Diagnosed as bipolar and off his medications, the 20-year veteran firefighter was naked in an elevator when he was first arrested in South Carolina.
Now a Crisis Intervention Team (CIT) trainer for police departments throughout Hampton Roads, Bryan Sanderson provides a textbook case for law enforcement personnel encountering a mentally ill scofflaw. He knows what it's like to hear voices that aren't there. He also knows what it's like to break the law and not receive necessary mental health treatment.
Still sick and delusional on his return to Virginia, he committed a double bank robbery and spent time in Virginia Peninsula Regional Jail. His meds adjusted, Sanderson recovered from his psychosis and received a verdict of NGRI (not guilty by reason of insanity) which earned him a months-long stay at Central State Hospital and a road to recovery. After a two-year conditional release, during which he lived at a Colonial Behavioral Health transitional apartment, Sanderson is back living independently and working in the community.
More than 6,300 others like him — diagnosed with a mental illness — are serving time in Virginia's jails, where they receive minimal or no mental health treatment, according to the 2012 "Mentally Ill in Jail" report of the state's Compensation Board. Of those, almost one-half has a serious mental illness, such as bipolar disorder, schizophrenia or PTSD, and 746 are kept in isolation.
The report pegged the annual in-jail cost of mental health treatment statewide last year at $13.3 million, including $3.7 million spent on psychotropic medications. More than 60 percent of the expense fell on localities, with the state chipping in only 10 percent.
How jails replaced hospitals
Fifty years ago, in 1963, passage of the federal Community Mental Health Act was intended to create community supports for the mentally ill so that they could receive appropriate treatment outside of institutions. In Virginia, it led to 1968 legislation to close state facilities and transfer resources to the community. "I pledged my career to that. I walk away from that now. It's not working," said Chuck Hall, executive director of the Hampton-Newport News Community Services Board, one of 40 boards established to provide mental health services. Dr. Baltej Gill, senior medical director for the HNNCSB concurred. "It's a national trend that went wrong. You're pulling your hair out to put people in the hospital."
In keeping with the promotion of "self-determination, empowerment, recovery, resilience, health and the highest possible level of consumer participation in all aspects of community life," as stated in a 2011 state report, Virginia scaled back on beds in behavioral health facilities and psychiatric hospitals. In 1976, there were 5,967 in-patient beds in state facilities; in 2011, just 1,252.
Over that same time period Virginia's population increased 30 percent. That leaves an estimated 7,000 state residents without access to inpatient care and the level of psychiatric care that they need, said Associate Inspector General Doug Bevelacqua.
In rebuilding its campus in 2010, Eastern State Hospital in James City County was part of the trend, reducing the number of its adult behavioral beds by 85. At the same time it set the parameters that for admission, a patient must be an immediate danger to themselves or others, substantially unable to care for themselves, and unable to be cared for elsewhere. It offers acute care for 14 days and intermediate long-term care. It now has a capacity for 302, divided between geriatric, civil, and "forensic" patients, the term for those involved in the criminal justice system.
The failure of de-institutionalization
Many more of the mentally ill are housed at Hampton Roads Regional Jail, whose census of local inmates hovers around 900, with 400 drawn from Hampton and Newport News. More than one-third has a mental health diagnosis — twice the 15 percent incidence in the general population — and half of those have serious illnesses, including schizophrenia and bipolar disorder. Hall dubs the jail "the state's largest mental health hospital." The Portsmouth facility, built in 1998 to relieve overcrowding in jails in Norfolk, Portsmouth, Hampton and Newport News, has become the go-to place for the mentally ill and those with severe medical needs from those jurisdictions.
"We should all consider that unacceptable," said David Coe, director of Colonial Behavioral Health, the community services board for four Peninsula communities; his agency serves between 40 and 50 held at the Virginia Peninsula Regional Jail. "The scope and scale are different, but the issues are similar," he said.
"It's trans-institutionalization. In the 1960s and 1970s the mentally ill were warehoused in big institutions. Now they're institutionalized in jails," said Virginia Executive Director Mira Signer of the National Alliance on Mental Illness, NAMI. "We're spending millions of dollars providing 'treatment' to people in jails. They're no place to treat someone with a mental illness."
The Compensation Board reported that forensic patients are almost evenly divided between pre-trial and post-conviction status, and cited the need for more than 2,200 additional beds statewide to house inmates with non-acute mental illness.
The problem is cyclical. Without sufficient community supports — the state's 2009 budget eliminated $2.6 million in funding, and the community service boards endured 5 percent cuts in the biennial budgets of 2008 and 2010 — the mentally ill often end up on the streets or in jail, while others remain confined after they're ready for release.
In April last year,166 adults were on the EBL (extraordinary barriers to discharge) list, ready to leave state psychiatric hospitals but with nowhere to go, according to the Office of the Inspector General's report. That, in turn, created a bottleneck that prevented those who needed inpatient services from being admitted. They included 19 inmates held in jails more than 48 hours after a court order for treatment in an in-patient state hospital. This month, the Department of Behavioral Health reported that 43 patients at Eastern State have been clinically ready for discharge for more than 30 days.
When his illness took hold in 2005 and he stopped taking meds because of their side effects, including rapid weight gain and sexual dysfunction, he went "to the dark side," said Sanderson. His journey through the justice system included being held in an isolation cell for 23 hours out of 24 in a regional jail.
Appropriate medication and the NGRI verdict that sprang him from jail for in-patient psychiatric treatment in a state hospital set him on the path to recovery. Eighteen months in CSB-supervised transitional housing completed his reentry. "I really needed it," he said. Since then, the CSB's Williamsburg housing has been a victim of budget cuts.
Now Sanderson works to spare others with mental illness from his experience. "The CIT is a huge thing," he said. "It's an eye-opener for them (law-enforcement personnel) — what it's like to hear voices and see people who aren't there." Through CIT, he has taught hundreds of police officers to recognize signs of psychosis, to ask the right questions, and to use alternatives to arrest — such as drop-off, or receiving, centers staffed by mental health professionals. In a small victory, this year's state budget added $900,000 for three more such centers to add to the 10 in existence. "They need to be open 24/7 to be effective," said Signer of NAMI, which advocates for these and other jail diversion programs.
"For those who are picked up for trespassing and loitering — they're not eating and at 7/11 they steal a bag of chips and a soda — they don't need to go to jail," added Sanderson.
Day One: "Jails are no place to treat someone with a mental illness"
Day Two: Hampton Roads Regional Jail and Eastern State Hospital: Same population, different treatment
Day Three: Meet some mentally ill inmates in Hampton Roads Regional Jail
Day Four: A Navy veteran with PTSD deals with jail after a vandalism charge
Day Five: A better way to look after those diagnosed with a mental illness