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Jailed Mentally Ill Can Face an Unending Cycle

Chronicle, The (Centralia, WA) - 10/23/2014

Oct. 21--The last time deputies arrested 33-year-old Luke Hall, he was walking down the road wearing a hooded trench coat in 80-degree weather.

It was early September, and Hall, a transient recently released from jail, had allegedly started a small brush fire in Onalaska and pretended to point a handgun at the property owner, then ran away, sparking an hours-long manhunt and a school lockdown.

Hall is well known to Lewis County law enforcement. He has been arrested at least six different times since 2009, according to court documents. Hall has documented substance abuse issues and numerous mental health diagnoses. He has also been temporarily committed to the state psychiatric hospital, Western State, on three separate occasions.

Nationwide, prisons and jails house more than three times as many mentally ill people than hospitals, according to a 2010 study by the National Sheriff's Association and Treatment Advocacy Center.

For Hall, and others like him, his life is a cycle of incarceration, brief hospitalization and medication, followed by drug abuse, out-of-control behavior then re-incarceration.

Court documentsshow Hall's erratic behavior follows an almost predictable pattern: He breaks the law, fights the arresting deputies and goes to jail. Due to his mental issues, a judge orders Hall to undergo an evaluation by doctors at Western State to determine if he is competent to stand trial.

Weeks go by before he ends up at the psychiatric hospital. Meanwhile, Hall acts out in jail, often racking up more criminal charges for assault and malicious mischief. Once at the hospital, he's medicated, and after several more weeks, doctors find him competent.

By then, months have passed since his arrest, and Hall pleads guilty and is released from jail with credit for time served.

A few months later, Hall is again homeless, off his medication and back to using drugs.

It doesn't take long for Hall to catch law enforcement's attention. It seems Hall, like many others suffering from mental illness and drug addiction, is on the never-ending merry-go-round of jail and Western State Hospital, stopped only by brief stints of freedom.

Currently, for the fifth time in five years, Hall is again in jail waiting for doctors at Western State to evaluate him.

For Laura Hall, Luke's mother, the cycle is aggravating. She said she does not know if her son's issues are rooted in mental illness or drugs, or if one exacerbates the other.

Ideally, Laura Hall said, the state would spend money providing resources to people like Luke to help them deal with their issues rather than spend it shipping him back and forth between Western State and the jail, only to release him back into society a few months later.

"I don't want him to be in jail or prison but I don't want him out hurting people or property," she said. "The solution isn't just to let him out."

The Lewis County Jail has four medical observation rooms that often are used to house those suffering from the most significant mental health problems. The four cells, located in a separate wing of the jail away from general population, are always full, said Jail Chief Kevin Hanson.

Mentally ill inmates take a lot more resources to manage, he said. They can be disruptive, unpredictable and sometimes pose threats to themselves, other inmates or corrections officers.

"If they are assaultive to staff or other inmates, we have to put them in isolation," Hanson said. "I can't house them in general population."

Attorneys, family members of the inmates, jail staff and Western State Hospital personnel all agree county jails are not appropriate places for the mentally ill. The problem is, there is no alternative.

Under state law, when someone is arrested, he or she must be mentally competent to stand trial. When a defense attorney raises the question of competency, the criminal case is paused until the issue is resolved. A judge orders the defendant to undergo an evaluation at Western State, which is run by the state Department of Social and Health Services.

The hospital, however, is under-budget, short-staffed and has a caseload so high there is a waitlist to get in.

WSH experienced an 8 percent increase in referrals between 2001 and 2011, Ron Adler, chief executive officer of Western State, told The Chronicle in June. Every year since 2011, the hospital saw an additional 8-percent increase in referrals.

Further aggravating the problem is budgetary issues. The pay scale allowed by the Legislature affects the hospital's recruitment of doctors as it cannot offer wages that compete with private practice, Adler said.

"Our ability to handle restoration cases is limited by the number of forensic evaluators we have," Adler said. "We are doing the best we can with the resources we have."

While the length of the waitlist fluctuates throughout the year, The Seattle Times reported in August that more than 100 people were waiting to go to Western State. The average wait was about 70 days.

The backlog means mentally ill inmates throughout the state remain stuck in procedural limbo and are warehoused in local jails -- oftentimes in isolation -- as they wait for an open bed.

Many mentally ill inmates end up getting sicker as they wait to get well. Hall is no exception. During his on-again-off-again incarcerations, court documents show Hall's mental state often grows worse in jail. Hall has fought corrections officers, tried to flood his cell and damaged a video kiosk by throwing a mop bucket at it. He has also rubbed his feces on the jail walls and attempted suicide twice.

Currently, the Lewis County Jail has six inmates waiting to go to Western State, according to the prosecutor's office. Every day those inmates wait in the Lewis County Jail, it costs taxpayers $82 per person.

Once at Western State, they will be stabilized with medication so they can understand the charges against them. Some cases are resolved quickly, some are not.

On occasion, doctors find the defendant competent and send him or her back to the jail, only for the person's mental health to deteriorate again. A judge then orders for the person to be returned to Western State for a second time and the cycle starts over. Again, the person waits at Lewis County Jail, often without a trial date, for several more weeks to return to WSH.

"It's a never-ending revolving door," Hanson said.

For some, it is not uncommon to spend more time incarcerated, going back and forth between Western State Hospital and the jail, then if he or she were convicted.

It is also important to note that the point of Western State Hospital is stabilization -- not long-term care. Once released from custody, the person must rely on local resources.

For some people who do not want to take their medication, such as Hall, it is only a matter of time before their mental states fall apart and they end up back in jail.

"I actually think the best solution right now is for Luke should be incarcerated," his mother said. "He is a very intelligent person when he was growing up, and he is a very sweet person when he's not under the influence."

But when on drugs, Hall loses his mind, she said. When the police contact her son, Hall will fight to try and get away.

During his latest arrest, Hall allegedly attacked the arresting deputy, pulling him to the ground, punching him in the face and ripped off his bulletproof vest, according to court documents. Throughout the years, Hall has been bitten by police dogs on two different occasions. He has also been tased multiple times, though deputies note in their police reports that most of the time Hall seemed unfazed by it. Hall's past fights with police have been so violent that Hall's mother fears he could one day be shot.

"It does concern me that they could injure him or he could be killed," Laura Hall said. "But of course (the deputies) need to protect themselves. I hate to think my son is murderous."

In the pastfew decades, mental illness and the criminal justice system have become more and more intertwined.

On a local level, the jail chief said over the past 20 years the behavior of those suffering from mental health issues have become more extreme, and the number of people with those issues have multiplied.

Adler, from Western State Hospital, said the problem is not limited to a local or regional level, it's nationwide.

"The larger trend around the country is the criminalization of the mentally ill," Adler said. "Sometimes it's more expeditious for local law enforcement to book people in jail rather than using a locally based crisis service."

In addition to the incarcerated population of people with significant mental health issues, there are countless more who suffer from more mild issues. For most mentally ill inmates, their mental state does not legally negate the charges against them, though many could argue that it was a factor in the behavior that led to their arrest.

Hanson estimates an average of 60 percent of the inmates at the Lewis County Jail have unmet mental health needs. In July, Hanson said, the county commissioners approved funding to provide three full-time mental health professionals to work with the jail in hopes of better meeting those needs. Prior to that, the jail had one part-time mental health professional.

On a national level, many hope the government will find better ways to help those living with mental illness. On a state level, some hope the Legislature will allocate additional funding during its upcoming session for Western State Hospital to shorten the wait list.

For Hall, his mother wants her son to enter rehab and stay away from drugs, which hopefully will tone down his behavior. Absent court-ordered inpatient rehab or hospitalization, however, Laura Hall doubts her son will stay away from the drugs that aggravate his mental illness.

Until something changes, she expects the cycle to continue.

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(c)2014 The Chronicle (Centralia, Wash.)

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