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Untreated mental illness is rampant in Florida jails, while mental health funding is almost the lowest in the nation

Arresting situations

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Following a stressful dispute with a local law firm in 2014, Orlando resident William Stiles, 48, was not in a good place. He was attempting to get Social Security disability benefits, and says the firm quit working with his case, but took his money anyway.

When he couldn't get his money back from the firm, Stiles called 211, the federal crisis support line, and told them, according to arrest documents from later, that he wanted to "shoot up" the firm. A local law enforcement officer responded by appearing at Stiles' residence, feeling that without care or treatment, he could be at risk of harming others. The officer intended to use the Baker Act to get Stiles admitted to the Lakeside Behavioral Health Center, a treatment facility for the mentally ill.

Stiles told the officer he intended to "run a fuel truck into the building and blow it up" if he didn't get the money he claimed he was owed by the next day, the court documents state.

Stiles refused to go to Lakeside, saying he "wasn't going anywhere," and instead got into a verbal altercation with the officer. According to court documents, he said they had caught him on a "lucky" day and that he wasn't ready for them.

"I would feel really bad for your wife, your mom, your kids and family if something happened to you," Stiles is quoted as saying in the arrest documents.

Because of that, as well as his refusal to go to Lakeside, Stiles was instead taken to the Orange County Jail, arrested for resisting an officer without violence.

Stiles, who suffers from depression and anxiety, said he was not on his medication at the time – and the incident with the law firm pushed him over the edge. In jail, though, he says, he didn't get much better.

"I was in there for 14 months before they let me out," Stiles tells Orlando Weekly. "They put you in this glass room, all glass windows like fish tanks. Like 10 of them in a row. There was no counseling. You just had to suffer in isolation whatever you were in there for."

Orange County Corrections Department health administrator Jane Jenkins says it's entirely plausible that an officer would have taken Stiles to jail for this incident.

"If law enforcement responds to someone who comes off as threatening, even in the slightest bit, a non-CIT (crisis intervention training) officer's response will be to bring them to for resisting with or without force," she says. "But a CIT officer would have known how to talk to them, and encourage them to go to Lakeside."

Crisis intervention training is a way police officers can learn to help better deal with sensitive situations on the job, particularly those in which they're dealing with a mentally ill person.

Eventually, a doctor finally deemed Stiles incompetent to stand trial for the resisting charge, due to his mental disorder. He was released.

Until the 2014 incident, Stiles' criminal record has been clean since a collection of burglary and weapon charges dating back to 1989.

Stiles says he's fine when he's on his meds.

He says he regrets the way the incident turned out and blames himself in some capacity for what happened. However, he also isn't a fan of how the jail treats the mentally ill.

"I should have gone to Lakeside," he says. "But there should be other places to go to. It's more convenient for them to take us to jail."

Stiles' case is not an anomaly. Inmates at the Orange County Jail too often find themselves trapped in a vicious cycle of imprisonment – homeless and often suffering mental illness, they get arrested if they act out on the streets. Then, when they're released, the cycle simply starts over.

And it isn't helped by how tight Florida's wallet is when it comes to spending for mental health needs.

A study by the Florida Policy Institute states that in 2014, the last time the data was collected, only $36.05 per person was spent on mental health needs in Florida, putting us dead last in the entire country. That's even less than the 2012 per-person spending, which was $37.28.

By contrast, Maine spent the most in the nation – $362.75 per person was spent on mental health in 2014, up from $338 in 2012.

The United States average for mental health spending in 2014 was $125.90 per person, the study says, which is more than three times what Florida spent.

Another number that paints Florida in a negative light is how many uninsured people are living with mental illness. In the FPI's 2017 "Report of Mental Health America," it's reported that there were approximately 594,000 in the state fitting that criteria, making Florida the third worst in the nation.

This doesn't bode well for them in terms of staying out of jail. The Florida Policy Institute's study doesn't mince words – they say it's "crucial" that Florida start redirecting more funds toward the issue of mental health.

"Acts of violence by people with mental illness are associated with the lack of needed mental health services," the study reads. "Further, serious mental illness can trap individuals in a lifetime of poverty, dependency and homelessness. Untreated mental illness has significant fiscal consequences for state and local governments and exacts a high toll on the nation's economy. It can also lead to costly and frequent hospitalization, institutionalization and recurrent involvement in the criminal justice system."

Florida Policy Institute president Joseph Pennisi says the problem comes down to not enough being done to help the mentally ill.

"Florida's level of support for the mentally ill is unfortunate," he says. "There are tremendous social, health and physical costs to letting this issue go unaddressed. Providing mental health services will reduce issues of poverty, homelessness and incarceration and help them become contributing members of society."

That hasn't been proven wrong in Orange County so far.

According to a study by the Orange County Corrections Department on homelessness and arrests, 42 percent of the 4,161 homeless people arrested in the area in 2014 suffered from some type of mental illness.

The study makes note of the vicious cycle of homelessness, mental health and imprisonment, too, noting that 91 percent of homeless inmates had prior arrests. And they weren't very likely to improve, either, the study states.

"Unfortunately, there are not many resources available upon release to help these individuals successfully reintegrate back into society," it reads. "The majority of homeless individuals that are released end up living on the streets again and committing crimes that will get them back into our facilities."

The mood of the Pathways Drop-in Center is tranquil and laid-back, a series of rooms decorated in pastel-colored bricks and tile, with a piano in the lobby and a kitchen where a dedicated staff cooks for the residents. There are couches where those who frequent the house can sleep, outside porch areas adorned with lunch tables where they can smoke and talk, computers where they can check email and use the internet, and TVs they can watch.

Some people play cards in the living room. Others lounge on couches outside in the Florida afternoon sun, on a covered patio providing much-needed shade.

The house serves as a support system for the homeless and the mentally ill. It is run solely by people who also suffer from mental illness, who know the struggle, and it's funded by money from Orange County and from charities and nonprofits such as the Chatlos Foundation, as well as money from the National Alliance on Mental Illness Greater Orlando, according to Pathways president J. Nelson Kull.

Many of those who stay at Pathways have seen the inside of the Orange County Jail. From their points of view, the jail's treatment of people like them is nothing but frustrating and frightening.

Keelan Murrell, 60, suffers from paranoid schizophrenia. He was in jail in the 1990s for a trespassing charge and, due to his illness, says he felt suicidal in jail for the 30 days he was inside. He says the people in charge of mental health there didn't seem terribly invested in the job – either that, or they were simply "not the right people for the job."

He describes an incident in which he said he had a strong negative reaction to a medication given to him at the jail.

"It made my throat swell up," he says. "I couldn't breathe. It was painful. But they didn't believe me – they didn't listen to me. They gave me another dose of the same stuff and refused to give me what I needed."

Murrell has been homeless for years and has numerous past arrests for charges of burglary, criminal mischief, trespassing, resisting arrest and battery, according to the Orange County Clerk of Courts files.

In one incident from 2016, Murrell was arrested for throwing a rock at a random car window as it was coming off a highway ramp.

Now he says he's living on an assisted income check and has received assistance from the Lakeside Behavioral Health Center in the past, but wants to get his own job and fend for himself.

"I don't want that [check]," he says. "I want a regular, legal job."

Unfortunately, he has yet to make that happen for himself.

Pathways president Kull was in the Orange County Jail in the 1970s and says he never had a problem with the mental health services offered there. He speaks from experience, as he suffers from depression and anxiety, and was diagnosed with schizophrenia in his teens.

Since his jail term, he has been an advocate for mental health, currently serving on the State Mental Health Planning Council and previously on the boards of National Alliance on Mental Illness Greater Orlando, NAMI Florida, the Mental Health Association of Central Florida and others.

He says the problem lies in the number of people in jail who shouldn't be.

"We need to get people out of jail and into mental health facilities," Kull says. "They do not need to be in jail."

Because of the nature of mental illness, not taking one's medication is a frequent problem and can lead to other troubles, Kull says.

"You're not taking your meds anyway," he says. "Some of them aren't. They tend to be people who need their meds – you're sick but you don't think you're sick. You don't realize you're sick. You don't take meds and you become disruptive of people's lives."

According to Ninth Circuit public defender Melissa Vickers, the problem isn't the jail itself – they try their best – but more just that they aren't a mental health facility and don't have the capabilities to treat people in the best way possible.

"The Orange County Jail tries to do the best they can with what they have," Vickers says. "They'll medicate them, but that's all they can do. And the medication is sometimes not the same as what they have on the outside. It's not set up to treat them – there's no therapy, no counseling. Some won't get medication at all, depending on the client and what behavior they've exhibited."

She says the issue is one for the courts and legislators rather than the jail itself – there needs to be an effort to identify and get people out of jail who are suffering from mental illness.

"It's not the jail's fault," she says. "If they're told to hold someone there, they have to do it."

Jenkins says this is true – and she doesn't mince words in saying the jail is not and never was intended to be a mental health facility.

"Everyone who comes in is screened for mental illness," she says. "They're seen by a mental health professional. But we're not a behavioral center here – we have a mental health coordinator, but we don't do counseling with a private office, with couches where you can put your feet up."

Inmates have the option to ask to speak to a mental health counselor, she says – but if they're deemed a danger to themselves, they can be put in isolation. The stress of coming into the jail may amplify their already tense mindsets, though.

"Anybody coming into the jail has a reaction," Jenkins says. "Those who are mentally ill may have an exaggerated reaction."

Crisis intervention training classes in Orange County are taught by Aspire Health Partners, an amalgam of three different local entities: Lakeside Behavioral Healthcare, Seminole Behavioral Healthcare and the Center for Drug-Free Living. The classes are intended to help law enforcement deal with mentally ill individuals in a compassionate and efficient manner. In Orange County, the training is funded by the Valencia Criminal Justice Institute and costs $2,500 per class.

Also known as the Memphis Model, CIT places officers in simulated scenarios so they can learn to problem-solve in a safe setting. According to NAMI, the model was developed through a partnership between NAMI, the University of Memphis CIT Center, CIT International and the International Association of Chiefs of Police. CIT was chronicled as an overall success in a 2012 study by the National Center for Biotechnology Information.

The study says because officers "frequently respond to crisis calls involving individuals with serious mental illness," it's important for them to know how to deal with those people delicately and intelligently.

"Serving as de facto psychiatric specialists, police officers often must assume roles held by nurses, social workers and case managers as the principal referral source to psychiatric emergency services," the study reads. "For these reasons, it is crucial that officers are equipped with knowledge about various mental illnesses, and have the appropriate communication skills to safely intervene and expedite the disposition of the individual who is experiencing a psychiatric crisis."

The CIT model focuses on educating law enforcement on the signs and symptoms of mental illness and techniques to de-escalate situations when dealing with a mentally ill person. Through role-playing and field trips to actual jails and mental institutions, officers learn more about the issue.

The study found that CIT training helped officers empathize more with the mentally ill and increased their knowledge of how to spot a mentally ill individual when responding to calls.

"Models such as CIT empirically show that this collaborative training is effective and provides a better standard of care to consumers, prevents a behavioral health crisis caused by unnecessary escalation, increased safety and proficiency for officers and lessens the intensity of care for psychiatric nurses, which is to the benefit of everyone involved," the study concludes.

The woman in charge of those classes in Orange County is Laura Gailey, Aspire's Director of Acute Services. From her office off Lee Road, Gailey discusses the importance of making sure officers know how to respond to delicate situations on the job.

"People with mental illness don't always understand what they're doing," she says. "They'll be arrested for trespassing. They'll be booked in jail. The other hope for CIT is they'll recognize it as a mental illness, and they can be brought here for treatment. It can be hard to get them to take medication in jail, so a lot of times it can be very symptomatic. They can hear voices in jail; they can be very depressed in jail."

The Aspire campus has nine beds total for the jail to use. Though they may have to return to jail when they're done at the facility, she notes that it doesn't always happen that way. Sometimes the system can be sympathetic, she says.

"A lot of the times, the charges are dropped because of the illness," she says. "It takes that CIT corrections officer to help identify those clients in the jail. These people are truly sick, and they need the stabilization. They don't really need to be in jail."

Some officers who take the CIT class relate stories of what they saw in jail and, retroactively, realize what they were seeing was symptomatic of mental illness.

"The CIT training teaches corrections officers to identify people who are truly sick," Gailey says. "They'll start sharing stories about what they see in jail, and they'll have no idea that was a mental illness."

Officers aren't required to undergo CIT training, though. Some of them do it voluntarily and others, if a supervisor thinks it would be prudent, are "voluntold" to do it – a portmanteau of "volunteer" and "told" that Gailey relays with slight humor.

Not every officer has to go to the training, though, under the current system Orange County uses.

But it's "best for everyone," Gailey says, if more law enforcement and corrections officials learn to recognize the signs of mental health and the best ways to de-escalate situations with those who may be suffering from mental illness.

"They're able to talk the person down," she says. "Or just talking to the person can actually calm them down. For us, it decreases injury."

At Pathways, Kull says the CIT programs are close to a godsend for some mentally ill individuals.

"My Pathways members love CIT officers," he says. "I tell [the officers] 'Your uniform, everything needs to have a CIT pin on it, every one of them.' The mentally ill know to look for that pin – it changes everything. ... I don't want to tell the jail what to do, but if all their officers had CIT training it'd probably be a good thing. Any jail is going to deal with mentally ill people. More than half of the inmates here have it. So all officers should take CIT."

However, none of these opinions matter as long as the state of Florida continues its trend at the very bottom of the country in terms of mental health spending. So the cycle continues: People go off their medications, they get sick and they end up in jail.

"We've bounced between 49th and 50th for mental health funding for years," Gailey says. "People here have wonderful ideas of what to do. But the services don't exist; nobody's willing to pay for them."

Pennisi says the solution will come down to not relying so much on the jail to place people – help will come when more distinction is made between who needs to be in jail and who doesn't.

"The jail is not the place to spend all our money," he says. "If we downsize the number of people we put in jail, that will enable us to provide more resources needed for mental health. We need to get people out of corrections who are not a danger, who have mental health issues.

"We need to separate people we're genuinely afraid of versus those we just don't like for some reason."

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