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Sunday, February 8, 1998

Mentally ill filling jails more than ever

The Commercial Appeal, February 8, 1998
By Shirley Downing / Reporter Michael Kelley contributed to this story.

A few friends buried Zygmunt `Ziggie' Karon on a cold, windy afternoon last week after a long wait.

Karon, 64, died after a heart attack in December during the last of many stays behind bars. He had been in the Shelby County Jail for 10 weeks that time, unable to make $100 bail on a trespass charge.

The Polish immigrant had been jailed 28 times, mostly for minor offenses, in the five years before his death. He also had been confined at the Memphis Mental Health Institute eight times for psychiatric problems.

"He was a special, little old man whose only crime was he was mentally impaired," Novella Smith-Arnold said of the man known on the street as Ziggie.

"He was like most seriously mentally impaired people," she said. "They don't take their meds (medication), and when they do that, they do silly things like shoplifting or walking into somebody's house, or taking cigarettes, a sandwich or an apple from a store."

Smith-Arnold, a chaplain at Calvary Episcopal Church, said Zygmunt Karon was a victim of a faltering mental health system.

Jail officials agree, but said there isn't much they can do: Lockup has become a dumping ground for the homeless, the criminally insane and mental patients whose families can't or won't care for them, said Insp. Robert Harper, jail security chief and a member of a county committee on jail crowding.

"I think we have become a catch-all," said Harper. "There's no other place for them to go. When police run into them on the street, they don't have anywhere else to go with them, so they bring them to us."

Recent jail surveys indicate almost a third of the average 2,600 daily inmate population have a diagnosed mental illness, a figure that pushes the census to an all-time high, straining the workforce and financial resources, jail officials said.

"One out of three? That's a real good figure," said Marron Hopkins, the new jail director.

"Out of a population of 2,600 to 2,700, there are probably about 800 folks who, if the (community) mental health care was done at the same standards that it was previously, then a good number of those folks wouldn't be here."

Concerned county officials "are trying to get a handle on this to determine how many inmates are just depressed and how many are seriously ill," said Peggy Edmiston, director of the division of community services for Shelby County. "We've been talking to the state, trying to get help."

Preliminary data collected by the county confirm large numbers of mental patients in the jail, although the exact percentage is not yet clear, said Nancy Lawhead, special assistant for health policy to Shelby County Mayor Jim Rout.

"We're very concerned about the large numbers, and we're trying to get a handle on the data about incidents of alcohol and drug abuse," said Lawhead, who wonders if cuts in substance abuse programs may be a major contributor to crime.

The state is willing to work with local officials "to try to find mutually beneficial ways to address the issues, within the available resources," said Tennessee Health Commissioner Nancy Menke.

She said she had no data on the number of jailed mental patients, and although the one out of three figure "sounds high to me, I don't have anything to judge that one by.

"But I'm not surprised that the number would be higher in the jail population than in the general population."

Nationally, the numbers of mentally ill in jails and prisons has swollen in the two decades since states began shifting public psychiatric care from large institutions to community-based treatment.

That trend was the result of a 1975 U.S. Supreme Court ruling that said mental patients could not be held in institutions if they were not harmful to themselves or to others.

Initially, the process called deinstitutionalization was seen as a positive movement that could save states money while providing for the least restrictive patient care.

But Tennessee's state mental health costs continued to climb. So in July 1996, the state adopted TennCare Partners, a managed care approach to funding mental health programs.

Local officials say the situation has deteriorated under Partners. Strained budgets forced the closing of one mental health center, and funding for many outpatient programs has been slashed. And jail officers say more and more mentally ill people are ending up in jail.

"It's been basically a shutting down at the state level of facilities to deal with these people," said jail security chief Harper, calling the state system a "shambles."

Some say Karon was an example of what's wrong.

He came to this country from Poland in 1975 and was self-employed for a time. No one knows what kind of work he did or how he got to Memphis.

Sometimes he told nurses at MMHI he couldn't speak English. When he did talk, he said he had no family or friends, no home or money.

He had a half-dozen different Social Security numbers, but never collected benefits, Smith-Arnold said.

After stays at MMHI, he'd leave - for a park bench or a mission, to the streets, and jail.

Records at the Criminal Justice Center indicate he'd been arrested 28 times since March 1994, almost always for minor offenses. His last arrest was Sept. 21 for hanging around an Exxon gas station.

He was arraigned two days later and sent to MMHI three times in October and November for mental evaluations, but wasn't released from jail because he couldn't make $100 bond.

He died in jail Dec. 12 after a heart attack.

Karon "exemplified the plight of the mentally ill in Memphis," said Turner Hopkins, a board member of the Alliance for the Mentally Ill.

"But here's a man who went into jail for some minor offense, $100 bond was set, he stayed in the jail for three months, and he died there."

Hopkins says society has failed people like Karon.

"Mental illness is a terrible ailment," he said. "These folks, especially those who are schizophrenic, the people with bipolar disorder, aren't as capable as they once were.

"Because of biological changes in the brain, they can't do what they have the potential to do. So they're dependent on the rest of us to take care of them, and this man is an example of the kind of care they're getting."

Jail officials said they do the best they can, considering the high number of inmates with mental problems. Steve Campbell, director of jail health services, said interviews, observations and confirmation by outside mental health providers leads jail officials to conclude about a third of inmates are mentally ill.

Perhaps 250 to 300 of the disturbed inmates are severely, chronically mentally ill, he said.

Previous estimates of much smaller numbers of mentally ill inmates in the jail were wrong, Campbell said.

"We know there are repeaters," said John Perry, mental health coordinator, noting many have been at Western State or other psychiatric facilities. "Most of the people we see have been in the jail off and on, off and on, in and out, for five or 10 years."

Campbell said his company, Correctional Medical Services, was hired by the county two years ago to provide health care services. The contract was for $1.8 million annually.

But CMS soon found "there were far more mental patients than we'd anticipated. It strains our resources both from the standpoint of manpower in that we haven't had the kind of resources budgeted to deal with that amount of psychiatric patients."

"If you compared us to jails of similar size - we are about the fifth-largest county jail in the country - typically you would need 80 full-time medical personnel, and we have 31. So that tells you something."

Another problem is what to do with disturbed inmates.

"You have people who have committed serious crimes and you mix in mental patients who are psychotic and delusional, and it will cause problems for the safety of that person," said Perry.

A mentally impaired inmate who floods the toilet with paper or who laughs inappropriately disturbs other inmates. So that's why a classification system is necessary, said Campbell.

When Perry arrived at the jail in 1996, he said there were two pods for mental patients. Now most of the second floor is filled with inmates who have been separated because of mental health problems.

"We're going toward the people who are psychotic," Perry said on a tour as men shouted at visitors."This is no different or worse than at MMHI (Memphis Mental Health Institute)," he said.

Up ahead, a nurse paused behind a cart loaded with medicine.

"Mannnnn. This medicine is not doing no good," yelled one man as a chorus of voices joined in.

Another inmate with bloodshot blue eyes blamed police for the wound on his face. Another banged metal bars.

"I was supposed to go home last month," yelled another man who had been charged with murder.

One inmate said he'd been run over by a police car and he'd fallen out of bed the previous night. He was hearing voices; where was his medicine?

Up and down the hall a blur of faces peered from behind bars: black and white inmates, men with tattoos, wrinkled faces and disheveled hair. Alleged murderers, traffic offenders, gang members and a homeless man who threatened to blow up the federal building.

Most jail detainees are in and out in three days, said Perry. Then there are those such as Karon.

They're picked up by police, taken to the Regional Medical Center at Memphis for evaluation, then to a hospital for treatment. After so many days or weeks, it's back to jail to await disposition of charges.

Sometimes, families are inclined to leave a mentally ill relative in jail as long as possible, Harper said. "On the street, something worse can happen to them."

Many in the mental health and criminal justice system say society should recognize people like Karon aren't necessarily criminals. They're sick.

Although Karon died more than a month ago, friends searched for family, and funds for his burial. In the end, Calvary Episcopal Church, Canale Funeral Directors and Elmwood Cemetery provided for the funeral.

A dozen or so members of the Alliance for the Mentally Ill, the church and officials with the funeral home and cemetery gathered under a gray sky Thursday afternoon for Karon's funeral.

Cold wind whipped among the granite tombstones of the historic cemetery.

Rev. Doug Bailey, rector at Calvary, said it was only right that Karon's life be acknowledged.

"We commit Ziggie's body to the ground," said Bailey. "Give him peace, now and forever."

Edition: Final; Section: News; Page: A1
Copyright (c) 1998 The Commercial Appeal, Memphis, TN


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