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“I Thought He Was Safe, That Was a Mistake”

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(April 15, 2014) When Bill O’Quin called the police to warn them that his 41-year-old paranoid schizophrenic son, David, was wandering the streets one night in February 2013, he had no idea the arrest would ultimately lead to David’s death in a Louisiana prison.

david_oquinYet “thirteen days later David Jackson O’Quin lay lifeless on a jail cell floor after being shackled to a restraint chair for nearly 170 hours during 10 days of often violent behavior,” reports the Advocate (“Dad hopes suit over mentally ill son’s death in jail will spur change,” April 14).

An artist, David O’Quin was fluent in Spanish and graduated from the University of Texas with a degree in studio art. Shortly thereafter, he moved to Los Angeles to further his art studies at UCLA.

What originally appeared to be the quirky behavior of an artist became more alarming when David moved to the west coast. “Helicopters and birds followed David around Los Angeles,” Bill O’Quin tells the Advocate. “Intelligence officials implanted listening devices in his brain . . . He often stripped naked in public.”

When he landed in the East Baton Rouge Parish Prison on that February night, David was suffering from serious psychosis, according to a medical report from a prison nurse. “Recognizing he was mentally unstable, intake workers kept him apart from the general population of inmates.”

On his sixth day in jail, “David spent 24 hours strapped to his chair, screaming for at least six of those hours, and he refused to eat.” Days later, David was “shot with a stun gun and had a spit mask pulled over his face.” Much of David’s last few days were spent restrained to the chair.

On his last night alive in prison, after being released from the chair but too weak to move, “David ate dinner lying on a mat on the floor of his jail cell . . . At about 5 a.m. a deputy yelled for him, but he didn’t’ budge. . .  At 7 a.m. a guard poked the motionless man through the bars with a broom.”

David was dead.

Officials with the Emergency Medical Services declined to comment to the Advocate about the causes surrounding David’s death. The autopsy report indicates that David died after blood clots in his legs dislodged and settled in his lungs.

Bill is suing the prison to facilitate changes in how jails and prisons treat people with mental illness.

While it is unknown whether significant efforts were made to treat David’s psychosis during his incarceration, our study, “The Treatment of Persons with Mental Illness in Prisons and Jails,” found that Louisiana is one of 13 states where involuntary treatment is significantly more difficult because it requires a court order or appointment of a guardian by the court.

David O’Quin is one more casualty in our nation’s failure to adequately provide treatment for inmates with serious mental illness who are in the throes of psychosis. As our report notes, the consequences of failing to treat mentally ill inmates are “usually harmful and sometimes tragic.”

In this case, the consequences were tragic.

Read or download “The Treatment of Persons with Mental Illness in Prisons and Jails.”

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My Son Needs AOT - personally speaking

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(April 14, 2014) My 39-year-old son was diagnosed with schizophrenia 13 years ago. It started with various pains throughout his body.

mental illnessAfter his first psychotic break we took him to the hospital where he was prescribed medication, but we realized a year later that he had never taken it. He even cheated the nurse who was sent to observe him comply with his prescription.

He has anosognosia. There have been many times when he does not believe he has an illness. When he goes off his meds, he decompensates. He becomes delusional, his thoughts race and I fear for him and others around him.  

Because of this he is a classic example of the revolving door of mental illness. He has been hospitalized about 11 times over the course of his illness, usually staying about six weeks. Once he leaves the hospital, though, he stops taking his prescribed antipsychotics.

In Connecticut, we don’t have an assisted outpatient treatment (AOT) law so as long as he doesn’t believe he is sick, he won’t take his medication. People like my son are thrown back and forth in and out of hospitals and jails. 

The lawmakers don't get it. It is hard for me to believe that even after the Newtown tragedy, they still can’t find a way to pass court-ordered treatment for the most severely mentally ill.  Our son is high functioning when he takes his meds.

An AOT law would help people like him by lowering the rate of crimes and victimization. It would prevent the cycling of my son in and out of hospitals.

All we are looking for is a law that helps people with severe mental illness who need guidance when they stop taking their medication and start to decompensate.

We know that the most severely ill patients aren’t a harm to anyone until they harm someone and end up in jail, or worse.

The mother of a a man with schizophrenia
Connecticut

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Recommendations for Improving Treatment for Mentally Ill Inmates

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(April 11, 2014) Given the large number of seriously mentally ill individuals in our prisons and jails and the associated, the question becomes how these individuals can be treated for mental illness.

prison_mental_illnessMany of the seriously mentally ill inmates will accept medication voluntarily. Others, especially those who are not aware of their own illness (in other words, those who have anosognosia), will not accept medication voluntarily because they think there is nothing wrong with them.

Just as inmates should be treated for tuberculosis, diabetes, and hypertension, so also should they be treated for schizophrenia, bipolar disorder, and major depression.

The consequences of failing to treat mentally ill inmates are “usually harmful and sometimes tragic,” according to the report, which represents the first compilation of state laws and practices governing such treatment. Without intervention, symptoms worsen, leading inmates to behave in disruptive and bizarre ways and become vulnerable to being beaten, raped or otherwise victimized, to mutilating themselves or committing suicide.

All recommendations for improving the situation begin with the general premise that individuals with severe mental disorders who are in need of treatment belong in hospitals, not in prisons and jails.

The ultimate solutions to the problems presented in this report include having an adequate number of public psychiatric beds for the stabilization of mentally ill individuals and involve a fundamental realignment of the public mental illness treatment system in which public mental health officials at the state and county level are held responsible for any failure of the treatment system. Until that is done, the following are some interim recommendations.

  1. Provide appropriate treatment for prison and jail inmates with serious mental illness
  2. Implement and promote jail diversion programs
  3. Promote the use of assisted outpatient treatment (AOT)
  4. Encourage cost studies
  5. Establish careful intake screening
  6. Mandate release planning

Excerpted from “The Treatment of Persons with Mental Illness in Prisons and Jails.” Read or download the complete report from our TACReports.org website.

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“Zookeepers Are Not Allowed to Keep Animals Like This”

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(April 10, 2014) The Treatment Advocacy Center reported on Tuesday that our jails and prisons have become the de facto mental institutions for people with mental illness, many of whom are kept in solitary confinement once they arrive there.

jail_barbedwire"Zookeepers are not allowed to keep zoo animals in the kind of housing that we put human beings in," said Dr. James Gilligan, clinical professor of psychiatry in the School of Medicine at New York University, about the use of solitary confinement as punishment for mentally ill inmates (“Are we torturing the mentally ill?,” The Huffington Post, April 4).

Solitary confinement is often used as a punishment of behaviors that are symptomatic of severe mental illness.

In fact, an estimated one-third to one-half of inmates in isolation “have some form of mental illness” and the isolation makes it exceedingly difficult for mental health practitioners in the jails to treat patients. Most often, the care they receive is minimal- medication and a brief check-in through the door with a clinician.

But “solitary is a crucial tool that helps guards maintain order and provide a safe environment in often overcrowded facilities,” corrections officers argue.

Placing someone who is mentally ill in solitary confinement perpetuates the problem- the more time someone with mental illness spends in solitary, the less time they spend receiving appropriate psychiatric treatment.  The more time someone remains in solitary confinement without appropriate treatment, the more likely they are to behave in a way that reinforces the decision to leave them there.

In our study on the treatment of inmates with mental illness in jails and prisons, we found there are now 10 times more individuals with serious mental illness in jails and prisons than in the nation’s remaining state hospitals. This makes the issue of how they receive treatment even more dire.

Read “The Treatment of Persons with Mental Illness in Prisons and Jails: A State Survey.”

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Criminalization: Our National Thinking Disorder

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(April 9, 2014) In 1972, Marc Abramson, a young psychiatrist in San Mateo County, California, sounded the initial alarm for what he viewed as the “criminalization of mentally disordered behavior.” As California was emptying the state mental hospitals, Abramson was noting a rapid increase in the number of mentally ill inmates in the San Mateo County Jail. Reports from the California state prisons were describing a similar increase.

jail studyForty-two years have elapsed since Abramson published his observations. The Treatment Advocacy Center’s newest report on the plight of individuals with untreated severe mental illness surveyed each state to ascertain what has happened to this trend during the intervening years.

The Treatment of Persons with Mental Illness in Prisons and Jails: A State Survey” found we have placed more than 300,000 severely mentally ill individuals in prisons and jails that are neither equipped nor staffed to handle such problems. We subsequently have made it very difficult to treat the mentally ill inmates by putting restrictions on other options for controlling their behavior and then blamed the prison and jail administrators when the limited options fail. It is a situation that is grossly unfair to both the inmates and the corrections officials and should be the subject of public outrage and official action.

The survey thus demonstrates that the transinstitutionalization of seriously mentally ill individuals from state psychiatric hospitals to state prisons and county jails is almost complete. From the 1830s to the 1960s, we confined such individuals in hospitals, in large part because there were no effective treatments available. Now that we have effective treatments, we continue to confine these individuals but in prisons and jails where the treatments are largely not available. We characterize seriously mentally ill individuals as having a thinking disorder, but surely it is no worse than our own.

Excerpted from “The Treatment of Persons with Mental Illness in Prisons and Jails.” Read or download the complete report from our TACReports.org website.

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