A REPORT RELEASED by Disability Rights Oregon (DRO) last March made it abundantly clear: The Multnomah County Detention Center, the downtown jail operated by the sheriff’s office, is a dreadful place for people with severe mental illness.
The limited staff is not well trained, and jail facilities and policies are harmful, the report found. It detailed incidents involving mentally ill inmates that would seem at home at Guantanamo Bay.
"Medical and mental healthcare in jail is woefully inadequate and so the jail relies on correctional tools: rampant use of solitary confinement, punitive use of restraints and suicide watch, and routinized force against people with mental illness," says the DRO report, which was written by attorney Sarah Radcliffe.
Last Thursday, more than eight months after the highly critical audit, Sheriff Mike Reese and other officials said fixes are in progress. Those with mental illness make up a significant portion of the jail population—estimates range from 30 to 80 percent—and in a hearing before the Multnomah County Board of Commissioners, Reese and his colleagues argued that the system is now less disastrous for this particularly vulnerable population.
"We’re not afraid to take a look at ourselves," the sheriff told commissioners, flanked by Corrections Health Director Michael Seale and Multnomah County Sheriff’s Office (MCSO) Facility Services Manager Katie Burgard.
Reese said the MCSO has hired more mental health staffers at the jail and trained hundreds of corrections deputies in mental health intervention and aid. And the sheriff unveiled a bit of news that hadn’t previously been disclosed: Local law enforcement and prosecutors have started a new program intended to keep some mentally ill suspects out of jail in the first place.
The pilot diversion program began this month, and is modeled on an existing program that provides drug users treatment options instead of jail. As of November 1, when police arrest someone downtown for disorderly conduct or trespassing and believe that mental illness is at the root of the crime, they can transport the arrestee to a Cascadia Behavioral Health clinic for evaluation (with suspects’ consent). Prosecutors will consult Cascadia before filing charges, which could mean the arrestees will avoid the criminal justice system if they’re getting help.
Advocates are heartened by the new effort, but Radcliffe emphasizes that because the program is based on officer discretion, it’s important to track the demographics of who the program is offered to. The stats could reveal racial or gender bias by officers.
The new policy is impacting one or two people per day so far, MCSO Chief of Staff Stephanie Prybyl tells the Mercury, and could be expanded in the future to include arrests countywide.
But the move hasn’t completely satisfied DRO. Radcliffe notes that the county is still housing incarcerated people with severe mental illnesses in solitary confinement—against the recommendation of her organization and essentially every mental health expert.
“Contrary to the recommendations of numerous clinical studies, those with the most serious conditions are placed in the most restrictive environment,” Radcliffe wrote in the report, railing against solitary confinement. The jail isn’t set up to “provide treatment and promote recovery, but to tamp down behavioral disturbances.”
The inevitable outcome of prolonged solitary confinement, DRO says, is “an exacerbation of symptoms and behaviors” that led someone to jail in the first place.
The report highlighted particular cases. Here are a few:
• A suicidal man in the psychiatric inpatient unit at Oregon Health & Science Universty was “uncommunicative” for several days, leading the hospital to order him out. The man wouldn’t leave quickly enough, the report said, so an OHSU cop arrested him for trespass and booked him in jail, where he wound up in solitary confinement for most of the next 14 months. “He lost a dangerous amount of weight, pulled out a tooth, and was terrified by hallucinations of monsters,” the report said. Care providers could only talk to him through the food slot of his cell. After more than a year there, the man pled guilty to a parole violation.
• A transgender woman with no prior criminal history was kept in solitary confinement for months as a form of punishment that DRO deemed arbitrary and unnecessarily harsh. “She had almost no access to visitation, phone calls, or any form of entertainment or stimulation” for two and a half months.
• One woman with a history of drug abuse was uncooperative during the booking process. She was combative, the report says, but then suddenly went completely limp. “Even after she had apparently lost consciousness they fastened her to a restraint chair, DRO found. Meanwhile, she spent a critical period of time without oxygen.”
The report went on to document incidents of corrections deputies physically assaulting inmates, seemingly unnecessary Taser use, and one deputy with a “pattern of misusing force and instigating confrontation that had persisted unchecked for years.” Radcliffe says jail officials sent one case involving that deputy to the Multnomah County District Attorney’s Office, but the office declined to prosecute, “noting that the alleged victim had a history of cursing” and had given the deputy a “look.” The jail didn’t have security cameras that record video.
The DRO report resonated with some elected officials.
“It was really shocking to read about some of the stories they told—particularly reading about something called the restraint chair, which sounds like a medieval torture situation,” Commissioner Sharon Meieran said on Thursday.
At the board meeting, Reese, Burgard, and Seale emphasized that the county is significantly ramping up training for corrections staff, bringing in more mental health staffers, and trying the new diversion pilot program.
After the ODR report, Reese said they trained 466 corrections employees with “a new curriculum based on a crisis-intervention model” that includes de-escalation and suicide prevention. This summer, he said, 450 corrections staffers were trained in “mental health first aid.”
In May, Burgard said, the county hired a “focused mental health sergeant” and a deputy to deal with mental healthcare in the jail. Seale said the jail recruited a full-time psychiatrist and renewed an OHSU fellowship program to bring in a psychiatrist once a week. There’s also a new mental health “manager” and officials are in the process of hiring two more consultants for guidance on the intake process and disciplinary decisions.
The jail’s now piping in music (Fleetwood Mac’s “Landslide” was playing in a video shown at the hearing). Officials have painted the walls with more “soothing” shades of green and blue, hung up large landscape photographs, posted chalkboards for inmates to draw on, and plan to add more comfortable furniture.
Jail operators will be back in front of the commissioners in the future, updating them on efforts in the training division, Reese said.
“We’ve worked hard the last six months to improve our capacity to deal with people with mental health crises,” the sheriff said. “And we know we have additional challenges we want to overcome: finding, keeping, and training the right people for the difficult work we ask them to do.”
Radcliffe tells the Mercury about the work jail officials have done in the months since the DRO report came out: “We’re engaged in a collaborative partnership, and we’re encouraged by the progress... but it’s just the first steps.”