with the achievements of the DMH in delivering consistent, high-quality services to some—but hardly all—of the 250,000 people they help each year. The agency has produced remarkable results, such as The Village program in Long Beach for the chronically homeless.
Those with life-threatening or dangerous crises usually can get an emergency response, including the help of effective outreach teams. Yet some clinics have waiting lists as long as ninety days for basic psychiatric care. Meanwhile, the number of complaints to the ACLU about violence in the LA County jails are still too numerous. Former inmates, their family members and reformers see a culture of neglect and violence in the jails, including Twin Towers, and seek to change it. “The treatment of mentally ill men and women in the jail is a disaster, and the fact that Southard isn’t honest about it is frightening,” Patrisse Cullors, director of the Coalition to End Sheriff Violence in LA Jails, said before Southard retired in November 2015. His denial of this harsh reality continues to influence the department.
So DMH officials boast about their quality jail care—including their discharge planning—unfazed by the needless deaths, homelessness and traumatized inmates signaling a broken system. “Everyone’s offered after-care and we make sure their needs are met, whether it’s for medication management follow-up or housing,” Hough said. The new Justice Department settlement, in contrast to these claims, requires the jail to halt the dumping of disoriented mentally ill inmates to Skid Row.
Yet, even in the face of lawsuits and scandals, DMH officials remained upbeat. As Hough’s then-colleague, Peter Maloney, said of the infamous Twin Towers jail, which holds most of the mentally ill inmates, “It’s a better way to live,” compared to other jails. In fact, he notes with pride, “The Justice Department sends mental health officials from other states to study us.” Sometimes it seems that it’s not the mentally ill inmates inside the LA County jails who are delusional.
As it turned out, in June 2015 the LA Board of Supervisors put an end to the DMH leaders’ misguided pride and their role in managing jail mental health care by what amounts to a no-confidence vote. As noted earlier, they removed the authority of both DMH and LASD to run the poorly coordinated and sloppy health care in the Los Angeles County jail system. Instead, they set up a new consolidated office under the county’s Department of Health, a separate agency, with a Correctional Health Director that assumed full authority in 2016.
That still wouldn’t guarantee that the culture of violence and neglect harming mentally ill inmates would disappear overnight, but Eliasberg said it was an important step. In a letter to the board supporting the reform, he pointed to “the obvious unsuitability of a law enforcement agency for the provision of medical care” and the “long-standing failures of DMH to provide appropriate care to inmates with mental illness.”
By removing responsibility from the DMH to run jail mental health care, the LA Board of Supervisors freed up the department to devote more resources, staff and its $2 billion budget to do things it was competent at, including delivering outreach services to troubled people in crisis that actually helped many stay out of jail; and, for the most serious and chronic mentally ill people, offering intensive, supportive team treatments that improved their lives. But until services and care were transformed for mentally ill offenders, and alternative diversion programs became commonplace, all the department’s other good works would continue to be undone by the hell known as the LA County Jail.
CHAPTER 10
To Live and Die in LA: How DMH’s Outreach Work Saves Lives, Stops Mass Shootings
AS SEEN IN LA COUNTY AND ACROSS THE COUNTRY, IF LOCKING UP THE seriously mentally ill in jail doesn’t help them or the community, then undertaking a dragnet to hunt down potentially violent, disturbed people and forcing them to take their medications doesn’t hold much promise, either.
Yet a few hours after the May 2014 shooting rampage by Elliot Rodger in Isla Vista near Santa Barbara that left seven people dead, Rep. Tim Murphy (R-Pa.) seized the opportunity to draw new attention to his controversial mental health reform bill that had been stalled in Congress since 2013—in part because it emphasized forced, long-term medication and outpatient treatment. But in the wake of the Charleston church massacre in June 2015 and other tragedies, its chances looked brighter. More than a year later, mass shootings—defined as four or more people injured or killed—occurred at a rate of more than one a day, spurring a renewed interest in mental health reform. Over time, Rep. Murphy also softened the bill’s outpatient commitment provision to win broader support.
His advocacy template has been set since the Newtown tragedy in December 2012. As he has so often done in recent years, Rep. Murphy, Congress’s only trained psychologist, declared in the aftermath of the 2014 Isla Vista killings, “I am angered because once again, our mental health system has failed and more families have been destroyed because Washington hasn’t had the courage to fix it. How many more people must lose their lives before we take action on addressing cases of serious mental illness?” A year later, even before the killings in Charleston, South Carolina, galvanized the country, Murphy reintroduced a revised version of his legislation on the anniversary of the Newtown shooting and proclaimed, “If we want to prevent the next Newtown, Tucson, Aurora, Isla Vista, Columbine or Navy Yard we have to do something comprehensive and research-based and we have to do it now.”
In July 2016, after he worked to modify its most controversial elements, including mandated treatment, his sweeping mental health reform bill passed a near-unanimous vote in the House of Representatives before passing the Senate. Then it was si
gned into law in December as part of a broader legislative package that speeded up drug approvals by the FDA. Democrats dropped their earlier opposition to the bill for allegedly undermining patient rights. In earlier versions, it sought to use federal funds to punish or reward those states that implement involuntary Assisted Outpatient Treatment (AOT) commitment programs; in the new version, the bill simply adds funding to some existing pilot AOT programs.
Murphy’s support for outpatient commitment, though, has never wavered. The nation’s mental health system, he told CNN, “is more interested in protecting people’s rights to be sick than their rights to be well,” arguing for greatly expanded mandated, long-term treatment for the seriously mentally ill as vital for reform.
Yet Los Angeles County, it turns out, has a solution that has stopped dozens of planned school and college murders—usually without requiring the mandated long-term medication and treatment that remains a goal of Murphy’s bill. But LA County’s successes have been ignored in the polarized national debate over Murphy’s involuntary outpatient commitment campaign that, to many frightened Americans, seems at first like a reasonable response to the threat posed by dangerous, mentally ill people.