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Today, America's biggest mental health treatment centers are its jails. Los Angeles has what is believed to be the largest. Its county jail system now holds more than 5,000 inmates dealing with a mental illness. Some 3,000 are held downtown in what's called the Twin Towers Correctional Facility. In the first of two reports, NPR's Eric Westervelt takes us inside the Twin Towers. And just a warning here - this story contains some graphic scenes.
ERIC WESTERVELT, BYLINE: Along one of the Twin Towers cellblocks, an inmate gestures frantically at a small window. He's piled garbage in a corner of his cell, like some grim, abstract sculpture. A door note warns guards he's a runner. Elsewhere, guards have posted cell door signs that an inmate is hostile or suicidal. And there are warnings of gassers, meaning one who's thrown blood, feces or urine. There's a smell of urine and dank water and, in several areas, water seeping out of cells.
What's all the water on the floor and the blanket sopping up the water?
TANIA PLUNKETT: He clogged the toilet. He continued to flush it, which resulted in overflowing.
WESTERVELT: Sheriff Capt. Tania Plunkett is with the Twin Towers Access to Care Bureau.
PLUNKETT: Unfortunately, with the design build, drains weren't incorporated, so it will collect water, sometimes an extensive amount of water, on the floor.
WESTERVELT: So toilet flooding is a daily occurrence.
WESTERVELT: Also a daily occurrence - new inmates with a mental illness entering the Twin Towers. In the last decade, the number of inmates housed here has skyrocketed. Capt. Plunkett.
PLUNKETT: When I started in 2013, mentally ill inmates were only housed on this seventh floor and the sixth floor right below it. Currently, to date the entire facility is - consists of mentally ill inmates.
WESTERVELT: It's overcrowded. It's understaffed. The Twin Towers needs 200 treatment beds for the most acute cases. It has only 40. It wasn't built for treatment. It doesn't have enough counselors. Ten psychiatrist jobs have gone unfilled for nearly two years. Social worker Luis Pena is the jail's mental health clinical program manager.
LUIS PENA: We used to have a psychiatrist see them every two weeks. But because of the lack of psychiatrists in the jail, we have to see them every month.
WESTERVELT: If lucky, the inmates on this floor will see a social worker once a week. By default, there's more of an emphasis on medication - critics say overmedication - and less on individual or group therapy. There's really no room for that or, Pena notes, almost no privacy. On some floors, bunk beds pack what should be common-use areas.
PENA: We have to scramble. We have to do whatever we need to do, whether the individual is suffering from schizophrenia, psychosis, provoked by drugs or whatever. But this is the population that we get. And this is the population that we need to target and provide the best that we can.
WESTERVELT: The best we can includes a ready supply of suicide restraints. They're heavy, belt-less garments akin to the thick blankets movers use. They're stacked like office supplies on a shelf in a secure area outside the cells.
PENA: This is now one of those floors...
WESTERVELT: On one of the several high-observation floors reserved for the more severe cases, half a dozen disheveled young men are standing still, staring into space and munching on sandwiches. Many are half-naked, except for the suicide gowns wrapped around them like some medieval garment. They're chained to the metal tables bolted to the floor. I asked Sheriff's Deputy Myron Trimble what's going on.
MYRON TRIMBLE: This is lunchtime. And they're actually programming right now. It's considered indoor recreation time.
WESTERVELT: This is rec time?
TRIMBLE: Yes, sir.
WESTERVELT: They're shackled to the table.
TRIMBLE: Yes, just to make sure that they're not walking around. If they're not taking their medication, they can be deemed unpredictable at the time.
PLUNKETT: I think everyone can agree that it's rather inhumane to have the inmate handcuffed while out.
WESTERVELT: Again, Capt. Tania Plunkett with the Access to Care Bureau.
PLUNKETT: However, because of spacing and the lack of programming, we're not able to really focus on getting the inmate better to eventually lead to having them program without being handcuffed.
WESTERVELT: Across the country, this is a mental health crisis largely hidden behind bars, unless you have a loved one in the system. Jails are the new asylums. Patrisse Cullors's older brother was diagnosed with schizoaffective disorder, mania and depression. During one manic episode, he took off in his mother's car. He ended up in a high-speed chase and was arrested for fleeing the scene. Then in LA's north detention center, Cullors says, he was beaten by guards while experiencing psychosis.
PATRISSE CULLORS: The first time I saw my brother in the county jail system, he was in terrible condition. And I just kept thinking, why would our society allow for someone who's sick to be treated this way, to not be given the kind of care they deserve?
WESTERVELT: Cullors founded the group Reform LA Jails. During her brother's time in the Twin Towers, she says, he did not get better.
CULLORS: They need to be in adequate mental health facilities. We have a slogan in our campaign, which is, you can't get well in a cell.
WESTERVELT: Last year, county supervisors finally agreed. They voted not to build a new correctional mental health facility here, what critics said was just a rebranded jail that would continue to criminalize people living with a mental illness.
TIM BELAVICH: By default, we have become the largest treatment facility in the country. And we're a jail.
WESTERVELT: Dr. Tim Belavich is director of mental health for LA County's jails. He says they're trying to deliver the best treatment they can, despite the strains and the overcrowding. We have to improvise, he says. But Dr. Belavich concedes something has to give.
BELAVICH: The number of mentally ill individuals is over 5,000. This facility was not built to house that many. So we are spreading out to other facilities, as well, which may be even less appropriate as to where we're able to treat them.
WESTERVELT: Even LA's top prosecutor, District Attorney Jackie Lacey, says the city has to expedite finding alternatives to the Twin Towers.
JACKIE LACEY: It's noisy. It smells terrible. Even when you're meeting with your mental health professional, you're chained to a bench. There are people swirling all around you. Some of them are rocking back and forth and talking to themselves. I don't know how anybody gets well in there.
WESTERVELT: The city's main plan to find a place where people can get well, which Lacey strongly supports, is to move more of the mentally ill from jail to an alternative sentencing and diversion court that includes housing. Eric Westervelt, NPR News, Los Angeles.
(SOUNDBITE OF SOLAR FIELDS' "FEELINGS (ALBUM EDIT)"[db:翻译]