Left in limbo, hundreds of Minnesotans with mental illness languish in jail

During his 40 days in the Hennepin County jail, Michael Schuler told deputies he was the Prince of Wales. He stood naked in his own feces and talked to himself for hours. He became so agitated that at one point the jail's contract medical staff deliberately withheld his medications.

In all that time, Schuler never received a psychiatric evaluation — even though years of court files showed that he suffered from severe psychosis.

On May 2, 2012, Schuler finally found a way out of jail: He stabbed himself in both eyes and was rushed to a hospital.

Twenty days later, Judge Jay Quam left his chambers at the Hennepin County courthouse and walked four blocks to Schuler's hospital ward for a special commitment hearing. Except for the horrific injuries, Quam says, Schuler wasn't much different from hundreds of other failed cases he saw in the county's Mental Health Court.

On any given day, the Hennepin County jail holds 100 to 200 inmates with severe psychiatric disorders, according to records reviewed by the Star Tribune. They represent fully one quarter of the jail's population, and they languish there, on average, for three months before getting proper psychiatric care.

Across Minnesota, judges, attorneys and sheriffs cite dozens of similar cases in other county jails. They describe a system that, in effect, criminalizes the mentally ill because of backlogs in the state commitment process and a shortage of psychiatric beds.

"What you're seeing is people who are mentally ill being labeled as criminals," said a frustrated Hennepin County Sheriff Rich Stanek.

Confined under harsh and dangerous conditions, many of these inmates get worse. Five days after Schuler's incident, Tyondra Newton, 25, a schizophrenic, hanged herself after spending 34 days in her cell. A week later, Jason Moore, an All America wrestler at St. Olaf College before he succumbed to schizophrenia, broke his neck after repeatedly smashing his face into a cell toilet.

"Jailing people for their symptoms is a travesty," says Sue Abderholden, who heads the Minnesota chapter of the National Alliance on Mental Illness. "Not caring enough to do anything about it, which is what we are seeing year after year, is inhumane."

Today, under a court order from Quam, the Minnesota Department of Human Services (DHS) is trying to reduce the backlogs. But top state officials admit that the state is failing to provide adequate care.

"I don't blame anyone for running out of patience with us and how we've managed this previously," Deputy Human Services Commissioner Anne Barry said in an interview. "People shouldn't be sitting in jail waiting for treatment."

Months behind bars

The Star Tribune examined records for nearly 100 inmates who were jailed in Hennepin County between 2010 and early 2013 and then evaluated for commitment to state psychiatric care. The documents show long delays at every step of the process.

Many were arrested on common misdemeanor charges such as disorderly conduct. Yet on average they waited in jail more than a month just to get a psychiatric evaluation. Then it took, on average, another 36 days for an examiner to submit a finding; a week for the court to open a judicial commitment case; and a further 30 days for a judge to decide whether to commit them to state psychiatric care, according to a Star Tribune analysis of jail bookings.

Among those who were eventually committed for care, inmates waited an average of 14 additional days in the jail before the state opened a bed for them, records show.

Since 2010, at least 15 of these inmates were jailed for six months or more, and two were jailed for more than a year.

Derres King, who has HIV and eight mental disorders, was jailed for more than six months before being committed to the Minnesota Security Hospital at St. Peter. Darrell Gibson, who was arrested last year for jaywalking in downtown Minneapolis, spent two months in the jail — barking like a dog and smearing urine on the wall — before he was hospitalized. That's more jail time than many inmates who are sentenced for ordinary misdemeanors.

Broken promise

The plight of these inmates reflects two decades of breakdowns in Minnesota's public mental health system. The state once operated several large psychiatric hospitals — the best known in Anoka, Fergus Falls and St. Peter — that housed thousands of patients. Under pressure from the courts and social reformers, Minnesota began closing them in the 1990s and releasing patients to the community.

For thousands of patients, life with medications and transitional services proved a huge success.

But for a small share — those who are aggressive and violent — the state never built suitable new facilities. Today, hundreds wind up in court and in jail.

These patients represent a small fraction of the estimated 200,000 Minnesotans who have serious, diagnosed mental illness. But their numbers are not small: Some 4,000 Minnesotans were committed by judges for state treatment in a recent 18-month period, including patients with severe mental illness, chemical dependency and developmental disabilities.

"We have broken our promises to the mentally ill," Quam said in an interview. "We've closed the institutions down and moved these people out into the community [but] did not give them the places to stay and treatment they needed. They end up in jail, and the conditions are beyond what most people can imagine."

Many wind up cycling through the system repeatedly.

Schuler, the inmate who stabbed himself in the eyes, is an example. Early last year, after one scrape with the law, he admitted himself to Hennepin County Medical Center for psychiatric care. While in the hospital, he missed a mandatory court hearing for his previous offense. The result: On his release from the hospital, he was immediately arrested and sent right back into the criminal justice system.

Talking to the wall

The Hennepin County jail — a drab, brown cube in the heart of downtown Minneapolis — runs like a huge machine that vacuums up the violent, the passive, the sick and the helpless.

It's a sterile place, yet one that overloads the visitor's senses: Fluorescent lights and the lack of windows throw off an inmate's internal clock. Screaming and threats are often the greetings to the day. People with fragile minds stand and talk to the wall or pace in their own waste until a cleaning team is ordered in. They pound on the metal doors and they shadow box with imaginary opponents. They stare off into a landscape only they can see from a 6- by 10-foot cell.

Injuries among these inmates can be brutal. One man recently jumped over a railing and fell 25 feet, landing face first and fracturing his skull.

Two psychiatrists contracted from Hennepin County Medical Center make weekly rounds, but records and officials say it's often insufficient to keep psychotic inmates from deteriorating.

Since he was elected seven years ago, Stanek has watched the jail — Minnesota's only detention facility with national accreditation for psychiatric inmates — become a medical center of last resort. If an inmate had a broken leg, he says, Hennepin County Medical Center wouldn't hesitate to admit. With mental illness, it's completely different.

"This is a fairness issue," Stanek said. "We should not be criminalizing the mentally ill because there's no other place to put them."

It's also an economic issue: The average cost per day to house a jailed inmate is $117; in a state psychiatric facility, the daily cost can exceed $1,000.

'A huge test'

In late 2010 and early 2011, Ronald Brewer spent several months in the Hennepin County jail before Quam ordered him committed to a state facility. Nearly a month later, the judge got a call from Brewer's attorney, who said Brewer was still sitting in jail.

Angered, Quam ordered a "show-cause" hearing, at which state officials would explain how they intended to begin complying with judicial commitment orders.

In April 2011, he got an answer. Mike Tessneer, then head of DHS's huge State Operated Services division, wrote Quam to assure him that psychiatric inmates were being swiftly moved out of jails and into care. He said the Brewer issue had been put to rest, and he described a "marked reduction" in the number of days that inmates remained in jail awaiting treatment after commitment.

But deputies at the jail produced dozens of cases in which inmates were still spending several weeks in jail after commitment orders had been handed down.

As a result, DHS has been stripped of the power to decide when it will open a bed for an inmate who has been committed by a judge. A state law that took effect Aug. 1 requires the agency to offer placement within 48 hours of a commitment order.

"It will be a huge test for us," said Barry, the deputy commissioner. "But it's the right thing to do. I agree."

Yet the new law addresses only one part of the long jail delays. Psychotic inmates can still wait weeks — even months — for a psychiatric evaluation and other steps leading up to a judge's commitment order.

191 days

Last May, Julie Berntson appeared in Quam's courtroom to close a circle with Derres King.

King, the patient with HIV and eight mental disorders, had been arrested in October 2011. The daily jail log described his steady deterioration and the risk he posed to himself and others.

On New Year's Eve, a fight broke out inside the jail. When Julie's husband, Sgt. Bradley Berntson, tried to intervene, King bit him. Two months later, taking a heavy dose of drugs to prevent the transmission of King's HIV, Bradley Berntson died.

King finally received a court hearing for psychiatric commitment in April 2012 — 191 days after his arrest.

"Mr. King, I don't blame you," Julie Berntson said. "I don't hate you. I forgive you because that is what Brad would do. But I ask that you take advantage of the opportunity that you have been given. And I ask Judge Quam [to] continue to work for the men and women who do this job every day. We have a responsibility to keep them safe."

She has sued Hennepin County for failing to protect her late husband.

As for Schuler, who stabbed himself in the eyes: He lives in the Twin Cities in a state-funded residential facility, where he receives continuous care and medication. He has hired two attorneys and is suing Hennepin County and its medical contractor for the care he received while in jail.

His mental condition has stabilized, according to those responsible for his care, but his eyesight will never fully recover.

Paul McEnroe • 612-673-1745