The Revolving Door Between Jail and Mental Health Care in Harris County

Tyrone Dolphin with his mother, Liz Willis, in 1993, not long after he was diagnosed with schizophrenia.EXPAND
Tyrone Dolphin with his mother, Liz Willis, in 1993, not long after he was diagnosed with schizophrenia.
Courtesy of Liz Willis

Before the schizophrenia set in, Tyrone Dolphin was on a full-ride football scholarship at Western New Mexico University, studying to become an aeronautical engineer.

He was a three-sport athlete in high school, and he graduated cum laude with big dreams, his mother, Liz Willis says. But once psychiatrists put him on antipsychotic medication during his sophomore year of college, Dolphin had to drop out and come home, often unable to get out of bed.

Her son is now 43 and homeless. Dolphin wants his independence, and so he has refused to live with Willis. He has tried to rent an apartment using his social disability check, but he never stays long, unable to pay. Willis says that, since his diagnosis derailed his college education, the thought of going back to school has become a fixation. At the start of every school year, he visits the Texas Southern University campus to surround himself with ambition. He’s tried to re-enroll, Willis said, but his mental illness always sets him back.

These days, Dolphin pretty much only receives mental health treatment when he is arrested for trespassing. His schizophrenia has become severe enough, however, that doctors have labeled him permanently incompetent, and petty charges against him are always dismissed. Instead of making him serve time, a judge orders that he be committed to the Harris County Psychiatric Center. He may stay for a few days, maybe a week, receive some medication, and then he’s back on the streets — only to be picked up by police the next month, when the process will start all over again. It has happened six times just in the past year.

“The only help that I know is the help that he’s getting, and it’s not working for him,” Willis said. “So what do you do? …Maybe they’re doing the best they can,” she added. “Maybe that’s all they can do.”

Tyrone Dolphin is just one example of the revolving door between the criminal justice system and mental healthcare. He is among the state’s most vulnerable citizens, those whom mental health doctors believe will never return to a level of competency that would allow them to understand the consequences of committing petty crimes, like sleeping on private property.  The Harris County criminal courts are doing, arguably, the best they can for people like Dolphin, by letting them go and transferring them to the custody of mental healthcare providers. But once they do, that's when both jails and the local mental health authorities run into the big problem: There is no room at the hospital. And so patients like Dolphin will wait in jail until there is — even though they are no longer charged with a crime.

“This is a time of bed scarcity,” said Dr. Floyd Jennings, chief of the misdemeanor mental health division at the Harris County Public Defender’s Office. “And in times of bed scarcity, you have to be real careful about how you use those beds. They’re only going to take the worst of the worst.”

That means that, even while some people wait between ten or 20 days to finally be transferred to treatment, they may arrive for an evaluation at Houston’s NeuroPsychiatric Center only to be turned away. Because even though their mental illness may be severe, their situation may not be urgent enough, Jennings said. Even if chronically ill patients are admitted, they generally don’t stay long enough for the treatment to make any meaningful difference, Jennings claims.

“When you begin to accept the tragic as normal, it’s very difficult to change,” he said. “I don’t think anyone’s doing this consciously. It’s not intentional. This is a comment about our culture in Texas, where we have now diminished the resources available to this population to such a degree that the providers intuitively realize that they can only devote their efforts to those who are likely to benefit the most.”

He compared the situation in Texas to a sinking ship, only with passengers who are mentally ill patients. They all need help, he said, but an unfortunate number will not receive any, due to the lack of resources. "There's only so much room in the lifeboat," he said.

It means that people like Tyrone Dolphin, those who suffer from chronic and severe mental illness to the point that they have been labeled "permanently incompetent" in court, are the passengers who may end up left behind.

***
Liz Willis keeps her son's sports trophies and high school graduation mementos on her fireplace mantel.EXPAND
Liz Willis keeps her son's sports trophies and high school graduation mementos on her fireplace mantel.
Meagan Flynn

The case of Shannon Miles, the man accused of killing Harris County Sheriff's Deputy Darren Goforth at a gas station last August, was the spark that turned Texas lawmakers' attention to the bed capacity crisis state mental health hospitals face on a regular basis.



Miles, whom doctors diagnosed as schizophrenic, was found

incompetent to stand trial

in February. The difference between him and Dolphin, though, is that doctors and the court still believe that, if they send Miles off to the state hospital for treatment for up to three months, doctors can restore his competency and the court will be able to continue with the trial, something that does not work for Dolphin. But Miles was also No. 61 on a long waiting list of people at the Harris County Jail awaiting transfer to the state mental hospital. Again, there is no room for them.

After becoming aware of the wait list issue, Sen. John Whitmire pledged to do something about the problem in the Lege next session. Which is all well and good. But the other problem is that, according to data from the Department of State Health Services, the state already devotes more beds to restoring people back to competency, so they can be convicted and go to jail, rather than to civil commitments.

Meanwhile, down at the local level, chronically mentally ill people who are cycling in and out of jail for petty offenses are unable to spend more than several days at the Harris County Psychiatric Center because it does not have the resources to keep them for more intensive treatment. Bill Kelly, director of public policy and government affairs for Mental Health America of Greater Houston, said these chronic patients are more so an "after thought" in the legislature. When forensic beds are eating up all the resources, he said, it results in an overburdened local mental health system. 

It results in Tyrone Dolphin waiting, on one occasion in December 2015, 15 days in jail with no charges against him before the Harris Center, the local mental healthcare provider, could transfer him to treatment. He missed Christmas, and rang in the New Year in jail.

"The fact that people are having to go to a facility here locally for inpatient acute care and it’s literally full every single day, that’s a pretty good cause for concern," Kelly said.

The Houston Press reviewed all 145 misdemeanor cases in 2015 in which, after doctors found a person permanently incompetent, a judge dismissed the case and ordered the person to civil commitment. On average, a person spent one week in jail before the Harris Center could transfer them to an open mental health bed. Nearly two-thirds of the cases were trespassing charges, which could be a sign that some of those people were homeless. In at least three cases, people waited 20 or more days in jail with no charges; one man waited just over a month. Twenty-eight others waited between 10 and 19 days.

The Harris Center, lawyers the Houston Press spoke with, and probate court staff had different opinions on what the law requiring "prompt" transfer of mentally ill patients from jail really means. Jennings, for example, pointed to a separate statute that said they must be released within 72 hours. But Beth Mitchell, a lawyer with Disability Rights Texas, said that these disagreements don't change the bottom line. What is the Harris Center to do, she said, if there is nowhere to take the patient because there are no beds?

It could be worse, Mitchell said: In many counties, judges don’t even dismiss the cases against the severely mentally ill and indefinitely keep the charges pending, even though doctors may never be able to restore the person back to competency so they can stand trial. But, she added, try telling that to concerned family members, who only want things to get better for their loved ones, who may be stuck in jail while they wait for a hospital bed to open up. 

One of those family members is Susan Noll, whose half-brother, Ross Ierrobino, a paranoid schizophrenic man, became homeless 15 years ago. She is the only relative he has left.

She remembers the first time he was charged with trespassing in the early 2000s, shortly after the bank stripped him of his home. She remembers the second time, too, a couple years later, when she flew down from New Jersey around Christmas time, shortly after her brother was released from jail. The judge had told him he was free to go, Noll remembers him saying. “But go where?” Noll says. “When a person's sick, they need help. How do you just throw a person out into the streets and say, ‘Good luck’? He walked from the courthouse. It had to be 40 miles. All the way back to Katy.”

She tried to bring her brother back with her to New Jersey so she could take care of him and their ailing mother, but he refused. He has been arrested for trespassing several times over the years. After he was involuntarily committed after one arrest in the mid-2000s, he filed a $900 billion lawsuit against the University of Texas Medical Branch, where the Harris County Psychiatric Center is located, claiming they were conducting psychological studies on him against his will. His last arrest was in March 2015; he waited in jail 13 days before he was transferred to civil commitment, with the permanently incompetent label decorating his criminal file. It is unclear how long he stayed, or what treatment he received, but Noll knows that whatever it was, he was released back onto the streets, free to go.

For the past 15 years, they had been keeping touch via email — Ierrobino used the computers at the Lone Star Library, their meeting place whenever she visited. But he stopped returning messages in October. Now, Noll is consistently checking in with the police department and the Harris County Medical Examiner’s Office, waiting for him to wash up in their custody, unsure if he is dead or alive.

* * * 

The type of care that would keep patients like Dolphin and Ierrobino from falling through society’s cracks is the type of care that the state funds the least, advocates told the

Houston Press.

In the past couple years, Harris County has, in fact, been able to devote more resources to its mentally ill population thanks to a $5 million grant from the state to launch a diversion program. It's intended for mentally ill defendants whom Harris County prosecutors often call “frequent flyers” at the jail, given how often they cycle through. Instead of putting them in jail, these defendants can participate in an intensive, long-term outpatient treatment program, and if they are homeless, officials can assist them with housing, in effort to close that revolving door problem, so often perpetuated by homelessness.

But this diversion program is also, in a way, a paradox: Those who need it the most, like Dolphin and Ierrobino, are not eligible because of the “permanently incompetent” label in their file. The director of the program, Dr. Reginia Hicks, said that, because they likely would not be able to consent to the terms of the program and keep up with it, they aren’t able to participate.

“These are folks that need a more structured living environment,” Hicks said. “If we put them into an apartment, they probably wouldn’t be able to do well there. They need a place where there will be staff able to guide them and direct them on their daily living skills.”

But residential facilities like the one Hicks has described, where people could maintain independence but also have access to care daily, are also the most expensive types of treatment, said Bill Kelly with Mental Health America of Greater Houston. No one disagrees that this would be the best thing for these patients, he said. The problem is, as always, money. According to the Kaiser Family Foundation, Texas ranks No. 48 in the country for state mental health care services expenditures per capita.

As Jennings put it, until the Legislature is willing to cough up the funding to aid the chronically mentally ill, "it has failed its most vulnerable citizens."

Tyrone Dolphin and his mother, Liz Willis, at a birthday celebration for Dolphin in 2007.EXPAND
Tyrone Dolphin and his mother, Liz Willis, at a birthday celebration for Dolphin in 2007.
Courtesy of Liz Willis

Dolphin's mother, Liz Willis, says that the only time her son received intensive, outpatient-type treatment is a testament to how important it is for him—and how well it really works. A few years ago, the Houston Police Department selected Dolphin to participate in its program for the chronically mentally ill population, called the "Chronic Consumer Stabilization Initiative," funded by the city. It may not have involved the type of residential facility Hicks described, but it did provide Dolphin with a case manager who constantly made sure that he had a place to live, usually in a group home, and that he was taking his medication and staying on his feet. It worked so well for him that he even graduated from barbering school. He re-enrolled in college for a little bit. He was building a new life, Willis said.

But after his first two case managers got a promotion and left the program, Willis isn't sure what happened to the third, and it wasn't long before he was back to being homeless again.

Willis is still holding out hope that her son will one day be able to go back to school and pursue the computer science degree he never stops talking about. She knows he can do it, she said—but he needs that case manager. He needs a home. He needs the treatment.

She worries that by the time he receives the care he needs, it could be too late. In recent months, she said, Dolphin hasn’t been back to visit the Texas Southern University campus—not since TSU police arrested him.

The school year had just begun. It was 8:30 a.m. on August 25, and Dolphin was walking around in the Leonard Spearman Technology Building, the building he might be sitting in that morning were he taking a computer science course. After receiving a suspicious person call, TSU police arrived and took him into custody.

Dolphin would soon go before a judge after being booked in the Harris County Jail. The charges would be dismissed. And he would be transferred to civil commitment thanks to the permanently incompetent label in his file — a label his mother refuses to believe is true.


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