The Fresno County Grand Jury recently released a report on mental health care in the Fresno County Jail. The Grand Jury’s investigation was triggered by complaints submitted by the local ACLU board.
A criminal defendant must be able to understand the proceedings and work with his or her attorney on the defense. Otherwise, the accused is legally “incompetent” because of mental illness and must be hospitalized and, if possible, stabilized in that hospital setting. From Fresno, men are sent to Atascadero State Hospital and women are sent to Patton State Hospital. There they are provided with medications and treatment and, if they sufficiently improve, they are returned to the Fresno jail to participate rationally in their defense.
Pablo Lopez, who covers the legal beat for the Fresno Bee, wrote in-depth about the number of criminal defendants who were being found mentally incompetent by Fresno criminal courts. They were then sent out for hospital treatment. If they minimally recovered, they were returned to Fresno to face trial. Many were then again found incompetent and returned to hospitalization. After several bus rides to and from, there were accused people who had waited years to go to trial. What was going on?
The person responsible for supervision of mental health treatment in the jail, George “Bud” Laird, Ph.D., had written what he called a “study” of the mentally ill in the Fresno County Jail. Laird’s “study,” which can be found on the Internet, relies heavily on right-wing criminologists who cynically assume jail and prison inmates use psychotropic and antidepressant medications for illicit purposes, either to barter with them or to get high.
According to Laird, inmates “malinger” or feign illness in order to obtain medications. Resting comfortably on this cultural rationale, it made sense for mental health professionals to cruelly and cynically reduce medications and provide only minimal treatment in the jail. The enormous financial benefits to the county were an inadvertent, if beneficial, consequence of the denial of medications to the undeserving. The cost of providing mental health medications to inmates was cut in half, a “welcome byproduct,” according to Laird.
Lopez’s lengthy and detailed article, which challenged the assumptions of Laird’s “study,” was met with a deafening silence. No investigation was launched. The Board of Supervisors asked no questions. There were no letters to the editor of the Bee protesting on behalf of sick people accused of crimes who were apparently waiting interminably for trials they ultimately could not understand.
The local ACLU Board sent a copy of Lopez’s article to Terry Kupers, M. D., a noted expert psychiatrist who has testified frequently in jail and prison litigation regarding the treatment of the mentally ill. Kupers said the article, if correct, exposed an unconscionable and unconstitutional denial of mental health care. Two local mental health experts agreed.
The ACLU, now extremely concerned about the welfare of the jailed mentally ill, began to distribute pamphlets in the jail visiting room asking for responses from people whose friends or family were in the jail suffering this fruitless cycle of treatment denial. The responses prompted the ACLU to visit several inmates. The ACLU then asked the Fresno County Grand Jury to investigate.
Although there are major differences of opinion about treatment methods for the mentally ill, it is heartless to ignore or deny the suffering mental illness brings to these unfortunate victims of fate. Many hear voices, are unable to understand what others say, suffer paralyzing and interminable fear, and are unable to earn a living and maintain comforting relationships. As we all know, many are even unable to live out of the rain, cold and searing heat.
It is impossible to live in Fresno County without being aware of the many ways responsible governing agencies have cut mental health funding first as if our public callousness had no effect on those afflicted. If Fresno County suddenly denied insulin to the diabetic poor, and we found ourselves surrounded by people dying of diabetes when a remedy is at hand, we would be outraged. For reasons complex and unjustifiable, we blithely ignore the many on street corners with cardboard signs who are obviously ill.
For the most part, the Grand Jury found the mental health treatment program in the jail minimally acceptable. However, the Grand Jury’s recommendations are remarkably demanding given its finding that overall mental health care in the jail is hunky-dory.
The Grand Jury asked the jail for a yearly report documenting the disposition of all mental competency restoration cases, a request that will result in an annual list of inmates who are hospitalized, returned and then hospitalized again, and it will provide basic statistical information that could result in tracking those who end up in a trial they are unable to understand.
It also required the jail to follow treatment recommendations of state hospitals if possible, a recommendation that flew in the face of the Grand Jury’s finding that the jail was providing adequate treatment for previously incompetent inmates.
Most significant, the Grand Jury recommended the jail establish a psychiatric facility within its confines.
Within two months, the district attorney, the public defender, the sheriff and the county health officer are all to respond to the Grand Jury report, findings and recommendations. The local ACLU, justifiably proud of this outcome, awaits these responses.