By Joel Warner
By Michael Roberts
By Joel Warner
By Michael Roberts
By Alan Prendergast
By Michael Roberts
By Michael Roberts
By Amber Taufen
In the second of a Westword series on Colorado's new breed of "special needs" prisoners, Karen Bowers goes inside the San Carlos Correctional Facility in Pueblo. Built specifically for mentally ill criminals, San Carlos offers an array of treatment regimens, ranging from mind-altering psychotropic drugs to more untested tactics like the therapy garden. Some inmates are schizophrenics who hear voices in their heads. Others suffer from depression. And family members of some crime victims say some inmates are fakers who aren't sick at all. In each case, San Carlos is redefining mental-health treatment behind bars--and testing the increasingly thin line that marks the difference between a patient and a prisoner.
"I'm blessed to be here and be a part of these activities," Birdie Kent says, his words a torrent that spill past his lips and the space where his bottom teeth should be. "I have more freedom, and I have someone to talk to when sometimes I feel stressed or depression."
Birdie's hands are in constant motion as he speaks; gesturing, tugging at his clothes, stroking his feathery mustache, they seem to have a life of their own. He is fidgety and insists on standing when others sit, but he smiles frequently and laughs almost as often, radiating a childlike innocence.
In fact, Birdie is neither a child nor innocent. Every wave of his hand is monitored by a phalanx of nurses, social workers and prison guards. Any disruptive acts or questionable behavior are quickly noted for the record.
Birdie Kent is 42, mentally retarded, mentally ill and a convicted felon. His rap sheet includes arrests for assault, obstruction and rape.
Although Birdie has been in and out of institutions and mental-health programs since he was an adolescent, he managed to stay out of prison until 1989, when a sexual-assault charge garnered him a twelve-year sentence.
Nothing--not even his stays in mental hospitals--had prepared Birdie for the realities of prison. Even the smallest change in his surroundings left him feeling frightened and powerless. He was an easy target for taunts--and worse. "People called me names," he says of the other inmates. "It's a mind thing, you know." He worried about being assaulted, and his belongings were often pilfered.
In 1995, however, things changed for Birdie. That's when he was sent to the San Carlos Correctional Facility in Pueblo, the state's newest prison and one designed specifically to house--and, theoretically, to help--chronically mentally ill felons.
Within months of its August 1995 opening, the $22 million facility was full, its 250 beds occupied by inmates who have been identified as the Department of Corrections' most seriously mentally ill. The DOC could have easily filled a prison twice that size. As it stands now, there are an estimated 350 additional prisoners throughout the system who have been diagnosed as suffering from chronic mental illness. (Those inmates receive mental-health treatment, but the services are minimal compared to San Carlos.)
Three psychiatrists, 3 psychologists, 9 social workers, 26 nurses and 118 correctional officers who received special training on how to handle the mentally ill were hired to staff the facility, an incredible ratio of nearly one staffer to every inmate. That compares with the remainder of the state penal system, where three psychiatrists serve 10,000 inmates and most of the state's prisons average one uniformed officer to every four prisoners.
That kind of special attention doesn't come cheap. It costs about $110 per day to house a prisoner in San Carlos--two to three times the amount for inmates at other Colorado prisons. In addition, the DOC is already pushing for an expansion that would add another 250 beds to San Carlos, even though DOC mental-health chief Jim Michaud says that number would still be inadequate to serve all of the state's mentally ill prisoners--and despite the fact there is no data to show that recidivism rates have been, or will be, reduced by placing prisoners in such facilities.
"It is expensive to house people here," concedes San Carlos warden Wallis Parmenter, who began her career as a parole officer. "But it costs far less than to put someone in the state hospital (where the price tag for treating and housing forensic patients is $252 per day)." And she insists that while the staff-to-inmate ratio is high, the number of uniformed officers is "barely adequate" to meet the facility's needs.
However, some opponents of the system complain that San Carlos's expenses are outrageously high, that inmates are being pampered instead of punished, that they receive better treatment than most mentally ill people who don't commit crimes, and that some of the inmates may even be faking mental illness.
"I think they mollycoddle 90 percent of them," says Chuck McQueen. "Where they live is better than some college dorms."
"They have a gymnasium and workout rooms," adds his wife, Marge, a touch of bitterness evident in her voice.
That the McQueens, like other Colorado taxpayers, are forced to bear the cost of San Carlos is galling to the couple for a very personal reason: One of the inmates residing at the prison is Philip Galimanis, who beat, stabbed and beheaded their daughter, Cynthia, in front of her two young children. While the McQueens struggle to raise their motherless grandchildren and pay a private therapist to help the children deal with their memories of the slaying, Galimanis is being tended to by a small squadron of mental-health workers. "We could put these girls through college ten times with what they're spending on [Galimanis]," Chuck McQueen says. "And there's no question of his guilt."
The McQueens also believe there's no question as to Galimanis's mental condition. "We feel he's not insane, but streetwise," Chuck McQueen says. "He's nothing but a spoiled kid."
San Carlos sits on the sprawling grounds of the state mental hospital, distinguishable from the other buildings only by its newness and the razor wire atop its walls. During its construction, Parmenter says, corrections officials debated whether the facility's primary purpose was to serve as a prison or a hospital. The answer is evident in the walled courtyards and guard stations that dot the four-story structure. In the words of Denver forensic psychiatrist Jeffrey Metzner, San Carlos is no country-club clinic for the "worried well."
"We are a prison, first and foremost," Parmenter says--albeit, she acknowledges, "a prison that offers a great deal of mental-health services." The routine is tightly structured; prisoners attend scheduled classes and therapy sessions that take up most of their day, leaving little time for watching television and playing cards, the favored pastimes in other DOC facilities. Because of that, Parmenter is not overly concerned about state prisoners faking illness to get into San Carlos. "It's not a pleasant place," she says.
Still, says Mark Diamond, chief psychiatrist for San Carlos and the DOC, "it's about as close as you can come to a hospital in an institutional setting. It's revolutionary in terms of corrections."
As with most things revolutionary, San Carlos didn't arrive without a struggle. It was established not out of any beneficence on the state's part, but as the result of a lawsuit. Ramos v. Lamm, which was filed in 1977 but settled just two years ago, was an omnibus legal action filed under the auspices of the American Civil Liberties Union that complained of oppressive conditions for prisoners, including the mentally ill.
As part of a negotiated settlement, the state consented to provide better psychological services for inmates. The legal standard today in Colorado, agreed to by the state in the settlement, is that prisons must provide criminals with medical and mental-health services comparable to what is available to ordinary citizens outside the walls.
The youngest of the San Carlos inmates is not yet eighteen. The oldest is seventy. And at last count, 24 of the 250 inmates were women. The inmates' crimes run the gamut from burglary to sexual assault to murder. Some of the prisoners, like Birdie, are both retarded and psychotic. Others suffer from manic depression coupled with an addiction to drugs and alcohol. Many have been diagnosed as suffering from paranoid schizophrenia; some of them hear voices in their heads that order them to commit gruesome acts. A number of prisoners suffer from severe clinical depression, operating in a mental fog that makes it difficult for them to function.
Then there are the special cases. A few of the inmates are afflicted with an organic brain syndrome that stems from head injuries or repeated substance abuse. Some of the older inmates suffer from disorders such as Alzheimer's disease. One prisoner, Ray Stuart, was convicted in the 1992 shooting deaths of his estranged wife and fifteen-year-old stepson. He landed in San Carlos because, when he tried to kill himself after putting at least four bullets into his wife and stepson, he succeeded instead at blowing away part of his brain. The self-inflicted wound left him mentally unstable, partially paralyzed and confined to a wheelchair.
San Carlos was designed as a multi-custody facility, where inmates ranging from minimum- to maximum-security classifications could be safely housed. The upper two floors house inmates with suicidal tendencies and those who literally cannot leave their cells without being assaulted or assaulting someone else. The headbangers and those bent on cutting themselves or carrying out some other form of self-mutilation also find their way to the upper tiers, where they spend most of their time in their cells, even taking their meals in seclusion.
There are several types of special cells at the facility, including "time-out rooms," stripped-down cells that are used for inmates who have become disoriented or are behaving strangely, and "four-point rooms" for inmates who are shackled to beds during psychotic episodes that may lead them to bite or cut themselves.
The vast majority of the cells are for one person only. "They don't do well together," Parmenter says of her charges.
The prison wraps around a landscaped courtyard where the more stable inmates can play games of pick-up basketball or volleyball. Inmate William Poor, who has bounced in and out of prison five times and is now in on an assault rap (a result, he says, of suffering from bipolar disorder and drug addiction), helps tend the garden, where he and others grow vegetables and flowers.
Visiting rooms have been provided for inmates' friends and family. But, says Parmenter, visiting days at San Carlos are not the crowded, bustling affairs they are in other prisons. "We just don't have the number of visitors we expected," she says. Adds Bob Flores, who heads a team overseeing San Carlos inmates, "Their friends and family don't deal with them real well."
About 60 percent of the inmates receive anti-psychotic drugs, which treat their symptoms and, as a consequence, make them easier to manage. But the image of zombie-like patients wandering the halls isn't the reality at San Carlos. "We monitor their blood levels and watch them closely," says prison staffer Lorraine Diaz. "If they appear too sedated, we might cut back on their meds. Our goal is not to snooker them."
San Carlos prisoners see a psychiatrist once every thirty days, and a psychologist about twice as often. Those who are well enough attend group therapy at least twice a week, learn to cook and sew, and are taught about their illness, its symptoms and the critical importance of taking medication.
In a nearly unprecedented commitment of resources, San Carlos even operates a special transitional program in which social workers help smooth the way for inmates ready to be paroled from the institution. The services provided are not unlike those commonly offered on the outside to the poor or the elderly by government agencies. Staffers link departing inmates with a network of social services and help them obtain Social Security disability benefits when warranted. (Many prisoners released from San Carlos receive monthly checks based on the claim that they are disabled by their illnesses.) Staffers also teach living skills to help the inmates establish some measure of independence.
For Birdie, those skills are of the most rudimentary sort. When he was outside the walls, he held jobs as a janitor and busboy, but his mother handled all his daily needs. "She gave me clean clothes every day," Birdie says, "and she put a meal on the table every day. She knows I love chicken."
But Birdie's mother died during his prison hitch, and he's learning to cook and sew for himself. "I make clothes," he says proudly. "I'm a tailor. Shirts, pants, jackets. Four weeks ago we were on a project. It was to put together an apron."
On the last Friday of each month, Birdie and the other inmates in the developmentally disabled unit get together and cook a meal. "We got muffins, and Miss K. (Anna Krafnick, a prison nutrition and cooking instructor) gave us some ingredients--olives and mushrooms and pork and beef--and we put them in the microwave," he says. "It was good, too."
Staffers believe that this multi-tiered system of treatment has been good for Birdie. His mental condition has allegedly been stabilized with a combination of three psychotropic drugs, and he attends counseling sessions and what he calls "socialism class" (where inmates are taught interviewing techniques and job-hunting skills).
Perhaps most important, staffers say they make sure that when inmates leave San Carlos, it's with a thirty-day supply of psychotropic medication--and with assurances that someone will monitor them to ensure that they take the pills. Remaining on their medication is a condition of parole for the majority of inmates who leave San Carlos. Cutting off the chemical regimen is simply too dangerous for some of them--and for the people whose paths they may cross on the outside.
Philip Galimanis was just 21 when he killed Cynthia McQueen. He was a troubled young man with a history of prior mental illness and a prescription for psychotropic drugs. Galimanis's mother testified at her son's trial that Philip refused to take his medication in the months prior to April 1983. (The McQueens maintain that the Galimanis family simply chose not to buy the expensive drugs.)
While off the medication, Galimanis's mother testified, her son had begun acting strangely--he believed that a neighbor was watching him through the floor and following him from room to room. Even his mother began to fear for her personal safety.
On the night of April 19 Galimanis attacked 22-year-old Cynthia McQueen, who lived across the hall from him in a Wheat Ridge apartment house. "It wasn't like going out and shooting somebody--bang!--and you're done," Chuck McQueen says of his daughter's murder. "This took hours. She was alive when he started to decapitate her."
The staff had feared this was coming. When Johnnie Summers arrived at San Carlos last September, he was highly unstable. He'd consistently refused medication for his schizophrenia and had slowly disintegrated to the point that he'd begun hearing voices. When it became clear that Summers had lost touch with reality, the staff placed him in a time-out room, where it was hoped he would be unable to hurt himself.
When Summers stripped off his clothes, rubbed his lunch over his naked body and began trying to bang his head on the floor, the staff members took more drastic measures. Their plan was to take him out of his cell and move him to one of the prison's four-point rooms. Summers's hands and legs would be cuffed, and he would be sedated. It would be no easy task. The 5-10, 200-pound Summers, whose rap sheet includes busts for trespassing and drug offenses, was certain to put up a fight.
It was decided early on that staffers would videotape the event, in part so they could use the film to train other officers in what are known inside the DOC as "cell extraction techniques."
On the tape, Summers emerges from his cell appearing relatively calm and cooperative. The struggle begins only after the guards try to give him a shower to rinse the food off his body.
Suddenly, Summers begins to buck and writhe, attempting to cast off the hands that hold his arms and legs captive. His voice rises in an unearthly shriek, his grunts and cries horrifying and unintelligible.
As Summers struggles and wails, the lead officer talks to him continually, trying to reach a part of the inmate's mind that might understand. "It's okay. Relax," the officer tells Summers. "Stop resisting. Calm down. You're okay. We're not trying to hurt you. Relax, partner."
But Summers is unreachable. Other staffers rush to the scene and place a helmet on Summers's head so he won't injure himself. They lay a towel over his genitals so he can't urinate on them, and another over his mouth so he can't spit in their faces.
Ultimately, it takes six people an hour and a half to subdue him.
"When they get like that," says Parmenter, watching the tape from a conference room down the hall from her office, "they are fearful and they will fight for their lives. When that happens, they're very dangerous."
Soon after the videotaped struggle, Summers was transferred to the state hospital, which serves as the prison's escape valve when it encounters inmates its staff can't control. It's a policy that speaks to a weakness in efforts to treat mentally ill inmates like patients: Because San Carlos is a prison and not a medical facility, the staff can't legally force prisoners to accept medication and treatment against their will. When inmates are on medication and their symptoms have eased, they are more amenable to treatment. But prisoners who refuse medication can quickly careen out of control. When, as in Summers's case, an unmedicated inmate becomes completely unmanageable, he or she is sent to the state hospital for evaluation. If doctors there determine that medication is necessary, they must petition a court and obtain a civil order for the right to provide treatment.
For that reason, San Carlos maintains twenty beds at the state hospital, some equipped with leather restraints. On any given day, most of those beds are filled.
Some experts believe that up to 20 percent of the more than 500,000 prison inmates in this country suffer some sort of mental disturbance. Colorado corrections officials estimate that 6 percent of the state's prison population are afflicted with a chronic mental illness.
Criminologists contend that the percentages of inmates with mental illnesses began increasing about twenty years ago, as the concept of "deinstitutionalization" took hold. Its roots were humanitarian (and in some cases, monetary) in nature, and it resulted in the release of untold numbers of people from state mental hospitals across the country. Colorado alone released thousands of patients during the 1960s and 1970s, says state hospital spokeswoman Nell Mitchell (many because the development of psychotropic drugs had made their illnesses easier to manage). The hospital's population eventually declined from a high of more than 6,000 patients to a recent count of 530.
Many of the mentally ill who'd been freed from state hospitals arrived in communities that had inadequate resources with which to help them. Some became homeless. Others turned to crime. And with the de-emphasis on hospitalization, incarceration seemed the only viable alternative for those who broke the law.
"There is a general consensus," says the DOC's Diamond, "that with deinstitutionalization, many of these people are ending up in county jails and/or prison. It's a problem nationwide. Somebody is going to end up with them. Unfortunately, many times it's us."
"We often find that we trade inmates with the state hospital all the time," Parmenter says. "A lot of our staff formerly worked at the hospital, and they see some of the same faces here that they saw there thirteen years ago."
The first stop for many of the mentally ill who land in prison is the office of the state public defender. "A lot of our clients, a lot suffer from mental illness," says Sharlene Reynolds, who heads the Denver branch of the public defender's office. "We're dealing with clients who have had abusive childhoods, who have been on the streets, who have a history of mental illness in their family.
"Oftentimes," Reynolds says, "I think the defense lawyers, the district attorneys, the judges--everybody in the justice system--gets so frustrated when they have to deal with the mentally ill defendant that they give up, and the defendant goes to prison. We throw up our hands and say, 'Nothing more can be done.' We don't know what to do with them."
But corrections personnel as a rule are equally unsure how to best deal with the mentally ill. "You throw in a schizophrenic who's actively hallucinating, and nobody knows what to do with them," observes Michael Steinert, a clinical manager with the Mental Health Corporation of Denver. "A lot of jails are not able to handle people like that."
Mentally ill inmates present significant problems when they're funneled into the general population at state prisons, notes Parmenter. "Other inmates target them for harassment and abuse, and they might try to get them to act out," she says. "They'll say, 'Go break into that candy machine,' and the [inmate] will do it." And the mentally ill can be victimizers as well as victims. Sometimes they assault other inmates. Sometimes their illness causes them to be combative.
In the past, the most a disturbed inmate might have received within DOC was minimal care--if he received any treatment at all. And Colorado's handling of the mentally ill wasn't all that different from what was happening in prisons across the United States.
Conditions in the country's prisons eventually reached the point that lawsuits over the treatment of mentally ill inmates became the norm. State or federal courts in at least twenty states ultimately intervened to require that mental-health services be expanded or improved.
In Colorado the pivotal case was Ramos v. Lamm, in which Fidel Ramos, a stick-up artist with a bad drug habit, and other inmates at the "Old Max" prison in Canon City banded together to complain of severe overcrowding, filth, and a general lack of services for those in need of medical and mental-health care.
U.S. District Judge John Kane asked Jeffrey Metzner and others to take a hard look at the prison system's psychiatric program. What they found was appalling. "Pre-Ramos," Metzner says, "there were three full-time staff psychologists in the department and one part-time psychiatrist [for roughly 4,000 inmates]. Even if the staff were the most wonderful in the world, it would not have been enough bodies to cope with the workload."
Because the treatment was inadequate, Metzner says, many of the prisoners suffering from mental illness were acting out. "People would throw fecal matter and urine," Metzner says. "They'd get in fights and cut themselves a lot."
Often when an inmate became psychotic, he or she would be placed in an "administrative segregation" cell and locked down 23 hours a day. "You won't get anyone to say that the treatment for seriously mentally ill patients is to lock them down 23 hours a day," Metzner says. "It only makes them worse. We'd get inmates who would cut their wrists so that they could go to the infirmary. So there were rashes of cuttings. It was a very stressful place."
Judge Kane agreed, and in 1979 declared that the prisons were in such poor shape that they violated the Constitution's ban on cruel and unusual punishment. Metzner and others were charged with getting the psychiatric care up to constitutional standards. Today, Metzner observes, "prisons are the only place in the country where there is a constitutional right to treatment."
Although Kane's sweeping ruling eventually led to the construction of twelve new prisons and the complete rehabilitation of Old Max, change was slow in coming to Colorado. State officials began discussions about building a special facility for chronically mentally ill inmates in about 1990, says the DOC's Michaud, but finding the money and a suitable site for the facility were stumbling blocks. As a stopgap measure until San Carlos could be built, the DOC set up two "special needs units" in August 1991. The more seriously mentally ill were housed in a unit at the Centennial prison in Canon City. The more stable were housed at the Arkansas Valley prison near Ordway.
When it was decided to build San Carlos on the grounds of the state hospital in Pueblo, workers soon stumbled across a grim reminder of the state's past treatment of the mentally ill. Construction had to be halted for several weeks in 1992 when crews preparing to lay the foundation began unearthing human skeletons with their backhoes in a vacant field behind the hospital power plant. An investigation was launched by the county coroner, whose best guess was that the remains marked a forgotten graveyard that had been used to dispose of state hospital patients between 1890 and 1915. The state hadn't bothered to put up tombstones--or even to keep records indicating the identity of the patients whose bodies had been laid to rest in neat rows outside what was then known as the Colorado State Insane Asylum.
San Carlos was subsequently reconfigured, primarily for financial reasons. The prison now sits across the street from the site of the old graveyard, whose residents, still unknown, have since been reburied elsewhere on the hospital grounds.
When San Carlos opened in August last year, the inmates from the pilot programs at Arkansas Valley and Centennial were the first to be admitted. Over the next few months, another 150 prisoners were handpicked from prisons around the state. Together the residents of San Carlos represent the most seriously mentally ill of all the inmates in the Department of Corrections.
Those inmates who had been management problems--who fought, threw feces or were suicidal--easily made the cut. But plenty of inmates whose crimes were seemingly the result of deranged minds weren't considered ill enough to be admitted to San Carlos.
For example, Gregory Clifford, whose lawyers claimed that he murdered and dismembered a woman at his Edgewater apartment during an alcohol-induced hallucination, is not living at San Carlos. Neither are brothers Vernon and Joseph Turley, whose two-state string of sadistic kidnap/rape cases landed them in prison six years ago.
An inmate's mental condition, not the nature of his or her crime, determines placement at San Carlos. Some of the prisoners there are in for theft or burglary. Some, such as Samuel "Dino" Salaz, are murderers.
Salaz, now 34, was just 17 when he lured a young neighborhood girl to a Federal Heights park and stabbed her in the back, heart and lungs with a four-inch buck knife. Though Salaz admitted his 1980 crime to family members, he eluded capture for ten years until, one night, he walked into a police station and turned himself in.
During the decade that passed between the crime and his surrender, Salaz's mental condition had deteriorated to the point that he'd been hospitalized at least twice and given prescriptions for psychotropic medications (which he didn't take). Salaz had become obsessed with cleanliness, scrubbing floors and counters by the hour and washing his hands so insistently that he once scrubbed his palms raw. He wound up pleading guilty to second-degree murder and received a twenty-year sentence.
But despite the aberrant nature of some of their crimes, none of the inmates at San Carlos are legally insane. The forensic unit at the state hospital (now known as the Colorado Mental Health Institute) remains the official custodian of people who have been found not guilty of a crime by reason of insanity. At the end of May, 190 such patients were housed at the hospital.
The difference between those patients and the inmates at San Carlos is sometimes impossible to distinguish. "It's a legal difference," says Parmenter. "Not a mental-health difference. When you talk about sane and insane in a legal sense, that line is fuzzy."
"People do crazy things," adds Diamond, "and it isn't excused by the law unless you meet certain criteria. Just because you're schizophrenic, that doesn't mean you meet the legal definition of insanity. To be found not guilty by reason of insanity is a two-pronged proposition. First, you have to suffer from a prolonged mental illness, and second, because of that, you have to have been incapable of determining right from wrong and be so unaware of what you were doing that you were incapable of forming intent.
"It also depends on what the jury buys."
Common perception to the contrary, lawyers rarely pursue an insanity defense, and when they do, they rarely succeed.
Salaz's attorney, for instance, pled his client guilty to the second-degree murder charge rather than face a prosecutor who felt he could prove Salaz knew right from wrong at the time of the murder and thus was guilty of first-degree murder. Galimanis has been found legally sane in two hearings (the first was overturned on constitutional grounds, and the McQueens say that Galimanis's public defender is appealing the second finding as well.)
Even Jeffrey Dahmer, who confessed to murdering seventeen young men, dismembering them and cannibalizing some, was found by a jury to have been sane at the time of the killings. So was John Wayne Gacy, who killed 34 men and boys and buried their remains in his basement.
John Hinckley, who tried in 1982 to assassinate President Ronald Reagan in an attempt to impress actress Jodie Foster, was declared guilty but insane, then shipped off to a mental hospital.
Colorado does not offer a verdict of guilty but insane. But in July 1995 the state legislature toughened laws regarding insanity pleas. Previously, sanity hearings were held separately, prior to trial. Under the new law, sanity issues are debated concurrently with the criminal trial in a single proceeding.
William Poor, 35, has been in and out of prison for decades. Counting his current incarceration (a three-year sentence for assault and menacing), he's been up the river five times, three times in California and twice in Colorado. He's been into alcohol and drugs in a big way--speed and crack were particular favorites, but he combined them all at one time or another.
"I had a pattern where I'd be fine for three or four years," he says, "and then I'd have a blowup." Poor was sent to Denver General Hospital after one of his "blowups" and was diagnosed with bipolar disorder (also known as manic depression). Following his assault conviction almost three years ago, Poor was sent to the pilot program for the chronically mentally ill at Arkansas Valley. When San Carlos opened, Poor was one of the first "guests" in the unit for those diagnosed with bipolar disorder and with a history of substance abuse.
Poor, along with fellow inmate Mike Lonas, served as a unit leader and program coordinator, helping new inmates get adjusted. Each man in the unit signs a contract promising to work in the kitchen or act as a clerk or porter. Everyone is given responsibility for enforcing the house rules.
"A lot of us have never been on medication before," says Poor. "They get us stabilized on medication and they try to educate us on how to deal with our symptoms and when to seek help." All in all, he says, "it's been a very safe environment to open up."
For Lonas, a chubby, baby-faced 39-year-old, opening up was particularly hard. Initially, he says, the prospect of divulging his deepest secrets--including the fact that he is gay--made him resistant to accepting treatment. "There was no way I wanted people to find out," Lonas says. "Not in prison. But my caseworker assured me that it would be no problem, and it hasn't been. Now I don't hide it."
Lonas has been in and out of mental wards, including the state hospital, and was diagnosed as bipolar fifteen years ago. He sought refuge in cocaine. But unlike Poor, this is Lonas's first stint in prison. He swears it will be his last.
Police caught up with Lonas while he was working for the Rocky Mountain Institute, a nonprofit, Aspen-based think tank dedicated to exploring alternative energy concepts. "He was involved in computer systems operations," says Dave Blaine, an investigator with the Pitkin County Sheriff's Department. "He could buy equipment and pay suppliers. But he embezzled money and stole computers, hardware and software. I think he stole between $9,000 and $17,000. He was arrested for forgery and theft." Lonas got an eight-year sentence; he's been "down" for two.
Much of Lonas's first year and a half in prison was spent at the Fremont facility in Canon City, where, he says, "you learn nothing about yourself. I slept and watched TV and ate meals." Since coming to San Carlos six months ago, however, "I'm a new person," he says. "I have a new life."
Lonas still has plenty of time before he faces the prospect of release. He isn't scheduled to go before the parole board until January 1998. Poor, though, is a short-timer. He voluntarily turned down a chance to meet the parole board earlier this year when he learned that he couldn't be released to a residential program that would deal with his addictions to drugs and alcohol. Another felony conviction could lead to a lengthy sentence as a habitual offender, Poor says, "and I don't have an opportunity to go out there and make a mistake." (Poor was recently accepted at another drug rehab center and has left San Carlos.)
In her ten years as a parole officer, Kelly Messamore has seen it happen again and again to ex-cons who suffer from mental illness: Released from prison and unable to cope with life on the outside, they quickly commit more crimes.
"One of the first cases I remember," says Messamore, "was a man who was released with the standard $100 and no place to live. He'd discharged his number [served every day of his sentence] and was not on parole. He didn't have the ability to find a home and a job. Within a couple days, he'd thrown a rock through a business window. He wanted the police to pick him up and take him to prison, because he thought he would be safe there."
Even when inmates had parole officers to fall back on, the system often failed. "What would typically happen," Messamore says, "is that they'd be released, and because mental-health issues are confidential, parole officers were not even aware that there were mental-health issues with a client.
"They would have been on medication [in prison], and they'd show up for their first meeting, and they'd look pretty good because they'd been on meds for a long time. When their next appointment came around, maybe in a couple weeks, they'd have [worsened]. And by the time we were able to address those problems, it was too late. A lot had already fled or reoffended."
At San Carlos, prisoners nearing the end of their hitch aren't necessarily guaranteed their freedom. If the San Carlos staff feels that an inmate close to being released is still a danger to himself, says staffer Lorraine Diaz, the inmate can be sent to the state hospital for evaluation--and a possible civil commitment after their prison term has been completed. One female inmate whom Diaz says is very violent is now in the process of being reviewed for possible commitment to the state hospital.
Those prisoners deemed well enough to be released into society often wind up on Messamore's Denver doorstep. One such client is Preston Lowe.
Lowe, like Birdie Kent, is developmentally disabled. Now forty, he was diagnosed with paranoid schizophrenia while still in his teens, and he has been in and out of hospitals since 1975. He has survived numerous suicide attempts and an addiction to illegal drugs.
His psychotic episodes, when they occur, are "scary," Lowe says, in an interview at the parole office in downtown Denver. "It's like shadows and wicked, wicked stuff. I hear things hollering out. But I never experienced a voice where the voice makes me do something. It's like they're having a conversation with somebody else."
Although anti-psychotic drugs helped keep the voices at bay, Lowe was resistant to the treatment because of the side effects caused by the medication. "I was on these shots, and I didn't like it," he says. "I'd shake, and sexually I had problems with it. Sometimes I could read, but it would get blurry."
So Lowe quit taking his prescribed treatments and self-medicated himself instead with alcohol and cocaine. In 1979 he went to prison on a ten-year sentence for sexual assault. He was paroled and got a job working as a janitor. But he went off his medication again, began taking illegal drugs, and in 1994 was arrested and convicted on first-degree assault charges. Although Messamore says she has few details about the sexual-assault case, she seems certain that Lowe's second assault conviction was a direct result of his failure to maintain his regimen of psychotropic drugs.
"He owed a guy some money," Messamore says of Lowe's 1994 case, "and when he came around, it scared Preston and he stabbed him. His perception of it is very distorted."
After that arrest, Lowe was sent to the Arkansas Valley prison, where he took part in the special-needs program for the chronically mentally ill. When San Carlos opened, he was transferred there.
Lowe has been out now for about nine months. And according to Messamore and Lowe's therapist, Mike Steinert, he is doing well. Some of the credit for that, they agree, must go to San Carlos.
"I think that when Preston went to prison, he really turned around," says Steinert. "He's never gonna be a, quote, 'normal' individual. But he's much more involved in his treatment, and he's motivated by the fact that he's on parole."
Some of that attitude is due to the prison's emphasis on getting inmates to understand their illness, says Steinert. But he adds that Lowe is also motivated by the fact that he doesn't want to go back to prison. "The whole experience was pretty traumatic for him," Steinert says. "He realized severe consequences for what he did."
Lowe was helped, too, by San Carlos's transition team, says Messamore. Prison staffers found him a place to live and signed him up to begin receiving Social Security benefits almost immediately. He also was enrolled in an intensive therapy program at the Mental Health Corporation of Denver. Unlike many of the mentally ill who come out of prison, notes Messamore, "Preston was really kind of lucky in that he had some VA benefits [from a short stint in the National Guard] and that he had some family to parole to. That's sort of unusual. A lot of these people end up in shelters or, because they're violence-prone, the shelters won't take them and they end up in hotels or the YMCA."
But not everyone agrees that what has happened to Lowe was the right way to deal with his problems. "It seems to me," says public defender Reynolds, "that if San Carlos is dealing with the chronically mentally ill, those people shouldn't even be in prison. I think they should be in a structured mental-health program." And if people like Lowe are imprisoned, she argues, they should be evaluated and released as soon as they have been stabilized through medication and therapy.
But Steinert sees a benefit in placing disturbed inmates in the correctional system--if their mental illnesses are treated. "For some, it can be a real comfortable place because of the structure," he says. "But it's also very important to allow the person to experience the natural consequences of their actions."
Messamore says it's important to remember that, mentally ill or not, the inmates at San Carlos are criminals. However, providing treatment inside prison is crucial, she adds, even if at times it creates the appearance that the state is cosseting criminals. "We're going to pay for these people one way or another," Messamore says. "Some day, some way, they're going to get out."
Corrections officials hope that when prisoners from San Carlos get out, they'll stay out. To date, however, there is no convincing data to show that, even with expensive treatment, the chronically mentally ill are any less likely to reoffend.
Officials so far seem to have hitched their hopes to an informal recidivism study conducted in 1994, when the state parole office surveyed 42 chronically mentally ill parolees. Although not statistically valid, the study pointed out the importance of pre-arranging housing and disability benefits for prisoners, many of whom lack the mental capacity or organizational skills to take care of those everyday matters themselves.
"Of those people who had no resources and went to live in a shelter," Messamore says, "about 90 percent of them went back [to prison]. Of those who had some kind of support, 50 percent went back. I know that those figures are [still] incredibly high. But that is a 40 percent difference in the recidivism rate."
Such slim evidence doesn't impress critics. But it's enough for prison officials, who are counting on San Carlos and its follow-up program to help keep mentally ill prisoners from reoffending. Those officials say it's critical that the new experiment succeed, because the numbers of such inmates are bound to increase. By the time San Carlos is able to double its bed space to 500, says Michaud, there will likely be 800 chronically mentally ill prisoners in the DOC system.
Back in his unit at San Carlos, Birdie Kent says he's ready to go. He's slated to meet the parole board this week, and he hopes the board members will decide to release him. In the meantime, the convicted rapist is trying to remain upbeat about his ability to make it on the outside--and to stay out of trouble.
"I'm thinking about Birdie Kent," he says, referring to himself in the third-person vernacular so familiar to veterans of therapy groups. "When I close my door and go to bed, I, Birdie Kent, seem important to me--who I am, how I'm feeling," he says. "I got to make it out of here someday.