Pubdate: Wed, 03 May 2006
Source: Wall Street Journal (US)
Copyright: 2006 Dow Jones & Company, Inc.
Author: Gary Fields
Bookmark: (Crime Policy - United States)
Bookmark: (Incarceration)
Bookmark: (Mandatory Minimum Sentencing)


Trapped by Rules, the Mentally Ill Languish in Prison For Such 
Felons, Parole Is Rare, Recidivism Is Probable; Lack of State 
Hospitals 'It Scares the Hell Out of Me'

LEXINGTON, Okla. -- Jesse James, a mentally ill prisoner, squinted 
into the gleaming sunlight toward the six-story guard station 
towering over Joseph Harp Correctional Center.

"Kojack is up there in that tower right now, listening," said Mr. 
James, looking up. "He's got a rifle too. He wants me dead."

Kojack isn't "Kojak" of the famous TV series. Mr. James, 59 years 
old, who is bipolar, paranoid and schizophrenic, believes that a 
medical aide called Kojack -- spelled with a "c," he insists -- has 
been stalking him for decades and has implanted a listening device in 
his prostate.

Nearly 16 years after robbing a convenience store, Mr. James has been 
rejected for parole three times. Because his sentence tops 100 years, 
parole is his only path out of prison. At his next hearing in 
December 2007, he will likely be rejected again. He has a history of 
prison-rule violations, stemming largely from his illness, and even 
if his record were clean, there are few qualified institutions to 
take him in. That alone would be grounds to deny his application.

For years American prisons have been grappling with a surge in the 
ranks of mentally ill prisoners, caused in part by the shuttering of 
state-run mental-health facilities a generation ago. The Joseph Harp 
prison spotlights an often-overlooked aspect of that problem: how it 
has become self-perpetuating. Once imprisoned, mentally ill inmates 
are rarely paroled. Some "max out" their sentence, serving at least 
85% of their term, and are released. With nowhere to go, and with a 
recidivism rate higher than that of the general prison population, 
they often end up back where they started.

Of the mentally ill prisoners housed at Joe Harp, as it is known, 
none are likely to be paroled, says James Keithley, the prison's 
psychologist and clinical coordinator. And then, if a violent inmate 
completes his sentence and is discharged, "Where do I send him? Mama 
don't want him," Dr. Keithley says. "If they act up here, you know 
what will happen if they're released. It scares the hell out of me."

In recent years, Oklahoma has had a dramatic increase in mentally ill 
prisoners, in part because it only recently shuttered state-run, 
mental-health facilities. According to the state, the number of 
inmates on psychiatric medications more than tripled between 1998 and 
2005 to 4,017. The system's budget for such medication climbed even 
faster, growing from $154,000 a year to more than $2 million, in part 
because of the growing number of medications available. By 
comparison, the overall prison population rose 14% to 23,205.

The National Alliance on Mental Illness estimates there are 300,000 
people suffering from mental illness in state and federal prisons, 
compared with 70,000 in state psychiatric facilities. "Our jails and 
prisons are our largest mental-health facilities now," says U.S. Sen. 
Mike DeWine, a Republican from Ohio who has co-authored bills to 
create federal programs to improve services for mentally ill inmates.

Dr. Keithley, 50, has worked in the prison world since 1983, leaving 
once for several years to get his Ph.D. His voice is low and 
soothing, an asset when trying to coax information out of reticent 
patients. When he receives an emergency call to assess an inmate 
threatening nurses and doctors at a county hospital an hour away, he 
rearranges his schedule so he can drive there. "There's no such thing 
as a normal day here," he says.

For male prisoners in the state, Joe Harp is the primary facility 
providing mental-health care. About 440 of the prison's 1,100 inmates 
are on psychiatric medication. Officials here estimate that 
medication in total costs $30,000 a month.

The guard tower, the tallest structure for miles around excepting the 
water tower of a nearby prison, looks down on scores of inmates 
standing in line for their evening medication. It takes more than two 
hours for the last inmate in the line to make his way to the infirmary.

Among those are about 100 inmates from the intermediate unit, one of 
two mental-health sections at Joe Harp. Prisoners there have been 
stabilized to some degree and are temporarily allowed out of their unit.

Even these inmates can be unpredictable. Last year, one tried to 
commit suicide by tying an electrical cord around his neck and 
jumping from the second tier. Misjudging the distance and length of 
cord required, he hit the deck of the first floor. As the lone 
officer on duty ran to the area, the inmate limped back upstairs and 
jumped again. He misjudged the distance once more and broke his foot. 
Another time an inmate set a fire in his cell and took the responding 
officer hostage, periodically slashing him with a blade from a 
disposable razor.

Prison Within a Prison

The most unstable inmates are housed in "Fantasy Island," the 
nickname for the acute-care unit. Surrounded by a 12-foot fence, it's 
a prison within a prison for 108. The walls, made of unbreakable 
glass, allow staff to see most of the unit at a glance. There is a 
four-point restraint table where uncontrollable inmates can be tied 
down until they're calm.

With temperatures in the teens one day earlier this year, few inmates 
ventured outside. Many milled around a recreation area in the 
zombie-like gait of the heavily medicated. Others, visibly agitated, 
paced back and forth and stared through the glass.

Those considered too unpredictable and uncontrollable ever to be free 
are locked behind thick doors with small windows. Screams, moans and 
chanting are normal. The noise level rises as the sun goes down and 
before the medication kicks in. One inmate believes he is in a 
prisoner of war camp in Vietnam while another screams that communists 
are taking over the facility. He believes two of the officers on the 
unit are Nikita Khrushchev and Fidel Castro.

A couple of years ago, one resident of the acute-care unit sculpted 
figurines out of his feces. Another feigned a catatonic episode and 
nearly bit off the tip of an officer's nose. Earlier this year, 
officers had to forcibly remove and shower an inmate who refused to 
clean himself.

The prisoners in "Fantasy Island," almost never get paroled. Behind 
each decision is a hard question: Should the prison records of the 
mentally ill be treated like those of any other inmate?

"The [parole] board here in Oklahoma is conservative towards these 
types of issues and unfortunately they judge the mentally ill like 
they judge the rest of the inmates in the system," says J.D. Daniels, 
deputy director of the Oklahoma Pardon and Parole Board. The board 
looks at the initial crime, the overall institutional record -- 
which, in the case of the mentally ill, is often poor -- and whether 
the inmate has anywhere to go if released.

Changing Ideas

Many states, responding to budget pressures and changing ideas about 
how to treat mental disorders, closed their residential mental 
institutions. Oklahoma was one of the last. It shuttered Western 
State Hospital in Fort Supply in 1997 and turned over the inpatient 
psychiatric hospital at Eastern State Hospital in Vinita to the 
Department of Corrections, a process completed in 2001.

The idea was that community agencies would take over treating and 
monitoring these patients but in almost all cases they haven't picked 
up the slack. The number of long-term, non-criminal psychiatric 
patients housed in Oklahoma's state facilities is about 200, a 
fraction of the 1,300 they held in the 1980s, according to the 
state's department of mental health. Griffin Memorial, the remaining 
state hospital, houses about 162 of those but generally only for two 
weeks at a time until patients are judged stable enough to be 
released into the community.There are private and community 
facilities where families can pay to have a patient placed, but most 
are not for the indigent. These organizations are also reluctant to 
take in people released from prison with mental problems, Dr. Keithley said.

Jesus House, which helps people who are homeless and mentally ill, is 
one of the few shelters in Oklahoma City that takes in ex-felons. The 
facility has 70 beds and usually has one or two ex-felons among the 
residents, says Executive Director Jan Mercer. "I could fill up 
another couple hundred beds if I had them," she says.

Corrections and mental-health officials are trying to ease the 
situation by developing new programs, such as mental-health courts 
that would steer some mentally ill defendants away from prison.

In his prison photos, Mr. James, the Joe Harp inmate, looks like a 
1920s gangster. In person, he is a small, thin man with 
weather-beaten features. A native of southern Oklahoma, just north of 
the Texas border, he committed a raft of burglaries in the 1970s and, 
not yet diagnosed, spent until 1990 in Texas prisons.

On Aug. 16, 1991, he went into a Colbert, Okla., convenience store 
shortly after 8 p.m. and pulled a knife on the clerk. He fled on foot 
through the back door with checks and cash from the register. A state 
trooper caught him a few minutes later less than a mile away trying 
to hide in some weeds. Drunk, he confessed immediately. He wanted to 
flee his nemesis -- Kojack -- he says now.

Since then, Mr. James has spent time at several facilities in the 
prison system where he often violated behavioral rules. Infractions 
range from smuggling contraband such as cigarettes to disruptive 
behavior and disobedience. He also has several attempted escapes on 
record. Once he tried to hop the 12-foot fence surrounding the 
acute-care unit. The guard tower has authority to shoot but the 
officer that day recognized Mr. James and stopped. "He wasn't trying 
to escape," Dr. Keithley explains. "He was trying to get away from 
Kojack." Mr. James's most recent infractions include refusing to 
provide a urine sample. Last June, he was caught smoking -- tea. 
Smoking of any kind is banned.

All this weighs heavily against his chances of parole. His file 
reads: "There's no place for him in the community. The defendant's 
mental illness compounds the defendant's unpredictably causing him to 
be a great threat to society."

In conversation, Mr. James is lucid as he talks about living outside 
on his own. He gets agitated, however, when talking about Kojack. He 
says he has lost weight because he can't sleep. Kojack has "been 
bugging the hell out of me. He's taken my life from me."

Warden Mike Addison says Mr. James would have to be paroled to a 
mental-health unit, and since there aren't any government-run places 
like that available, "he'll stay here with us. He'll be with us the 
rest of his life."

Michael Bruton is a mentally ill prisoner who has been paroled a few 
times before winding up back in jail again. His crimes have been 
minor -- usually involving worthless or stolen checks totaling no 
more than $800 -- and his behavior in prison often exemplary. In the 
past, he lived with relatives or in state mental institutions.

The fifth of seven children, Mr. Bruton left school without 
graduating in 1972 and enlisted in the Army. There, he had a nervous 
breakdown, according to Mr. Bruton and his prison records.

As he was being discharged, military doctors suggested he take 
Thorazine and Cogentin, two drugs that help control schizophrenia and 
the tremors that come on when he gets nervous. It was the first time 
any medication had been suggested for him. For years after, he 
resisted the idea. "I used to be ashamed to take medication because 
they teased you," he says, referring to people in general. "They'd 
say you're doing the Thorazine shuffle."

Instead, Mr. Bruton turned to alcohol and drugs. His first crime came 
in April 1976. Then 20, he was living in El Reno, Okla., when he 
wrote a $20 check to a crafts store in town even though he didn't 
have a bank account. He wrote another check for $40 to a grocery 
store and a third for $21.50 to another business.

Over the years he would go back to jail or prison for infractions 
from setting his cell on fire to stealing $15 worth of gas from an El 
Reno Wag-A-Bag grocery store. He stole a Wizard sewing machine from a 
family member.

With his spotless, wrinkle-free uniform, neatly trimmed goatee and 
amiable manner, Mr. Bruton is well liked here. He greets people as an 
old friend and shakes hands vigorously.

Mr. Bruton's smile vanishes, though, when he talks about his 
imaginary gunfights. On many mornings, including that day, after Mr. 
Bruton makes his bed and heads to his job picking up trash in the 
yard, he imagines he is a gunfighter, say prison officials. With 
knees bent and hands hovering over a make-believe holster on his 
hips, Mr. Bruton stares at his adversary, usually one of the guards. 
Then, as prison officials describe it, he laughs hysterically before 
sobbing uncontrollably.

Asked about the incidents, the 6-foot-4 inmate, with braids dangling 
from his scalp, stares menacingly before blurting out: "What are you 
talking about? I don't do that...I'm not Quick Draw McGraw."

Mr. Bruton, 50, has been in jail since 2000 on a 10-year term for 
using a stolen credit card. He is scheduled for a parole hearing in 
May 2007 but he likely won't get out because of his lengthy, albeit 
non-violent, record as well as his mental-health status. Even if he 
crosses those two hurdles, he doesn't have any place to go. His 
mother, with whom he used to live, suffers from schizophrenia and is 
in a nursing home.

Dr. Keithley says he would rather Mr. Bruton be paroled and put on 
supervision than be allowed to finish his sentence and simply 
dissolve into the outside population. "The parole board doesn't 
necessarily see it that way," the doctor says. "He deserves to have a 
better life than being crazy."

Maurice Smith is one of the prisoners who most worries Dr. Keithley. 
Mr. Smith, who is schizophrenic, has been at Joe Harp on a 
drug-possession charge since June 2004 and has been in and out of 
prison since 1989. At the age of 16, he was convicted in an adult 
court for dropping a rock on a passing car from a train trestle. His 
other crimes included car burglaries to fund a drug habit.

Mr. Smith has been eligible for parole but was passed over. In 
September, though, he will be released after completing his sentence.

His record doesn't suggest he's a violent man, but he talks about how 
he has threatened his mother with a knife when she hasn't given him 
money. He also gouges himself with his fingernails, according to 
prison records. At 5 feet 9 inches and less than 130 pounds, he is a 
small man and looks older than his 33 years. He says his fear is to 
be moved into the general prison population where he couldn't protect 
himself from stronger inmates. "I can't fight," he says.

"When the day comes for him to be released, we've got to let him 
out," Dr. Keithley says, sighing and shaking his head. The doctor 
says he'll refer Mr. Smith to whatever treatment is available in 
Tulsa and will warn the man's mother that he may be violent. He also 
plans to introduce Mr. Smith to the Program for Assertive Community 
Treatment, a pilot program that tries to monitor ex-offenders.

The prison will discharge Mr. Smith with two weeks of medication that 
Mr. Smith says he won't take, because a "genie in my rectum" told him 
he doesn't need it. He says he has heard the genie for as long as he 
can remember. Throughout his life, he says, he has used drugs and 
alcohol to quiet the voice.

Having served his time, Mr. Smith won't be under court supervision. 
"I won't have to take any drug tests," he says. Asked why that's 
important, he answers bluntly: "Because I want to do drugs. I like 
crack and marijuana and drinking." 
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