The Good, The Bad & The Mad

What happens to the mentally ill in the justice system is just crazy.

Thomas Espinoza met with Westword twice in the weeks leading up to his trial. Both interviews took place in a small, bare room in the Arapahoe County Detention Facility, without escort, handcuffs or barriers of any kind. Some of his visitors have refused to be alone with Espinoza; at one point even his own lawyers weren't allowed to meet with him outside the presence of a sheriff's deputy. At a court hearing several months ago, his attorney at the time asked to be removed from the case because of irreconcilable differences, which his client had summed up in a few well-chosen words at their last meeting.

"Get off my case or I'll kill you," Espinoza reportedly said. "Fuck you."

But at other times, Espinoza's behavior has been more odd than threatening. He begins the first interview by lifting his shirt and pulling down his pants to display a rash he acquired in jail, which he insists the staff has ignored. He presents piles of paperwork, much of it grievances he's filed over his skin condition and articles from medical journals dealing with post-traumatic stress disorder resulting from childhood burns. But talk about fighting and killing people is never far away.

Thomas Espinoza complained of voices telling him to hurt people; he blames his mental problems on the fire he was in as a child.
Thomas Espinoza complained of voices telling him to hurt people; he blames his mental problems on the fire he was in as a child.
NAMI Colorado executive director Lacey Berumen wants state lawmakers to fix a breakdown in services to the mentally ill.
mark manger
NAMI Colorado executive director Lacey Berumen wants state lawmakers to fix a breakdown in services to the mentally ill.

He cut off his mother's boyfriend's finger when he was fifteen, he says. He lived on the street for years and slept on rooftops with a gun, expecting to be attacked. Of the four years he's spent in jail and the state hospital since his arrest, nearly eighteen months were counted down in the hole after fights with other inmates.

"I'm in a day room with a bunch of idiots," he says. "If someone touches my discovery, I'll kill them. I've told the judge that. I haven't hit anyone in a year. But if you touch me, I'll break you in half. I had two fights in one week."

Although he sometimes binged on booze, cocaine and meth on the street in an effort to "feel normal," he's refused the prescription drugs available to him from the jail medical staff. He says he wants to avoid the "Thorazine shuffle."

"I'm not going to make myself defenseless like that," he declares. "I want to know what's wrong with me before I take anything ever again. All they want to do is give you the magic pills. They got guys in here on Depakote, Risperdal — they're not mentally ill. They fake it to get high."

Prosecutors say Espinoza is the faker. If he truly suffers from a treatable mental illness, they contend, he would have sought help more earnestly, and there would be more extensive medical records than a handful of emergency room visits over twenty years, with their conflicting symptoms and tentative diagnoses. But Espinoza says he's known something was very wrong in his head for most of his life. "If I never asked for help, I would shut my mouth and take what they give me," he says. "But I did ask — over and over. You know how frustrating that is?"

Espinoza is hardly alone in claiming a history of mental problems that eluded clear diagnosis. Common barriers to seeking mental-health treatment include homelessness, substance abuse, lousy or non-existent health insurance and the stigma associated with mental illness — all factors in Espinoza's case. And when help is sought, the presence of a personality disorder — an untreatable kind of defect of the soul, which the shrinks at the state hospital believe that Espinoza has in spades — can complicate matters by masking other symptoms.

Even people who've been properly diagnosed can encounter a bewildering series of setbacks as they attempt to negotiate the maze of bureaucracy, which guards its bare-bone services and resources like crown jewels. Case in point: In the 1990s, Colorado developed an innovative, community-based program for Medicaid clients whose severe, chronic mental illness might otherwise consign them to nursing homes. By 2005 the program was serving 1,800 consumers at an annual cost of $8 million. But a federal audit last year found many of the same problems identified in a 2002 audit, and critics of the program say the state is simply ignoring serious instances of neglect, substandard care and poorly trained providers. Almost lost in the bureaucratese of the report are signs of recurrent breakdowns:

• A visit to one Denver "alternative care facility" found no house manager on the premises. The 55 residents of the boarding home were often left on their own during daylight hours. Several were flying signs on Federal Boulevard for beer money or wandering the streets.

• Some "personal care providers" brought small children with them when they visited the homes of their mentally ill clients. One client, who kept a loaded firearm beside his front door, questioned the wisdom of this.

• Another armed client barred all visitors from his house and piled boxes everywhere to block the lasers that he believed enemies were beaming at him. Caseworkers notified him by cell phone before leaving meals or paperwork outside the house. Leftovers were tossed back in the yard, attracting rats and other vermin.

• A severely depressed woman on the Western Slope called her case manager and talked about killing herself. Aware of several previous suicide attempts, the case manager persuaded her to hold on until a crisis team could arrive from the local mental-health center. No team showed up, though, and four hours later the woman took her own life. No investigation resulted, and the agency involved failed to notify the state of the death.

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