Published Nov. 13, 2016

Veda Carter thought she could protect her son as long as a jail cell was available.

For more than 10 years, she tried to find Corey Carter quality, consistent treatment.

Corey had schizophrenia and, sometimes, he struggled with paranoia.

The Corey whom Veda knew and loved would start to change.

That’s when Veda knew she and Corey needed to make the 100-mile drive from Valliant, a small town in southeast Oklahoma, to McAlester.

There, Veda would beg the staff at Carl Albert Community Mental Health Center to give her son an inpatient crisis bed.

Repeatedly, she was told that, because Corey wasn’t a danger to himself or others, he didn’t meet the criteria to be admitted against his will for treatment.

So Veda developed a Plan B, a plan she still feels guilty about today.

She would call police and tell them that Corey was trying to hurt her or another family member. When Corey drove her car, she would tell police that he had stolen it.

And the police would come, knowing Corey’s mental health history, and take him to jail.

“He would go in the jail because that was the only way ... we could get him some help, because a lot of times, they would say, ‘Well, he’s not trying to harm anybody, he’s not a danger to himself or anything like that,’” Veda, 58, said. “It’s sad to say, at times, we would have to come up with one of the things that would fit the criteria, like, ‘He’s being mean,’ ‘He hit his sister,’ just to get them to get him some help.”

But this plan to help Corey failed, too. Corey died in the McCurtain County jail last February.

His death is a tragic symptom of a broken mental health system that hasn’t ever fully served the people who need it. 

Years ago, when Oklahoma closed its large psychiatric hospitals, the state inadvertently turned patients into inmates.

For decades, Oklahoma has spent among the least in the nation on its mental health system.

Meanwhile, Oklahoma has one of the highest rates of adults with serious mental illnesses. Only one of three Oklahomans who need treatment receives it.

Oklahoma has, instead, chosen to spend its dollars on the least effective, costliest form of “treatment” — the criminal justice system.

The cost of a year of state-funded mental health treatment: $2,000.

The cost of a year in prison for someone with serious mental illness: $23,000.

At last count, 60 percent of the Oklahoma Department of Corrections’ population, 17,000 people, have either symptoms or a history of mental illness. It’s the equivalent of jailing 20 percent of Edmond.

State Health Commissioner Terry Cline said the state of Oklahoma has prioritized funding its criminal justice system over mental health and addiction services.

“What does it mean when jail is better than being at home?” Cline said. “That is a real symptom, to me, of a broken system where people don’t have access to those services in the community.”

Why jail is easier to get into than treatment

Often, the journey of Oklahomans with mental illnesses and substance use disorders into the criminal justice system starts in the county jail.

Every county in Oklahoma has at least one jail, overseen by either a sheriff or jail administrator. Additionally, 13 cities have jails, usually operated by the local police department.

Each year, these 90 jails operate as holding facilities for thousands of Oklahomans. Most of them don’t have any strategies in place to intervene in the lives of people they see repeatedly for crimes committed as a direct response to untreated mental illness and addiction.

Oklahoma is missing out on a substantial opportunity to divert thousands of people away from the criminal justice system and into the treatment system, health leaders say.

“I’ve heard people say, ‘Well, if we’re more successful at diverting people out of jails, we’re only going to tax the treatment system more than it’s already taxed,’ and I’m saying ‘Bring it on,’” said Mike Brose, CEO of Mental Health Association Oklahoma. “That becomes our leverage to convince our elected officials that treatment in the community needs to be appropriately funded.”

A monthslong investigation by The Oklahoman, including the examination of hundreds of pages of jail inspection reports, found that mentally ill inmates are dying at an alarming rate, leaving their families and the taxpayers with the burden.

In the first of a four-part series, The Oklahoman examines how four Oklahomans died in jails across the state. Their families share a common experience: not giving up on the people they loved. Collectively, they’ve driven hundreds of miles across the state in search of care, and they’ve faced many of the same barriers. And despite their best efforts, they all got the same phone call.

The 77 county jails sprinkled throughout Oklahoma are providing medical and mental health care in 77 different ways, if they’re providing care at all. Some jails train staff to some degree about mental illness. Others provide nothing, which can lead to the mistreatment of people with mental illnesses who often are viewed in the eyes of an untrained officer as an inmate who won’t follow instructions.

“We celebrated the closings of these large hospitals — we were proud of it, and it was the right thing to do,” said Brose, of Mental Health Association Oklahoma. “But what we’ve done is basically replaced it with a system that’s worse. Now it’s incarceration, and there are not mental health professionals treating people and caring for them. It’s correctional officers, being asked to do something they’re not properly trained to do.”

Until the mid-1960s, Oklahomans with mental illnesses were primarily housed at Central State Hospital in Norman; Western State Hospital in Fort Supply; and Eastern State Hospital in Vinita.

On an average day in 1960, nearly 6,400 Oklahomans were housed, sometimes for years, in these three facilities.

The Community Mental Health Act of 1963 started a move away from these institutions, but Oklahoma was slow to act. 

Eastern State Hospital finally closed in the early 2000s. Half of Western State Hospital was converted into a prison.

The Legislature never appropriated enough money to fund community mental health centers, creating the fractured, overburdened system of today, advocates say.

Oklahoma has 820 state-funded beds to address the needs of adults with mental illnesses and substance use disorders. That’s compared with 90 jails and 41 temporary holding facilities with more than 15,000 beds.

This is why a jail cell was always available for Corey Carter.

Shortly before Corey died in the McCurtain County jail, Veda stood inside the office of a mental health facility in McAlester, begging them to take her 40-year-old son.

After more than a decade of trying to find Corey quality, consistent treatment for his mental illness, Veda resorted to saying her son was dangerous and threatening to harm his family — and in some cases, Corey’s family would say he had already hurt them.

This caused Corey to rack up criminal charges, but his family believed he was safer in jail than on the streets, especially when they were told Corey didn’t meet criteria to be admitted to a state-run mental health facility.

Families of loved ones with serious mental illnesses say meeting “criteria” is a struggle, especially when their loved one isn’t able or willing to receive care.

In Oklahoma, the laws are specific: If an adult isn’t a danger to himself or others, he cannot be held against his will. Often, that’s how it’s decided who will get treatment, because turning away those who are dangerous has potentially lethal consequences.

These laws exist to protect the civil rights of people with mental illnesses. Whether a person with mental illnesses should be forced to receive treatment remains a debate among mental health professionals and advocates.

“We should be trying to figure out how we get what families and individuals really need so we can intervene in a crisis — and not turning our backs and saying, ‘They don’t meet criteria’ or ‘We don’t want to violate anybody’s civil rights,’” Brose said.

Some states have updated their laws. Instead of focusing on dangerousness, they use a standard they call “need for treatment,” said John Snook, executive director of Treatment Advocacy Center, a Virginia-based nonprofit.

Doctors aren’t consistent in their ability to evaluate dangerousness, Snook said. Research has shown they’re correct about half the time about whether a person will hurt themselves or others. But they’re good at evaluating a person’s capacity, or ability to make their own medical decisions, Snook said.

Under Oklahoma’s current law, some people will never qualify for care because they won’t be considered dangerous, and they’re not doing well enough to understand they need care, he said. They fall apart but aren’t able to ask for help.

“That’s how you have families doing things like lying about being assaulted,” Snook said. “It’s a terrible situation because they feel like there’s nothing they can do.”

‘Nobody responds’

Corey (pictured above) grew up in Wright City, a small town of about 800 people in southeast Oklahoma. He was the oldest of three children.

Throughout elementary and high school, Corey made good grades, didn’t get in trouble and loved basketball. During his senior year at Wright City, Corey scored 850 points. His team, the Wright City Lumberjax, finished 30-3 and went to the Class A State Finals.

Tony Robinson, who coached basketball at Southeastern Oklahoma State University for 20 years, worked hard to recruit Corey to play for the school.

As a freshman, Corey came in with raw, underdeveloped talent. But over the next four years, Robinson saw Corey work to become one of the best players he ever coached. When Corey came to Southeastern, he could bench press 140 pounds. By the time he left, he was benching 340.

“He just kept working and made himself into an all-around player,” Robinson said. “There wasn’t anything he couldn’t do.”

It’s still hard for Corey’s teammate and college roommate Anthony Bruner to talk about losing Corey.

When Anthony moved to Durant to play ball, Coach Robinson introduced him to Corey. Corey then introduced Anthony to his entire family, who took him in as one of their own. Corey helped Anthony, who grew up in Norman, feel like a part of the community.

“I honestly still can’t believe it,” Bruner said, of Corey’s death. “I really don’t think about it. I shut it out. It just seems too fresh, like it happened yesterday. I try not to think about it. It was so weird to go back there, and my boy is not there.” 

The years Corey played basketball at Southeastern were some of his best — he scored 520 points his senior year, the 1996-97 season, helping the team reach the second round of a national tournament. It’s still listed as one of the highest single season records at Southeastern.

But the years following were some of Corey’s hardest. As Corey got older, the symptoms of serious and persistent mental illness started to show.

At first, he was diagnosed with bipolar disorder, a brain disorder that causes unusual shifts in mood and energy, sometimes causing people to stay up for days without sleep.

Later in life, he was diagnosed with schizophrenia, a mental illness that can affect the way a person thinks and behaves, sometimes causing them to hear voices, hallucinate or believe they’re someone they’re not.

Corey’s family remembers the mania, the days he would go without sleep or food. 

Corey received medicine at Carl Albert Community Mental Health Center. Sometimes he would ask them to change the amount he was taking. When they lessened the dosage, Corey soon would be sick again, his mother said.

The last time Veda took her son to McAlester to be evaluated at a state-funded treatment center, Corey had been awake for almost five days.

Sitting in the supervisor’s office, Corey repeatedly said things suggesting he was not in touch with reality.

He told them he needed to get his hard hat to go to work. Veda pointed out to the mental health worker that Corey didn’t have a job, much less one in construction.

At one point, Corey said, “Your mama is dead,” without directing the statement to anyone in the room.

Veda told the mental health worker: “He is very smart. He’s going to try to maintain as much as he can.”

The supervisor asked to speak to Corey alone. Veda felt hopeful that the supervisor, once one-on-one with her son, would see that Corey wasn’t himself.

But soon, the supervisor came out and told Veda, “He’s not homicidal. He’s not suicidal. He doesn’t seem to be a threat to others.”

“Are you going to wait until someone kills him? Or he kills somebody? Hurts somebody?” Veda asked.

“Basically, yes,” she said the supervisor responded.

Veda left McAlester with her son and drove the 100 miles back home to Valliant.

She left Corey at home and headed to work at a local drug treatment facility.

That afternoon, Veda got a call that Corey had been arrested. She felt somewhat relieved, knowing he was safe somewhere.

But soon, she got another phone call: Corey had been taken from the jail to the hospital. Jail staff at the McCurtain County jail in Idabel alleged that he became combative, according to state jail inspection reports.

In a lawsuit filed against the jail, Veda’s attorneys allege in court records that the jail staff choked, beat and repeatedly used a Taser on Corey, injuries that caused his death. They settled out of court in late October.

McCurtain County jail officials’ attorneys did not respond to requests for comment. At the time Corey entered the McCurtain County jail, he had been there repeatedly, and his mental health diagnosis was known to staff, court records show.

Jail staff noted at intake that Corey was showing signs of “psychiatric problems.”

According to court records, at 8:14 p.m. Feb. 12, 2015, jail staff called the local paramedic service and told them Corey had a shallow pulse after having a Taser used on him. Five minutes later, they called and said he didn’t have a pulse. An ambulance was sent to the jail.

When paramedics arrived, they found Corey unresponsive, not breathing and without a pulse.

Once at the hospital, doctors found Corey had suffered brain damage from a lack of oxygen to his brain. He was pronounced dead at 8 p.m. Feb. 13, 2015.

Four days later, the McCurtain County jail reported the incident to the state Department of Health: “Officers got into an altercation with Combative Inmate Corey and administered Taser to subdue the subject. After the altercation, inmate was unresponsive and Officers had to perform CPR on the subject. Inmate was taking by EMS to McCurtain Memorial Hospital.”

The report, filed by the jail to the agency that performs jail inspections, did not include that Corey died or the extent that force was used.

Shortly after Corey was processed through the jail, three jail officers put him in a restraint chair, a use of force tool that tethers a person to a chair at points across their wrists, ankles and chest, according to court records.

They took Corey, still in the restraint chair, from the booking area to an isolation cell. Jail staff later told OSBI agents that Corey refused to change out of his street clothing.

Corey was left strapped to the chair in the isolation room for two hours. No one checked on him, court records show. Three jail deputies came and let Corey out of the chair for less than two minutes. They placed him back in the restraint chair for an hour and a half.

After almost four hours in the chair, Corey was released. Video from the isolation room shows him struggling to stand, trying to stretch.

Records show that, at this point, Corey is taken into a change-out room nearby, off camera. Three other deputies are nearby.

Three deputies inside the room begin to beat Corey, at one point holding his arms, court records show. They strip him naked, and then another deputy lunges into the room, using a Taser on Corey at least three times, including twice in the chest. Three more officers come into the room off camera, and the seven men continue to beat Corey.

“At some point, other arrestees can hear Carter repeatedly pleading over and over again for someone to help him,” a court record noted. “Nobody responds.”

Inside the change-out room, Corey’s body goes limp, records show. The officers take his naked body and put him back into the restraint chair, wrapping his limp arms and legs inside. No one leaves the room to find a medical professional at the jail to check on him.

Instead, they wheel him back into the isolation room and stand around him for 11 minutes. At one point, one officer starts smiling and making punching gestures “as if he was re-enacting the physical assault on Carter inside the change-out room,” the court record reads.

Veda’s attorneys note that the jail staff used physical force and a weapon on Corey despite knowing that his mental illness could affect his ability to follow or understand their commands.

The jailers weren’t properly trained in how to communicate with inmates with mental illnesses — nor were they trained in how and when to use force, the attorneys allege.

“Given the nature of operating a jail facility, i.e., knowledge that staff are authorized and expected to use force, and that a fair number of arrestees exhibit mental health concerns, the need for more or different training on these particulars is so obvious MCJT’s failure to provide adequate training on these topics predictably led to the excessive, inappropriate, or unsafe use of force on Carter sufficient to result in a constitutional violation,” the court record notes.

The attorneys also argue in court records that the jail deputies’ choice to conceal the extent of force they used to paramedics and the state Health Department jail inspectors suggests they knew what they did was excessive.

Corey is buried a mile from his high school in the Joe Slater Memorial Cemetery in Wright City.

Kayla Bowers, executive director at Oklahoma Disability Law Center, said there’s a significant need for better training on mental health for Oklahoma jail staffs.

Police officers go through an academy and receive extensive training. The same is not true for jail staffs, where training is often “word of mouth” through work, she said.

“All that training dead ends when you hit the jailhouse,” Bowers said. “The sheriff’s offices are the ones who take care and maintain the hotels we call jails. They’re like hotel managers — and if they’re not getting the training on how to run this hotel, you’re going to be in trouble.”

Hundreds of people filled the Wright City School Auditorium for Corey’s funeral, his mother said, including his former teammates and coaches.

Veda said she wants people to understand that her son was more than his illness.

“He had a purpose for being here,” Veda said. “He had dreams. I just hoped one day, he could get the right treatment, get on the right medication and that he could lead a normal life and enjoy his kids.”

A few weeks after Corey’s death, his daughter won in the 400-meter run at the Class 6A state track meet. She graduated high school a few months later.

“He would have been so proud to see his daughter graduate,” Veda said.

Deputies as doctors not a safe setup

For two years, Debra Porter, of Salina, Kansas, and her family could not find their brother.

And then, a few days before Easter last year, they got a call — 51-year-old Benjamin Ferguson (pictured above) had been arrested following an assault on a fellow patient at a mental health facility. He was in the Cherokee County jail in Oklahoma. His family was thankful he was alive.

Known as “Benny” to his family, Benjamin was diagnosed with schizophrenia at 19.
When he was on his medicine and receiving care, Benjamin was a kind, funny and thoughtful person. He was an attentive father.

His niece Kellie Savage, 25, remembered how Benjamin taught her how to fish when she was 8, and then when she was older, how to drive. She sometimes drove him to his doctor’s appointments.

“On his good days, it would be, ‘This is awesome, Kellie — let’s go grab some tea,’” Savage said. “But then there were the days when it was like, ‘Should I really be driving with you in the vehicle with me?’” 

During his bouts of paranoia, Benjamin got to a point where he believed someone was trying to kill him. Sometimes, it was the mafia. Sometimes, it was his family.

He started to believe that he was his father. They shared the same name, and they looked alike. When his dad died, Benjamin’s delusions worsened. He saw a truck parked at a construction site that looked like his dad’s truck. The keys were inside. Benjamin got in and drove off. This prompted one of many arrests.

Benjamin was repeatedly jailed and hospitalized in Oklahoma and Kansas. The longest he received care, his sister said, was when he stabbed himself in the leg. He was finally considered a danger to himself. That time, Benjamin stayed in a psychiatric hospital for several weeks.

Other than that, his stays at hospitals were short, and his treatment was inconsistent. Porter and her family called police because, like Veda, they believed it was their only option.

“At least we knew he was in a safe environment,” said Porter, 48, Benjamin’s youngest sister, from her home in Salina. “He was getting a roof over his head and food in his belly when he was in jail. That was the only good thing about him going to jail. He was not on the streets. … At least we knew he was safe. At least we knew where he was. Well, we thought he was safe, obviously.”

The joy that Debra and her family felt when they found out that Benjamin was still alive quickly faded.

The day after Easter, their mother received a call. Benjamin was dead, a Cherokee County jail staff member told her. He had suffered what looked like a heart attack.

When the Cherokee County jail reported Benjamin’s death to the state Health Department, they wrote “Setting (sic) on toilet, collapsed and found later.”

When Oklahoma state jail inspector Alan Coffee arrived in Tahlequah four days later to investigate Benjamin’s death, he found a scene that warranted more than seven words.

Coffee watched the jail’s surveillance video that showed Benjamin sitting naked on the toilet in the back of the cell.

When Benjamin was booked into the jail, he told them that he had a history of mental illness and had attempted suicide. Inside the cell, he talked to himself while making hand gestures, catching things that weren’t there and shooting them with his fingers.

The following is a timeline of the events leading up to his death April 5, 2015, obtained by an Open Records request by The Oklahoman.

 

9:42 p.m.: Benjamin fell to his knees, his head resting on his mat, which he had pulled in front of the toilet.
9:43 p.m.: Benjamin fell over on his left side, his body shaking. He shook for 40 seconds and then started breathing slowly, sporadically.
9:56 p.m.: Benjamin took his last breath.
3:30 a.m.: The cell door opened for the first time. A detention officer saw Benjamin dead, naked, alone on the concrete floor, and left.
3:31 a.m.: The same officer came back in the cell and stood over Benjamin’s body. He did not touch him. Instead, he walked out and closed the door.
4:43 a.m.: Someone entered the cell and touched Benjamin Ferguson. They then left. A few jail staff came into the cell and took pictures.
6:08 a.m.: The medical examiner arrived and took Benjamin’s body to Tulsa.

 

Although the Cherokee County jail staff is trained in CPR and on how to operate a defibrillator, no one used their medical training to attempt to save Benjamin’s life.

Cherokee County jail administrator T.J. Girdner said that after Benjamin’s death, the jail launched an internal investigation on three of its staff members. One person resigned. 

The jail did not request that the Oklahoma State Bureau of Investigations look into Benjamin’s death, which would have resulted in an independent and confidential report sent to the jail and the Cherokee County district attorney.

Girdner said he couldn’t comment on the specifics around Benjamin’s death, only that it was against their jail protocol for no one to respond.

Girdner said he has seen a significant increase in inmates with mental illness and substance use disorders coming into the jail — and no substantial investment from the state in how to treat them or keep them out of jail. 

If people come into the jail with a diagnosis and their medicine, the jail can often get them their medicine, he said. But if they aren’t able to tell the jail staff about their mental illness, or if they refuse treatment, it’s difficult to find them the care they need, he said.

“All the families want you to treat them — they need to be treated, and I agree with that, but where does the funding come from?” Girdner said. “It’s hard to have every detention officer expected to be trained to be a psychiatrist or whatever. These guys back here carry many, many different hats. They’re all counselors. They’re expected to be doctors, police officers — and just the counseling side of it, what they go through every day, being cussed at, spit on, feces thrown on them, it’s not a job for everybody.”

Meanwhile, Benjamin’s sister Teresa Farris, 49, of Newport News, Virginia, said she is left to wonder what would have happened if her brother had received emergency medical care.

After Benjamin was arrested, his counselor from the treatment facility where he was living came to see him at the jail. The counselor told Benjamin that he would get Benjamin out of jail and drive him to a new treatment facility that had agreed to take him. 

But Benjamin told the counselor that he wasn’t ready to trust him, and he wanted to think about it.

“It was that weekend that Ben had the heart attack and died,” Teresa said. “He could have been in a facility when he had the heart attack and maybe not a jail if he had just agreed to go that Friday.”

Recognizing a medical emergency

Even though jail staffs are usually trained to provide basic first aid, most officers aren’t medically trained beyond that.

In Benjamin’s case, no emergency medical care was provided by the people trained to deliver it.

In the case of Sherry Elliott (pictured above), the staff at the Grady County jail didn’t seem to understand that Sherry was slowly dying in front of them.

Sherry, 42, died of a drug overdose at that facility in Chickasha.

She was arrested outside of her home in Chickasha on Sunday, July 5, 2015, on a charge of public intoxication. A Chickasha police officer responded to a domestic disturbance call to find that Sherry Elliott and her girlfriend had a verbal fight. As the officer spoke with Sherry in an alley outside of her home, he noticed the smell of alcohol on her breath, according to the police report.

“Sherry’s speech was slurred, slow, and thick,” the officer wrote in his report. “Sherry was unstable on her feet. Sherry’s reactions were slow and delayed. Sherry’s eyes were glassy. Sherry’s eye lids (sic) were droopy. Sherry told me that she had consumed two beers along with her regular prescribed medications.” 

Sherry’s sister, Chrystal Elliott, 50, of Houston, said Sherry had been taking a lot of prescription painkillers, and she was worried that Sherry was addicted to them. Sherry was getting a lot of pills from her doctor, especially considering she was only about 5’1” and weighed 102 pounds, her sister said.

Once in the jail, Sherry had trouble staying awake. When she was awake, she acted bizarrely.

The jail staff watched on the cell camera as Sherry lay on the floor, eating paint chips.

Instead of taking Sherry to the hospital, the jail staff gave her a sandwich.

Chrystal has wondered for months why no one, neither the police officer who arrested her nor the jail staff, took her sister to the hospital.

“I can see her stumbling around in there, but picking at the wall or chips of paint, I don’t get it,” she said. “I don’t understand why they didn’t realize — ‘This ain’t normal.’”

Throughout the night, Sherry snored loudly, inspection records show. This could have been a sign that she was overdosing.

The symptoms of an opioid overdose include: pinpoint pupils, unconsciousness and respiratory depression, according to the World Health Organization.

In cases where a person dies from overdose, their breathing slows, and they don’t have enough oxygen in their blood to support their vital organs. As their oxygen levels fall, their brain struggles to function. Typically, they become unresponsive, their blood pressure drops and their heart rate slows. They can die within minutes.

“But often, before death there is a longer period of unresponsiveness lasting up to several hours,” the World Health Organization notes. “This period is sometimes associated with loud snoring, leading to the term ‘unrousable snorers.’”

At 10:40 p.m., five hours after Sherry was booked into jail, an officer noticed Sherry hadn’t moved in a while. When officers entered her cell, her skin was cold. She didn’t have a pulse.

The nurse working at the jail came into Sherry’s cell and could not find any vital signs. An ambulance was called, arriving 15 minutes after Sherry was found unresponsive in her cell. Rather than go to the hospital, Sherry’s body left the jail when the medical examiner arrived to pick it up.

The medical examiner ruled Sherry died from a drug overdose, brought on by two prescription painkillers, tramadol and oxycodone.

One month before Sherry’s death, the jail administrator told a state Health Department jail inspector that he had implemented a “policy procedure for jailers to follow when an emergency is warranted for an inmate” and provided the agency with a copy of the policy.

“The administrator said he had a meeting in April 2015 with all Sergeants and Jail Staff stressing the importance of calling for medical assistance when an inmate is down on the floor,” the jail inspector noted in her report. “Jail staff was required to sign a form stating they read and understood the Policy and will comply with the Policy.”

The jail administrator’s actions were in response to a different inmate who had died after she hanged herself in the Grady County jail on August 4, 2014. They performed CPR but never called 911, and the jail officer who found her stood outside the cell because “he did not know what to do,” according to inspection records.

The state Health Department cited the jail after the 2014 incident. After the jail administrator implemented the new policy — that jail staff should seek medical help when inmates need it — the health department closed its investigation, noting “no further action required.” That was June 16, 2015. Sherry Elliott died 19 days later.

Sherry and her girlfriend had just moved to Oklahoma to start their lives over. They had struggled to find work where they lived in Texas and hoped Chickasha, where Sherry had grown up for part of her life, might have more opportunities.

Sherry left behind five children, ranging in age from 7 to 19. Her youngest children were at the house when Sherry was arrested.

“That’s the last thing they remember — is (their) mom getting handcuffed and taking her to jail, and then the police coming to the house and knocking on the door and announcing (her death) with the kids standing right there,” Chrystal Elliott said.

Inmates get medicines — sometimes

Health leaders, attorneys and mental health advocates agree that the level of medical and mental health care delivered in jails varies widely.

For example, some jails tell families that if they bring their loved one’s medicine to the jail, the jail will administer it. Other jails have a policy against this, citing liability issues and a risk that illegal drugs could be smuggled into the facility.

Medicine to treat mental illness can be costly for jails to provide, so sometimes sheriffs and jail administrators make the argument that they will provide a generic or similar medicine.

But advocates argue that sometimes, people with mental illnesses don’t get any medicine.

“It is not consistent across all jails and our state that people have access to psychiatric medicines,” said Commissioner Terri White, of the Oklahoma Department of Mental Health and Substance Abuse Services. “In some jails, there is no access. In some jails, there is infrequent access, and in some jails, it’s either done well or there’s a good partnership between the mental health center and the jail, so it depends on the jail, and unfortunately, it also often depends on the person who’s in jail, and whether or not they were already engaged in the mental health system, so the community mental health center can even make the offer to bring medication for them.”

Under Oklahoma state jail standards, jails are required to provide medical and mental health services, but the standards are vaguely written and hard to uphold in court when challenged. There is an effort underway to revise the standards, but that will likely take several more months.

Some jails pay medical companies to provide nurses, physicians and mental health professionals who treat inmates. Others hire nurses and work with local physicians to provide care. And some take inmates to urgent care facilities and emergency rooms as needed.

Leaders say examples like these suggest that every county jail in Oklahoma is operating under a different protocol than the next to deliver medical and mental health care.

As alleged in Larryn Rayburn’s (pictured above) case, county jails are inconsistent about giving inmates with mental illnesses their medicine, leaving them untreated in their cells, advocates say.

The family of Rayburn argues that they provided the medicine — and then the jail staff failed to administer it.

Larryn’s mother, Terryl Ann Rayburn, brought her daughter’s medicines to the jail, the family notes in a tort claim filed against Pontotoc County commissioners. Without her medicine, Larryn, diagnosed with bipolar disorder, began to suffer from the symptoms of the disorder.

Larryn was in jail after a few back-to-back arrests in 2014, including two arrests on charges of driving under the influence of drugs and one for possession of meth.

On Sept. 29, 2015, Larryn died by suicide, alone in a cell at the Pontotoc County jail.

“All employees, agents, and servants of the Pontotoc County Jail owed Ms. Rayburn a duty to provide reasonable and adequate medical care and attention and to use reasonable care in the administration of her prescription medications,” the tort claim reads.

Larryn graduated from Ada High School in 1999. She was certified as an EMT and paramedic. She had worked with the youth department at the First Baptist Church in Ada. Her family declined to comment, citing their pending legal action.

Almost a year after her daughter’s death, Terryl Ann wrote on Facebook that she was in the emergency room.

“Came out here with a splitting headache from crying so hard and so long today,” she wrote. “I just got a shot. ... already feel a little bit better ... at least my head does — my heart still hurts.”

She noted that, “In 8 days it will be one year since a gaping hole was made in our family.”

The Pontotoc County Sheriff’s Office did not respond to requests for comment.

‘We can’t do this anymore’

Other states have implemented solutions to divert people with mental illnesses out of county jails and into treatment.

For example, in Colorado Springs, Colorado, specialized three-person teams, made up of a medical professional, a mental health practitioner and a police officer, respond to calls where officers believe a person is suffering from untreated mental illness. Their goal is to take the person to treatment, not jail.

Oklahoma’s efforts, however, have been minimal, at best. Only 16 of 77 counties have mental health courts, diversion programs that provide people with treatment and require them to regularly report their progress to a judge overseeing that docket.

Without this option in every county, many Oklahomans go to prison instead of finding recovery in their own communities.

Public misperception, mental health advocates say, is that “inmates” are violent criminals.

But often, these inmates’ only victims were themselves, self-medicating with drugs and alcohol to try to quieten the uncontrolled symptoms of their brain disorders.

It’s unsurprising that in Oklahoma, where the waiting line to state-funded residential drug treatment is more than 800 people long, the top offense in prison is drug possession.

“It really is still the myth that we get (people with mental illnesses) because they’re violent,” said Janna Morgan, chief mental health officer at the Oklahoma Department of Corrections. “We do get some of those, but the majority of people with mental illness are not violent, including those that come to prison.”

No agency has a good count of how many inmates in Oklahoma county and city jails have mental illnesses or substance use disorders. No one argues the number is small, but the estimates range.

For example, at Oklahoma County jail, at least 400 people in custody have a mental illness.

At Tulsa County jail, they estimate between 500 and 600 inmates are taking psychotropic medications.

And at the third largest jail in Oklahoma, Cleveland County Undersheriff Rhett Burnett estimates out of about 450 inmates, about 100 have a mental illness on any given day.

“I think law enforcement, at some point, needs to stand up and say ‘People of Oklahoma, we’re not only a county jail — we’re a mental health facility now, we’re a homeless shelter now,’” Burnett said. “At some point, law enforcement, particularly county jails, has to say, ‘We’re all of these things, Oklahoma,’ and at some point, we’re going to have to say, ‘We can’t do this anymore.’”

Published Nov. 20, 2016

Capt. Reese Lane saw an opportunity to do some good in the world.

The Payne County jail administrator looked at one inmate’s charges recently and determined, "This is a mental health issue. She is not a criminal. She needs help."

The inmate, a 40-year-old mother of five, had been in and out of the Stillwater jail numerous times. In just one week during the summer of 2007, she called the police and fire department 26 times.

Lane was familiar with the woman’s mental health and substance abuse history. He went to the Payne County district attorney and asked to drop the woman’s charges. Next, they filed an emergency order to keep the woman in custody for her own safety, rather than for criminal charges. 

That Friday, a Payne County deputy took the woman to a state-funded mental health treatment facility.

It felt like a win. Then Lane found out the woman died the next day of a drug overdose. She had been released from the facility because the medical staff concluded she wasn’t a danger to herself or others.

This woman’s life and death could be a case study for why law enforcement are nearly unanimous in their frustration over county jails becoming Oklahoma’s de facto warehouses for people with mental illnesses and substance use disorders.

A monthslong investigation by The Oklahoman, including the examination of hundreds of pages of jail inspection reports, found that jail staffs across Oklahoma are tasked with attempting to be mental health professionals, often with little or no training.

In this, the second of a four-part series, The Oklahoman examines how jails across the state have responded, or ignored, the needs of inmates with mental illnesses and substance use disorders.

Since statehood, Oklahoma has grappled with how to create a sustainable, comprehensive mental health system. The state has spent among the least in the nation on mental health care, all while filling jails and prisons with people who wouldn’t be there if they could afford and access basic health care for their brain disorders.

Imprisonment is not only the least effective form of "treatment" but also the costliest.

The cost of a year of state-funded mental health treatment: $2,000.

The cost of a year in prison for someone with serious mental illness: $23,000.

At last count, 60 percent of the Oklahoma Department of Corrections’ population — 17,000 people — have either symptoms or a history of mental illness. That’s the equivalent of jailing nearly everyone attending an Oklahoma City Thunder game on a sold-out night.

Often, before these Oklahomans are sentenced to prison, they spend months, if not years, cycling in and out of county jails.

Like the woman that the Payne County jail staff tried to help.

The week after her repeated 911 calls, Stillwater police took the woman to the hospital.

"After numerous attempts to resolve the situation, Officers with the Stillwater Police Department detained (her) on an emergency order of detention and transported her to Stillwater Medical Center for evaluation," a 2007 court record reads. "After evaluation, it was determined (she) was not a direct threat to herself or anyone else and was released."

After the woman’s death in 2012, Lane changed his outlook on how he and his jail staff respond when an inmate is in the jail largely because of untreated mental illness, and a jail bed is more readily available than a spot in a mental health facility.

"We don’t get everybody out of here just because we can any more," Lane, 55, said. "For a lot of these people, sad to say, county jail is the best care that’s available to them."

Lane is frustrated by the state’s lack of action. "(People in jail with mental illnesses) have no voice," Lane said. "They can’t speak for themselves, and there’s not much of anybody speaking for them. (Her death) just made me a little more diligent to try to make sure they’re protected as well as everyone else."

Psychologist Linda Evans speaks with inmates in a pod at the Payne County jail in Stillwater. Photo by Sarah Phipps / The Oklahoman.

Therapy in cinderblock rooms

When Oklahomans with untreated mental illness break the law, the scenario is often the same: the police are called, and they take that person to jail, rather than to a mental health crisis facility or emergency room.

In Oklahoma, a jail bed is always available. The state has 90 jails and 41 temporary holding facilities with more than 15,000 beds. Meanwhile, Oklahoma has just 820 state-funded beds to address the needs of adults with mental illnesses and substance use disorders, hardly enough to serve that sold-out Thunder game worth of people.

And long before a person with mental illness needs inpatient care, he or she faces barriers in receiving basic services like therapy.

Community mental health centers in Oklahoma — considered the backbone of the mental health system — regularly turn people away. Their leaders say that based on the amount of state dollars they’re appropriated, they can only treat the sickest patients.

When someone with mental illness is in the back of a police car, the officer could take that person to a crisis center or emergency room, but officers know the chances of that person being released are high, leaders say.

"What does a cop do with a mentally ill person? What do they do with them? What options do they have?" Lane said. "They come here. That’s the only option we’ve given them … . And then it becomes standard operating procedure — 'Grab him and take him to county, I’ve got another call waiting.'" 

The 77 county jails throughout Oklahoma provide medical and mental health care in 77 different ways, if they’re providing care at all. Some jails train staff to some degree about mental illness. Others provide nothing, which can lead to the mistreatment of people with mental illnesses who often are viewed in the eyes of an untrained officer as an inmate who won’t follow instructions.

And sometimes, jail staffs seem unaware of how serious their responsibilities are in keeping these inmates safe.

In the Muldrow city jail, an inmate tried to kill himself by removing a blade from the razor that jail staff gave him to shave. They didn’t get it back from him, and he used it to slit his wrists. In response to the man’s suicide attempt, the police chief put up a sign to remind his staff to get razors back 15 minutes after issuing them, a requirement under the state jail standards.

At the Cleveland County jail, an inmate was taken by ambulance to a hospital and spent a few days in a hospital’s intensive care unit after using a razor to try to kill himself. He was supposed to shave only under direct supervision, but a detention officer assigned to watch over him left the area and put a newly hired officer in charge.

In Payne County, officers receive regular training on mental health, Lane said. Lane estimates his staff receives at least 10 times the amount of training hours the state Health Department requires.

When Lane started as jail administrator at Payne County jail in 2008, no medical or mental health professionals worked at the jail.

Instead, there was one officer, who was not a medical professional, who decided which inmates went to the doctor or the dentist. Lane, who has spent 20 years working in corrections, saw a lawsuit waiting to happen.

Eight years later, he has something few county jails have: a psychologist who works at the jail two days a week and is on call when staff needs her, and a clinical psychology doctoral student from Oklahoma State University who provides individual and group therapy to the women at the jail.

Evans and Capt. Reese Lane at Payne County jail in Stillwater. Photo by Sarah Phipps / The Oklahoman.

Linda Evans, a licensed psychologist who worked at the Oklahoma Department of Corrections for 10 years, spends at least two days a week at the Payne County jail.

On a recent Tuesday, Evans sat at a metal table in a small cinderblock room across from a 32-year-old man who suffers from serious and persistent mental illness.

She went through a list of questions with the man. She asked him if he has had thoughts of hurting himself or others. He told her that he knows he doesn’t want to hurt anyone, but sometimes the voices in his head try to persuade him. She checked "yes" on the form.

The man isn’t aggressive toward Evans. He’s apologetic about his delusions. At one point, he apologized for speaking in a foreign language, telling her that he was sorry if she doesn’t speak Russian. There is no moment during the visit when the man actually speaks in any foreign language.

The man pleaded with Evans to be transferred to Griffin Memorial Hospital, a state-run hospital in Norman that largely serves as a crisis stabilization unit.

Ashlee Jayne, a doctoral student intern from OSU, sat next to the man. She has been working with him, too, trying to teach him coping skills, such as meditation. The man said it’s hard to meditate when voices are screaming inside his head and outside his cell.

He is in jail for driving with a suspended license, an out-of-date license plate tag and without insurance. Another charge he has is for stealing a gardening cart. Never arrested for a violent offense before, the man punched an officer a few months ago. Even with his delusions, the man tells Evans that if he stays in jail much longer, he will get worse.

Evans, 70, spent much of her life working as a mental health professional in correctional settings. She retired from the Oklahoma Department of Corrections after serving as the clinical coordinator for the western half of the state. She lives in Stillwater and took the job at the jail after seeing an ad in the newspaper. That was three years ago.

During that time, she has seen the need for mental health care in jails grow.

"This is where the mentally ill are," Evans said. "As they cutback resources for the Department of Mental Health — and cut them and cut them and cut them — this is where they’re ending up. We have criminalized being mentally ill." 

In Oklahoma, the laws are specific: If an adult isn’t a danger to himself or others, he cannot be held against his will. Often, that’s how it’s decided who will get treatment, because turning away those who are dangerous has potentially lethal consequences.

These laws exist to protect the civil rights of people with mental illnesses. Whether a person with mental illnesses should be forced to receive treatment remains a debate among mental health professionals and advocates.

"It’s one of my drum beats is that we need to change the law," Evans said. "We need to make it a little more where we can intervene."

Evans recruited Jayne, 28, to work at the jail in June. Evans had worked with interns at DOC for years and thought the same model could work in a county jail setting.

Before Jayne started offering group therapy sessions with the women at the jail, Jayne and Evans wanted to assess how many inmates were interested in individual or group therapy. Of about 60 women, only three said they weren’t interested.

Jayne facilitates the group twice a week inside a dayroom in the middle of a female unit.

"When we were doing the group with only eight out of 50, everybody had their ears pressed to the door, and they were listening," Jayne said.

The long-term plan is to provide group therapy for the men, as well, likely starting sometime next year.

Evans and Jayne are also working to reach out to the local community mental health center and other agencies in the community to provide a network for when the inmates leave jail. The goal is for Jayne to also provide discharge plans for inmates with mental illnesses.

Currently, the waiting period to get into a local community mental health center is five weeks, Evans said. Their patients can’t wait that long.

"We want to set up a network so that when the severely ill people come out, they don’t have to wait five weeks because then we’ve lost them, and they’re back in jail by that time," Evans said.

At county jails, staff members have tear-resistant suicide smocks, restraint chairs and a limited list of medicines that they can’t distribute themselves. Some jails have doctors who visit, but many cannot afford full-time medical staff members. This leaves hundreds of jail staff members — with limited, if any, medical or mental health training — to oversee thousands of inmates, many of whom have serious and untreated mental illness and addiction issues.

Payne County is one of the few, if not the only, jails providing this level of care, Lane said.

For Lane, Evans and Jayne, their work is personal. They agreed that not only is it the right thing to do but also it is what their faith calls them to do.

"The majority of people, thankfully, do not go onto prison," Evans said. "They’re going to stay in the community one way or another. It’s an obligation to the public as well as to them. I grew up in Stillwater. This is my home. I want to make it better."

Published Nov. 27, 2016

When the inmate asked for a wheelchair, the Beckham County jail staff gave him an alternative option: crawling.

The man’s feet were swollen, bleeding and cracked, caused by gout, a painful form of arthritis. He couldn’t walk.

For days, the man crawled on the cold, concrete floor. When his family came to the jail to visit him, he crawled across the floor to meet them. When staff brought his medicine to the cell, he crawled to the cell door.

The man also told jail staff that he couldn’t eat hot dogs, a food that can worsen gout symptoms. A detention officer told him that if he didn’t eat the hot dogs, the officer would turn them into a suppository and “stick them up his a--,” inspection records show.

State jail inspector Cindy Rice arrived at the Beckham County jail in Sayre, about 25 miles from Texas on Interstate 40, to investigate claims that an inmate was not provided a wheelchair. Jail records noted the man had “road rash” from fighting deputies while being arrested, but when Rice got to his cell to interview him, she found that the man was “very frail.” A detention officer had to help the man out of his bunk to escort him to the interview room, she noted in her report.

Rice’s employer, the Oklahoma Health Department, is mandated by state law to inspect each jail once a year, along with going to facilities to investigate complaints they receive from inmates, family members, attorneys and private residents.

Agency leaders say they prioritize certain complaints, such as inmates suffering from medical issues. It took 44 days for Rice to arrive at the jail after the complaint was lodged about the man crawling.

When asked why it took so long, Espaniola Bowen, who oversees the jail inspection division, gave a one-word answer: “Staffing.”

A monthslong investigation by The Oklahoman, including the examination of hundreds of pages of jail inspection reports, found that the Health Department, the state agency charged with inspecting jails at least once a year, does little to hold them accountable. Jail staffs are rarely, if ever, punished or prosecuted, regardless of the severity of their actions.

In the third of a four-part series, The Oklahoman examines how this lack of accountability not only leaves thousands of jailed Oklahomans vulnerable to abuse, but also sets up taxpayers to finance the mistakes of jail staffs.

Oklahoma has 90 city and county jails, plus 41 temporary holding facilities that the agency inspects — and just 1.5 jail inspectors to do the job. These facilities’ total capacity is more than 15,000 inmates.

As a former jail administrator, Rice understands the issues that jailers face. At the same time, she expects them to follow the law and treat inmates humanely. Rice, the Health Department’s only full-time jail inspector, is paid a yearly salary of about $39,000. She has been at the agency since 2005.

When the Health Department had more jail inspectors, Rice was able to oversee fewer jails and visit them more frequently, which allowed her to address problems more promptly, she said.

 “If you’ve got a jail that’s having some problems, I think it was helpful to get them the resources they needed,” Rice said. “You were just there often enough to see their struggles. … You’d see them a couple of times, versus now — we get there when we can get there. You try to triage the stuff to get back out there as quick as you can.”

An inmate talks on the phone in the men's mental health unit at the Oklahoma County Jail. Photo by Chris Landsberger / The Oklahoman.

A lack of reporting

The inmate forced to crawl is one of many issues noted in jail inspection records of the Beckham County jail.

Jail administrators have been cited each year since 2008 — the oldest records available from the Health Department — for not training staff.

Under state standards, jails are required to provide 24 hours of training to new staff members within the first year of their jobs and 12 hours the following years.

Required training is supposed to include how to supervise inmates, what to do during an emergency and how to provide first aid and CPR.

However, the training ranges. Some jails use a mix of online videos and in-person training, and some even surpass what’s required, seeing training as a key way to avoid a host of issues. Other jails have a lower bar. For example, at least one facility trained its staff by having them watch the 1999 film “The Green Mile,” where Tom Hanks plays a death row correctional officer.

Over the past eight years, the Beckham County staff has been cited by the Health Department each year for never providing training.

And for the past eight years, the jail hasn’t reported any inmate deaths, serious staff injuries or suicide attempts, which they’re required by law to provide to the Health Department.

But that doesn’t mean there weren’t any.

In 2014, an inmate returned from the state psychiatric hospital in Vinita after he was found competent to stand trial. Three months later, he tried to kill himself. He previously had attempted suicide at the Beckham County jail in 2012 before going to Vinita.

Rice discovered the jail hadn’t reported either attempt when she went to Beckham County regarding a complaint that the jail wasn’t properly addressing the inmate’s mental health.

“I spoke with the Jail Administrator and she stated that she was not aware that they had to report these incidents to the State Department of Health Jail Division,” Rice wrote in her report in 2014. “… the Jail Administrator failed to notify the Department regarding the two attempted suicides in accordance with the Jail Standards.”

When reached by phone for comment, Beckham County Jail Administrator Diana Bilbo declined to comment, deferring questions to Beckham County Sheriff Scott Jay. Jay could not be reached for comment.

Former state jail inspector Don Garrison, center, in 2001. Photo by Chris Landsberger / The Oklahoman.

A different era

When Dr. Leslie Beitsch started as state health commissioner in 2001, the Health Department was “rife with corruption from top to bottom,” he said.

The agency was at the end of a bribery and “ghost employee” scandal, with several employees accused of receiving thousands of dollars for work they never did.

Jails across Oklahoma were tremendously overcrowded, and Don Garrison, who oversaw the jail division, was frustrated. Jail administrators took warnings from the Health Department about as seriously as a parking ticket, Beitsch said.

Beitsch and Garrison got to work, repeatedly threatening to close county jails that did not comply with state jail standards.

“I took a more draconian approach, never really expecting people to pay us $700,000 worth (of violations), although I told them I expected them to because that would get them to the negotiating table to get something done,” Beitsch said.

Beitsch got repeated calls from lawmakers, asking him whether he was serious. He told them he was.

In 2002, the agency threatened to close 12 county jails.

“These things are kind of suicide missions,” Beitsch said. “You do them up to a point, but at some point, you manage to p--s off everybody’s special interest.”

Garrison, who passed away in 2013, retired in 2010. During his 13 years as jail inspection director, he saw 50 counties build new jails or remodel existing ones, thanks to his and his staff’s efforts.

"It is a lot,” Garrison said in a 2010 interview. “Even back when we thought we were doing well, we didn’t have this many going.”

Photo by Chris Landsberger / The Oklahoman.

A history lesson

While Garrison oversaw the jail division, he had four inspectors, each with a quadrant of Oklahoma. Their goal was to inspect jails on a quarterly basis.

However, over the past seven years, the Legislature cut the Health Department’s state funding by almost 30 percent. The agency lost 228 employees through attrition, buyouts and layoffs. This also meant budget cuts for the jail division.

“Honestly, we are going to have to do less with less, and that’s the unfortunate situation that we're in right now,” Senior Deputy Health Commissioner Julie Cox-Kain said. “… There’s a real risk to the population when we have limited capacity to do what it is that we’re supposed to be doing to protect the public’s health. I hope we don’t see the downstream consequences of it.”

The jail inspection staff, composed of one full-time jail inspector, one part-time inspector, a part-time director and a full-time administrative assistant, still meets its state mandate — inspecting jails once a year — but it can take weeks, if not months, for them to address complaints.

Bowen, who has overseen the jail inspection division since last October, said if a complaint comes in — and it isn’t a medical issue or death — her staff generally cannot address it within 10 days. However, with only 1.5 inspectors, they sometimes can’t get to even to the most pressing complaints in less than two weeks, she said.

For example, when Corey Carter was beaten to death in the McCurtain County jail in February 2015, jail staff did not report to the state Health Department that he died. A complaint was filed with the Health Department six months later in August, alleging the jail staff had improperly used the restraint chair and hadn’t evaluated Carter for mental health issues. A state jail inspector didn’t address the complaint until the following February, almost exactly a year after Carter was beaten. The inspector cited the jail for improperly using the restraint chair — but the agency did nothing else.

The Health Department doesn’t investigate for criminal wrongdoing but rather whether the jail staff followed state standards.

“The jails aren’t sitting there shaking, wondering what our reports are going to say to get them in trouble because that’s not our purpose,” Rice said. “They need to be more afraid of what the Oklahoma State Bureau of Investigation and the medical examiner are going to find than they do the Health Department. We’re not the ones who will slap them on the hand or fire someone.”

After an inmate dies, a sheriff can request the Oklahoma State Bureau of Investigation provide an independent analysis. However, OSBI only investigates jail deaths when requested. Once complete, the investigation’s results are sent to the requester, usually the sheriff’s office, and the local district attorney. Under state law, the results are confidential.

“Why wouldn’t they call us?” OSBI spokeswoman Jessica Brown said, when asked why sheriffs request the agency after an inmate death. “We’re a free investigative agency, and we’re independent.”

The McCurtain County sheriff’s office did not request OSBI after Carter’s death. Out of the 20 inmate deaths reported in 2015 to the state Health Department, OSBI was asked to investigate nine deaths.

When Benjamin Ferguson died in April 2015 in the Cherokee County jail after his heart suddenly stopped working, a jail inspector arrived four days after Ferguson’s death. Through watching surveillance video, the inspector discovered that Ferguson lay naked and dead for more than five hours in his cell before a staff member found his body. The inspector cited the jail for not performing regular sight checks, but didn’t mention that the jail staff failed to deliver emergency medical care. The Health Department took no further action against the jail. OSBI was not asked to investigate.

‘Water is a privilege’

Sources familiar with the agency’s jail division, who asked not to be named for fear of retribution, said some jails continue to operate despite being regularly cited for neglect, training violations and infrastructure hazards. Under Garrison, they would have been threatened to be shut down.

Overcrowded and underfunded, in some cases their conditions rival state psychiatric hospitals, closed after decades of neglect.

“Jammed together, bed to bed, are these unfortunates living out their last days,” journalist Mike Gorman wrote in The Oklahoman in 1946, in discussing Western State Hospital in Fort Supply. “No bedside tables, dirty linen, no ventilation, an overpowering stench, sagging wooden floors, desultory care from overworked attendants — this is the overall picture.”

Seventy years later, jail inspection records from the state Health Department give a similar view of Oklahoma’s unofficial asylums.

For example, the Kiowa County jail in Hobart, a southwestern Oklahoma town of 3,700, has been cited repeatedly for “black residue,” or mold, and rust throughout the building.

“The cells in the facility were built using metal from an old submarine and parts of the ceiling and floors of the jail have completely rusted through,” according to a 2015 Kiowa County jail inspection report.

In August, the Kiowa County jail administrator told inspector Rice, “Water is a privilege,” after she asked him why jailers weren’t bringing inmates water to drink.

After two inmates were treated for dehydration, the administrator decided on a compromise: Inmates could have jugs of water in their cells each night.

The water in the pipes, he told Rice during the inspection, “probably doesn’t taste good.”

In 2009, Rice cited Kiowa County for a “very bad” sewer smell, wafting through the female pod and kitchen. Four years later, Rice noted the jail was “filthy” and understaffed. Inmates slept on torn, dirty mattresses. The staff and inmates agreed that the air conditioner didn’t work. In 2014, jail staff told Rice that birds had pooped into the jail through holes in the ceiling.

Kiowa County Sheriff Jeff Smith, elected in June, said the jail is more than 80 years old, and when it was built, the standards for a jail were vastly different.

"If you go to typical older building in a downtown anywhere, you might have a building that's 80 or 100 years old, but it has been occupied, and someone has tried to keep that up and maintain that building," Smith said. "Well, despite the best efforts of every sheriff of this building ... you’ve also got inmates here who, like in every other jail in the world, they’re trying to destroy something. We’re not dealing with a building that has been babied and well cared for." 

Tim Binghom, Kiowa County commissioner, said the county has been hit hard in the economic downturn, leaving little money to repair the jail. Last year, the county’s major employer, SKF USA, which makes seals for vehicles, announced it was closing its Oklahoma plant and opening a similar facility in Mexico.

Binghom said he hopes the state Health Department doesn’t threaten to shut the jail down.

“Our (jail) is very old, and it’s usable,” Binghom said. “We would like to be able to build a new one, but the economy and all is not fit for it. Ours is not one of the better ones in the state, but we try to keep it functional and usable.”

An inmate is moved down a hallway by two correction officers at the Oklahoma State Penitentiary in McAlester. Photo by Paul Hellstern / The Oklahoman.

Limited accountability

Oklahoma is one of the only states to house its jail inspection division within its state Health Department. Early state jail standards, written in the 1970s, noted that the agency was required to inspect all jails.

Most states have their jail inspection divisions within their state Corrections Department, or under their state sheriff’s associations, which doesn’t produce strict regulation either, research shows.

Michele Deitch, a senior lecturer at the University of Texas law school, said after 30 years of criminal justice policy research, she has found that no state has ever performed significant oversight of jails.

Throughout the 1970s and 1980s, federal courts provided oversight by intervening in inmates’ cases against jails and demanding administrators and sheriffs take action. But then, in 1996, Congress enacted the Prison Litigation Reform Act.

Almost overnight, the reform act changed the ability of courts to intervene to protect inmates, she said.

The law not only hampered how inmates traditionally brought lawsuit against jails but also made it more difficult to win lawsuits brought forward. Today, Deitch said, it is incredibly rare for a lawsuit focused on the treatment of inmates to make its way to a federal court.

“It has done more damage to prisoners’ rights than any single thing in this country,” Deitch said.

The jail inspection division at the Health Department relies solely on state funding. Jails don’t pay fees to the department, and the department doesn’t usually fine jails when they’re breaking state standards. Leaders say that’s, in part, because many of the counties likely couldn’t pay the fines anyway.

The Health Department hasn’t taken legal action against a sheriff or county commissioners since 2010, when a case was dismissed in district court.

State Health Commissioner Terry Cline said the Health Department hasn’t taken legal action recently against jails because the state standards didn’t hold up in court. It has nothing to do with politics, he said.

Instead, because the state standards are vaguely written and contradictory, this makes it easy for jails’ attorneys to fight them, he said.

The Health Department’s inspection division has a group of jail administrators who have spent the past few months reviewing state standards, and the agency expects to present the group’s findings — and possibly new jail standards — in 2017.

Cline, a psychologist, said although the Health Department could use more inspectors, and that inspecting jails only once a year isn’t ideal, what Oklahoma could benefit from even more is having a comprehensive mental health and addiction treatment system.

Oklahoma has seen a significant increase in the number of residents with mental illnesses and substance use disorders entering not only jails but also state prisons.

At last count, 60 percent of the Oklahoma Corrections Department's population, 17,000 people, have either symptoms or a history of mental illness. It’s unsurprising that in Oklahoma, where the waiting line to state-funded residential drug treatment is more than 800 people long, the top offense in prison is drug possession.

Cline said many of the issues that arise at jails occur when staffs are asked to be mental health professionals.

“Is the solution to the problem to have more jail inspections and have bigger jails and to be building more new jails, or is the real solution to be moving upstream?” Cline said. “… That would actually increase resources tremendously (and) get people the services they need in the community.”

Published Dec. 4, 2016

Ask Mike Brose what someone can do to help Oklahomans with mental illnesses.

As leader of one of the largest mental health advocacy organizations in the state, Brose will give you several answers.

Own a business? Hire people with felonies. It’s not a handout — it’s an opportunity. It’s a chance for someone to prove themselves, start over and get out of poverty.

Maybe you’re a landlord. Make your apartments available for supportive housing — homes where people with mental illnesses can live while being supported by a social worker and other care managers who check on them. And have that social worker’s phone number in case your tenant is struggling. 

Are you a person of faith? Then be the person who asks how your church, synagogue or mosque can help.

The only inexcusable thing to do is nothing.

“Nobody can tell me, ‘I want to help, but I don’t know how to help,' ” Brose said. “There are a lot of ways for people to help. Sometimes, at the end of the day, we can be fooled into an excuse — I get it. People are raising their kids. They’re busy. They’re active. They do fight for time, but there are a lot of things people can do to get involved. … Every little bit counts.”

A monthslong investigation by The Oklahoman, including the examination of hundreds of pages of jail inspection reports, found that Oklahoma jails serve as warehouses for the mentally ill because the state has ignored its mental health system for decades.

In the fourth of a four-part series, The Oklahoman examines the solutions — because without change, many Oklahomans with mental illnesses and substance use disorders will funnel into jails and prison, the least effective and costliest form of “treatment.”

The cost of a year of state-funded mental health treatment: $2,000.

The cost of a year in prison for someone with serious mental illness: $23,000.

At last count, 60 percent of the Oklahoma Department of Corrections’ population — 17,000 people — have either symptoms or a history of mental illness. It’s the equivalent of jailing seven Devon towers full of people.

After 23 years leading Mental Health Association Oklahoma, Brose feels tired — tired of not seeing change for some of the most vulnerable Oklahomans.

“A lot of the conversations I’m having now at age 62 we were having back when I got out of graduate school in 1980,” said Brose, the organization’s chief empowerment officer. “We’re having a lot of the same conversations. That tells you something — ‘Ain’t it awful?’ Yeah, it’s awful. Let’s do something different. We need the political leadership. We need high-level leadership that says we’re going to do it a different way.”

Tested solutions

Part of Brose’s job is to travel to other states and learn how communities address the needs of residents with mental illnesses.

This year, he took Tulsa Mayor-elect G.T. Bynum with him to Albuquerque, New Mexico, to learn how that city created a work program to not only combat panhandling but also empower residents.

With an initial budget of $50,000, the city of Albuquerque’s solid waste department drives to areas frequented by panhandlers and offers them day labor, such as landscape beautification and garbage removal. The pay is $9 an hour.

After their work day is complete, city workers take the day’s laborers to a homeless outreach organization that connects them with emergency shelter to house them overnight. For the 2017 fiscal year, the city of Albuquerque budgeted $181,000 for the program.

“I went down and got on the van at 7:30 in the morning (to work),” Brose said. “People who are homeless on the streets were running after this van, waving their arms to get on so they could work for the day.”

Brose took a group of Tulsa leaders to Colorado Springs to learn about a mental health first responder program. Specialized three-person teams — made up of a medical professional, a mental health practitioner and a police officer — respond to calls where officers believe a person is suffering from untreated mental illness. Their goal is to take the person to treatment, not jail.

In San Antonio, Brose learned about how its police department has diverted hundreds of people with mental illnesses away from jail and into treatment. Specially trained police officers respond to mental health-related calls, and their goal, as well, is to keep that person from going to jail.

Brose took these specific trips because he wants to see a similar approach taken in Oklahoma.

First responder teams, he said, could play a key role in diverting Oklahomans with mental illnesses away from jail and into treatment.

With Oklahoma’s current budget crisis, mental health advocates and leaders are too quick to point to the lack of funding available when they hear solutions proposed, Brose said.

“We may need more money, but it’s also about the courage and political will to look at how we’re spending the dollars we have and to look at new models and have the leadership that says we’re going to try some different things,” Brose said.

The alternative

Before starting his job at the Oklahoma Corrections Department in 1999, Robert Powitzky toured Oklahoma’s prisons.

He was shocked with how drastically different the inmate population was.

Powitzky worked for the Federal Bureau of Prisons in the 1970s and early 1980s. Then, he went into private practice for 15 years.

As Powitzky, then-chief mental health officer at the Corrections Department, walked through the prisons, he felt like he was walking through an old state psychiatric hospital.

Robert Powitzky. Photo by Paul B. Southerland.

“And it continued to get worse,” said Powitzky, who retired in 2013. “I really Pollyannaishly expected, ‘This is a tipping point — we’re going to fix this, and it’s going to get better.’ It got worse every year.”

Thanks to a lack of money, vision and leadership, the number of inmates with mental illnesses continued to rise, he said.

But state leaders seemed skeptical of how serious the issue was. Powitzky wanted to prove to them how significantly the population of inmates with mental illnesses had grown.

Statisticians at the Corrections Department ran the numbers and found compelling evidence: The number of offenders incarcerated increased 20 percent from 1998 to 2010, while the number of incarcerated offenders requiring psychotropic medications increased 292 percent. This was the time period that followed Oklahoma closing its three state psychiatric hospitals in the 1980s and 1990s.

After spending decades working in corrections, Powitzky, 70, has seen a range of inmates with serious mental illness.

Some inmates were dangerous and needed to be in prison.

“There are some very, very dangerous people who have a serious mental illness, and, quite frankly, a lot of times those people who get on medications still are psychopaths,” he said.

However, those people don’t make up the majority.

Rather, Powitzky estimates 45 percent of the inmates with current symptoms or a history of mental illness wouldn’t be in prison if they received quality, consistent treatment in the community.

“And I think that’s a conservative number,” he said. "... There is a pipeline of people going to the criminal justice system whereby they used to go into the mental health system, and that’s just got to change.”

During the next legislative session, the state Corrections Department will request $1.65 billion from the state Legislature — $1.165 billion more than the agency’s last budget request. This is one-fourth of the current state budget.

The state’s prisons are crumbling and overcrowded — and full of people who should receive mental health and substance use disorder treatment, rather than incarceration, leaders say.

“Since coming to the department 10 months ago, I have found the agency has been largely ignored for more than 30 years,” state Corrections Director Joe Allbaugh said in mid-November after the budget announcement. “It is time for the Oklahoma taxpayers to fully understand the picture of our state’s correctional department, get more efficiency out of the system and bring the department into this century.”

Access is crucial

Dr. Ray Cordry didn’t plan on becoming a psychiatrist.

After working as a primary care doctor in northwest Oklahoma, Cordry went back to the University of Kansas in the late 1980s with the goal of becoming a pediatrician. But then he started to hear about advances being made in psychiatry. It sounded hopeful.

Working in primary care, Cordry found his options for treating patients with schizophrenia and other psychotic disorders were limited to drugs that came out in the 1950s, such as Haldol and Thorazine, which came with serious side effects.

Haldol works by decreasing abnormal excitement in the brain, but it can cause uncontrollable body movements, dry mouth and drowsiness, according to the U.S. National Library of Medicine. Thorazine comes with similar and serious side effects, too.  

At Eastern State Hospital in Vinita, patients on these older drugs were sometimes seen shuffling, barely lifting their feet, because the drug left them without energy to walk. 

Cordry believed when he prescribed these older drugs, his patients suffered from so many side effects that it didn’t feel like they were truly helped. 

Dr. Ray Cordry. Photo by Doug Hoke / The Oklahoman.

In the late 1980s, Prozac became available. It was like the penicillin of the psychiatry field, he said. Cordry believed he finally could help patients with depression and anxiety.

Then in the early 1990s, Risperdal came on the market to replace Haldol and Thorazine, drugs to treat schizophrenia. 

Cordry saw patients who found relief from their symptoms — without experiencing the serious fatigue caused by older generation drugs.

“They didn’t know you could feel this good,” Cordry said.

Today, Cordry has even more options for medicine, including injections that people with schizophrenia can take once a month, rather than a pill every day.

However, even though these drugs can make a tremendously positive impact, many Oklahomans cannot afford the medicines they need, Cordry said.

In Oklahoma, more than half of adults who need mental health treatment do not receive it. For Oklahomans with substance use disorders, the waiting list for state-funded residential drug treatment is more than 800 people long.

“There are all of these treatments that would be incredibly effective — if people could get them,” said Cordry, medical director of the Red Rock outpatient clinic in Oklahoma City. “… If (state leaders) want to keep people out of the hospital and out of jail, they’re going to have to treat them.”

One person ‘can definitely change things’

These are the issues that lawmakers will face when they return to the Capitol for the legislative session in February.

During her time in office, Sen. AJ Griffin has heard the conversation change around mental illness and addiction in Oklahoma.

More people recognize that mental illnesses and substance use disorders are brain diseases that need to be treated. Rather than blaming the person or suggesting they have a weakness, people are starting to realize that mental illness is a treatable disease, she said.

Griffin, a Republican representing the Guthrie area, said she’s ready to start moving upstream and treating more than just the symptoms of the problems Oklahoma faces.

Senator AJ Griffin. Photo by Steve Sisney / The Oklahoman.

This session, Griffin and other lawmakers want to address how Oklahoma can better support families in need, she said.

“Do I have colleagues from the far right that think government has no role in that? Yes. Are they in the minority? Yes,” Griffin said. “The rest of us understand that we either support families or pay for prisons — one or the other.”

Griffin said the people of Oklahoma sent a clear message to lawmakers when they voted in support of the criminal justice reform measures, State Questions 780 and 781.

Oklahomans can continue sending those messages by calling their lawmakers and sharing their stories of mental illness and addiction — and telling lawmakers what services would have helped their families while in crisis, she said.

Here's a quick tutorial on how to use the Oklahoma Legislature website to search for your representative and contact them.

In her four years at the Capitol, Griffin has seen small groups of organized people make differences — and quickly.

For example, a small group of parents advocated at the Capitol for better health insurance coverage for their children with autism. Their request was specific, and the Legislature responded with a law that requires insurance companies to provide increased coverage for autism screenings and treatment, Griffin said.

Ali Dodd, an Oklahoma mother whose infant son, Shepard, died at a day care, helped get three child care-related laws passed in one session after she went from lawmaker to lawmaker to explain how leaders could help protect children in day care settings, Griffin said.

“One person who is focused and persistent can definitely change things,” Griffin said. “But the keys are to know what you’re asking for, and then to approach everyone with professionalism and courteousness, and if you do that, you really can change things.”

It’s your turn

Almost 80 years ago, Oklahomans were warned what inaction would bring.

The National Mental Hospital Survey Committee published a report that noted that Oklahoma would save money if it invested in its mental health system.

“Whatever the future may bring,” the 1937 report concluded, “Oklahoma cannot look on itself with pride until provision is made for adequate care of its mentally helpless citizens.”

The future did not bring change. Instead, Oklahoma repeatedly has been cited as a state with high rates of mental illness and drug abuse — and little action.

Already this year, at least 725 Oklahomans have died by suicide. That’s almost two people per day.

Suicide is preventable — when people can access treatment.

Jail time is preventable — when people can access treatment.

Homelessness is preventable — when people can access treatment.

Whatever the future may bring, history and research show that Oklahoma cannot look on itself with pride until its lawmakers, state leaders and residents take responsibility for an epidemic ignored.