Nevada’s largest mental health facility isn’t a treatment center at all.
At any given time, about 20 percent of the 3,000 inmates in the Clark County Detention Center have mental problems severe enough to require psychotropic medication, making the downtown Las Vegas jail the state’s largest asylum.
The most violent, suicidal and mentally ill inmates are housed in North Tower, module 2C, which has 28 windowless cells, one inmate each. Most are checked every 15 minutes; potential suicides are constantly monitored by a corrections officer who notes the subject’s actions every four minutes.
Inmates with less severe mental problems also are segregated in four other modules, three for men, one for women.
For many inmates, the severity of their mental illness outweighs the seriousness of their crime.
The vast majority of mentally ill inmates are jailed on misdemeanors, with trespassing the most common charge, according to a 2011 study by Nevada Mental Health & Developmental Services.
Christy Craig, an attorney in the Clark County Public Defender’s Office, told a recent training class for jail personnel that a mentally ill person who commits a nonviolent crime may well land in jail, but is just as likely to be taken to an emergency room for a medical evaluation and then to the Rawson-Neal psychiatric state hospital on a 72-hour observation hold.
It often depends on how belligerent the person is and on the police officer’s judgment.
Craig gave the example of a frequent jail inmate and Rawson-Neal patient known as “the naked guy.”
“He would walk down the street naked,” Craig said of the man many of the officers knew by name. “When he was a jerk, he got arrested and taken to jail. When he wasn’t a jerk, they took him to the hospital.”
It costs $140 per day, plus medication, to jail a mentally ill person. A stay at a mental hospital is far more expensive, but the jail offers only custody, not treatment.
The naked guy is among hundreds of Southern Nevada’s mentally ill who can’t keep out of trouble, Craig said, mostly because they don’t stay on their medication or cannot get long-term care, which is lacking in the state. Many frequent inmates are homeless or have drug and alcohol problems that exacerbate their mental state.
At Rawson-Neal, which is budgeted for 190 beds, patients at the Las Vegas facility are given medication to control their mental illnesses, and offered group counseling with psychologists to work through their problems.
It’s an acute care hospital, so the goal is to get the patients stabilized quickly — sometimes it takes days, sometimes weeks or months in extreme cases — so they’re no longer a danger to themselves or others.
Hospital social workers are supposed to help arrange post-hospitalization care for the patients, who may return home, go into a group house or go back on the streets, joining thousands of homeless men and women.
In jail, the mentally ill get no therapy and are given only a few days’ supply of medications when they are released.
“Because of the way the system is broken, you guys are working in the largest mental health facility in the state,” Craig told the officers. “The problem is there’s not always room at Rawson-Neal and the ERs stay clogged up. It hasn’t changed in years and, frankly, I don’t think it’s going to change.”
CRISIS INTERVENTION TEAM
What has changed is how the state’s largest asylum deals with its inmates.
In the late ’90s, conditions were so bad at the Clark County Detention Center that the U.S. Department of Justice opened an investigation because of crowding and inadequate treatment, including poor care for mentally ill inmates.
By 2002, the federal agency closed its investigation following improvements.
Among those improvements: In 2003, the Metropolitan Police Department began Crisis Intervention Team training with the help of the National Alliance on Mental Illness.
The program was patterned after a CIT training started in Memphis, Tenn., in response to a public outcry after the police shooting of a mentally ill man who was cutting himself with a knife.
Clark County took it a step further, becoming the nation’s first detention center to also train corrections officers to handle mentally ill detainees. About 400 officers — half the staff — have now been trained to deal with everything from autism to schizophrenia.
In Las Vegas, several high-profile cases pointed to the need for better mental health training, including the 2001 death of a French citizen, Philippe LeMenn, 33. The mentally ill man died during a struggle with two jail guards. Two years later, his family settled a lawsuit for $500,000.
But Crisis Intervention Team training isn’t a cure-all, as Las Vegas police saw in the Dec. 12, 2011, death of Gulf War veteran Stanley Gibson. His death underlines the potential for tragedy when a mentally ill man is overlooked in jail rather than treated in a hospital.
Gibson, 43, was killed by an officer who fired seven shots from his AR-15 rifle into the unarmed man’s car during a standoff. Two days before the shooting, Gibson, who was off his anxiety medication, tried to punch a police officer who had responded to a 911 call to Gibson’s apartment.
Gibson was booked on a charge of resisting arrest and was supposed to receive a full psychological evaluation; but he spent less than 10 minutes with a jail nurse and was released on his own recognizance after nine hours because the jail was full, according to an incident review in February.
Gibson’s death helped prompt a federal review and sweeping changes in the Metropolitan Police Department’s use-of-force policies.
Inside the jail, suicides still happen despite the extra training and watchfulness. The latest came March 29, when Dillon Michael Hill, 25, a prisoner in general population, hung himself in a dormitory shower. He was found unconscious and taken to University Medical Center, where he died four days later.
‘OH BOY, HUG-A-THUG’
As part of a recent Crisis Intervention Team training session, corrections officers interviewed some of the mentally ill inmates they normally see through cell bars, but don’t often engage in everyday conversation.
One 19-year-old, accused of attacking a Las Vegas police officer on the street, got a wary reception from guards. They whispered to one another that the man in the dreadlocks was the one who punched a cop.
But sitting around a table away from his cell, they heard him out.
A high school dropout, the man said he was diagnosed last year as bipolar, and he hears voices. His illness gets worse when he takes drugs such as methamphetamine, although marijuana calms him.
He said the voices put him down and tell him to do bad things, making him “mad and a little bit sad.”
He said he sometimes blacks out and can’t remember what happened.
“I started hearing voices and they told me to hurt other people,” he said of his most recent violent episode. “Once I get set off, there’s no coming back.
“If I’m having an episode, have some patience,” he asked the officers. “If you keep talking to me, I’ll slowly calm down. Like, tell me I’m a good guy and stuff ’cause I tend to down talk myself.”
The man said he will enter a Mental Health Court drug treatment program after he is released from jail. He said he plans to stay on his medication, and hopes to go back to school.
“I’ll keep a busy schedule, stay off the drugs,” said the man, whose name wasn’t released to protect his privacy.
Capt. Frank Reagan, who runs the detention center and who conducts some of the crisis training, told the 30 officers who took the recent 40-hour course that he sometimes gets push-back from jail guards and street cops.
“I’ve had people tell me, ‘Oh boy, hug-a-thug. I don’t want to be in the class,’ ” Reagan said. “But I’ve also had people come to me with tears in their eyes because they’ve been doing everything wrong.”
Jim Ratel, a 17-year jail veteran, acknowledged that he and other corrections officers tend to think of the jail as being full of “zeros, losers, criminals, drug addicts.”
“Maybe we need more compassion,” Ratel told Reagan in class. “Maybe it’s not 100 percent their fault.”
Reagan said the goal of the training is to change the way officers “think and feel” about mentally ill detainees so they are more skilled at dealing with them and can better avoid endangering themselves, the inmates and others.
“You’ve got to protect yourself so you go home at night,” Reagan said, putting safety first.
But mentally ill inmates often are incapable of following orders. “They want to comply, but there’s another side of the brain that’s saying, ‘They’re trying to hurt you. They’re trying to kill you,’ ” which can lead to confrontations.
LOOKING FOR RESPECT
Craig, the public defender, was one of about 20 instructors who recently conducted four days of mostly classroom training at Metropolitan Police Department headquarters on Martin Luther King Boulevard.
Topics ranged from suicide prevention and psychotic disorders to crisis negotiations and communication.
The students went to the jail to interview mentally ill inmates, and to Rawson-Neal to observe group therapy sessions.
In the jail’s women’s mental health unit, known as 6 Mary, the four women interviewed all had drug or alcohol problems as well as a mental illnesses. None had significant family support.
One 25-year-old said she was diagnosed as bipolar and was in jail for drinking and doing drugs, including heroin, cocaine, marijuana and methamphetamines, whatever she could get.
“I don’t have so much control over my moods,” which vary hour to hour and minute to minute, she said.
Asked by one officer what she wanted from guards, the homeless woman said “respect.”
“We just want to be treated like people,” said the woman, who was thin, her bones jutting out from her prison uniform. “Some officers treat us like we’re idiots. Talk to us like human beings, not dogs.”
The other women all had children, though two said they hadn’t seen their kids for several years.
One 33-year-old mother of four said she left her husband after he hit her in the face with a brick. Diagnosed as bipolar, she spoke rapidly and smiled as she told the story.
The woman said she was in a manic phase, going for 16 or 17 days without sleep and hearing voices, when she tried to take back one of her daughters and was charged with second-degree kidnapping.
“This is the mental ill unit. We’re the worst of the worst,” she said, and laughed.
A 44-year-old woman from Elko said she lost her two children. Slumped in a chair, her hair falling over her eyes, she said she was diagnosed with schizophrenia at the age of 29.
“I’ll start drinking and then I’ll get in trouble with the law,” she said with a shrug.
She didn’t say what brought her to jail, this time around.
Another woman, hair in cornrows, had a job in hotel housekeeping before her latest DUI arrest. She also had an apartment and medical insurance with her job.
She said she was depressed and heard voices, mostly of her dead husband and grandfather.
“They say, ‘Don’t eat; don’t sleep,’ ” she said. “I’m so tired, but I can’t ignore them.”
In their visit to module 2C, the trainees spoke with an inmate who said he was lucky to be alive because the police had a hard time taking him in.
The 36-year-old, diagnosed as bipolar and schizophrenic, said he was hallucinating and hearing voices on the hot summer day when he was arrested. He hadn’t been taking his meds, but had smoked marijuana.
“I was stealing because I was trying to feed myself,” he said. “I didn’t get very far.”
Police caught up with him outside a Walmart where he was shoplifting. He jumped on the police car, dented the hood and smashed the windshield.
“I wanted to fight,” he said, making a fist and displaying a string of birds tattooed on his left arm.
Several officers shot him with stun guns.
“The Taser wasn’t working. It wasn’t affecting me,” he said, adding that he felt no pain.
Finally, he just collapsed, and the officers subdued him with pepper spray.
The officers had all seen his type before; the uncontrollable ones who may be experiencing “excited delirium,” a medically dangerous, high body temperature state that can be fatal.
Mario Yuzon, a member of the jail Special Emergency Response Team called in to deal with inmates who are violent or refuse orders, said the training gives him more tools.
“All the examples they gave, I’ve dealt with, I’ve seen that,” Yuzon said. “This class will help me be more patient. I want to educate myself about mental illness so I don’t get so frustrated.”
On the last day of training, the officers had to deal with scenarios involving mentally ill inmates and use everything they learned through the course.
One involved “excited delirium,” where no amount of talking could calm an inmate, played by a Las Vegas police officer.
Such cases are handled as medical emergencies, with a nurse called to help stabilize an inmate subdued by the extraction team, the officers were told.
Others cases involved an inmate who refused to take his court-ordered medication, a woman hearing voices in a cell and another woman who was belligerent and fighting with other inmates in the booking area.
The booking area is where the incoming inmates get medical and psychological evaluations for placement in appropriate units, Reagan said.
The most serious scenarios involved suicide threats. One man put a razor to his neck, saying he didn’t want to live.
“It’s too tight in here. I can’t go anywhere,” the inmate said. “Go away! Don’t hurt me!”
A series of trainees took turns trying to calm him. They introduced themselves by name and used his first name to try and make a connection. They found out he had a dog he was worried about.
Finally, he agreed to put away the razor when officers said he could talk to his doctor, whom he trusted.
In the other suicide scenario, a man climbed out onto the second tier of a cell unit and threatened to jump. He said he had just been sentenced for a murder he didn’t commit.
“I’m not staying my whole life in this place!” he shouted, pacing back and forth.
Officers who tried to talk him down told him he could appeal his case. And they asked if he had any family who would miss him. He said he had two daughters he had hadn’t spoken to in a while.
“I’m just going to end it right here,” the inmate said.
The officers told him it was never too late to appeal with a new attorney, or to be reunited with his daughters.
“Come down so we can get started on this,” said an officer, who finally got him to climb down.
George Gafford, a corrections officer for 23 years, said he has had to deal with a few suicide attempts, including one involving a man who threatened to jump from the second tier.
In that case, they just grabbed the inmate, he said.
Another time, a female inmate with AIDS hanged herself with a blanket. She died several days later.
Contact Laura Myers at firstname.lastname@example.org or 702-387-2919. Follow @lmyerslvrj on Twitter.