A Merry Go Round that Never Stops:Mental Illness in the Multnomah County Detention

Center

The Protection and Advocacyoffice for Oregon

Opportunity, Access, Choice

LAWYERS FOR PEOPLE WITHDISABILITIES

DRO is a Non-Profit Law Firmdesignated as Oregon’s Protection& Advocacy office. (P&A).

P&A Systems were established byCongress in the 1970s. Each stateand territory has a P&A funded bythe Federal Government.

P&As have broad statutory powersto safeguard the human and civilrights of people with disabilities.

Disability Rights Oregon has a vision of asociety in which persons with disabilities

have equality of opportunity, fullparticipation and the ability to exercise

meaningful choice.

1. Too many people end up injail because of behavior relatedto mental health crisis 138 designated mental health beds in Multnomah County

Jails

Year end 2016: an estimated 1.5 million people were instate or federal prison in the United States . . . . but therewere 10.6 million admissions to jails

50% of Multnomah County jail beds dedicated to probationviolations

Myth of a “forensic” population . . . . Where you end up hasmuch more to do with privilege, bias, luck? (vs. “criminality”)

“Spivey”Ms. Spivey was committed to the state hospital in the fall of 2014. She was facing misdemeanor chargesfor theft and interference with public transportation, and she had been found unable to “aid and assist” inher defense.

After 8 ½ months at the state hospital, she was found competent to face her charges, received credit fortime served, and was discharged to the streets with no discharge planning. Given her history of trauma,homelessness, drug use, and serious mental illness, she would have benefited from behavioral healthservices and housing assistance. Ms. Spivey would have been receptive to any and all of these services.She deeply wanted to get her life on track so that she could regain custody of her children. Unfortunately,none of these services were arranged or available for Ms. Spivey.

Instead, she struggled on the streets. Her next arrest occurred at OHSU. She has visited the ED atOHSU 7 times in the 2 ½ months since her discharge. This time, she had been sexually assaulted. Shereceived a sexual assault examination and a catscan, and was discharged.

About six hours later, Ms. Spivey was found sleeping in the waiting area of a different wing of the hospital. OHSU police observed that she was wearing blue hospital scrubs and a patient’s wristband butdetermined that she was loitering, with no continued legitimate reason to remain on hospital grounds.OHSU police then arrested Ms. Spivey on a warrant that was more than one year old, for interfering withpublic transportation. The officer also issued a trespass warning, and took Ms. Spivey to jail.

Her booking photo shows Ms. Spivey looking directly at the camera, with a blank expression and a blackeye. Despite her “acute signs of mental illness,” Ms. Spivey spent four months in jail before she wasfinally found unable to aid and assist (again) and sent to the state hospital for competency restoration inmid-January of 2016.

“Spivey” cont.

During that time, Ms. Spivey was held primarily in solitary confinement. Her jail recordsdocument a steady psychiatric decline. A nurse noted that she did not shower for 45 days. Adeputy stated that “her room and person smell like a dumpster.” Jail records contain multipleentries stating she was “too unstable to walk,” meaning that jail deputies determined Ms.Spivey’s psychiatric symptoms prevented her from exiting her cell to shower and experiencehuman contact. Instead, she remained alone in her cell incessantly battling assailants seenonly to her. She is described as screaming and punching her mattress, engaging in “shoutingmatches with nobody,” begging deputies to stop allowing attackers to enter her cell, andoccasionally pacing back and forth as if she is holding a baby.

Finally, Ms. Spivey was committed to the state hospital, where she spent another three months. Then, almost exactly two years after the alleged interference with public transporation, thecase was dismissed.

How to decriminalize mentalillness:

Philosophy:lcommunity-based l trauma-informedlMeets the needs of the whole person lHarm reduction (vs. “compliance” driven)lPeer-delivered serviceslStart with the services that the person

desires

Decriminalize mental illnessDiversion

Recommendation What’s happening Issues

Diversion programs:services rather thanincarceration

Cascadia BehavioralWalk-In ClinicDiversion Program

Efforts to reduce useof jail for probationviolations

Data? Trackingeffectiveness

Officer discretion→bias

Lack of communityresources

Best practice is: nocharges

Decriminalize mental illnessDiversion

Recommendation What’s happening Issues

Jail gatekeeping: don’tbook someone whosephysical/behavioralhealth needs can’t bemet by the jail

? RN as 1st point ofcontact in booking

Law enforcement wouldneed to wait for medclearance

Increased burden onhospitals

Solutions?

lNon-hospital behavioral health crisiscenter• 24/7

• With respite housing/shelter

lMore housing! All types,supported/supportive housing inparticular

2. Isolation and sensory deprivation (solitary confinement)

According to the Nat’l Comm. on Correctional Health Care:l Prolonged (more than 15 consecutive days) solitary is

cruel, inhumane, and degrading treatment and harmfulto an individual’s health

l Juveniles, mentally ill individuals, and pregnant womenshould be excluded from solitary confinement of anyduration• (Isolation is presumed contraindicated for people with serious

mental illness)

l Correctional health professionals should not condone orparticipate in a decision to place someone in solitary

confinement.

Ending Solitary Confinement

Recommendation What’s happening Issues

Increase out of celltime and humaninteraction

Inmates with mentalillnesses now receive 2-4 hours per day out ofcell (instead of 1 or less)

Failure to grant theallotted 2-4 hoursrequires documentationand approval

StaffingDifficult access tooutdoor spaceJail is not a therapeuticenvironment

Architecture (no spacefor programming orconfidentialappointments, elevatorrides, difficult to facilitateprovider in-reach)

Ending Solitary Confinement

Recommendation What’s happening Issues

Increase access tohealthcare andcounseling

Introduction of someprogramming

Hiring of a MH deputyand sergeant allowedexpansion of clinichours (doubled to 12-14 hrs per day)

New medical/MH staff

Staffing

Architecture (no spacefor programming orconfidentialappointments, elevatorrides, difficult to facilitateprovider in-reach)

Ending Solitary Confinement

Recommendation What’s happening Issues

Move people toInverness

This idea was notsupported

Dorm or large block ofcells not seen asconducive to populationwith mental illnesses

3. Mental-health relatedbehaviors in the jail responded to

with forcePeople are held in conditions known toexacerbate their symptoms, then responded towith punishment and forcelRestraintslViolencelDisciplinelPunitive Suicide Prevention Protocols

Ending Jail Violence: RestraintsProblem What’s happening Issues

Restraints61.4% (67 of the 109)incidents weredesignated as“voluntary” andtherefore exemptedfrom review

African Americansmade up 34% ofpeople “voluntarily”restrained

No longer consideringany use of restraints as“voluntary.”

Jail cut its use ofrestraints in half (32instances involving 26inmates in 2017)

Restraints remain muchless regulated incorrections settings vs.clinical settings

Ending Jail Violence: Use of ForceProblem What’s happening

Violence against inmatesMCDC houses 1/3 of thepopulation but accounts for83% of the uses of force.MCSO’s own consultantsaid this is likely driven byexcessive “lock downtime.”

Training: CIT, De-escalation, suicideintervention, MH 1st Aid (400+ staff)

Employee Information System: rollout end of2018, will track UOF by staff member/inmate,demographics

Installation of cameras with recording capacity- $4million project

Ending a Punitive Response toMH behaviorsProblem What’s happening Issues

Discipline7-10 disciplinaryhearings per day-volume critiqued bySheriff’s own expert

African Americansmake up 19-20 % ofthe jail population, but36% of misconducthearings

Increased out of celltime should help

MH Sergeant reviewsincident to determinewhether theproblematic behaviorwas MH-related

EIS system will trackstaff use of discipline

Specific recommendationshaven’t been implemented• One incident = one

infraction.• Shorten timeframes• No discipline for

disability relatedbehavior

• No isolation for longerthan two consecutiveweeks or more thanthree weeks in a 60-day period.

• Tracking demographics

Ending a Punitive Response toMH behaviorsProblem Recommendation What’s happening

Suicide WatchRequired to wear aheavy smock with noother clothing.Mattress, sheet, andblanket are removed.Denied access to anyprogramming, visits,phone calls, andshowers.

Individualized clinicallydetermined restrictions

Clinical staff assigned towelfare checks

No changes

“Garcia”Mr. Garcia told the deputy that he “could not stay in his cell because he was hearing things”and that he wanted “his meds.” After the conversation, he tried to push his way out of his cell.

Handcuffed, brought to elevator.

In the elevator, he struggled against them, screaming that “someone was in his head,”repeatedly asked where they were taking him, insisting that he had done nothing wrong, andaccording to one deputy “staring off in a catatonic gaze,” “yelling nonsensically and convulsing.”

He was tased 5 times – twice with a drive stun to the back, 3 times through probes.

Back-up deputies described arriving on the scene to find Garcia handcuffed and face down onthe floor, “breathing heavily, and repeating ‘don’t hurt me.’”

“very animated, he was paranoid and was clearly delusional [,] making it difficult tocommunicate with him and calm him down.”

“Garcia continued to yell for help, and that ‘they’ were after him. He also asked why we where[sic] doing this to him and trying to stab him. Several deputies and myself tried to reassureGarcia that no one was trying to hurt him and that once he was secured on the chair we wouldleave him alone. Garcia was unable to comprehend this.”

“Garcia” cont.

Finally, Garcia was fastened into a restraint chair. A nurse came and injected him with Ativan.He was then wheeled to a disciplinary unit, but he was placed (while in restraints) in view ofother inmates, and they taunted him. He was subsequently moved to a different disciplinaryunit.

On review:

“appeared to be suffering from some sort of psychotic break.”

“a professional response to secure a large combative inmate that displayed mental healthissues.”

Mr. Garcia was charged with the following disciplinary violations: Failure to do as Ordered,Disruptive Behavior, Assaulting, Fighting and/or Threatening a person/staff, Escape, Attemptedescape, and Unauthorized departure.

“Clifton”On suicide watch, but wanting “shower, phone call, and visit.”

He covered the window of his cell with his suicide smock or blanket, then removed it.

“[w]hen he took the blanket down I saw that he had bars of soap, paper, a large Band-Aid, and a book in hiscell.”

“I could see that he had two band-aids, multiple bars of inmate soap, a book, mattress, and two smocks. Themajority of these things are not authorized while on active suicide watch.”

Mr. Clifton was told to cuff up through the food port, which he did, and he was led out of the cell. He was toldthat he would be able to keep his smock and that his mattress would be returned at bedtime, but everythingelse would be removed. This made Mr. Clifton upset. He wanted his bedding and refused to return to thecell “if he didn’t have a smock, blanket, and mattress.”

When a deputy took hold of his arm, he tried to run. The Deputies took him to the ground and attempted tocarry him to the cell, but he resisted. They tried to hobble (tie together) his legs, and he kicked. Then, adeputy tasered him, using the drive stun mode, to his thigh.

Like Garcia, he was tased while in hand cuffs.

Deputies were then able to hobble Clifton and carry him back to the cell, laying him face down on the floor.He then began to bang his head against the floor. A deputy straddled him, pressing his knee againstClifton’s head. Due to the head banging, they forced Clifton into the restraint chair, where he remained forover six hours.

“McKenzie”young woman in the psychiatric infirmary - had removed her clothing and smeared feces on her cellwindow. She was yelling and pounding on the cell door. The responding deputies told her that they would“place her in a restraint chair if she did not comply with commands to let medical administer medication.”She was ordered to put her hands through the cuff port so that she could be handcuffed.

When she didn’t comply, deputies entered her cell and forced her to the ground. She was handcuffed anda spit sock was placed over her head and face. She was placed in the restraint chair, where “The nursethen injected [her] with a sedative to calm her down.” A deputy “covered her torso with a sheet becauseshe was naked.” Deputies checked the restraints and wheeled her to a new cell. While she was inrestraints and forcibly sedated, deputies removed her nipple rings, which must have been overlookedduring booking.

She remained in restraints for 5 ½ hours until the medication resulted in her “acceptable behavior,”justifying her release from restraints.

Contact with mental health was through cuff port: described feeling suicidal, and she talked about wantingto skateboard at the Burnside skate park.

“frightened, skittish,” and “startled each time neighboring inmate kicks door and yells an outburst.”“[A]ppears fearful, ‘it’s scary in here.’”

“McKenzie” cont.Ms. Mckenzie was in her mid-20s, with no prior criminal history. She was in jail onmisdemeanor charges including trespass and disorderly conduct.

At the initial booking, mental health staff determined that further assessment was needed andcould not be completed in jail. They decided to put her on a Director’s mental health hold andhave her transferred to a hospital. She was diagnosed with psychosis, possibly substanceinduced, and returned to jail. The hospital also recommended that the jail consider hypo orhyperthyroidism. It’s not clear from her jail medical records whether that recommendation wasfollowed.

4 days after her release from jail, she was found deceased under a bridge.

OPPORTUNITY, ACCESS, CHOICE

Sarah Radcliffe, PAIMI Managing Attorney

Disability Rights Oregon

sradcliffe@droregon.org

503-243-2081 x 222

www.droregon.org