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Monday, December 9, 2013

Epidemic: Being mentally ill and imprisoned: ‘Talk about cruel and inhumane’

wonderful article By Matthew Spina, The Buffalo News, Dec 8, 2013

In the wee hours of a frigid winter morning, a wanderer considered both odd and smart towed a toy wagon through a field and along a line of power poles. Rattling in his wagon were random items: a can of spray paint, a sleeve of golf balls, a gas can, a chain saw.
An Orchard Park patrolman saw him step out of some woods and didn’t buy his story that he was out hunting for firewood and returnable bottles – not in 10-degree weather at 4 a.m. But seeing no crime and knowing something about the man’s past, the officer got him to a hospital for a mental check-up.
Ten days later, a wind storm toppled three of Orchard Park’s wooden power poles. The National Grid crew that restored electrical service to 6,300 customers discovered the poles had been cut three-quarters of the way through with a chain saw and left to snap.
Detectives zeroed in on the fellow with the Radio Flyer Wagon, Gregory J. Seifert.
In January 2012, Seifert had just turned 43. Nearly 6 feet tall, he was lean and handsome, with close-cropped hair and a wary gaze. In a suit, he could look like a business consultant – which is what he was when he earned more than $100,000 a year setting up computer networks. But that winter, after moving in with his parents because he had nowhere else to go, he sometimes walked the streets in bare feet.
James and Carol Seifert could not convince their oldest son that he was sick. Nor could they place him long-term in a state psychiatric center, even after multiple evaluations. The number of state-provided psychiatric beds had fallen to historic lows, and though their son had worsened for almost a decade, he was not seen as dangerous to himself or others, a crucial legal threshold for involuntary commitment.
After an hours-long interrogation, Orchard Park police formally accused Seifert of sawing into the power poles and booked him into the Erie County Holding Center. It was Jan. 23, 2012.
Gregory Seifert was finally in an institution. But it was the wrong one for someone seriously mentally ill.
Decades after the country began closing mental institutions en masse, jails and prisons have become America’s de facto psychiatric centers. Psychiatrists say that about a third of the severely ill people who, 50 years ago, would have been placed in a psychiatric center still need a structured setting. But today’s structured setting is often a jail or prison.
As the new century approached, the number of mentally ill inmates in New York’s prisons was exploding. During a 13-year period – from 1991 through 2004 –the volume of inmates receiving treatment grew by 71 percent, three times faster than the general population, according to the Correctional Association of New York, an independent prison watchdog for almost 170 years.
The new reality is that roughly one of every seven prisoners is on the state Office of Mental Health caseload. The number of seriously ill inmates has waned in recent years, along with the overall state prison population and the growth of mental health courts and prison-diversion programs. But the 7,800 mentally ill inmates are too many for the system’s designated treatment units, said Jack Beck, who visits prisons for the Correctional Association.
The consequences are serious, for mentally ill inmates and the community:
• Mentally ill inmates nationwide are more likely to become sexual victims while behind bars. Some 6.3 percent of state and federal inmates with “serious psychological distress” reported that they had been victimized by another inmate. That’s nine times greater than the percentage of victims with no mental disorder, according to the Justice Department’s Bureau of Justice Statistics.
• Inmates in designated mental health units are involved – as victims or perpetrators – in more assaults, contraband violations, self-injuries and other “unusual incidents” than general population inmates in New York’s most dangerous prisons. The rate of unusual incidents among prisoners in six of the system’s specially established mental health units in 2011 was more than three times the rate for Auburn Correctional Facility, a notorious maximum-security prison.
• Mentally ill inmates are easily preyed upon by general population inmates. Sometimes called “bugs,” inmates with psychiatric disorders are enlisted to run drugs or fill other dangerous tasks. A mentally ill or developmentally delayed inmate is “like a lamb or a zebra to a lion,” one prison-based mental health worker said. “Easy pickings.”
• Studies suggest that mentally ill inmates released from prison are more likely to re-offend if they return to drug abuse – which often accompanies mental illness – and drop the prescribed medicines they received in prison. The more effective the treatment while they are in prison, the less likely they will cause problems once paroled.
Many of the people in charge argue that caring for the mentally ill should not be their job. But jail and prison rosters are likely to grow.
In New York, the state intends to close more psychiatric centers starting next year.
“Talk about cruel and inhumane,” said Chautauqua County Sheriff Joe Gerace. “Having them in jail because they are problematic in society is not their choice. A treatment facility is much more appropriate.”

Unaware of their illness

There are many Gregory Seiferts, if you count those mentally ill people who don’t believe they are sick, doubt their need for medicine, have a brush or three with hospital care, commit foolish or nuisance crimes and then board the conveyor for jail or prison.
Jerome Brylski’s family saw him spinning out of control in 2010. The West Seneca resident, diagnosed with paranoid schizophrenia, replaced his medication with marijuana. His children, in statements to police, said they tried to get him admitted to Erie County Medical Center’s psychiatric unit for longer-term care, but two attempts ended in frustration for them and made Brylski angrier and more violent.
In the second try, Brylski was released within days. Then, in April 2010, he blasted two shots from his deer rifle at the West Seneca police officers who pulled over the car in which he was riding. Brylski was injured by the barrage of return fire but survived.
An unarmed friend who wanted no part of a gunfight, Jeffrey J. Edwards, was shot twice as he tried to surrender while assuring police he meant no harm. The wounds paralyzed Edwards from the neck down, and he has been in a hospital bed ever since.
Before the shooting, Brylski’s family had wanted him in a psychiatric center, where he could get help. He’s now serving a 20-year prison sentence after pleading guilty to attempted murder.
It is often up to families – the Brylskis and the Seiferts were among many – to steer a seriously mentally ill person toward treatment and expect them to continue with treatment. Some agencies, such as Erie County Crisis Services, are ready to help. But it’s difficult to force people to take medication and accept counseling if they doubt they need it, especially if they are not acting in a dangerous manner.
While the vast number of people diagnosed with a mental illness live safely, some don’t. Further, psychiatrists say that roughly half of the people with schizophrenia, when off their medication, don’t realize they are ill because the disease damages the part of the brain responsible for self-analysis. So they have no drive to seek treatment.
After seeing the difficulties his mentally ill sister-in-law experienced, D.J. Jaffe began a blog based in New York City called the Mental Illness Policy Org. It offers up a trove of information about the toll of untreated mental illness. Jaffe believes courts should order treatment for those patients who become dangerous and shun care because they cannot comprehend that they are sick. The stance places him directly against those patient-advocates who say forced treatment violates personal rights and does more harm than good.
“When someone is walking down the street screaming, ‘I am Jesus Christ,’ it’s not because they believe they are Jesus Christ,” Jaffe says.
“It’s because they know they are Jesus Christ.”

A family’s anguish

Gregory Seifert became a textbook example of how the onslaught of a serious mental illness can redirect a life, blindside a family and force its members into a crash course on the confounding mental health system.
News reports about Seifert’s arrest portrayed him as someone whose schizophrenia drove him to bizarre acts. In 2007, he torched his Chevrolet Suburban on busy Elmwood Avenue because he thought it contained devices to spy on him. He set a fire that ruined his Cape Cod in Hamburg the month before the power poles fell.
The news reports, however, failed to fully describe the depth of Seifert’s spiral. It began when he was hospitalized in his 30s for what everyone thought was an anxiety attack. It was the first shadow of a serious mental illness that would leave him unstable and sometimes delusional.
Over the next decade he lost his job, split with his wife and grew distant from his four sons. In recent years, he drifted homeless in South Carolina for a few weeks. Rescued by his parents, he returned to live alone at his house in Hamburg but soon after set it on fire. Weeks later, he was facing charges in a puzzling act of vandalism that knocked out power to 6,300 customers and drew notice from the Joint Terrorism Task Force.
Days before the power poles were cut, Gregory Seifert was released from the Lake Shore Health Care Center in Irving against his doctor’s advice. His father, too, knew it was a bad idea. But the insurance had run out on his inpatient care.
James Seifert, squarely built with thinning gray hair, is a retired General Electric engineer who, like his son, made his living solving problems for business and industry. A former Marine, James Seifert has no trouble saying things people don’t want to hear. When a Lake Shore employee told him Gregory would be released, he told her: “For the next couple of weeks, you should wear a good dress to work. Because we are all going to be on TV.”
That’s how sure he was that his son, diagnosed with paranoid schizophrenia, among other things, would surprise everyone again and probably land in jail.
“One of the things that I have been criticized for is not bailing him out,” James Seifert said. “I don’t know. Maybe that’s something I am going to have to live with for a long time. But I really believe that if I bailed him out, he would just be gone.
“He would be living under a bridge someplace, and he’d either get mugged and killed or do some other stupid things out there. I cannot in good conscience bail him out without some plan for keeping him in a place that can help.
“I’m not afraid of my son. He is not a violent person in the sense that he would try to beat somebody up or try to shoot somebody or stab somebody. But he does stupid things, and he does believe that he’s working for the CIA.
“People don’t realize what a terrible, traumatic thing this is for a parent.”

The crime of mental illness

In Arlington, Va., in 2010, researchers at the Treatment Advocacy Center, a nonprofit think tank, ran some numbers.
Studies showed that 16 percent of inmates nationwide were suffering from serious brain illnesses, such as schizophrenia, bipolar disorder or major depressive disorder. So the researchers ran that percentage against an inmate census for each state.
Their findings: If there was a tipping point in the transfer of mental patients out of psychiatric centers and into jails and prisons, it had long since passed. The nation had far more mentally ill prisoners than mentally ill hospital patients.
Three times more.
Using the factor of 16 percent, every state had more mentally ill prisoners than patients. Even New York, which was spending more to run its remaining treatment centers than any other state, housed 2,700 more mentally ill people in cells than in hospitals and psychiatric centers.
“Many of these individuals wouldn’t even be incarcerated if they could get the help and care they need in their community,” the Civil Service Employees Association said in testimony given to the State Legislature this year. “The state has emptied out the state psychiatric centers but has failed to follow the individuals who leave these institutions.”
It would be easy to dismiss the CSEA statement as union rhetoric intended to save state jobs by blocking Gov. Andrew M. Cuomo’s plan to close four of the state’s remaining 24 psychiatric centers because inpatient care is so expensive. But the CSEA’s remarks echo those from many others who study the mental health system and whose priority isn’t necessarily protecting state jobs.
Among them is E. Fuller Torrey. As a research psychiatrist in Chevy Chase, Md., Torrey argues that government mental health agencies should focus on those seriously ill individuals who are so deep into their own reality that they don’t know they are sick and won’t seek help on their own – the people who, as D.J. Jaffe said, “know they are Jesus Christ.”
To Torrey, the nation has taken a giant step backward, to the early 19th century, when mentally ill people were warehoused in prisons where brutal conditions sparked a reform movement to place them in specially built institutions. With those mental institutions mothballed in the latter half of the 20th century, jails and prisons again were pressed into service for the mentally ill.
Torrey worked as a hospital psychiatrist in the 1970s as states boarded up psychiatric centers and laid the cost to care for patients on federal programs. In 1998, he founded the Treatment Advocacy Center, the nonprofit that ran the numbers in 2010.
“We were very good at emptying out the hospitals,” Torrey says, “and then very bad at providing treatment.”
In Western New York, the number of hospital beds available for psychiatric patients continues to fall. The new behavioral health center that will open next to Erie County Medical Center early next year – to be run by ECMC and Kaleida Health – will offer fewer beds than ECMC and Kaleida’s Buffalo General once offered separately.
Further, while the state-run Buffalo Psychiatric Center intends to add a small number of beds next year, it will have to absorb the Children’s Psychiatric Center in West Seneca, which will close under Cuomo’s consolidation plan. Facing its own financial pressures, the Lake Shore Health Care Center, which for a time had Gregory Seifert in one of its 24 behavioral health beds, may close as well, unless some other entity buys that hospital.
Torrey, now in his 70s, has become a folk hero to families frustrated that the porous system makes it likely that their ill loved ones will encounter a cop before a psychiatrist or land in a cell before a hospital bed.
“I remember a recent one you had,” he said during a Buffalo News interview early this year, recalling the case of a mentally ill man thrown into a Western New York jail for an odd crime after several efforts to help him.
“The guy took his chain saw to some of the telephone poles up there. Which I thought was kind of novel.”
“I’ve seen a lot of things,” Torrey said. “But that was a new one on me.”

‘My cloned twin did it’

Mental health courts can be invaluable in directing someone faced with a crime to accept treatment. But not every community has a mental health court. Sometimes the system steams along without regard to a defendant’s mental illness.
James and Carol Seifert cooperated with police during their investigation. They did so thinking that the police would agree their son belonged in a treatment facility, not a jail. But the Seiferts watched the police and prosecutors follow well-worn grooves – toward an arrest and conviction.
When Orchard Park police first asked Gregory Seifert about the downed telephone poles, he admitted being in the area near 3949 California Road with his wagon. Then they showed him pictures of the damage.
“His eyes began to flutter, inside closed eyelids. He swallowed hard, and he became visibly upset,” police wrote in a report. Seifert ended the interview and walked away.
Later, Detective John Payne quizzed him in detail at Police Headquarters. In a recording of part of the interview, Seifert sounds foggy. He drawls out his answers. He starts sentences and does not finish them.
He barely acknowledges a problem.
“I got stressed out,” he says at one point, to explain the turmoil in his life.
“You’ve been separated from society for a long time,” Payne counters.
Seifert pauses and then says, “Yeah.”
But he never really confesses or explains his actions.
“I know this sounds weird, but my cloned twin did it,” Seifert said, according to a police transcript.
“So you are saying your cloned twin cut the poles?” Payne responded.
“I know. It sounds weird,” Seifert said.
“I want you to take responsibilities for your actions,” the detective said.
“I did. I am responsible for those poles coming down,” Seifert shot back.
“So you are telling me that you cut the poles?”
“No,” Seifert said.
In jail, he took his medicines sporadically. He sometimes refused to see his parents when they came to visit. He wrote threatening letters to people he knew around Orchard Park and implied that he works undercover for the CIA, his father said.
According to jail records, he tore up a T-shirt and wore parts of it as socks. He trashed his cell with food. He removed his identification bracelet. All of the above violated the rules. But what happened in December 2012, nearly a year after he was locked in jail, put him in another league.
Seifert, according to statements given detectives, jammed a shower rod tipped with foil from a juice container into the outlet powering a television set. Another inmate yelled at him to knock it off, because the TV picture could be lost. But Seifert kept at it until the tip of the rod grew hot.
Then, according to witnesses, Seifert set his smoldering tool against some pillow stuffing he had jammed into his cell’s air grate. The flames were extinguished before causing major damage or inflicting harm. But, to the deputies, he endangered the building’s occupants. That fit a charge of second-degree arson, a felony that could put him in prison for up to 25 years.

Greater risk of suicides

In both jails and prisons, suicide is a leading cause of death.
Various studies report that anywhere from 40 to 70 percent of the victims had a history of mental illness. Many displayed a clear warning sign: a prior attempt to end their lives. But in jails or prisons, clear warning signs aren’t necessarily enough to prevent someone from taking their own life.
Amare Seltun, who had been diagnosed with major depression, tried to hang himself several times before he succeeded in killing himself in a solitary confinement cell at Attica Correctional Facility in September 2009. State Commission of Correction investigators faulted the mental health staff for the way Seltun, 37, had been handled.
George Scribner, 43, was placed in the Orange County Jail in Goshen for stealing $20 from his stepdaughter to get high. Scribner, already diagnosed with depression, admitted during his screening that he had attempted suicide six weeks before. After two days in the jail, he hanged himself in his cell in January 2008.
Edward Berezowski, 54, was booked into the Erie County Holding Center in August 2012 after tearing off a Best Buy employee’s name tag, choking a manager and throwing him into a store display, according to the Erie County Sheriff’s Office, whose deputies arrested him.
His friend Frank Sausner surmised that Berezowski was angry about the big-screen TV he bought weeks earlier.
“He could control himself under most circumstances,” Sausner said. “But if he did lose control, he would be, if not physical, real boisterous.”
Skilled as a plumber, mason and chef, Berezowski was a smart and determined nonconformist, according to another friend in an online tribute to him. Berezowski declared on Facebook that he works at “surviving life and maintaining my sanity.” He also was adamant about taking his medication for depression and bipolar disorder.
In August 2012, the Holding Center was about to emerge from a Justice Department lawsuit that sought more humane conditions within one of New York’s worst-run county jails. The county had already agreed to long-neglected improvements that would lessen the chance for inmates to commit suicide, but officials had not yet converted a second-floor gymnasium into an expanded intake and assessment area, which then-County Executive Chris Collins agreed to create.
Sausner said he once heard his friend Berezowski admit to a suicide attempt years earlier. The Holding Center’s initial report for state regulators indicates jailers were unaware that Berezowski once tried to take his own life and had been treated for a mental illness.
But were there other signs he was at risk?
A lawsuit contends that Berezowski’s ex-wife, who remained among his friends, contacted the Holding Center staff to tell them he was suicidal, and she delivered his crucial medicine to the jail. But Berezowski failed to get it, and he was not placed under constant watch nor in one of the more modern cells retrofitted to make suicides by hanging more difficult.
The day after his arrest, Berezowski strung his jail-issued pants to the bars to create a noose and hanged himself. He died days later in a hospital.

Could he stand trial?

The side door to a quiet courtroom in recess swung open, and an officer led in a wiry defendant dressed in a tan oxford shirt, faded blue jeans and a chain cinching his arms at the waist. With a full beard and longer hair sweeping nearly to his collar, Gregory Seifert looked thinner, younger and deeper into his own world than in the booking photo snapped in January 2012.
He slipped into a chair at the defense table without acknowledging the worried couple in their 60s who sat behind him, little more than an arm’s length away.
Seifert had turned 44 during his nearly 20 months in jail, which included time served for his conviction in the telephone-pole vandalism, his father said. At issue on that September morning was his mental fitness for his arson case.
There was no disagreement that Seifert is mentally ill. Psychiatrists over the years diagnosed him with a slate of serious brain ailments no one would want: bipolar disorder, schizophrenia, chronic paranoid schizophrenia. His mental state had led to six different hospital stays to stabilize him.
The question, 10 months after the fire in his cell, was whether he could understand what was going on in the courtroom.
Could he participate in his arson defense?
Did he know what was on the line?
Prosecutor Paul J. Glascott asked three psychiatrists if Seifert understood the charge against him and could testify in his own defense if asked. Did he understand the role of a judge, a prosecutor, a defense attorney? Could he envision the serious consequences if convicted of second-degree arson?
Two of the psychiatrists, Michael Cummings and Evelyn Coggins, answered affirmatively.
“He had awareness of his legal rights,” Coggins said of the time she examined Seifert in late February of this year, after the fire in his cell. He could testify and handle the stress, she said.
Cummings, now Erie County’s executive director of behavioral health, provided the same answers.
He agreed Seifert had appeared calm, was reasonably well-groomed and answered questions in context during his exam. When taking the antipsychotic drugs Seroquel and Haldol, Seifert seemed more open and friendly, but there was little difference in him when he didn’t take them, Cummings said.
Brian Joseph was the only psychiatrist to testify who was not connected to Erie County’s Forensic Mental Health Service. Joseph was formerly the chief of psychiatry at the Erie County Holding Center. For years he had testified for prosecutors and knew, he said, that prosecutors expect the county’s psychiatrists to deem felony defendants fit for trial.
Joseph, a gray-haired veteran of hundreds of hearings like this one, quickly revealed that he considered Seifert seriously mentally ill. When asked if he would identify him in the courtroom, Joseph pointed toward the defense table and said in his deep baritone, “Mr. Seifert. The one with poor eye contact.”
He had examined Seifert at the request of Seifert’s defense attorney, Lawrence Desiderio, when Desiderio concluded Seifert wasn’t working to defend himself. With Seifert refusing to see Desiderio, the lawyer filed papers to force Holding Center personnel to let him in, and he arranged for Joseph to see the defendant, too.
Joseph said that in no way could Seifert “meaningfully go forward” with a trial.
“As far as I am concerned, Mr. Seifert is a walking conglomeration of symptoms,” he said.
Joseph said that when assessing someone’s capacity, he chiefly wants to know whether the lawyer and defendant can work together. But he found “no meaningful interaction” between Seifert and Desiderio, because the client’s answers to his lawyer’s questions were sometimes nonsensical or absurd.
“He does not understand that he is mentally ill,” Joseph said. “He is overwhelmed with his schizophrenic view of the world. His answer to the world around him is simply to withdraw.”
If such talk angered Gregory Seifert – who did not respond to The News’ request for an interview – he did not show it. Gazing elsewhere in the room, he sat as an island of indifference as the psychiatrist’s words washed past.
When the hearing concluded, Seifert was led away without a fuss, and without acknowledging his parents.
In the hallway outside, James Seifert went off for a moment to be alone with his thoughts.
Carol Seifert, stoic during the hearing, steadied herself on a bench, then pulled out a tissue to dab at her eyes.
“All we wanted was to get him help,” she said. “That’s what this was all about.”
Christopher J. Burns, the State Supreme Court justice who presided over the hearing, said he would rule quickly and in writing. He circulated his decision Sept. 16, just four days later.
“The court finds, by a preponderance of the evidence,” he wrote, “that the defendant currently lacks the capacity to stand trial.”
He ordered Gregory Seifert into the custody of the state Office of Mental Health for up to a year. If his condition improves in the meantime, he will be returned to face the arson charge.
Seifert’s parents go to see him now in the Rochester Psychiatric Center. He takes his medicine, sees a psychiatrist regularly and talks more frankly about his illness, they said.
From everything they can see, he’s getting better and showing more promise than he ever did while in jail.

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