This article was published in collaboration with Vice.
I received the phone message early one morning from an older woman with a soft voice and a slight Southern accent. She sounded desperate.
“Please find my grandson, Marion1," she said. "He is schizophrenic; he is anemic and has fits. I don’t know where he is at the jail.”
The woman provided a last name and birth date, and that was it.
My job as a clinician for the Los Angeles County Sheriff’s Department Mental Evaluation Team was to identify and locate the mentally ill inmates who represented at least 20 percent of the population, get them out of the dorms filled with their more violent peers, and take them by patrol car to Tower One, the mental health facility. I evaluated each of these inmates prior to extraction, contacted any available family, collected available data on their prior psychiatric history, and wrote recommendations for the psychiatrist who would, at some point, see them.
But very few of my referrals were like this one — from the inmate's family member — since the seriously mentally ill are often homeless. Instead, it was normally my routine to scan the jail database looking for young inmates who had been picked up for minor charges (trespassing, public nuisance, etc.), because this was most typical of the mentally ill population.
I also received messages under my door, pleas from inmates who needed help.
Other times, I could immediately spot them when I walked into a crowded dorm: they were always thin, disheveled, and were either standing rigidly against a wall or moving around in an agitated manner. Their numbers were overwhelming, and our team saw as many of them as we possibly could, but it was never enough.
The day I received that phone message, my partner was out sick, so I was on my own. I looked Marion up in the database: He was 19, had been picked up on a trespassing charge, and had already waited in jail for two months for a court appearance and a public defender.
I arrived at the jail and on the third floor found 345 — the large dorm where Marion was supposed to be housed.
I walked onto a metal catwalk that had tiny cells on each side. Inmates were crammed into the cells, with no room to move around. Some came to the bars and watched me, others slept, and a few called out to me for help2.
Suddenly, two inmates, heavily tattooed and muscular, cornered me and began to demand action on their cases. The men wanted a psychiatric diagnosis to help them get "diversion" and believed I was the one who could do that. My heart started to pound, but the cell boss, the leader of the inmates, said, "Déjala en paz/déjala tranquila" and they went away.
Finally, I came to cell No. 12, where I expected to find Marion. The inmates were loud, restless. and irritable, barely able to restrain themselves. I had to yell Marion’s name out.
No one came to the bars.
Eventually, one of the inmates pointed to a lower bunk on the right side of the cell. Someone was under the bunk.
A deputy came down the row and asked me what I was going to do, and I explained the situation. He'd assisted me before, and was one of the officers who appreciated that I was taking the “dings,” as they called mentally ill inmates, out of their territory. He smiled, put one hand on his weapon, and opened the bars.
The seven inmates inside stepped back. I went over to the bunk and crouched down. It was dark and damp underneath, but I could see a bundle of bedding — and a long foot with yellowed nails, covered with flies, protruding from underneath the pile.
My breath caught in my throat. The stench of old urine was overwhelming.
I asked the inmates to ease the body out from there, and they pulled at him by his feet; he was limp and heavy, but they managed to spread him out on the floor.
This must be Marion: a very tall, emaciated boy who was covered with sores and unconscious. Although he was African-American, his skin was a shade of yellow I had never seen before, and he was barely breathing. His thin chest rose and fell in an uneven rhythm, and red-tinged fluid seeped from his swollen lips.
The other inmates moved away quickly and the deputy immediately got on his radio for an emergency extraction. Several officers arrived, placed Marion’s inert body on a stretcher, and wheeled him out to be transferred to the jail ward of the Los Angeles Hospital.
For mentally ill inmates like Marion, delusions, hallucinations, and paranoia can make incarceration even more brutal. Some are even jailed without being charged, because they are waiting until a mental evaluation can be performed and there are no psychiatric hospital beds available. Others are simply lost in the system after having been transferred from dorm to dorm, jail to jail — because that's the protocol to keep the population from forming gang-related alliances.
But with Marion, it was obvious that he was in an even more desperate condition.
Back at the office, I spoke with his grandmother, Ruby, for over an hour. Her voice was strained with tears, and at several points, she had to take a deep breath to calm herself. She told me she had applied to become Marion’s guardian when her daughter failed to care for him. He had come from a violent, abusive home, where he had been sexually and emotionally abused since early childhood, she claimed. Ruby said that when he was finally able to leave the house and go to a clinic, she had been informed that he had many developmental disabilities and emotional scars. At age seven, he was a diagnosed schizophrenic with PTSD.
He was a sweet and passive boy, she added, but had never spoken more than a few words and communicated mostly through facial expressions and gestures. He became confused and hid or ran when he heard loud voices or noises; she had spent many hours looking for him on the streets of South Central Los Angeles, only to find him crouching in a doorway or hiding in an alley.
But despite all that, on numerous occasions, the police arrested Marion, handcuffed him, and booked him into jail on charges of trespassing or resisting an officer.
Now, after this jail stint, he was in the intensive-care unit, connected to dozens of tubes and wires. The doctors hesitated to give me a prognosis, but warned that if he became conscious, his brain would be profoundly damaged.
The terrible truth is that people like Marion feel the same pain as everyone else. Each time they cycle through the jail system, they spiral toward a condition of having no hope at all.
Margaret Altman is a semi-retired clinician with three decades of experience in the mental-health field. She was a mental health evaluator for the Los Angeles County Sheriff’s Department, in addition to positions at UCLA, USC, and elsewhere. Currently, Margaret consults with the families of mentally ill prisoners, writes on the subject of forensic mental health, and manages a small practice.