Surge blamed on metham­phetamine use but doc­tors are not so sure

New Straits Times - - World -

PER­HAPS the largest group of men­tally ill in­mates in the United States re­sides in Los An­ge­les in one of the world’s largest jail com­plexes.

Over the past seven years, the jail’s pop­u­la­tion has spiked al­most 50 per cent — with nearly every in­mate hav­ing both men­tal ill­ness and sub­stance abuse prob­lems — and of­fi­cials sus­pect the rise is due to metham­phetamine use.

The Twin Tow­ers Cor­rec­tional Fa­cil­ity is home to about 4,000 men­tally ill in­mates. The in­crease in the num­ber of men­tally ill pris­on­ers — about 30 per cent of the county’s to­tal jail pop­u­la­tion — has led the sher­iff’s de­part­ment to adapt its poli­cies as deputies and clin­i­cians work to treat peo­ple deal­ing with both psy­chi­atric dis­or­ders and sub­stance abuse.

County Sher­iff Jim McDon­nell blames the surge on meth use, but doc­tors say it’s of­ten dif­fi­cult to dis­tin­guish whether the pa­tients had un­der­ly­ing con­di­tions and then started us­ing drugs, or if their chronic drug use led to psy­chi­atric dis­or­ders.

Chronic use of meth, a highly ad­dic­tive stim­u­lant, can cause para­noia, vis­ual and au­di­tory hal­lu­ci­na­tions and delu­sions.

“It’s caus­ing peo­ple to be­come men­tally ill, and we’re go­ing to be deal­ing with those in­di­vid­u­als in one way or an­other for the rest of their lives,” says McDon­nell.

Sher­iff’s of­fi­cials say they are train­ing deputies to deal with men­tal ill­ness and fo­cus on treat­ment in­stead of pun­ish­ment.

“No one ever ex­pected jails and pris­ons to be men­tal health in­sti­tu­tions,” says Kelly Har­ring­ton, the as­sis­tant sher­iff who over­sees the county jail sys­tem.

“The deputies, al­though they don’t have spe­cific psy­chi­atri­cor psy­chol­ogy-type de­grees, we give them as much train­ing as we can in the short pe­riod of time we have them.”

The Amer­i­can Civil Lib­er­ties Union (ACLU) rou­tinely re­ceives com­plaints from Twin Tow­ers in­mates who say they haven’t been able to see doc­tors or psy­chi­a­trists, haven’t re­ceived their med­i­ca­tion and that their med­i­cal needs are be­ing ig­nored, says Es­ther Lim, jails project di­rec­tor at the ACLU of South­ern Cal­i­for­nia.

“The jail has a his­tory of not pro­vid­ing ad­e­quate med­i­cal care or men­tal health­care,” she says.

Har­ring­ton says he has heard sim­i­lar com­plaints but noted the jail sys­tem has made sig­nif­i­cant progress in re­cent years to en­sure that in­mates re­ceive proper care. Still, he con­cedes, more work needs to be done.

Over the past year, the sher­iff ’s de­part­ment has rolled out train­ing pro­grammes that fo­cus on de-es­ca­lat­ing po­ten­tially vi­o­lent sit­u­a­tions and teach deputies to han­dle men­tally ill in­mates, says Har­ring­ton.

They have also adopted tech­niques and pro­grammes that take the in­mates out of their cells for recre­ational pro­grammes and ther­apy.

In ad­di­tion, county of­fi­cials have launched a pro­gramme to tran­si­tion men­tally ill in­mates with sub­stance abuse prob­lems to con­tinue treat­ment in com­mu­nity pro­grammes so that they don’t re­turn to a life of crime to get quick cash to buy drugs.

Re­cently at Twin Tow­ers, in­mates took part in life skills lessons, sub­stance abuse coun­sel­ing and classes to earn a Gen­eral Ed­u­ca­tional De­vel­op­ment diploma.

Some in­mates met one-on-one with clin­i­cians to dis­cuss their progress, while oth­ers chat­ted with peer men­tors and passed the time play­ing cards and check­ers.

The in­mates spend nearly all of their days in con­tained jail blocks. Some are seg­re­gated into pods be­cause of their crimes, sex­ual ori­en­ta­tion or gen­der.

On the jail’s fourth floor, in­mates sat at small ta­bles around their cells and had a group dis­cus­sion about the harms of sub­stance abuse. They seemed to cling to every word from teacher Ed­ward Mon­teilh.

“I re­ally want them to un­der­stand how their brain works,” says Mon­teilh, who has led classes at the jail for about five years.

“I try to ex­plain to them how men­tal ill­ness af­fects them, how sub­stances affect their brains and the com­pound ef­fects of the two.”

Even as sher­iff’s of­fi­cials work to im­ple­ment new pro­grammes and treat­ment ini­tia­tives, experts say the re­stric­tive set­tings can of­ten lead men­tally ill pris­on­ers, who are al­ready more likely to break jail rules, to be­come more symp­to­matic and vi­o­lent.

“That kind of iso­la­tion is not go­ing to help your psy­chosis in any way, shape or form,” says Dr Jef­frey Reynolds, a so­cial worker who spe­cialises in sub­stance abuse and ad­dic­tion dis­or­ders.

“They are prob­a­bly walk­ing out in a lot worse shape than they were when they went in.”

And ac­cess to drugs in­side the jails only makes the prob­lem more com­plex. Be­tween 2011 and last year, the amount of meth re­cov­ered dur­ing searches in­side Los An­ge­les county jails in­creased by nearly 750 per cent.

Jail of­fi­cials across the na­tion are strug­gling with how to deal with men­tally ill in­mates, in­clud­ing those who are also ad­dicted to drugs.

A 2014 re­port by the Treat­ment Ad­vo­cacy Cen­tre and the Na­tional Sher­iffs’ As­so­ci­a­tion found 10 times more men­tally ill in­mates in Amer­ica’s jails and pris­ons than in its state hos­pi­tals. The re­port also showed the num­ber of men­tally ill pris­on­ers and the sever­ity of their con­di­tions con­tin­ues to climb.

“That cy­cle is feed­ing off it­self, and we end up with what was ini­tially a health prob­lem as a very ex­pen­sive crim­i­nal jus­tice prob­lem for years to come,” says McDon­nell. AP

In­mates par­tic­i­pat­ing in a pro­gramme at the Twin Tow­ers Cor­rec­tional Fa­cil­ity on Thurs­day in Los An­ge­les. AP PIC

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