MODESTO Inmates with serious mental illnesses deemed incompetent to stand trial are languishing in California jail cells for months as they wait for state hospital beds to open up, according to advocates, jail officials and family members.
State and county budget cuts to mental health programs are combining with prison realignment and a shrinking number of state hospital beds to exacerbate the problem, they say.
In many counties, seriously mentally ill inmates routinely wait three to six months in jail before a state hospital bed opens up, said Randall Hagar, director of government affairs for the California Psychiatric Association. He calls the situation, which he says has gotten worse in recent years, "tragic."
Here in Stanislaus County, the numbers of mentally ill inmates in the local jail increased nearly 50 percent in the past six years, according to sheriff's department data.
Deputy David Frost, who oversees the jail's two mental health wings, said it's not uncommon for seriously ill inmates to wait for months after a judge orders them transferred to a state hospital.
"The misconception is that mentally ill offenders are just these raging (people), punching walls. They're not. They're pretty much scared people," Frost said.
For Kim Green, the latest chapter of a recurring nightmare began last fall.
In October, her 24-year-old daughter, who suffers from severe bipolar disorder and a mood disorder related to schizophrenia, was booked into the Stanislaus County jail after being arrested on a probation violation. In December, a judge declared the young woman incompetent to face charges and ordered her to Napa State Hospital to get well.
But with no beds available at Napa, Green said, her daughter instead spent five months in the jail.
Green, a registered nurse, said her youngest daughter has been sick since she was a little girl; at the age of four, she tearfully told Green that she didn't want to be alive anymore. By age six, she was hearing voices.
Now her family watched, helpless, as she waited in jail, off her medication and increasingly lost in her delusions.
"I guarantee that, with no help, she will end up dead or in the system," Green said.
Shannon McBride, the deputy public defender representing Green's daughter, said she sees many such cases.
"It's terrible, because they're just sitting there and they're not getting any help," she said. "The environment is such that, for a lot of them, they just get worse during that time."
In recent years, counties around California have been severely hit by budget cuts to mental health services. From 2009 to 2012, California has reduced mental health funding by $765 million, more than a fifth of its mental health budget, according to a report by the nonprofit National Alliance on Mental Illness, or NAMI, which advocates for services and treatment. As funds and services have disappeared, the number of people with mental illness landing behind bars has surged.
State prison inmates with mental illnesses increased from 19 percent in 2007 to 25 percent in 2012, according to the California Department of Corrections and Rehabilitation.
Dr. Gregory Sokolov, medical director of Sacramento County jail psychiatric services, said the county has also seen a steady increase in inmates with severe mental illnesses, which he attributes in large part to the reduction in mental health services.
He said wait times to get into state hospitals got so bad six years ago that a local Superior Court judge ordered the hospitals to accept Sacramento's mentally ill inmates within seven days of a judge committing them. That improved the local situation for a while, Sokolov said, although lately the transfers have started to slow down again.
A pilot program in San Bernardino County has offered a partial solution to the long wait times for state hospital beds, though not to the larger issue of shortages of services. In that program, inmates with mental illnesses can receive the medication and education services needed to restore them to competency while in county jails, rather than having to wait until a state hospital bed opens up, Hagar said.
Proposed legislation, AB 1693, would expand the pilot program to a few other counties.
Curtis Hill, legislative representative for the State Sheriffs' Association, which supports the legislation, said sheriffs have been dealing with this problem for years. But now he believes the issue is coming into greater focus.
"It's set up a whole separate third class of inmates that are just kind of shuttled around by bed space issues," he said.
Advocates emphasize that state hospitals are not ideal places for the majority of seriously mentally ill patients, many of whom might flourish if they received intensive support services in the community. But few suggest the jails are a better substitute.
Darrell Steinberg, state Senate president pro tem, said incarceration of the mentally ill was one of the main reasons he authored the Mental Health Services Act, a 2004 ballot measure that levied a 1 percent tax on millionaires to fund innovative programs for this population.
"The criminalization of the mentally ill is Exhibit A for how, as a society, we have not made mental health a priority," he said.
Kim Green thinks about the shortage of services all the time.
Green describes her youngest daughter as a "sweet, loving, charismatic, artistic" person when on her medication, though she's "never been really okay, completely." Starting when she was small, she was deemed sick enough to receive intensive mental health services from Stanislaus County, Green said. Her daughter received excellent services from the county until she was 18,she said.
But after the young woman legally became an adult, her mother said, those services largely dropped away. Her daughter ended up cycling between the streets, family members' homes, and single-room occupancy hotels that crawled with roaches.
At some point, society began to classify her as a criminal.
In 2008, the young woman spat on a jail deputy while being restrained and was charged with assaulting an officer, said McBride, her public defender. Ever since, probation violations on that one case have caused her to cycle in and out of jail and state mental hospitals, her mother said. Each time, once she stabilizes, a judge releases her to the streets with minimal follow-up by the mental health system, she said.
"If there is no help available, people end up paying the cost," Green said. "If they don't have a program, a plan, a place that puts them in another direction, it's guaranteed to fail."
The California HealthCare Foundation Center for Health Reporting, an independent news organization, is funded by the nonprofit, nonpartisan California HealthCare Foundation. Read more at www.centerforhealth-reporting.org.