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Head Games

Talk all you want about bad men and madmen. The truly scary ones are those who know rage so well that they scare themselves. The anger pours out of them without warning, like floodwater surging through crumbling earthworks, rolling and roaring over everything in its path. They become howling bedlamites,...
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Talk all you want about bad men and madmen. The truly scary ones are those who know rage so well that they scare themselves.

The anger pours out of them without warning, like floodwater surging through crumbling earthworks, rolling and roaring over everything in its path. They become howling bedlamites, bat-shit berserkers, pure engines of mayhem and destruction.

Troy Anderson knows that hot, blinding rush. One moment everything's hunky-dory, the next is a blur of blood and screams. "My anger comes like lighting a match in a dark room," he once told a psychologist.

Sometimes it can take days. There's a perceived slight -- somebody bumps into him, maybe, or disrespects him somehow -- and he broods on it. He can't sleep. His head aches. Then the rage erupts.

"Man, you don't know," Anderson writes from his cell at the Colorado State Penitentiary. His letters shuffle forward in short, hobbled sentences, as if he has to check himself at every turn. "My rage. The horrible things I am capable of when I'm angry. I have like this hole inside. I just trip. Once I get a bad thought, it snowballs in my head. Scares me to death."

When he was ten years old, young Troy shot up a waterbed with his father's handgun and wrote a note to his teacher, telling her that he wished he was dead. At twelve he threatened other students with knives.

By the time he turned fifteen, he'd set fire to a vacant house, run away from his Longmont home and graduated from marijuana to cocaine and heroin. At seventeen, having attempted suicide several times, escaped repeatedly from closed mental wards and racked up a fistful of robbery charges, he fled to California -- and ended up writhing on the pavement, shot in the hip by cops and watching his best friend bleed to death.

At twenty, Anderson began his first stretch in the Colorado Department of Corrections. He did most of it in lockdown, after a series of assaults on staff and other inmates.

At thirty, he survived two shootouts with police in the course of three months; in the second incident, he helped himself to a deputy's gun and took over a bus full of inmates in an underground garage below the Adams County Justice Center. While awaiting trial, he picked up several more charges for biting, stabbing and striking his jailers and hurling feces and urine at them.

At 37, Anderson lives in 23-hour-a-day isolation at CSP, the state's supermax prison. He's doing 75 years on multiple convictions stemming from the shootouts seven years ago and won't see a parole board for another 35 years. His DOC file notes his street nickname -- Evil -- and describes him as "an extreme management problem" and a high escape risk with a long history of violence, drug abuse and mental-health issues.

A pre-sentencing report, prepared when Anderson was only fourteen, called him "a keg of dynamite waiting to explode." He's been blowing up regularly since then. During the past five years, though, he's had no violent incidents whatsoever. Anderson says this is not because of his lockdown status, but in spite of it.

"This place makes you angry," he writes. "Makes you paranoid, testy, anxious and violent. The guards aren't trained to deal with it. They write you up for outbursts. And take away the TV. Which leads to more problems, writeups and cell extractions. I have watched young kids come in here all quiet. And turn violent and full of hate. If people don't have issues prior to CSP, they have them before they leave."

Anderson has spent almost all of his adult life in CSP or other isolation units. In early 2004, a warden's review board told him he'd never be allowed out of solitary unless he was on the proper medications to control his mood swings. He's been trying to get evaluated for medications ever since, he says, without success. In fact, he waited more than a year for an appointment with a DOC psychiatrist -- an appointment that was first requested in July 2005, urged in subsequent memos by a psychologist who visits him on a monthly basis, and only took place last week, days after a reporter inquired about his case.

"CSP is not designed to treat or manage any mental-health problems," Anderson contends. "Everyone I know is in here for 'acting out.' But they don't do anything to treat them."

The DOC refused a request to interview Anderson; as a rule, the department doesn't allow inmates in administrative segregation to communicate with reporters except in writing. But to back up his claims, Anderson made his prison mental-health records available. The file contains a bewildering series of contradictory diagnoses and surmises, as well as evidence of indifference, neglect and outright hostility from the mental-health professionals supposedly treating him. His markedly improved behavior in recent years doesn't seem to have earned him any reciprocal privileges or better care. Treatment plans are proposed but rarely pursued; concerns about security and cost squelch occasional efforts to try promising drugs or therapies.

Extreme as his case may be, Anderson's situation reflects certain fundamental truths facing thousands of mentally ill men and women in Colorado's prisons. For most of them, the treatment available is grossly inadequate. Many will deteriorate further during their time inside, particularly if they're in a place like CSP, where access to actual doctors and drugs is highly restricted. But even non-violent offenders face long waits for psychiatric visits and poor followup. More often than not, they'll return to the streets without viable treatment programs or the means to obtain the medications they need and will soon be behind bars again -- not because they're career criminals, but because they have nowhere else to go.

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."

White was an aggressive advocate for his son during his time in the DOC. (His son was released last year and is currently establishing a new life; White asked that his first name not be published.) One health-related concern, he recalls, required 38 phone calls to resolve, by which time the condition had cleared up on its own. "I'm sure I was perceived as a very large pain in their backside," he chuckles.

His son had a rocky start in the prison system. While in jail, he'd been taking a mood stabilizer, an anti-psychotic and an anti-depressant that seemed to relieve his symptoms. But prison pharmacies often use older versions or approximate substitutes of certain medications -- with more severe side effects -- because of cost concerns. (Picture the worst kind of bean-counting HMO, multiply its ruthlessness tenfold, and you might come close to the bottom-line strictures of prison health-care systems.) The prison formularies didn't work on White's son, who had a psychotic episode and ended up strapped to his bed, "four-pointed" for two days.

White's son was sent to San Carlos -- where, White says, he received excellent care: "They put him back on the original medication. Wonder of wonders, he improved." Back in general population, though, he had problems maintaining the same regimen of meds, resulting in subsequent writeups. Many of the problems mentally ill prisoners encounter come from "destabilizing" as a result of denial of meds, ineffective meds or inconsistent meds; White says he's also heard of inmates selling their meds to other prisoners seeking to get high.

"If you're mentally ill and in prison, you're more likely to be victimized by other inmates," he notes. "And if the inmate who's mentally ill is violent, the guards and other inmates are at risk."

Prison officials maintain that inmates in segregation are put there because of bad behavior, not mental illness. But that's a distinction that easily blurs. Surveys in several states indicate that supermax prisons have a disproportionate number of seriously mentally ill prisoners, from 30 to 50 percent, apparently because lockdown is the simplest way to deal with their behavior. The American Psychiatric Association has noted a tendency among prison mental-health workers to devote resources to the most obvious cases -- psychoses, major depression, those who are disruptive and need to be "managed" with heavy sedatives -- while offering little treatment to prisoners whose illnesses may be just as serious but don't cause as much stir.

Jim Michaud, the DOC's director of mental-health services, says that around 30 percent of CSP inmates have been diagnosed as mentally ill. He acknowledges that there are "special challenges" to treating patients in a high-security prison, but he insists the care at CSP is comparable to what the mentally ill receive at other prisons. "Sometimes they prefer high security," he says. "They prefer being alone, even when it isn't necessarily good for them."

Not all of the delusional or most vulnerable inmates wind up at San Carlos. The mail Westword receives from CSP prisoners includes ample evidence of paranoia, hallucinations and obsessive thinking. One recent letter contained hair samples, which a prisoner wanted tested because he's convinced his keepers are lacing his food with mind-altering drugs. Psychologically, almost no one does well in isolation, but the mentally ill tend to fare worse than most.

Among the inmates themselves, there are all sorts of theories about how one ends up in CSP as opposed to San Carlos or one of the "special needs" units at other prisons. Prisoners claim that schizophrenics, bipolars and others who happen to respond well to DOC-approved drugs, such as Thorazine or lithium, are more likely to find a bed at San Carlos. Those with more convoluted treatment needs or sketchier diagnoses -- such as anxiety disorders or attention deficit disorder, a condition that is commonly treated with stimulants -- wind up in the hole.

Michaud says the mental-health staff doesn't provide medications for a case of ADD "unless it severely interferes with management of the institution." Stimulants such as Ritalin are unlikely to be prescribed because they can be readily abused. "We're cautious with drugs like that, particularly because of the substance-abuse problems of our population," he explains.

Having ADD has nothing to do with placement in administrative segregation, Michaud says. But try telling that to Lee Vasquezdiaz.

"No one in all the facilities I've been in has ever done anything about my condition," complains Vasquezdiaz, a CSP inmate doing twenty years for a robbery and assault committed when he was seventeen. "When I tell them I have ADD, that it was a formal diagnosis with a prescription and everything, they say that the meds for it are stimulants and can't be given out. But they have non-stimulant alternatives, and when I bring that up, they act as if they can't do anything."

Vasquezdiaz can't see the review board to get out of CSP until he goes six months without "negative chrons" -- rule violations noted by his keepers. He says he's received chrons for running too fast down the stairs in leg shackles ("if that's possible"), using a piece of paper to cover a light in his cell that stays on 24 hours a day ("three feet from my face when I go to sleep") and covering a window.

"Basically, a chron sets me back half a year," he explains. "Since it costs an extra $20,000 a year to house me here, you, the taxpayer, pay $10,000 for every chron I get." And that's over the cost of an average prison cell.

After five years of being ad-segged, Vasquezdiaz hopes to be approved for transfer from CSP in February -- provided, of course, he can avoid further chrons.

Others, like Troy Anderson, are probably permanent residents of the place.

There was a time when Carol Anderson looked to the doctors for some explanation of her son Troy's condition, some magic pill that would make the nightmare stop. Not anymore.

"I've gotten to the point where I don't even listen to what they say," she says. "Whoever sees him comes up with their own diagnosis, and they don't follow through with it, anyway."

Carol and her husband, Darrel, adopted Troy as an infant. The Boulder couple still visit him at CSP several times a year. They've never quite given up on him, but they have lost faith in the mental-health system that was supposed to help him. The pattern, Carol says, has always been the same: a crisis, followed by confinement and short-term treatment, then release without adequate planning or medication, followed by another violent episode and longer confinement.

"He had to be locked down or he would be gone, from the time he was fourteen," she says. "Probably, in the long run, it's hurt him. But it seems to be the only way he can function without medication. And he's self-medicated for years."

Troy Anderson can't remember ever feeling like he fit in. "Never felt like I was anywhere I belonged," he writes. "Couldn't relate to other people. I knew my family loved me. But I always felt like I didn't deserve it, or that I'd just let them down. I've always screwed up right when things got to be good."

Carol discovered she was pregnant shortly after the adoption. She remembers angry family-therapy sessions in which her teenage son accused her of loving her biological daughter more. "I finally put a stop to that," she recalls. "I told him, ŒYep, every time I look at your sister, I see blood. But I must love you more than I love her, because it takes a whole hell of a lot more love to love you.'"

Carol says her son can be "a very charismatic guy." He's well-read, and other prisoners respect him. He even orchestrated a hunger strike last year to protest conditions at CSP that dozens of other inmates joined ("Starved for Attention," February 17, 2005). But from an early age, something was terribly wrong.

The suicidal thoughts Troy expressed when he was ten, along with firing his dad's gun into a waterbed, led to his first meeting with a psychologist. The evaluation found "aggressive or explosive urges," mood swings and "strong guilt feelings." Before long, he was running away from home, stealing and threatening others. Another therapist decided he had attention deficit hyperactivity disorder (ADHD); he started taking Ritalin, and his concentration at school and general attitude seemed to improve.

Only for a little while, though. He dropped out of Niwot High School in the tenth grade. In 1984, at the age of fourteen, he was put on probation for burglary and criminal mischief. But he continued to break into homes and was sinking deeper into drugs. For his parents, the last straw was a fire he set in a vacant house, apparently while huffing something flammable. He was placed in a lockdown unit at the Boulder Psychiatric Institute for almost two years.

"All I did there was fight and try to escape," he recalls. "It was horrible. I cut a nurse's throat with a soup-can lid trying to escape. Their solution was to give me Thorazine and lock me in a room. I was tied down for days. I spent most of my time there locked in a room with nothing but my books. Made me hate the world."

One doctor at BPI believed Anderson was suffering from severe depression. Another thought he was probably psychotic. Another suspected he was bipolar and suggested lithium. They threw in a diagnosis of borderline personality disorder for good measure. The whole experience, Darrel Anderson agrees, did little to help his son.

"It increased his anger immensely," he says. "Toward us, because we were the ones who put him there, but generally, too. He stayed there until my insurance ran out, and then they cut him loose."

He wasn't out long. By 1987 Anderson considered himself a hard-core skinhead and superbad speed dealer. Someone broke into his apartment and ripped off a lot of dope and money, so he went looking for the thief with a gun, busting into other dealers' houses, and caught an aggravated-robbery charge. This was on top of an involuntary-manslaughter case, the result of a fight that left the other combatant with a subdural hematoma; he died the next day.

Anderson fled to California and got into even deeper trouble there. A car chase with the cops ended in a gun battle. Anderson was wounded; his best friend was killed. Although he was looking at six years in a California youth camp, a deal was worked out to bring him back to Colorado on the earlier charges.

Questions about his mental competency prompted a trip to Fort Logan. The shrinks there decided he was a fine case of a mixed personality disorder with anti-social and borderline features: "A great deal of his identity seems to be related to rebellion," one remarked. He was practically an adult now, but he caught one last break, a sentence of three years in a closed adolescent treatment center. Subsequent escapes and suicide attempts led to additional trips to Fort Logan. A doctor warned that he seemed unable to function in a correctional setting and would probably become psychotic if sent to prison.

In 1990, Anderson walked away from a drug rehab center and returned to his own street meds, including methamphetamine. A few months later he picked up his first prison sentence -- eight years for attempted burglary -- but the charge doesn't quite do justice to the strangeness of the crime, as detailed in the prisoner's file:

"Mr. Anderson entered a house, and after being confronted by the occupant and told to leave, was found to be standing at the front door starting to pull a long knife from his pants. Mr. Anderson then entered another home, where the occupant found Mr. Anderson hiding behind a door with a knife over his head in an 'Alfred Hitchcock' position and a can of mace in one hand. This occupant, who had a gun, ordered Mr. Anderson into the study and then called the police."

You might think that Anderson -- 5'7", 130 pounds and all of twenty years old -- would be easy prey in the state prison system. You would be wrong. "I came to prison a scared kid," he recalls. "Yeah, I could be violent. Didn't follow the rules. Too tough to do any kind of mental-health treatment. So I got ad-segged. And was even worse in ad-seg. All I did was fight, stab people."

Records show that Anderson racked up numerous serious assaults against other inmates and staff during his first few years in the DOC. At one point, he was charged with twenty assaults in as many months. He was sent to Pueblo or San Carlos several times for evaluation; some doctors believed he was faking or exaggerating symptoms, but others suspected a schizotypal personality. He spent almost his entire sentence in administrative segregation. He was released from CSP right to the street on October 30, 1997, twelve days before his 28th birthday.

"We begged him to come home," Carol Anderson recalls. "We thought that after eight years, maybe he will want to be out. He always says, 'I'll never go back.' But what he means is he would rather die than go back."

Darrel had a job lined up for his son, but Troy was ill-prepared for the hurdles of life on the outside. "It was like he'd just woken up from a long sleep and found out the world had changed around him," Darrel says. "He was confused about how to get along, how to go to the mall and find things."

Anderson stayed with his parents only a couple of weeks. He drifted to the streets, to old buddies and ways. In CSP he'd made so many plans. He'd studied to be a securities broker. He'd earned a certificate for anger management. Now that he was out, it all seemed like a joke. He couldn't even stand in line at the DMV for his driver's license without losing it. All that rage, just boiling, rattling the lid right off. What was the use?

"I was out three months," he writes. "I was cooking, shooting and selling meth. And chased some guy down the street with a knife. I got some county [jail] time. Stabbed two inmates, Danny Martinez and a guy named Alton. I stabbed Danny cause he raped and murdered Brandy DuVall ["Dealing With the Devil," February 25, 1999]. Stabbed Alton cause he was loud. Still ended up doing the county time. And got out. Went right back to the dope."

In late 1998, Anderson showed up at a motel in Commerce City, brandishing a .38 revolver and looking for someone who'd burned him in a dope deal. The police were called, and Anderson traded shots with them before being arrested. Three months later, after boarding a police bus that was supposed to take him back to jail from a court appearance, he kicked out a wire-mesh screen and grabbed a handgun from the dashboard. The Adams County deputies escorting him ran for cover. He fired eighteen shots and kept them at bay in the courthouse garage for thirty minutes before surrendering. He was handcuffed to another inmate the entire time.

No one was injured in the shootouts -- which could indicate that Anderson, who discharged a total of 26 rounds in the two incidents, is either the world's worst shot or was trying to accomplish suicide by cop. ("I wanted everything to stop," he would later testify.) Whatever his true motives, he was charged with multiple counts of attempted murder, and more charges piled on as he got into repeated fights with his jailers.

The judge who presided at his trial, Murray Richtel, was the same judge who'd handled his first case in juvenile court sixteen years earlier. Richtel gave him 75 years and recommended that the DOC consider sending him to San Carlos.

He wound up at CSP instead. By now his keepers' appraisal of his mental state had become so convoluted -- schizoaffective disorder, post-traumatic stress, plus a shopping list of untreatable personality disorders -- that a clear course of action was impossible. James Waters, an outside psychologist retained by the court for extensive neuro-psychological testing, had a different view. Waters concluded that Anderson probably had ADHD, among other issues. "While he does not seem to qualify for bipolar disorder, it is still possible that he has a disorder that might respond to mood-stabilizing medication," Waters reported.

The prison docs put him on Elavil and Neurontin -- an anti-depressant and an anti-convulsant, respectively. Anderson complained that the drugs made him feel manic. At a 2000 hearing, he burst into a rage and attacked the hearing officer. He was then sent to San Carlos and taken off the meds. A few weeks later, he was shipped back to the supermax.

He's been off drugs -- and locked down -- ever since.

Mark Jason Seibel sits and fidgets in a corner of a Denver Starbucks on a Friday afternoon. He's pale and thin, with short-cropped hair, and his eyes dart nervously around the room, looking everywhere but at the person he's talking to. He spent his last four dollars on the untouched iced drink, with extra shots of espresso, at his elbow.


At 31, Seibel has seventeen years of experience with the criminal-justice system -- and the tattoos to match. He also has a lengthy history of untreated mental illness. Talking about it is difficult. He squirms and speaks softly, but with intense deliberation.

"I feel more comfortable in a life-threatening situation than I do in a job interview or something like this," he says. "Like a couple weeks ago, there was a problem, and this guy came at me with a tire iron. Fortunately, I ended up with the tire iron. But this is harder than that."

Seibel is a parolee from the Colorado prison system, but he hasn't reported to his parole officer in months. Instead, he's launched a MySpace page airing his frustrations with his situation ("Parole Sucks") and gone back to what he knows best -- living by his wits, getting by on whatever money he can scrounge up. He knows it's only a matter of time until the law catches him and sends him back to prison for failing drug tests. All the same, he wonders if his life had to turn out this way.

"I take responsibility for my own actions, but I can see that a lot of what happened over the last twelve years has to do with the lack of treatment," he says. "If someone had taken the time to ask me how I was feeling or give me the treatment they suggested, perhaps I wouldn't be facing habitual criminal status and my life in shambles."

Seibel has lived on the streets since he was eleven years old. Records list him as a runaway; he says his parents threw him out after years of severe abuse. He had several run-ins with juvenile authorities before entering the adult prison system in 1994, at the age of nineteen, on burglary cases in Denver and Lakewood. By his own account, at the time he was a "blackout drunk and a gang member" and using amphetamines heavily.

A psychometric report prepared at the DOC's diagnostic center found symptoms of more deep-rooted mental-health issues: "The test findings imply a strong likelihood of 'crazy,' irrational behavior. Prompt referral to medical and counseling programs is recommended....Mr. Seibel shows evidence of substantial, generalized psychotic illness, which tends to make his behavior bizarre and inappropriate. Anti-psychotic medication may enhance well-being and performance."

The recommendation was never pursued. Seibel didn't even find out about it until more than a decade later, when he stumbled across the report in his court file -- which by now had grown quite thick. His initial eighteen-month sentence had mushroomed into a decade-long journey through the prison system, compounded by parole failures and additional theft and drug charges. Last year a sympathetic counselor finally arranged for his first thorough mental-health evaluation, which found, beneath his substance-abuse problems, a severe case of post-traumatic stress, anxiety and ADHD. Some of the drugs prescribed to treat ADHD, such as Adderall and Desoxyn, are amphetamine cocktails, regularly abused as pick-me-ups by college students pulling all-nighters; chemically, they're not much different from the drugs Seibel had been using on the street.

The self-professed amphetamine gobbler now had a doctor's prescription for Adderall. He also had a spot in a group therapy session for Offenders with Serious Mental Illness (OSMI). But the therapy turned out to be "a lot of bitching and reading aloud from lame handouts," he says, and it took four months to get a single appointment with a psychiatrist at Denver Health Medical Center, under the indigent-care program that was supposed to help him obtain his medication. Although the drugs helped him "focus and feel normal," he couldn't get the required monthly appointments for refills and soon went back to using the version he could buy on Colfax -- and testing positive for street drugs, a violation of his parole.

Many mentally ill offenders seem to be stuck, like Seibel, in a prolonged cycle of neglect and new charges. For every Troy Anderson buried deep inside the walls, there are dozens of non-violent parolees hitting the streets with substance-abuse problems and medication and treatment needs, and not enough programs to handle them.

Prisoners lose their Medicaid and Social Security disability benefits after as little as four weeks of incarceration; it can take months to get them reactivated. The Colorado Legislature passed a law two years ago that directed the DOC to get the paperwork processed sooner, before a prisoner is released, but the results have been spotty; the process is "tremendously complicated," the DOC's Michaud notes.

"Some of the biggest hurdles have to do with coming out with adequate medication and continuity of care," says Harriet Hall, a clinical psychologist who's president of the Jefferson Center for Mental Health and the current chair of the inter-agency task force studying the issue. "Housing, jobs, community acceptance -- they're all major issues. But they don't come out with enough medication to keep them stable until the community can feasibly get them medication, and there's not a funding stream to pay for it."

More than most lawmakers, the members of the task force know the compelling economic arguments in favor of community mental-health programs. A bed in San Carlos costs more than $60,000 a year; providing one person with mental-illness treatment in the community costs between $5,000 and $8,000 a year. A recent report by the National Institute on Drug Abuse shows that every dollar spent on addiction treatment results in a $4 to $7 reduction in costs associated with drug-related crimes. But during the lean budget years since 2001, lawmakers have tended to ignore arguments about long-term savings, focusing instead on what a particular program costs in the short run.

"Until the passage of Referendum C, the task force knew that anything that had a fiscal note attached to it wasn't going to get passed," Hall says. "Now we can start thinking about how we can best demonstrate the long-term benefits of spending a modest chunk of money now."

According to Michaud, the prison system has a crying need for increased resources as well. "There's no doubt that we need more special placement beds for people with mental illness," he says. "The budget cuts have really hurt us."

But a psychiatrist who's worked in many areas of the criminal-justice system says the most critical need is for diversion programs for the mentally ill before they end up behind bars. "Better mental-health care in prison is not the answer," insists the source, who asked to remain anonymous because of ongoing relationships with the state. "The mentally ill flat-out do poorly in a correctional setting. They start piling up charges. They're less likely to be granted parole. They just keep sinking further and further; it's like using a thimble to bail out a boat.

"If you want to see that system keep growing, just keep pouring money into it. The fact is that too many jails and prisons do no dispositional planning. They're not about treatment; they're about management. And the bureaucracy is deliberately sluggish about restarting people's disability benefits because it saves money. We need to keep mentally ill people out of that system in the first place."

There's no oversight of the current system, insists Mark Seibel. A few months ago he wrote to the state's Mental Health Occupations Grievance Board, complaining that the DOC had ignored his mental-health needs for more than a decade. "The Board is unable to intervene in the matter because it is not authorized to regulate correctional facility programs," program director Gayle Fidler responded. Fidler urged Seibel to take up the matter with the DOC -- a tricky business, since Seibel is now a parole violator.

"I'm not a punk," he says quietly. "I'm not going to lay down and let them do shit like this. I don't like being taken advantage of."

For now, he's getting his meds on the street, in the netherworld of speed freaks and meth maniacs that Troy Anderson used to inhabit. It's a small world; at the mention of Anderson's name, Seibel's eyes light up with recognition.

"You mean Evil?" he asks. "How's he doing?"

How Troy Anderson is doing depends on whom you believe. For the past five years, he's been in a strange stalemate with his keepers.

Shipped back to CSP from San Carlos, at first Anderson refused any mental-health treatment at all. He claimed that the meds he was being given caused his outburst at the hearing, so he stopped taking them. His psychiatric rating was downgraded to a point where he would no longer have routinely scheduled appointments with mental-health workers.

In early 2004, he changed his tune. Recognizing that he would have to be on medication to be considered for transfer from CSP, he began pushing for an appointment with a psychiatrist. The staffer dealing with him was suspicious of his request. He described Anderson as "addicted to his anger" and recommended a psychobabble course of action: "Confront thought distortions, encourage tolerance and gratitude attitudes."

When Anderson continued to press for a psychiatric evaluation, the same mental-health worker accused him of engaging in "narcissistic entitlement" and "manipulation of issues" in a ploy to get Ritalin. After several months, a psychiatrist decided to try him on an anti-depressant, imipramine, but Anderson complained that it "messed him up" and soon stopped taking it. "Irritable, pressured, angry, threatening lawsuits," the psychiatrist wrote in a follow-up visit in July 2004. "Threatens potential for assault."

He didn't see a psychiatrist again for months. His efforts to be considered for other possible medications were viewed as the scheming of a "manipulative narcissistic extremist," in the words of his mental-health worker. As the months dragged on, Anderson told the worker he was angry at the psychiatrist for not helping him and not even coming back to see him. Asked if he was having thoughts about harming himself or others, Anderson replied that he wanted to kill the psychiatrist. The worker reported him for making threats -- prompting Anderson to file a grievance. "How can he ask me a question like that and write me up for it?" he asks. "That's insane."

His relationship with the staffer continued to deteriorate. "Having a good time playing chess," the latter observed in one particularly snarky entry. "His ADHD must have disappeared for awhile."

In July 2005, another psychiatrist recommended that Anderson be evaluated for "appropriate medical intervention." Subsequent entries in his records show that Anderson, psychologist Peggy Steele and others made multiple requests for such an evaluation over the next ten months, with no success. Steele was sufficiently concerned about Anderson's "escalating" symptoms to upgrade his psychiatric rating. Her own assessment of his condition seemed to shift with each visit: "Paranoid personality...ADHD...maybe bipolar...possible frontal lobe injuries...OCD-like symptoms...borderline personality disorder, narcissistic personality disorder, antisocial personality disorder...frequent mood changes, hostility, grandiosity."

"They're tossing out diagnoses like confetti, aren't they?" says John Macdonald, a retired forensic psychiatrist who reviewed documents from Anderson's prison mental-health file for Westword. "I've never seen a case like this."

The author of numerous books on investigative procedures, Macdonald has performed court-ordered psychiatric evaluations of hundreds of violent criminals, dating back to John Gilbert Graham, who blew up an airplane in 1955 to collect an insurance policy he'd taken out on his mother. He laments the increasingly impersonal care that mentally ill prisoners receive as the system has grown larger and more bureaucratic.

"In the old days, I could wander around the prison and talk to anybody," Macdonald says. "That made a hell of a lot of difference. Now, you're lucky to get a few minutes through glass with someone. There's no depth of relationship. I think they're probably all scared of this inmate, and I don't blame them, really. But not dealing with him is increasing the problem."

Stefani Goldin, Anderson's attorney, points out that he has a record of cooperation and no violence at the supermax for the past five years -- except for the disputed "threats" report about wanting to kill the psychiatrist. Yet this clear demonstration that he can control himself in lockdown has resulted in diminished mental-health services and no increase in privileges. Anderson's history of violence has defined him, regardless of what he does now.

"He's no closer to getting out of ad-seg than he was five years ago," Goldin says. "From a management perspective, you have to wonder what CSP is thinking. What's his incentive to continue with good behavior? If he's left to believe that he's just going to rot in CSP the rest of his life, why shouldn't he be a problem?"

Anderson finally saw a psychiatrist last week, only days after Westword inquired about the fourteen-month delay. Michaud denies that the inquiry had anything to do with the appointment scheduling; he blames the lag time on a system-wide staff shortage that has left his psychiatric providers playing catch-up for months. "My guess is that Mr. Anderson was not seen as a very high priority," he says.

Although the patient has waived confidentiality, Anderson's actual treatment providers refuse to discuss his care -- or defend it. But after one visit, Steele noted in the file, "I told him that medication alone would not cure his anger."

Anderson agrees that he needs more than drugs. But he sees Steele only once a month, he writes, and sometimes not that often. So what officials know about him is what is in the file: his psychiatric rating, record of assaults, his score on the Resource Consumption Scale, medications prescribed. "Every time I have been turned down [for transfer], we discuss the fact that I am not on meds," he writes. "They told me at my last hearing that they won't approve me because they know it's not a matter of if I stab someone. It's when. Period.

"I know I need help. Talking about things helps. Have to trust to do that. That's really hard in here."

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