Head Games

At least one out of every five Colorado prisoners is mentally ill -- some violent, some undetected or untreated. How did the Big House become the Bug House?

The problem has been growing for years, outpacing the general increase in Colorado's prison population. The number of inmates diagnosed with serious mental illness rose from 293 in 1991 to 3,750 in 2004 -- a jump from 3 percent to 20 percent of all state prisoners. Although the latest DOC numbers indicate a slight drop in that count -- to 3,590 -- the true figure may be much higher, since some inmates' illnesses are never properly diagnosed. The stigma of mental illness is so great in prison that some inmates do whatever they can to conceal their symptoms rather than be labeled as head cases.

A decade ago, the state opened a special prison for the chronically mentally ill, the San Carlos Correctional Facility. The care available there for inmates in crisis, including those with severe schizophrenia and bipolar disorders, can be better than anything they've received on the outside. But San Carlos has only 255 beds -- the DOC has been planning, then postponing, a 250-bed expansion for years -- and operational costs are more than double that of a typical prison. The majority of mentally ill prisoners aren't considered sick enough to be at San Carlos, or, like Anderson, they're regarded as management problems and receive bare-bones care in solitary confinement -- even though their illness may be directly linked to the behavior that put them there.

"Our prison population just keeps increasing, and a lot of it is that we're using incarceration instead of treatment for the mentally ill," says state senator Sue Windels, an Arvada Democrat who's working with an inter-agency task force seeking to change how the mentally ill are handled in the justice system. "We just have this revolving door, and it doesn't make sense."

Anderson knows he'll probably be on the wrong side of that door for the rest of his life. He doesn't expect to see the streets again. But he wants a shot at going from CSP to a less restrictive prison, and he wants the public to know what passes for mental-health care in lockdown.

"It may be too late to help me," he writes. "But if I can help anyone else get better treatment. At least I did something. There's no hope here, man. I don't think it's right that I stay here, possibly for the rest of my life. All over a problem that medication could solve. Or at least help.

"But I can't get it. That's crazy!"


There are many reasons for the national surge in prisoners diagnosed with mental illness, including better screening techniques and expanding definitions of what qualifies as a mental disorder. But the increase is also a logical consequence of policy decisions made decades ago.

In the 1960s and '70s, mental-health crusaders lobbied to shut down sprawling, substandard hospitals and asylums across the country. The goal was to develop community-based services and small group homes, thereby liberating people who'd been locked up and neglected, in some cases for decades, simply because they were mentally ill.

When the crusade began, Colorado's mental hospitals at Pueblo and Fort Logan had more than 6,000 beds. The state's population has since doubled, and 90 percent of those beds are gone. Across the country, half a million beds in state institutions disappeared. Mission accomplished -- except that the community safety net that was supposed to replace the old system never got the funding it needed.

In Colorado, community mental-health programs have been prime targets for legislators' budget-slashing in recent years. According to one study, six out of ten people receiving mental-health services in the state are now getting them outside of the health system -- including from the Department of Corrections.

Last year's passage of Referendum C has helped restore funding to some community programs, but Colorado is still well below average in its per capita spending on mental health. It particularly lags behind other states in providing services and treatment for those mentally ill citizens most at risk of ending up in jail or prison: the poor, the homeless, and those with "co-occurring" drug and alcohol problems or developmental disabilities. Bizarre behavior that might be treatable with mood-stabilizing drugs can, unchecked, lead to confrontations with police -- and incarceration. And people who are uninsured and mentally ill, overwhelmed by feelings of anxiety, depression and other demons, often seek their medicine on the streets, leading to convictions for drug-related crimes.

"There's a lot of self-medicating going on because they don't get the treatment they need," says Doyle Forrestal, director of public policy for the Colorado Behavioral Healthcare Council, a coalition of community mental-health centers and related organizations. "My personal feeling is that there are a lot of people in prison because they forged checks or did something else to buy drugs to self-medicate."

Steven White, a citizen member of the inter-agency task force studying the issue, is convinced his bipolar son's manic, impulsive behavior had a great deal to do with his conviction on a sex offense. His son's involvement with an adolescent girl who lied about her age and a subsequent effort at "suicide by cop" landed him in prison for six years.

"The general public doesn't have a good concept of the impact of mental illness on every soul in Colorado," White says. "As a parent, I can recognize chicken pox, but if my kid has early onset bipolar disorder, I'm pretty ignorant of what that looks like."

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