Trouble in Mind

Texas's mentally impaired used to go to treatment centers. Now they go to prison.

His face is pasty and pale, a sharp contrast to his greasy coal-black hair. His dark eyes are sunken under a low forehead and thick eyebrows; he frequently jabs, mashes and grinds his eyes with the balls of his thumbs. When he speaks, he rarely makes eye contact. Even while sitting on the couch in his mother's living room — and even after 15 months of freedom — Aaron George still looks like he is in prison. And in a way, as a bipolar schizophrenic, he is: still in the prison of his own mind.

In a monotone, George recounts his recent incarceration in the Texas Department of Criminal Justice system, and he talks fatalistically about the very real possibility that he'll return to the special hell that a growing number of mentally impaired inmates inhabit.

"If I have to go back, I'll either let them kill me or I'll kill myself," he says. His voice is void of emotion; he is resigned to his fate.

At the Hodge Unit: Ruben Morales, a second-time offender serving ten years.
At the Hodge Unit: Ruben Morales, a second-time offender serving ten years.
"If I have to go back, I'll either let them kill me or I'll kill myself": Aaron George, temporarily out of prison, with his sister and mother, Beverly.
"If I have to go back, I'll either let them kill me or I'll kill myself": Aaron George, temporarily out of prison, with his sister and mother, Beverly.
Skyview: Mentally impaired inmates at the psychiatric unit prepare to man their mowers.
Skyview: Mentally impaired inmates at the psychiatric unit prepare to man their mowers.
Schizophrenic Joann Jones at the Rose Garden: Prison officials "never paid any attention to my psychiatric background". They medicated me with their fists and boots."
Schizophrenic Joann Jones at the Rose Garden: Prison officials "never paid any attention to my psychiatric background". They medicated me with their fists and boots."
Keith Ard: He refuses to take his old-generation antipsychotic drugs because they leave him sleepy, unable to defend himself.
Keith Ard: He refuses to take his old-generation antipsychotic drugs because they leave him sleepy, unable to defend himself.
Rose Garden resident Roger Pirkle: An amateur lawyer, the ex-con defends the halfway house against the state.
Rose Garden resident Roger Pirkle: An amateur lawyer, the ex-con defends the halfway house against the state.
Convicted killer Larry Robison, at the Ellis Unit: Doctors told his mother they couldn't commit him to a mental institution until he did something violent.
Convicted killer Larry Robison, at the Ellis Unit: Doctors told his mother they couldn't commit him to a mental institution until he did something violent.

It's May, and George is waiting to be retried for the 1992 shaking death of his seven-week-old son. In 1996, a Montgomery County jury found George guilty of murder and sentenced him to 60 years in prison. In January 1998, a state appeals court overturned the conviction. Four months later, he was released to await a second trial.

George, a slightly built man, looks even younger than his 25 years. During his time in prison, he says, he was raped twice and repeatedly left unprotected from predator inmates. Additionally, he says, he was also denied the psychiatric medications prescribed to him by his free-world psychiatrist — new, relatively expensive drugs that help George and other schizophrenics deal with the voices and signs that only they can detect.

Of course, accusations of barbarous living conditions within Texas prisons are nothing new. In 1972, several Texas inmates filed a landmark federal lawsuit that became known as Ruiz v. Estelle. The lawsuit challenged the constitutionality of almost every aspect of the state's prison operation, from the size of a cell to the use of solitary confinement and prisoners as guards. Following the trial that covered parts of 1978 and 1979, U.S. District Judge William Wayne Justice mandated sweeping reforms within the Texas prison system. Included in Judge Justice's ruling was an order for TDCJ to overhaul its physical and mental health care systems.

In 1995, Judge Justice released TDCJ from parts of the order but ruled that its health care system was still not sufficient. This March, he updated his opinion, ruling that the system's health care is now up to the standards of the U.S. Constitution.

But the judge still has great reservations about the quality of Texas prisons' health care. Even as he writes that treatment of the mentally impaired has improved enough to be "constitutional," he notes that TDCJ lacks compassion. "Simply stated," writes the judge, "large numbers of inmates throughout the TDCJ system are not receiving adequate [mental] health care."

He continues, writing that in light of recent rulings by the U.S. Supreme Court, "the standard for evaluating the constitutionality of medical care in prisons is Š unduly low.

"As the law stands today, the standards permit inhumane treatment of inmates. In this court's opinion, inhumane treatment should be found to be unconstitutional treatment."

Unfortunately, a growing number of mentally challenged prisoners are possibly subject to such treatment. In 1972, when the Ruiz federal suit was filed, Texas prisons held approximately 25,000 inmates. Today that number stands at more than 140,000. Mental health organizations estimate that as much as 17 percent of Texas prisoners — that is, as many as 23,800 inmates — suffer from some form of cognitive disability. But TDCJ designates fewer than 4,600 beds specifically for the mentally impaired.

And it seems ever more likely that a mentally ill person will end up in prison. Over the past ten years, according to the Texas Department of Mental Health and Mental Retardation, the number of state-funded nonprison beds for the mentally ill and mentally retarded has dropped from almost 8,000 to fewer than 5,500. Among the other states in the nation, Texas ranks a lowly 46th in mental health funding.

To Sharron Dishongh, the former head of a TDCJ psychiatric unit, the numbers point to the obvious — and they make her question the state's strategy for dealing with the people that few others want.

"The people that used to be in state [mental] hospitals are now here in prison," says ex-warden Dishongh. "But is this the best place for them?"In third grade, Aaron George was diagnosed with attention deficit disorder and began taking Ritalin. By the time he was 13, full-blown schizophrenia had been added to the diagnosis.

"He found it difficult to accept criticism," says Beverly George, Aaron's mother. "He took everything very personally. You could just ask him to take his foot off of the table and, if it was the wrong time for him, he would just be devastated. He was afraid to go into a store for fear he would make a mistake."

Often he would sit in front of the television for days without moving, talking or even eating. He grew increasingly paranoid and defensive. He suffered panic attacks. He heard voices. He became delusional. The television spoke directly to him. There were messages in numbers. Everything meant something, and it was all bad. He was convinced there was a conspiracy to kill him or, as he says, "to cross me out."

Aaron's deterioration sent Beverly George into her own panic. A divorced mother of two, she marshaled her limited resources and put Aaron under the care of psychiatrist Gary Miller. Miller diagnosed Aaron as "schizoaffected," suffering from both schizophrenia and mood disorders. To combat the problem, the doctor placed Aaron on two "new-generation" medications: clozapine, an antipsychotic, and sertralline, an antidepressant.

For the first time in years, Aaron's mental health improved. He still heard the voices, but he didn't hear them as often, and their messages weren't quite so ominous. The panic attacks were shorter. He became more sociable. He even met and married Jennifer Phillips, who had received treatment for her own psychological problems.

By time he was 18 and she was 17, they had two children and lived outside Magnolia. To make ends meet, Aaron worked occasionally at his dad's remodeling shop. But mostly he collected his Social Security disability check. Jennifer waited tables at a Golden Corral.

On August 15, 1992, while Jennifer dealt with the steak house's lunch crowd, Aaron tended to their two sons, 15-month-old Daniel and seven-week-old Alexander. It was about noon when Aaron called his mother, Beverly. He was hysterical. He told her that the baby wasn't breathing.

Beverly's first thought was that Aaron was having another panic attack, but she didn't take any chances. A friend had been visiting; with him, Beverly immediately drove to Aaron's. She says it took less than five minutes to get there, and she didn't even stop to open the chain-link fence's gate; instead, she drove right through it. Still, by the time she arrived, the baby was blue.

While her friend performed CPR on Alexander, Beverly called 911. An ambulance carried the baby to Tomball Regional Hospital, where he was declared brain-dead. Even so, several hours later, the baby was flown by helicopter to John Sealy Hospital in Galveston. There, Alexander underwent a battery of tests and treatments — or at least, says Beverly, that's what the family was told. Now she suspects that the transfer had less to do with saving her grandson's life than it did with giving investigators time to build a criminal case against her son.

"They tell us that the baby's not going to make it," says Beverly, "and then — boom — they separate us into different rooms to question us. There's a uniformed officer at the door. And I'm thinking, 'Should we be doing this?' "

Aaron told detectives from the Montgomery County Sheriff's Office what they wanted to hear: that, yes, in an effort to revive Alexander, he had shaken the baby.

On August 18, three days after Alexander was first rushed to the hospital, he was pronounced dead. Two days later, Aaron George was arrested for injury to a child; he was later charged with murder as well. On March 25, 1996, a Montgomery County jury found him guilty of both and sentenced him to 60 years.

But his troubles were only beginning. After spending about a month in the Montgomery County Jail, Aaron was transferred to TDCJ's Diagnostic Unit in Huntsville. There, inmates are tested and screened before assignment to one of the more than 100 prisons across the state. While being evaluated, Aaron told the prison doctors about his history of mental illness and the medication prescribed by Miller. And on April 29, 1996, Miller — who served as commissioner of the Texas Department of Mental Health and Mental Retardation from 1982 to 1988 — wrote TDCJ officials, urging them to keep Aaron George on the drugs he'd prescribed.

"These medications were beneficial to Mr. George," wrote Dr. Miller, "and I consider them medically necessary."

Medically necessary or not, George was instead placed on Mellaril and Haldol, two so-called old-generation medicines.

Since old-generation drugs are less expensive than new-generation drugs, they are obviously more financially attractive to the two TDCJ health care providers, HMOs run by the University of Texas Medical Branch at Galveston and the Texas Tech University Health Science Center. The problem, say critics, is that the old-generation drugs are also less effective and have more adverse side effects.

"When I complained," says George, "I was told that if I didn't take the medication they prescribed, then I wouldn't get any treatment at all. So I had no choice." For much of the next two and a half years, George was basically out of his mind. The voices, the signs, the paranoia — his old nemeses began to return.

At first, while still in the Diagnostic Unit, George took the old-generation meds. But Aaron says the medicine caused his neck to lock up and bend backward and sideways. Prison medical records obtained by his mother show that it took injections of Cogentin to counteract the side effects.

After that episode, George was transferred to the Connelly Unit in Kenedy, Texas, near San Antonio. There, he says, doctors took him off psychotropic medications altogether. His psychosis soon deepened, and he ran afoul of other prisoners.

Once, during Bible study, he refused to share a cup of water with another inmate. George says that not long after that incident, his cellmate — whose name he either can't or won't remember — warned that there was a "hit" out on him.

The next thing George knew, it was 12 hours later, and he sensed that something was wrong. His ribs were bruised, and he had severe rectal pain.

"I didn't want to believe that I had been raped," he says, "but I finally started putting the pieces together."

Those pieces, he says, came in flashbacks — flashbacks of people standing around him, flashbacks of being held down and kicked, flashbacks of being sexually assaulted.

He theorizes that he was drugged, and correctly points out that prisons are hardly drug-free zones. George believes that someone slipped something like Rohypnol — the date rape drug — into his food or water.

Of course, these are the claims of a man who admits to being delusional, and who acknowledges that he was out of his mind while in prison. Still, in October 1996, prison officials believed his allegations enough to place him in protective custody for a month, then transfer him to another unit. After a month in the Ferguson Unit, George was sent to Skyview, the psychiatric unit. He says he was told he'd be placed in a private cell, but instead was housed in the unit's dormitory area. He again feared he would be assaulted.

"I stayed awake at night," he says. "I heard people talking about plans to get me. I tried to stay awake, but they kept watching me. I stayed awake for days, but I finally fell asleep."

When he awoke, George says, he again felt rectal pain. He requested a physical examination to determine if he had been raped.

"And they said that if I got tested and it didn't happen, that [TDCJ] Internal Affairs would rain thunder on my ass," says George. "So I told them to forget about it."Beverly George is a woman obsessed. Throughout her son's incarceration she made calls to wardens, to prison officials and to administrators. She contacted her state senator, and she contacted the media. And she told anyone who would listen that she was certain of three things: that Aaron did not murder his own child; that Aaron did not receive a fair trial in Montgomery County; and that he was not receiving proper mental health care in the Texas Department of Criminal Justice. She built a Web page about her son's dilemma (www.geocities.com/Heartland/Ridge/ 8616/aaronvsmoco.html), and she networked with other families across the state with similar problems. She also invested what was left of her hope and resources in getting Aaron a second trial.

To Beverly it was clear that, though Aaron admitted he had shaken Alexander, his actions had been those of a panic-stricken mentally challenged teenager. Even if Aaron was responsible for the baby's death — and she wasn't sure that he was — at worst the death was a terrible accident, not murder.

But Aaron's attorney, Dexter Patterson of Conroe, was unable to block the prosecution from presenting evidence showing that the baby had suffered rib damage sometime before the shaking incident. Although the prosecution could not prove who had damaged the baby's ribs or how, the evidence did not help Aaron's case. In January 1998, a state appeals court ruled that state District Judge Fred Edwards had erred by allowing the jury to hear the evidence about the rib injuries, and ordered a new trial.

To handle the second trial, Beverly found Houston attorney John Osborne, a small man with a sharp wit and an acid tongue, recommended by noted criminal defense attorney George Parnham. To prepare for the second trial, Osborne — who took the case pro bono — wanted to meet Aaron. Their first encounter was hardly the typical attorney-client conference.

The meeting took place at the Powledge Unit near Palestine, Texas, where Aaron had been transferred. Before Osborne drove there, Beverly George warned the attorney that her son was sick; that he was a schizophrenic and that his condition had deteriorated in prison; that he now believed computer chips had been placed in his head and even she was part of the conspiracy against him.

Osborne didn't put much credence in this woman from the sticks of rural Montgomery County. He was a big-city lawyer from Houston, and he knew that clients are prone to exaggeration. He'd heard it all before.

But he was completely unprepared for what he saw. In a prison visitation area, Osborne sat waiting for his client to be escorted out of his cell. Aaron emerged shackled by chains around his arms, waist and legs. Three guards surrounded him, each carrying a Plexiglas riot shield pressed against the prisoner.

"They marched him into a cage and locked the door," recalls Osborne. "Then, I swear to God, they suspended the cage an inch or two above the ground. And I'm sitting there trying to talk to this guy who thinks he's being controlled by computer chips." Osborne thought of The Silence of the Lambs, with Aaron George in the role of Hannibal Lecter.

The conversation proved useless to Aaron George's defense. But Osborne left the prison with the sense that George was hardly the only mentally impaired prisoner being treated in a questionable manner. And he was right. Though hard numbers are difficult to come by, there exists striking anecdotal evidence that TDCJ often falls short when caring for the mentally impaired.

Joann Jones, 51, is a soft-spoken woman with mesmerizing green eyes. When she was 18, doctors diagnosed her as schizophrenic, and she grew dependent on the care of her parents in Chicago. When they died in 1979, Jones decided to move to Houston — for the weather.

"There's no snow in Houston," she says, without a trace of a smile.

But without someone to make sure she took her medicine, Jones soon found herself living on the fringes of reality and in trouble with the law. She began to act strangely, conversing aloud with the voices in her head. Taunted by two co-workers at the construction cleanup company where she worked, she attacked them with a knife. The men didn't die, but Jones was convicted of aggravated assault and sentenced to ten years in prison. At the time, prisoners in Texas routinely served no more than a third of their sentences. Jones, however, did nine of her ten. She failed to accrue much "good time," she admits, because she was a disciplinary problem. And she was a disciplinary problem, she says, because prison doctors ignored her schizophrenia.

"They never paid any attention to my psychiatric background," says Jones. "They just punished me. I was sick, and they knew I was sick because I told them. And they medicated me with their fists and boots."

As a result, Jones says she spent almost her entire time at the Gatesville Unit in what is known as administrative segregation strip cell. No sheets or pillow. No radio. No reading material. No personal articles of any kind. Just her, her mattress and her hallucinations.

These days, Jones lives at a halfway house in Temple, Texas. She rides a small motorcycle, makes extra money by cleaning toilets, and stays on her antipsychotic medicines.

"The only reason I made it through prison is that I never gave up on me," says Jones. "I just had the will to live."

At 6 a.m. on July 26, 1995, 46 mentally ill TDCJ prisoners were loaded onto an un-air-conditioned bus at the Jester-4 psychiatric unit for the long drive to the Montford Unit, a TDCJ psychiatric facility near Lubbock. Also on board were three guards and ten gallons of drinking water. In Mineral Wells, west of Fort Worth, the guard stopped at a truck stop to change drivers and refuel. Unfortunately, one of the guards inadvertently pumped unleaded gas rather than diesel. Not until the tank was almost completely full was the mistake discovered. The guards called a mechanic who said he could get the fuel out of the tank, but that it would take him about an hour to get there.

That was around 2 p.m., when the temperature in Mineral Wells was 107 degrees. According to a lawsuit filed against the prison system, despite the heat and the fact that all the drinking water had been consumed, the guards did not remove the prisoners from the bus, which had basically become a large oven. Additionally, although employees of the truck stop offered to take the prisoners water, the guards would not permit them to do so. It wasn't until 3 p.m., after the guards had sent a radio request for backup and three local lawmen had arrived on the scene, that the prisoners finally received more water.

Two hours after leaving the truck stop, one prisoner, Wallace Britton Jr., began pacing, wringing his hands and acting very agitated — classic signs of a heat stroke. Attorneys for the Britton family say prison doctors at Jester-4 had placed Britton on psychotropic drugs that make it hard for the body to regulate its heat.

According to the lawsuit, when Britton arrived at a local hospital, his temperature was 108 degrees. He died two days later. The hospital listed the cause of death as heat stroke, although an autopsy report maintains that Britton committed suicide — a contention the dead man's family's attorneys say is absurd.

"Obviously TDCJ hasn't heard of global warming," says attorney Charles R. Houssiere III, who is representing Britton's survivors in their wrongful-death suit against TDCJ. "If TDCJ can't even transport somebody across the state of Texas and understand that the drugs they are taking could cause a heat stroke in the middle of summer, how can they handle the serious problem of mental health therapy?"

The Britton family's lawsuit against TDCJ is expected to go to trial later this year.

In the aftermath of Britton's death, a TDCJ spokesperson commented that the prison system hoped to learn from the tragedy. It apparently didn't. On June 29, 1998, during one of the worst heat waves in the state's history, 48-year-old inmate Archie White, another psychiatric patient, died after a two-hour ride from the Montford Unit to the Robertson Unit in Abilene.

In 1995, a Randall County jury sentenced 16-year-old Rodney Hulin to eight years in prison for throwing a Molotov cocktail at a neighbor's house. Although Hulin had previously been treated in a mental institution, when he entered prison, he was classified as mentally sound and was taken off his antidepressants. Hulin complained about depression but was told by prison officials that he was just hot. A month later, Hulin reported that he had been raped. No rape test was performed. Afterward, Hulin claimed that he was raped twice more and made three requests to be placed in protective custody. The requests were denied. On January 22, 1996, Hulin was found hanging in his cell. On April 26 of this year, the state of Texas settled with the Hulin family for $215,000.

On April 17, Reginald Lavergne died, ostensibly from pneumonia, at the Michael Unit near Palestine; an autopsy was conducted at the University of Texas Medical Branch at Galveston. According to the Houston Chronicle, although there is no evidence that Lavergne suffered from mental illness before entering prison, the initial autopsy report stated that he had been acting strangely prior to collapsing while taking a shower. According to the report, for approximately a month before his death, Lavergne had been displaying bizarre behavior, including coprophagia, or eating feces — something that would seem to be a strong indication that he'd suffered some kind of breakdown after coming to prison. But even so, he was not given mental health treatment.

Keith Ard, 30, a pudgy guy who talks in a whisper, says he was diagnosed with schizophrenia at age 13 or 14, after being sent to a boys home in Houston. He doesn't remember the name of the home or exactly why he was sent there. "I think I busted up this dude real bad when I robbed a store, or something like that," he says.

Ard makes his comments in the visitation room of the TDCJ's Retrieve Unit near Angleton, Texas, where he is serving a 25-year sentence for stealing stainless steel oil drums. According to one prison official, Ard's file "has psycho all over it." Unlike Jones, prison doctors prescribe antipsychotic drugs — albeit old-generation ones — for Ard. His problem is that he doesn't want to take them. He says the old-generation drugs make him feel sleepy and slow-moving, leaving him unable to defend himself. He says he has been assaulted in prison but hedges on the question of rape.

"You don't know the half of it" is all he will say. "These people just don't care what happens to you. But I'm going to have to get me some help."

How or from where, he doesn't know.This past spring, Judge Justice held hearings to determine whether parts of the Texas prison system should be released from the Ruiz order. National mental health experts testified to a host of problems: lack of access to psychiatric assessment, overdiagnosis of malingering, a restrictive medication list, lack of monitoring to make sure that inmates take their medicines, inexperienced guards, failure to protect heat-sensitive inmates using psychotropic drugs from exposure to the sun, and an overall failure to identify and treat inmates with mental illness. One expert called the psychiatric staffing "wholly inadequate," noting that one psychiatrist covers the approximately 7,000 general-population inmates housed at the Michael, Terrell and Powledge Units.

TDCJ executive director Wayne Scott did not respond to a request for an interview.

In 1993, the Texas Legislature created the Correctional Managed Health Care Advisory Committee. In an effort to control the health care costs of the state's rapidly expanding prison population, the committee contracted with two state medical schools — UTMB and the Texas Tech University Health Science Center — to provide health care for Texas prison inmates. UTMB covers the eastern half of the state, where more than 70 percent of all Texas prison inmates are housed. The Texas Tech media relations officials referred questions to Dr. Ronnie Owens, who until last August was regional director of psychiatric services for the school's HMO contract with TDCJ. Owens, now an assistant professor of psychiatry at Tech, acknowledges that the prison health care system is far from perfect, but he also defends it, especially when it comes to costs.

For example, he points out that new-generation medicines cost around $2.50 per pill. Old-generation medicines cost about 8 cents.

"If you have something on the order of 30,000 or 40,000 people taking medications, and the difference is around $2 a dose, times 365 days a year, you see the difference pretty quickly," says Owens.

He acknowledges that the older medicines have side effects but says that inmates on those medications are given drugs to counteract those symptoms and are also excused from work detail. Critics of the system point out, however, that because of the inherent boredom of prison, work is often a privilege.

Owens also says that if the older medicines are found to be ineffective on a particular prisoner, prison doctors have the authority to order the newer meds.

Nevertheless, says Owens, sometimes people forget that the first priority of a prison system is security, not health care.

In her testimony before Judge Justice earlier this year, Dr. Suzanne Ducate, director of mental health services for UTMB/TDCJ Correctional Managed Health, rejected the criticism. She says that telepsychology — the use of closed-circuit television to interview patients at multiple locations — allows doctors to assess inmates across the state. She also estimated that "based on the job description of the psychiatrists in our system, a caseload of up to 700 patients could easily be cared for by one psychiatristŠ."

"So these individuals," testified Ducate, "I don't think, had a clear picture of just how extensive our inpatient services are, because I don't understand how they could state that we are not caring for patients with the state-of-the-art facilities we have, with the extensive programming that we have, with the inpatient facilities, the special shelter housing programs, the stepdown units, the extensive development we have done of specializing programs like the psychiatric inpatient program."The Skyview and Hodge units are located next door to each other atop a hill in Rusk, Texas, with a view of the the oldest state-funded mental hospital in Texas. It's one of the places your parents used to threaten to banish you to if you didn't behave.

Both Skyview and Hodge are relatively new facilities. With a capacity of 528, Skyview houses mentally ill inmates of both genders, mostly in a dormitory setting. Hodge has room for 989 mentally retarded male inmates; they live in more traditional security units, behind solid steel doors with a small window and a slot for their food trays. Both facilities include administration segregation cells.

Some inmates come to Skyview and Hodge for extended care, but most are short-timers. They check in for 20, 30 or 60 days before being judged mentally fit enough to return to one of the general-population prison units across the state.

In May, before her retirement, Warden Sharron Dishongh led the Press on a tour of the two units. She seemed shocked when asked about claims that some inmates had been taken off their psychotropic medications upon entering prison.

"I mean, that's the opposite of what we would want," said Dishongh. "We don't want to take them off of their meds, because if we do, their mental illness is going to pop back up."

In one of the wards for the mentally retarded, one inmate refused to remove his arm from the slot. Dishongh jokingly asked the inmate if he had "taken the slot hostage." The wisecrack displeased the prisoner.

"I'm mad at everybody!" shouted the inmate, upset because he had broken the light fixture in his cell. He said he broke it because the guards would never turn it off.

"We could gas him," said Dishongh, only half-seriously, "but we don't want to do that." Instead, she squatted next to the slot trying to talk with the prisoner, promising that she would have the light replaced. The slot remained his captive.

No one would mistake either Skyview or Hodge for something like a school or day-care center; razor wire runs along the tops of the perimeter cyclone fences. But even at first glance, something about the two facilities broadcasts that they are different from most other prisons.

Flowers appear in rows and clusters along the fences and in the yards. A crew of prisoners armed with lawn mowers keeps the yards trim. Others inmates tend gardens of tomatoes, peas and peppers — all of which are used in the units' kitchens. Still other inmates work in the prison greenhouse or attend the in-house landscape design school. There's also occupational therapy such as barbering. There's animal-assisted therapy where, for a few hours a month, volunteers share the affection of their pets with inmates. And there is training in life skills such as cooking. "Some of these guys can't boil water when they first come here," says Dishongh.

Too, the atmosphere here is somehow looser than that of many prisons. The standard armed-guard towers are positioned strategically around the prisons, of course, and violence occasionally breaks out. (Even during the tour, an inmate attacked a guard who need several stitches to close the wound to his head.) Still, both guards and prisoners seem more relaxed than their counterparts at other prisons. Dishongh says it's that way by design. In addition to meeting the regular requirements to be certified as peace officers, guards at Skyview-Hodge must take 32 hours of special training on dealing with the mentally impaired, as well as yearly refresher courses. Additionally, Dishongh says not all TDCJ guards are cut out for work at her prison; she's choosy about who comes to work for her. She adds that there is also an internal culling process: Not all TDCJ guards want to come to Skyview-Hodge.

But inmates certainly do — at least to Skyview, that is. Like the other three TDCJ psychiatric units where patients receive psychotropic drugs, Skyview is air-conditioned. Contrary to popular belief, regular units are not. Because of that amenity, Dishongh says her staff has to screen out prisoners who don't need to be there.

"Do we weed them all out?" she asks. "No. And do we sometimes weed out someone we shouldn't? Yes. But all in all, I think we do a very good job."

But she also admits that that job is getting tougher.

Up until June, Dishongh had been in charge of the twin psychiatric facilities for the past six years. Before coming here, for six years she oversaw the TDCJ headquarters for psychiatric services, in Huntsville. Prior to that she worked at the Rusk State Hospital just down the hill. Only half joking, she says she basically followed her clientele here because as the state reduced the funding for MHMR beds, the mentally ill have found their way to prison.

"Our nation, not just our state, has not done a real good job in determining how to manage the mentally ill," she says. "And so what are they going to do when they leave here? They are going to get into trouble. Because the services in Texas are not there for the mentally ill or the mentally retarded."On that point, former Skyview psychologist Jeri Houchin agrees with Dishongh. But she does not concur with the warden's assessment of the overall treatment provided to the mentally impaired in TDCJ. It's not that Houchin doesn't want disabled inmates to do their time. She just believes they have a right to the reasonable accommodations and care guaranteed to them by law.

In 1995, Houchin formed Back To Life, a company that conducts seminars for the mentally impaired and the people involved with them. The seminars cover the criminal justice system — how to avoid getting in trouble, and if you do, what your rights are. She is also a board member of the Texas Planning Council for Developmental Disabilities.

In 1988, Houchin was sitting in a coffee shop in Jacksonville, Texas, just down the road from the Skyview Unit, where she worked as a psychologist. As she sat there, an elderly gentleman walked to her table and asked if she'd mind if he joined her. She politely told him that she was sorry, but she didn't have lunch with men she didn't know. The man introduced himself as Governor Bill Clements. And after talking with Houchin, he asked if she'd mind if he appointed her to the disabilities council. She didn't, and he did.

Although Judge Justice has removed TDCJ health and mental health divisions from the Ruiz order, Houchin believes the high patient-to-doctor ratio will send them back to federal court. "Psychiatric services in TDCJ is pretty much like a meat market," she charges. "People just get processed through. There is very little therapy whatsoever. I talked to a [prison] psychiatrist the other day who was just going round and round with them because they just wanted him to go ahead and renew medications without seeing the inmate individually. And he just refused to do it. It's a horrible caseload they have there now, and the prisoners are just not getting the mental health services they need. Once the bulk of the Ruiz order got lifted in 1995, they started going back to their old ways. It's just a matter of time before it gets back to being as bad as it used to be."

Houchin also says that despite TDCJ denials, the mentally impaired are indeed often taken off their medications upon entering the prison system. She chalks it up to misdiagnosis by low-quality psychiatrists who often can't get work anywhere else.

"Some have had some fraudulent stuff with Medicare, or they've had problems with medication themselves," she says. "While I was there, we even had one guy working as a psychologist who was business major, and he was an idiot."

In January 1997, The Dallas Morning News identified eight doctors who had practiced in the state prison system the previous year after having been publicly disciplined by medical review boards.

Houchin adds that even if inmates get back on their feet at units such as Skyview, there is not enough oversight in general-population prisons to make sure inmates stay on their medications. She also maintains that many inmates are chronically ill, and so sick that they have no business being placed back into the general population. Once these people go back to regular prisons, she says, they are going to either assault someone or be assaulted.

"The reason I left TDCJ," she says, "was a 15-year-old mentally retarded Hispanic kid who, by the time he got to me, had been gang-banged so much he was also mentally ill because of the trauma."For the past two decades, Al Slaton, a 67-year-old convicted murderer, has done what he could to keep the mentally impaired off the streets. In 1975, after spending 22 years off and on behind bars, Slaton found employment in several state and veterans hospitals. In 1980, he opened the Rose Garden, a generous name for a dozen or so dilapidated little houses several blocks east of downtown Temple.

Slaton says he takes people that other halfway houses don't want. The unfortunates who live at the Rose Garden consider him their guardian angel. If not for Slaton, they say, they would have nothing and nowhere to go.

But for almost all of the Rose Garden's existence, Slaton has been engaged in battles with numerous state agencies over the halfway house's operation. According to a spokeswoman for the Texas Department of Human Services, Slaton is illegally operating a personal care home and dispensing medicine without a license. She adds that TDHS agents have previously found deplorable living conditions at the Rose Garden; that they have found residents living in trailers with dirt floors and rotting food in a tractor trailer used by the Rose Garden as a pantry. The department complains that Slaton keeps inadequate records of his expenditures of residents' Social Security funds.

Slaton acknowledges that he doesn't have a license to operate a personal care home but maintains he doesn't need one. He does, however, admit to dispensing drugs.

"One of their arguments is that I'm giving these people medication," he says. "Well, it's true. Through the years I have given medication because no one else would give it to them." He claims he gets the meds through area doctors and MHMR. He also volunteers that some of the Rose Garden's houses are coed, and that no one stops the residents from having sex or drinking beer if they choose to.

On several occasions state agencies have raided the compound and relocated residents to other facilities. The most recent raid occurred last month, when agents from the Texas Department of Human Services again removed several residents from the Rose Garden. Among them was 37-year-old Janice Hankins, a schizophrenic. The cheery, rotund redhead died not long after being forced to leave. Slaton says she committed suicide. (Bell County Justice of the Peace Eddie Lang has yet to rule on the cause of Hankins's death.)

But even as state authorities move to shut down the Rose Garden, resident Roger Pirkle, a sort of lawyer without portfolio, plots Slaton's own legal move to have the former residents returned to the halfway house. While serving time for murder, Pirkle became one of the original writ writers in the Ruiz lawsuit and may be better at filing legal actions than some attorneys. In a filthy room at the Rose Garden, he sits surrounded by stacks of legal briefs and newspaper clippings. His hair is slicked back; his frame is lanky. He listens simultaneously to a police scanner and a boom box playing the Righteous Brothers.

For both Pirkle and Slaton, Hankins's death is all too reminiscent of a similar raid in 1989, when the state revoked a contract he'd won two years before, and removed several residents. Among them was 47-year-old Mildred Weaver, a schizophrenic.

Two years later, Slaton filed a lawsuit in which Weaver was the lead plaintiff. The lawsuit challenged the Texas parole system's treatment of the mentally disabled. Specifically, the suit contended that TDCJ's parole division did not have an adequate number of officers trained to deal with the special needs of the mentally impaired. As a result, the suit claimed that an inordinately high number of mentally ill and mentally retarded parolees were returned to prison. After the suit was settled, the parole division more than doubled the number of officers with expertise in working with the mentally handicapped.

Slaton now blames the Rose Garden's troubles on the suit, saying that the state resented his victory. The suit didn't seem to do much for Weaver, either: Following her eviction from the Rose Garden and relocation to another halfway house, she found her way back to prison. Weaver committed suicide.

Rose Garden resident Joann Jones did time with Weaver. Like the rest of the parolees and mental patients who remain at the halfway house, Jones remains devoted to Slaton.

"I have a freedom here that I wouldn't have somewhere else," says Jones, whose garage apartment is neatly kept. "Al doesn't give up on me. He has never turned his back on me. He has never thrown me away. And believe me, I know what it's like to be thrown away."Thirty or so years ago, mental patients were mostly corralled into a few large hospitals. But the civil liberty laws of the mid-'60s granted the mentally impaired the right to expect treatment in their own communities. At the beginning of the movement toward deinstitutionalization, government funding was supposed to follow the patients back to the individual communities. But according to a spokesperson for the Mental Health Association in Texas, it didn't turn out that way.

"That was really a myth," says Melanie Gantt. "The money did not follow the patients. And so, as they were deinstitutionalized, these people became homeless. And as new people came into the system, the number of beds had been reduced, so there was no longer the capacity in the institutional setting to serve them. Nor have community services been augmented to the point to be able to take on the new capacity. And so, in Texas, our prisons have become our largest mental health institutions."

According to the Mental Health and Mental Retardation Authority of Harris County, the county jail is currently Houston's largest repository for the mentally impaired. But late this summer, the MHMRA — with a mandate to provide mental health care for the indigent — will open a 40-bed hospital dedicated to mentally ill people in crisis, the first of its kind in the Houston area. The neuropsychiatric center, located in the Texas Medical Center, will treat many people who would now be sent to the Harris County Jail.

Besides reducing the level of human misery, similar intervention programs could save the county and state significant sums of money. Dr. James Baker, MHMRA's medical director for adult mental health, laments that in the last ten years the state of Texas has built two prisons to deal exclusively with psychiatric patients. Those same patients, he says, could have been handled by agencies like his own for a fraction of the price.

"For the cost of three days in prison, I can manage a patient for an entire year in the community, if he's kept out of trouble," says Baker. "But the state's not into building community health centers. It's into building jails."

Baker points to alternatives such as the MHMRA's Assertive Community Treatment program. ACT treats mentally challenged parolees in their communities, assigning each one to a team of counselors, social workers, nurses, case managers, vocational specialists and substance-abuse specialists. The client-to-team-member ratio can't exceed ten to one; each patient is seen by at least one team member at least once a day.

"We get to know them as people," says Tom Mitchell, an ACT team leader, "and they get to know us."

So far, the program has provided intensive care for 205 patients. The result, he says, is a recidivism of rate of almost zero. Mitchell estimates the cost at between $7,500 to $10,000 per patient per year. While critics may say it's too expensive, Mitchell doesn't see it that way, especially when all the costs of sending mentally disturbed offenders to prison are factored into the equation: the cost of the initial arrest, the cost to the victim, court costs, and the cost of long-term incarceration and treatment. "The problem," he says, "is we could use 20 ACT teams in Harris County alone."

But if the last session of the Texas Legislature is any indication, lawmakers are not inclined to approve bills that would improve the lives of mentally impaired offenders.

During the recently ended session, state Representative Glen Maxey sponsored a bill that would have created a pilot program under which mentally impaired inmates would receive the new-generation psychotropic medications. The bill would also have allowed paroled inmates to continue receiving the new medications through MHMR facilities.

"Ultimately, UTMB opposition was pretty much the reason we couldn't do it," says Robin Chandler, Maxey's aide, who made the bill her top priority during the session. "They would have had to administer it, and they said they didn't have the money or the capability. They were just totally and completely unwilling to do it. It was very unfortunate. We didn't feel like it would have cost a lot of money."

A bill by Houston state Senator Rodney Ellis to ban the execution of mentally retarded capital murderers met the same fate as Maxey's bill. The legislation would have outlawed the death penalty for any defendant with an IQ of 65 or less. The bill made it out of the Senate but ultimately died. Legislative sources say it was crushed by the governor's office.Ellis's bill would not have helped death row inmate Larry Robison, who suffers from schizophrenia, not mental retardation. Still, Lois Robison feels that the system failed her son.

In the summer of 1982, Lois tried desperately to have Larry placed in a mental hospital because of his increasingly strange behavior. He thought people were trying to kill him. He thought he was receiving messages from aliens and having out-of-body experiences — psychotic episodes intensified by his use of speed and LSD. Each time, she says, doctors and administrators told her they couldn't help until Larry actually did something violent. But when he finally did, it was too late.

In August 1982, Larry Robison fatally stabbed and shot five people in two cottages on Lake Worth, west of Fort Worth. He decapitated and sexually mutilated one of his victims, claiming he was acting on orders from the Bible.

"We were so naive," says Lois, "that after he was arrested, we thought he would go to a mental hospital." Instead, Larry was convicted of capital murder. He is scheduled to be executed next month.

Despite a campaign by his family and anti-death-penalty groups such as Capacity For Justice, Larry Robison says he's ready to die. "I believe there is something better waiting for me in the next life, and I look forward to it," he says. "I know my mother probably doesn't agree. She's very attached to me. But I'm trying to help her with that."Aaron George's mother, too, is very attached to Aaron. But unlike Larry Robison, Aaron George does not see a better life for himself anywhere on the horizon.

At the conclusion of his retrial, George was again found guilty of murder by a Montgomery County jury. He was sentenced to 99 years in prison — 39 years more than after his first conviction. Before the trial, George's attorney was gung ho about filing a class-action lawsuit about TDCJ's treatment of the mentally impaired. Now, even the appeal of George's latest conviction appears to be on hold.

George is still waiting to be transferred from the Montgomery County Jail back to the psychiatric care TDCJ system. Every day he makes a collect call to his mother, but each time the conversation grows shorter.

"All he can say over and over," she says, "is '99 years.'" "As the law stands today, the standards permit inhumane treatment of inmates." " U.S. District Judge William Wayne Justice"The reason I left TDCJ was a 15-year-old mentally retarded Hispanic kid who, by the time he got to me, had been gang-banged so much he was also mentally ill because of the trauma." " Former Skyview psychologist Jeri Houchin"For the cost

of three days in prison, I can manage a patient for an entire year in the community."

" James Baker

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