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Exclusive: Inside the US’s largest psychiatric ward, the LA County Jail

The jail is the nation’s largest caretaker of the mentally ill, and even the DA acknowledges it is cruel and unusual

LOS ANGELES — At Pod 172, the men are evaluated in shackles before they’re given permanent housing in the nation’s largest caretaking facility for the mentally ill: the Los Angeles County Jail.

At the inmate reception center of the Twin Towers Jail, inmates are booked, screened and evaluated for their physical and mental health. When we visited earlier this month, 4,287 were detained in special housing there. The Department of Mental Health projects up to a 50 percent increase in the next five years.

In the nation’s biggest jail system, 1 in 5 inmates suffers a mental illness, according to officials there, and 75 percent will return after they’re released, compared with 60 percent of the general jail population.

An inmate in the psychiatric ward at L.A. County Jail.
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L.A. District Attorney Jackie Lacey called it “Groundhog Day” when she took “America Tonight” on the first-ever TV tour of the jail’s psychiatric ward.

“How you doin’, Ms. Lacey?” said one inmate, crouched on his knees and yelling through a slit in the door. “A petty theft, and they still got me in here … I’m on 800 milligrams of Seroquel. I’m diagnosed with paranoid schizophrenia, yet other people mostly bipolar. I need help, and they can’t offer me help.”

Lacey nodded in agreement. “If he were not mentally ill, he would be in court. He would have pleaded guilty. He would already be going about his business,” she said. But because he’s mentally ill, she added, “this is the only option.”

The county realizes the need for change. Lacey heads up a new task force to improve the way the mentally ill are treated in jail and to divert low-level offenders from jail in the first place. A prosecutor for 30 years, she now wants to free people who don’t belong behind bars, even if her office put them there.

“Have we contributed to it? Sure, in some sense,” Lacey said. “But I am determined that we are going to lead this cause. My dream is that we’ll be able to close down some wings of the jail.”

‘Coming out far worse’

It’s shocking enough to witness firsthand a collection of men confined to a prison of their own minds — broken, vulnerable and in unrelenting pain. But this is not a place for a hurting mind to heal. The ward is overcrowded and noisy and offers no privacy. Even Lacey acknowledges that it’s cruel and unusual.

“They are packed in here,” she said. “Can you imagine trying to get well and rest in this environment?”

In June a searing report from the Justice Department cited a “dramatic increase” in suicides at the L.A. County Jail and called the treatment of mentally ill inmates unconstitutional, describing the conditions as “vermin-infested, noisy, unsanitary, cramped and crowded.” In the previous 30 months, the government noted, 15 inmates killed themselves. The feds are seeking court oversight of the jail system. 

When Terri McDonald took the job of L.A. County assistant sheriff in March last year, she inherited a jail system beset by controversy. Ten months later, the sheriff resigned amid scandal.
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“I would say Los Angeles County Jail is about the worst place to be, but any jail is a terrible place to be,” said Peter Eliasberg, legal director of the ACLU of Southern California.

“You have this combination of physical and sexual abuse, poor mental health care, overcrowding,” he explained. “All these things are devastating for people with mental illness, and frankly, many, many of them come out of jail far worse than they went in.”

L.A. County Assistant Sheriff Terri McDonald wouldn’t say all that, but since her first day on the job last year, she recognized there was something wrong. Specifically, she was struck that there was no group treatment space where inmates could safely get help.

“I just realized this is not the right place or right structural environment for some of these mentally ill people,” she said.

There is some treatment here, like a group therapy session we observed for substance abuse. But with so many inmates, we’re told, guards are often de facto caseworkers. And the tight quarters create desperation.

Several months back, McDonald approached Lacey about the problem, and the diversion plan was born.

‘An awakening’

L.A. District Attorney Jackie Lacey doesn’t believe her reformist stance on jailing the mentally ill indicates a change of heart. “I became a prosecutor 30 years ago because I wanted to do justice,” she said.
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“If you are so mentally ill that you’re out murdering people or committing atrocious crimes, then that’s different,” Lacey said. “We’ve got to treat you in a locked facility such as a jail. But what I’m saying is we’re overusing that option for those who are lower-level offenders.”

More than 1,000 of the 19,000 inmates in the L.A. County Jail are behind bars for nonviolent offenses, including drugs, petty theft and indecent exposure.

With the help of an outside contractor, the task force is modeling its diversion plan on successful programs in Miami-Dade County and Shelby County, Tennessee, where the recidivism rate has been cut in half. The approach includes probation and the possibility of later dismissing all charges once mental health treatment is completed. It also involves greater community outreach to the mentally ill to prevent arrests.

The need was so urgent that within months, Lacey said 100 partners signed on, from law enforcement agencies to mental health service providers.

To relieve crowding, L.A. County recently approved plans for a new $2 billion central jail. But Lacey’s task force is seeking to divert money from building jails to create more mental health beds. It simply makes more financial sense, she said.

An inmate in the jail’s psychiatric ward.
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“The way we're doing it now … is the most expensive way you can possibly do it,” she said. “You have to have more deputies, more security here. We could absolutely save taxpayer money. We could absolutely reduce recidivism by 20 percent."

The ACLU crunched the numbers, and Eliasberg said the cost of housing somebody with severe mental illness for a year costs about $65,000 a year, compared with $20,000 to $25,000 for permanent support housing with services on site.

It’s not just law enforcement that has recognized the need for change. The L.A. County Board of Supervisors recently voted to allow families and police to commit a mentally ill person to involuntary treatment, keeping them out of jail. The board also voted to expand outpatient treatment.

“There’s a huge commitment in this county to doing something different, which excites me,” said McDonald. “I don’t want to warehouse mentally ill people. I don’t want to warehouse any inmate. People matter.”

Lacey said there was nothing short of “an awakening” in the way prosecutors and law enforcement are coming to appreciate the underlying causes of incarceration.

“That's our main goal — to do justice. Not to pick on the sick and powerless and defenseless,” she said. “I am about holding criminals accountable, and I think the wise prosecutor understands the difference between a criminal and someone who is sick.”

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