They miss medication doses, sinking further into psychosis as their symptoms take hold.
They try to kill themselves and sometimes succeed.
They lash out at staff and fellow inmates in the midst of mental breakdowns, at constant risk of lengthening their sentences.
Mentally ill people are wasting away in Colorado jails and crowding the state’s prisons, paving the way for disasters by making correctional workers de-facto practitioners in what critics say is perhaps the worst possible environment to treat psychiatric issues.
The faulty system is so “starved for care” that it keeps those who need help cycling from captivity to the streets and back to cinder blocks and steel bars, said John Snook, executive director of the national nonprofit Treatment Advocacy Center.
“You have jailers who are not medical professionals who are completely at their wit's end,” Snook said. “And you have tragedies, over and over again, that could be easily averted if you were providing mental health care.”
The resulting dysfunction comes at a high cost to taxpayers. Penal institutions face security risks and threats of multi-million dollar lawsuits as they perpetuate a system that mental health advocates and criminal justice experts compare to modern-day warehousing.
"Instead of keeping people in mental institutions, we're keeping them in jails and prisons," said Boulder County Sheriff Joe Pelle, a vocal critic of a criminal justice system that's become a "last resort" for people with mental illness. "Our jail is the largest inpatient mental health facility in Boulder County. It’s not supposed to be."
In the decades since the "deinstitutionalization" movement attempted to shift mental health care from vast, state-run mental asylums and into communities, correctional facilities have become default mental health care institutions in Colorado and across the country. Yet, even as this hellish situation has become the norm, few solutions have emerged.
Data provided to The Gazette by the El Paso County Sheriff’s Office and the Colorado Department of Corrections show that:
- Last year, about one-third of the more than 22,500 inmates booked into the El Paso County jail reported having mental health issues during psychiatric assessments. Nearly 6,300 of them had “mental health alerts,” flagging them as suicide risks or noting a mental health diagnosis or history.
- Today, one out of every three men imprisoned in Colorado — and four out of every five women inmates — say they have some type of moderate to critical mental health need, according to the Colorado Department of Corrections. The number of inmates with mental health needs in Colorado’s prisons has steadily risen in the past two decades, from about 4,500 in 1998 to about 10,700 last year.
- More than 300 of the state’s prison inmates have tried to complete suicide from the beginning of 2014 through the end of 2018. Thirty-four people killed themselves. Another 62 people incarcerated at the El Paso County jail attempted to take their own lives, but none were successful.
“What the system does to everyone involved — it’s devastating, really,” said Stephanie Gangemi, the jail’s former mental health care director. “It’s trauma, day in and day out.”
High stakes for mentally ill inmates
In the six months that Mikolaj Warszawski spent in solitary confinement at the El Paso County jail last year, his grandmother feared that his zombie-like psychosis was worsening.
Georgianna Warszawski worried that Mikilaj was being pushed around “like a rag doll” by fellow inmates and correctional officers. His mental illness has made him an easy target — a 12-year-old in a 27-year-old’s body, she said.
She dreaded, too, that he might be driven to kill himself.
“When somebody is mentally ill, you worry, ‘They could die in here,’” said Georgianna Warszawski, showing off photos of her grandson as a child — before schizophrenia, bipolar disorder and other mental health problems overtook him as a teenager, triggering a pattern of arrests and suffering.
When mental health diagnoses go unattended at the El Paso County jail, the consequences can be dire.
Last year, an inmate twice tried to commit suicide by jumping off the top of a bunk bed after she went without her anti-psychotic medication, her mother told The Gazette. A Colorado Springs man lost part of his leg to gangrene when a dog bite he suffered during his arrest festered while he was in the haze of psychosis.
It’s difficult for officials to accurately gauge exactly what percentage of the jail’s inmates have mental health problems because the Sheriff's Office relies on them to self-report the issues.
A past detention bureau chief estimated in 2017 that 60% to 75% of the inmates in the overcrowded facility had some sort of mental health issue.
Often, a trip to jail starts with uncontrolled symptoms.
A manic state may drive irrational and unsafe behavior. Paranoia may give way to a violent outburst at an authority figure who’s trying to help.
“The majority of individuals with mental health issues who end up in jail — if they did not have the mental illness, they wouldn’t be in the system,” said Gina Shimeall, a Colorado criminal defense attorney who serves on a legislative task force focused on mentally ill people in the criminal justice system.
Once in jail, people with mental health issues often stay there for longer. They wrack up additional charges when crucial mental health needs go unaddressed, fueling aggressive or irrational behavior.
And in the militant environment of a correctional facility, there's no room for error, Shimeall said.
“You follow rules, you don’t cross the line — that’s how jails are run to keep people safe,” she said. “When you have somebody who is psychotic, those don’t register … It’s not that they don’t follow the rules. They’re not able to follow the rules."
The ruthless cycle
For Mikolaj, a downward spiral often begins when he forgoes his prescribed medication for recreational drugs, his grandmother said.
“He gets out on the streets, and people take advantage of him,” Georgianna said.
It’s a common story, advocates say.
People with mental health issues might not receive any attention for their conditions when they’re behind bars, said Vincent Atchity, executive director of the Denver-area nonprofit The Equitas Project, devoted to “disentangling mental health and criminal justice."
And when the mentally ill are released from correctional facilities, they’re not connected with the resources they need to become more stable, Atchity said.
Instead, they often resort to getting high or drunk. The countdown to their next arrest begins.
“They end up cycling in and out of jail repeatedly, at great cost to the community, without any fruitful outcome, because the health care is not there,” Atchity said.
Mikolaj’s mental health problems have been exacerbated by a tumultuous family life. He lost one of his brothers to a gunman in a Walmart store and his father to a heroin overdose.
Mental illness runs in the family, Georgianna said.
One confrontation with authorities began when his grandmother called the police in 2016 when he was experiencing a mental episode. He allegedly hurled a rock through a police station window, and was struck by a car while fleeing on a scooter, according to an arrest affidavit.
Later, he punched an officer and spit on a nurse at an area hospital, the affidavit states.
The breakdown resulted in charges including two counts of felony assault and one count of felony criminal mischief.
More charges came in April 2018.
Police found him toting what appeared to be an orange and green shotgun at the Fountain Creek Nature Center with a glass pipe full of methamphetamine in his pocket, according to another arrest affidavit.
The gun was a toy, he said.
Once in jail, he grew more psychotic.
Mikolaj, who has since been released, recalled his “bad days” in an interview with The Gazette — the ones he spent sobbing, missing his family, constantly looking over his shoulder and pacing his cell.
He tore up the daily letters that Georgianna wrote him, flushing the scraps down the toilet. He was afraid someone would read them, he said.
He made threats and ignored deputies' orders, Sheriff’s Office spokeswoman Jacqueline Kirby said in an email.
Cells were flooded, mattresses destroyed and emergency buttons broken as his “disruptive behavior” intensified, Kirby said.
He was no longer allowed to speak to his family after he was moved to solitary confinement, where he spent six months alone in a cell for 23 hours a day.
By then, Georgianna was able to glean little from the conversations they had during visitation.
He wasn’t making sense, she said.
Providing someone who’s incarcerated their prescribed medications frequently becomes a struggle, defense attorneys and criminal justice experts say.
Concerned family members often make phone call after phone call to correctional facilities, only to be referred to another staff member, asked to jump through another bureaucratic hoop, or blocked in the name of patient confidentiality.
It can be even more of a challenge if a family member doesn’t have a current prescription, or if the medical staff is limited to a formulary of specific medications, Shimeall said.
Meanwhile, the loved ones they’re trying to reach wrestle with unbridled symptoms.
El Paso County jail's inmate medical contractor, Miami-based Armor Correctional Health Services, declined to arrange an interview with the facility's current mental health director. Instead, a public relations representative asked The Gazette to submit a list of questions and provided a written response.
More than 150 inmates in the El Paso County jail had been identified as "chronically mentally ill patients" as of the first quarter of 2019. About a quarter of those patients were on psychotropic medications in February, according to a statement from jail Mental Health Director Tanya Belknap.
She noted the figures are "not all-encompassing.”
If someone who is booked into the jail says they are taking medications for a mental health condition and intake staff can verify the prescription, the person is then scheduled to see a provider, she said.
But the jail’s medical team often face obstacles in administering medication, Belknap said.
State law prohibits staff from forcibly medicating an inmate — even if the inmate's symptoms have made them a danger to themselves or others, she said.
For those who enter the jail with severe substance abuse issues, the medical team's first priority is to help them detox and avoid withdrawal symptoms, Belknap said. Any mental health needs that those inmates report come second.
When tragedies become legal battles
Travis Bickford thought his wife, Jacqueline, would be safer at the Summit County jail than at home after she was arrested in April 2016.
She hung herself with a bedsheet at the facility five days later.
The 31-year-old mother had threatened to commit suicide and repeatedly asked jail staff for her prescribed antidepressants, according to a federal lawsuit that her family has filed against the Summit County sheriff.
In addition to paying the high cost to provide health care for mentally ill inmates, governments often face another hefty expense: Legal settlements.
These claims often arise when “terrible things” happen in facilities that lack adequate resources and staff, said Nastassia Walsh, who manages a National Association of Counties initiative that aims to reduce the number of people with mental illness in jails.
Jacqueline Bickford’s death came as the mental health issues she’d experienced since she was seven were worsening with bouts of postpartum depression, her husband said.
But he couldn’t get her a bed at a local inpatient treatment program. So he didn't pay her $1,000 bond.
She was arrested on suspicion of child abuse and neglect after she was found halfway conscious at their Breckenridge apartment.
Her blood alcohol level was more than .35 -- roughly four times the legal threshold for being charged with driving under the influence in Colorado-- and her infant son was nearby.
“The whole system failed her, completely. The mental health system, the jail system — they failed me and they failed her son,” Travis said.
El Paso County, too, has paid for mishaps that have occurred when people with mental health problems are in its custody.
A $675,000 payout from the county’s insurer — the largest on county record books — went to a woman who was in the midst of a mental health crisis when jailers ripped her legs out from under her and forced her to a cell floor in 2014.
Philippa McCully’s ACL was torn, her knee fractured and her body bruised all over.
The takedown happened just after the then Colorado College junior was arrested for erratic behavior that her attorneys blamed on the mix of psychiatric drugs she was prescribed for depression and anxiety.
In 2017, the county agreed to a $15,000 payout after an inmate claimed she was nearly choked to death in a 4th Judicial District Courthouse holding cell by a woman who was mentally ill.
Ryan Partridge sued Boulder County Sheriff Pelle after he ripped his eyeballs from his head in the midst of a psychosis-induced rage while being held at the county jail in 2016.
Partridge, who is now blind, also broke his back when he attempted suicide by jumping head-first from the jail’s top tier, alleges the lawsuit, pending in U.S. District Court in Denver.
But the harrowing claims that make it to court are only a small window into the widespread dysfunction that occurs when people with mental illness are in correctional facilities, Denver civil rights attorney David Lane said.
“The cases that get filed are cases resulting in extreme outcomes, like Ryan Partridge,” said Lane, who represents Partridge. “Most people who are psychotic don’t even understand that they need to reach out and ask for help.”
The new asylums
When America moved to "de-institutionalize" mental health care and shutter primitive psychiatric hospitals in the 1960s and 1970s, the intention was a positive one: To get people with mental illness the treatment they needed while allowing them to live in the community.
But the funding to support the transformation never followed, advocates say.
Instead, taxpayer dollars have bankrolled the construction of jails and prisons, and people with mental illness have increasingly found themselves lost in the criminal justice system.
Now, Colorado’s prison system has evolved to resemble a mental health care institution.
The number of inmates with mental health problems in state prisons has steadily risen since the late 1990s, according to data from the Department of Corrections.
In 1998, nearly one-fourth of the state’s roughly 19,300 inmates had mental health needs. Last year, almost 40% of the roughly 29,000 people imprisoned in Colorado had mental health needs.
That rise is likely due to societal change in attitudes that’s made people more accepting of seeking help for mental health problems, Department of Corrections Deputy Executive Director Kellie Wasko said.
"Fifty years ago, it was not socially acceptable to say that you had mental illness or to say that you were hearing voices," Wasko said.
But advocates blame a lack of treatment options, from a shortage of state hospital beds to a dearth of other facilities and programs that would allow people with mental illness to recover in the community.
Instead, the mentally ill people are trapped in a system that’s incapable of delivering the long-term care that many of them need, said Maureen Cain, legislative and policy director for the Colorado State Public Defender’s Office.
“We keep people in the criminal justice system to get treatment because there isn’t the right treatment in the community,” Cain said.
A challenge for correctional staff
In the El Paso County jail’s mental health ward for women, moods can change quickly — especially if inmates are refusing to take the medication that’s dispensed to them by the jail’s medical staff, Deputy Billie Mahan said.
But Mahan knows these women, she said.
She can help avert mental health episodes which might drive them to hurl their food trays, bang on cell doors or strip off all their clothes.
“You just have to learn your inmates. That’s the nice part about me being in that particular ward. I know what helps them, and I know what things can trigger them to have a bad day.”
In the jail’s mental health wards, jailers use “de-escalation” tactics daily, Sgt. Josh Seiter said.
Typically, it starts with a conversation.
Handcuffs, restraint chairs, and other uses of force are a last resort, he said.
Seiter often works in a maximum security ward, where one jailer is typically responsible for watching about 30 inmates, many of whom have mental health issues.
They wear "safety smocks" that can't be fashioned into a noose.
“That, at the end of the day, can be very mentally challenging, very mentally draining — when you’re the person in there and you’re dealing with 80 other different personalities. But we do it," said Seiter, who works 10-hour shifts, like all of the jail's floor security personnel.
An estimated 85% of the 535 sworn staff members of the sheriff's detention and patrol bureaus have taken an eight-hour Mental Health First Aid training course, meant to help law enforcement officers better understand and respond to signs of mental illness, said Kirby, the Sheriff’s Office spokeswoman.
Armor’s mental health staff includes six full-time behavioral health professionals who are counselors or social workers.
Those identified as having a mental illness during an initial health screening are referred to the mental health team, according to Belknap, the jail's mental health director. Patients can also ask for therapeutic services by submitting an electronic request. Anyone with urgent medication needs is seen the same day, she said.
But multiple family members of former jail inmates have claimed that requests for vital psychiatric medication have gone unheeded for days, weeks, even months at the jail.
In the days after he was arrested for randomly killing an Air Force veteran in August 2016, Timothy Hagins attacked a nurse and two El Paso County Sheriff’s deputies.
The schizophrenic, who turned violent after going off his medications, was ordered to serve an indefinite commitment at the Colorado Mental Health Institute at Pueblo after a judge found that he was legally insane at the time of the killing and subsequent attacks.
His case illustrates the risk that mentally ill inmates can pose to corrections workers.
But, as experts point out, people with mental health problems are often victimized by other inmates or staff members in a jail or prison setting.
Mikolaj Warszawski has said he was brutally beaten by jail staff in March 2015.
The alleged takedown came shortly after he was arrested on suspicion of two misdemeanor counts that have since been dismissed.
He was taken into custody after he became "verbally belligerent" at the county's detox facility, spit in a staff member's face and punched a wall, according to an arrest affidavit.
Once in jail, he was “hit all over” and “slammed to the ground” many times, he wrote in a complaint to the Sheriff’s Office.
He told the jailers that he was mentally ill, but they continued to beat him, he reported.
The Sheriff’s Office has denied the allegations. Sheriff’s spokeswoman Kirby said in an email that the accusations, including the claims of injuries, are “completely false.”
Georgianna Warszawski keeps Mikolaj’s complaint and other documents detailing the incident at the family business, “Kash's Gems" thrift store on Platte Avenue. She recently spread the paperwork on a counter for a Gazette reporter to examine.
Mikolaj’s ACL and a band of cartilage in his knee had snapped, an orthopedic doctor concluded in medical records. He needed reconstruction surgery.
The incident left him with bruises covering most of his body and “strains and sprains” in his shoulders, elbows, wrists, knees and spine, a chiropractor who examined him wrote in another report.
The Sheriff’s Office reviewed surveillance footage and documentation from the incident as part of an internal investigation, according to a November 2015 letter responding to his complaint.
But command staff concluded none of the jail’s policies or procedures were violated.
The force used by deputies “was both reasonable and proper,” a sheriff’s inspector wrote in the letter.
Data have shown that deputies at the jail frequently use force on mentally ill inmates.
From January 2015 to April 2016, jail staff used force about 280 times in the intake and release section, from handcuffing to hitting or kicking an inmate, according to a Sheriff's Office report.
Nearly 130 of those inmates had a mental health issue based on a mental health assessment, the report states.
No open beds
Mikolaj Warszawski spent months at the jail last year awaiting a spot at the Colorado Mental Health Institute at Pueblo.
There wasn’t a bed open for him when a judge ordered that he undergo competency restoration services at the hospital until he was deemed mentally fit to stand trial.
Hundreds of other people with mental illness have been left to suffer in Colorado jails due to the shortage of state hospital beds.
They go without medication and treatment, often “getting worse and worse,” said Terri Hurst, policy coordinator for the Colorado Criminal Justice Reform Coalition.
Denver-based nonprofit Disability Law Colorado sued the state in 2012 over the plight of these inmates, who have been found mentally incompetent and often face minor, nonviolent charges.
Under a watershed agreement announced in March, the Colorado Department of Human Services pledged to hire new clinicians, tighten certain treatment deadlines and shift care for many criminal defendants from state psychiatric hospitals to community-based programs. If it doesn’t, the state could face fines of up to $10 million a year — a new measure to ensure the state keeps its promises after it broke the terms of two previous settlements in the yearslong legal battle.
A bill that Gov. Jared Polis is expected to soon sign will help implement many of the provisions of that agreement. Patients will be admitted to the Pueblo hospital based on need, rather than the order in which they were court-ordered to complete restoration services, said Disability Law Colorado Legal Services Director Alison Butler. The measure also requires that the Colorado Department of Human Services provide funding to jails for mental health care services, including medication, Butler said.
Under another bill that Polis is poised to sign, the state’s human services department will have five years to strengthen a safety net to help people with severe behavioral health disorders get the services they need in the community and avoid involvement in the criminal justice system, she said.
Since the beginning of October 2018, some criminal defendants have waited up to 186 days for a bed at the Pueblo hospital or another competency restoration program at Arapahoe County jail, according to data that Disability Law Colorado obtained from the state.
As of March 7, defendants in 150 cases statewide were awaiting competency restoration services, including 25 defendants in El Paso County, the data show. Some of those defendants have more than one case.
Mikolaj Warszawski was returned to the El Paso County jail in March after a three-month stay at the Pueblo hospital. He is now taking four different types of medication that were prescribed to him at the psychiatric facility.
“I feel stable,” he told The Gazette.
He was released from jail on a personal recognizance bond, or a written promise to appear in court, in April.
The struggles of release
Jackie often hears her 23-year-old schizophrenic son pacing like a captive animal on the carpeted floor of their Colorado Springs home.
He picked up the nervous habit in recent years during stints at the El Paso County jail, where the voices in his head intensified.
Without his medication, he became more and more paranoid. He felt safer on suicide watch, where he wasn’t such an easy target for his fellow inmates, who often bullied him and forced him to give away his meals, she said.
“He described it as being like PTSD when he got out. It was chaotic, it was crazy, it was never calm,” Jackie said. She declined to give her last name or her son’s name, citing concerns about identity theft and retaliation by law enforcement and others in the criminal justice system. The story of Jackie's son was corroborated by court records.
When people with mental illness get out of jail, they often have to navigate complex bureaucracies to find counselors and psychiatrists, seek disability and medical benefits and access other services to help them stay out.
And, without a caring friend or spouse or family member, they’re on their own.
It’s a flaw in the criminal justice system that helps “feed the pipeline to jails and prisons,” said Nancy VanDeMark, interim president and CEO of Mental Health Colorado and former director of the state’s Office of Behavioral Health.
Jackie said her son had no prior criminal record before he was arrested on suspicion of harassment and disorderly conduct in 2015. Since then, he’s faced felony drug charges and more than a half-dozen misdemeanor counts.
But Jackie wants to help him break the cycle, so she spends hours each week doing what she can to help him.
She schedules doctor’s appointments and takes him to therapy.
She registers him for programs that will help him get his GED diploma and kick his substance abuse habit.
She helps him discern what’s real and what isn’t when the voices get louder.
“If you don’t have somebody to advocate for you here in Colorado Springs, you have nothing," she said.