Armando Cruz tied a noose around his neck and hanged himself from the ceiling of his prison cell. He left a note that ended in two chilling words.
His mother Yolanda, who was shown the note after her son's death, wants to make sure no one forgets.
“They took away my only son,” she says, her voice breaking.
Cruz killed himself on Sept. 20, 2011, during his incarceration at California State Prison in Sacramento, after a long history of mental illness. His story, first reported by the blog Solitary Watch, is an example of how the criminal justice system is ill-equipped to handle people with mental health issues.
Cruz spent years in solitary confinement and died while locked in a tiny solitary cell. The rates of suicide in solitary confinement tend to be higher than in the general prison population.
Suicide is the number one cause of death among inmates in local jails and in the top five for state prisons, according to a federal report.
Yolanda Cruz describes her son as a warm, funny person who was an easy child to raise. When he became a teenager, he began to change. He started to experiment with drugs and alcohol. Then, he was arrested for stealing tools from his neighbor’s garage.
When he was 15, he admitted that he heard voices in his head. Psychiatrists first diagnosed him with psychosis. Later, he would be diagnosed with schizophrenia.
A 2006 study by the Bureau of Justice Statistics found that over half of all jail and prison inmates have mental health issues; an estimated 1.25 million suffered from mental illness, over four times the number in 1998. Research suggests that people with mental illness are overrepresented in the criminal justice system by rates of two to four times the normal population. The severity of these illnesses vary, but advocates say that one factor remains steady: with proper treatment, many of these incarcerations could have been avoided.
“Most people [with mental illness] by far are incarcerated because of very minor crimes that are preventable,” says Bob Bernstein, the Executive Director of the Bazelon Center for Mental Health Law. “People are homeless for reasons that shouldn’t occur, people don’t have basic treatment for reasons that shouldn’t occur and they get into trouble because of crimes of survival.”
Bernstein blames these high rates on a lack of community mental health services. In the past three years, $4.35 billion in funding for mental health services has been cut from state budgets across the nation, according to a recent report. Because of the cuts, treatment centers have had to trim services and turn away patients.
State hospitals have also been forced to reduce services. A report by the Treatment Advocacy Center even found that there are more people with severe mental illness in prisons and jails than in hospitals.
Yolanda Cruz tried for years to get her son the right kind of care. But it wasn’t easy. She says that the first doctor she took him to refused to prescribe him any kind of medication, saying that he was only getting into trouble because he was using drugs and hanging out with the wrong kind of people. Other doctors would later prescribe him a host of medications but the one that eased his symptoms the most left him nearly catatonic.
In 2000, when Armando Cruz was 17, a local police officer was attacked with a knife from behind. His throat was cut but he survived. Cruz confessed to the crime and was arrested. To this day, his mother swears he was manipulated by the voices in his head or by the real perpetrator.
The courts didn’t see it that way. Cruz was convicted of the attempted murder of a police officer and sentenced to life in prison, with the possibility of parole after 8 years. Three years had passed between his arrest and his sentencing, most of which he spent in county jail.
Eric Balaban, an attorney with the ACLU’s National Prison Project, said that mentally ill people who have contact with the criminal justice system are too often incarcerated while awaiting trial, rather than sent to hospitals or treatment centers.
“There has been a very disturbing recent trend to keep them in jails and not send them to a hospital which is done as a money saving measure,” said Balaban. “They’re not receiving the appropriate level of care.”
Once people with mental illness are incarcerated, Bazleon’s Bernstein says, it becomes a tough cycle to break.
“Most people are there for minor crimes but then they deteriorate,” he explains. “They can’t follow the rules there and so they stay a long time, and they become difficult to release.”
According to the Bureau of Justice Statistics report, most inmates with mental illness don’t receive treatment while in prison.
Patti Jones’ nephew Tony Lester was sent to state prison in Tucson, Ariz., for aggravated assault. Like Armando Cruz, Lester heard voices. He told his aunt that before he was incarcerated, he had only heard two voices. After he was admitted, there were seven.
Lester was diagnosed with schizophrenia. He was prescribed medication but didn't always take it while in prison, Jones said. Lester was placed among the general prison population with little treatment available.
His symptoms grew worse.
“He started saying he thought his attorney was the Antichrist,” Jones says. “He thought Obama was an alien. He thought he was a time traveler.”
Jones says she begged the jail to force him to take his medication, but staff told her he was allowed to refuse treatment.
In June 2010, Lester stopped taking his medication completely. After he told a guard he was contemplating ending his life, he was placed on suicide watch. On July 9, he was deemed stable. On July 11, his roommate woke up to Lester’s blood dripping on him. He had stabbed himself vigorously in the neck, wrist and groin with a razor.
“Treating the mentally ill is different than acting with a normal population,” says Joe Baumann, a corrections officer at the California Rehabilitation Center. “The problem is there’s so many of them either self-medicating or not taking medication at all. No one monitors whether inmates take their medication.”
Corrections employees are not properly taught how to recognize and handle mental illness, he says.
“There's a lack of any real training to identify specific issues and how to deal with them," says Baumann, who says he only receives a few hours of mental illness training each year and it isn’t enough. “There’s a lack of direction from management.”
Corrections officers on staff at the time of Tony Lester's death said that when they arrived at his cell, they weren't sure what to do, according to a state investigation of the incident. One officer said that he "was never trained on how to apply pressure to a wound." Lester bled to death while the officers struggled to deal with the situation.
Donn Rowe, president of the New York State Correctional Officers and Police Benevolent Association, says that mentally ill inmates place a huge strain on the corrections facilities and their employees.
“It’s very challenging on our members,” he says. “They need much more attention than your average inmate population. It's a very expensive and very demanding job to manage these people.”
The expense is high, to be sure. The average inmate in New York costs the state over $60,000 per year, according to a report by the Vera Insitute of Justice. That figure doesn't take into account the extra resources that mentally ill inmates require. Experts say that funding mental health services for these inmates would cost less than imprisoning them and could help prevent many incarcerations in the first place.
According to a Bazelon Center report, the annual cost of case management for mentally ill people in Michigan is $2,165 per person. A more intensive program, the popular Assertive Community Treatment, costs the state $9,029 per person per year. In contrast, the average Michigan inmate cost the state over $34,000 last year.
But mental health services are dramatically underused. Over half of inmates with mental health problems never received treatment prior to incarceration, according to a Department of Justice report.
“We're paying criminal justice and other costs, we're investing there and we really should be investing in the services that could prevent that whole trajectory to begin with,” says Bernstein.
Not all mentally ill inmates’ stories end like Lester’s or Cruz’s. But the figures are too high to ignore. In 2010, 520 inmates committed suicide in local jails and state prisons. To the loved ones and advocates of these inmates, their deaths were avoidable.
“When Tony was on his meds, he was our Tony,” says Jones. “If he’d had access to care, he would have lived.”