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Altered State

Christopher Gardner Come As You Are: As a child, his parents say, Andrew Barnett grew up much like anyone else. It wasn't until adulthood that his bipolar manic depressive disorder caused the mood swings and delusions that made it hard for him to function normally and caused him to run afoul of the law. Is it really so crazy to choose death over prison? Mental patient Andrew Barnett didn't think so. A special report on what happens to the mentally ill behind bars. By Jim Rendon SOMETIME IN THE early-morning hours of March 5, 38-year-old Andrew Barnett quietly slipped out of his father's Saratoga home and walked along the tree-lined streets to Congress Springs Park, a small strip of green adjacent to Route 85. Barnett wrapped his hand around a pistol he had made himself, using a homemade drill press in his father's garage. Alone, amid the swings, the baseball diamond, the budding young trees and the muffled hiss of the freeway, Andrew Barnett put the gun to his head and, with one .22-caliber bullet, ended his life. Just a few hours later, while Pauline Bermudes, Andrew's mother, was drying her hair, getting ready to accompany her son and ex-husband to court, the phone rang. Edward Barnett, her former husband, was on the line. "When he told me Andrew was missing, I was shaking. I knew in my heart and soul my son had taken his life," she says in her soft voice, a slight British accent peeking through. Hours later, when plainclothes detectives finally came to her door with the news that Andrew's body had been found lying in the park, Bermudes couldn't bear it. "I knew what the detective was going to tell me from the look on her face. It was a mother's worst nightmare. He was just gone," she says, clenching her hands in her lap, her voice just beginning to crack. Since he was a teenager, Barnett suffered from manic depression, or bipolar disorder. "He thought he was being followed, he took photographs of everything." Bermudes says, explaining some of the symptoms Barnett suffered in the years leading up to this incident. "He heard voices in his head, he suffered déjà vu a lot. He'd say things like, 'I can't believe I'm alive, I just shot myself.' " For decades Barnett was plagued by delusions and depression and peaks of mania where he would work on projects for days on end. Even when faced with his own erratic behavior, Barnett refused to acknowledge his illness, and most of his parents' numerous attempts to get him into treatment were unsuccessful. "He had a pretty miserable life," says his father, Edward Barnett, an Englishman with bushy salt-and-pepper eyebrows and mustache. In a manic episode during the spring of 1997, Andrew Barnett decided to become a political activist. California was considering changing its labor law to require overtime pay after a 40-hour work week instead of after an eight-hour day, and Barnett became convinced that a powerful public statement was the only way to stop it. Sitting in the State Building auditorium in San Francisco before a hearing on the proposed new law, Barnett turned his wallet and car keys over to a friend, asking him to keep them "in case there was any trouble." Little did his friend know that Andrew, who had no record of violence, was carrying a gun. Following the committee's vote to overturn the current law, Barnett approached the podium, where chairwoman Robyn Black was sitting. After arguing with Black, he reached for the gun hidden in the back of his pants. But Barnett fumbled, and before he could get the pistol out, he was wrestled to the ground by highway patrol officers. Mental Prisoner BARNETT, AS IT TURNS OUT, never intended to harm Black. His target then as it would be on March 5 was no one but himself. In his mind, a public suicide, the ultimate violent self-destructive statement, was the only thing that would change the debate on the overtime law, and such a martyr's death would have provided him with an excuse to silence his own anguish. Despite his intent, he was arrested for attempted murder and spent over a week in a psychiatric care unit and the county jail before he was bailed out. When he was released, his parents barely recognized him. "He was vacant, so drugged that he was drooling. He wasn't my son," Bermudes says. Andrew moved back in with his father, was put on medication and received counseling at Fremont Hospital while his case dragged on. With this attention and a stable home with his father, Andrew's health seemed to be improving. After months of expensive legal negotiations by his private attorney, the charges against him were reduced to illegal possession of a gun, which held a maximum sentence of 16 months in state prison. On the morning Barnett killed himself, he was to begin 90 days of psychiatric observation at San Quentin, during which Department of Corrections psychologists would decide whether to release Barnett on probation or dump him into the prison system. It was the prospect of doing time in state prison that his parents believe drove Andrew to kill himself. "Andy was terrified of prison," says Bermudes. "He realized that the majority of the people that go in for observation still get a sentence. He did not want to go." Bermudes' voice brightens when she comes back from her dining room with images of Andrew, her oldest son. She points out grade-school pictures of Andrew with neatly kept reddish-blond hair. In middle school, his hair and shirt collars got longer. As a teenager, he turned from the camera as he sat behind the wheel of his dune buggy. Finally she pulls out a blow-up taken not long before Andrew died. Even then the smile is bright, and there is a flash of light in his blue eyes. "What happened to my son is wrong, it is dead wrong," she says fighting back tears. "Andrew was a wonderful child; he loved life." Hearts and Minds MORE THAN 25 MENTALLY ill people a day flow into the Santa Clara County jail. Fourteen percent of the jail's 4,700 inmates have serious mental-health needs, according to jail spokesperson Rick Kitson. Since the state began shutting down its mental hospitals, the mentally ill have been a regular fixture in jails. A 1982 study found that the number of people with serious mental disorders in the Santa Clara County jail went up 300 percent following the closure of Agnews State Hospital. The problems posed by such large numbers of mentally ill inmates became so severe that a lawsuit settled in the late 1980s forced the county to devote an entire floor of the jail to acute mental-health services. Kitson speaks with pride about the jail's mental-health achievements, noting that San Mateo County rents beds on the mental-health floor and that other counties often call for advice. Though the local jail may do a reasonable job of treatment, it is certainly an odd role for it to fill. But with the lack of funding for alternatives, jails may be forced to fill that role for some time to come. Most people with severe mental health needs suffer from schizophrenia, bipolar disorder or major depression. Together, these diseases account for a small but significant portion of every society. According to the California State Department of Mental Health, 1.1 percent of Californians suffer from schizophrenia, 1.2 percent are bipolar and 5 percent have major depression. The county Public Health Department estimates that 112,000 county residents require some specialty mental-health services. Despite this large number, Santa Clara County's mental health services treated only 20,000 people last year. When then-governor Ronald Reagan closed state mental institutions in the 1960s, policy-makers anticipated that a network of community-based programs would develop to care for the mentally ill. But only a smattering of those facilities have materialized during the last three decades. In this county only 30 of these privately-run facilities provide 24-hour care to the mently disabled, leaving thousands with mental-health needs to fend for themselves. At the same time, new laws made it tougher to commit someone to the existing and meager state hospital system. California currently runs only five state mental hospitals, one of which is in Vacaville state prison. Of the 3,664 patients in state mental hospitals, the vast majority, 2,723, were placed there for criminal activity. Fewer than 1,000 Californians are held in state mental hospitals for solely medical reasons. For those who need 24-hour care but are not outwardly violent and have no police record, there are few institutions with openings, leaving patients in the care of families and communities often under-equipped to deal with them. Just getting by day to day for someone suffering from severe mental illness is like trying to complete a jigsaw puzzle that keeps falling apart. Linear, coherent thought can be disrupted, causing circular thinking or jumps in logic that make communication a struggle. "The world is unpredictable; there is no cause-and-effect relationship," says Dr. John White, director of psychiatric services at Fremont Hospital. "The world does not play by rules you understand." Many people suffer from aural and visual hallucinations. "The brain registers voices in your head as real. You really believe someone called your name, or that God is telling you that you deserve to die. This can be agonizing," he says. The give and take of communication, eye contact and smiles get disrupted. "There is a crushing aloneness and alienation." Throw someone like that in jail? "It is all your worst expectations cast in spades," White says without hesitation. "They are punished, beaten. They don't understand; there is no one to help them. It is horrific. Beyond your worst nightmare." Bar None FROM ITS OPENING IN 1989 until a court decision in 1995, the Secure Housing Unit at Pelican Bay, California's Alcatraz, where some of California's toughest inmates are housed, received a higher percentage of mentally ill prisoners than any other California prison. In the early 1990s Vaughn Dortch, a Pelican Bay inmate with a history of mental illness, was cuffed and held down in a tub of scalding water by guards, causing second- and third-degree burns over a third of his body. When he was allowed out, clumps of burnt skin hung from his legs. Yet guards had to be dissuaded by a nurse from returning him to his filthy cell. His infraction? Covering himself with his own fecal matter. Despite the hundreds of mentally ill inmates at Pelican Bay, there was no staff psychiatrist for 2 1/2 years. Inmate after inmate who displayed severe symptoms such as auditory and visual hallucinations, psychotic fits of screaming and incoherent rambling, and even some who attempted suicide, were either ignored or celled alone so as not to bother anyone. One inmate, identified in the court proceedings only as Inmate E, suffered a severe psychotic breakdown. After he wrote a suicide note in his own blood in April 1992 and stated that he planned to kill himself, doctors recommended that he be disciplined for trying to manipulate the system. Later, when he cut his forearms and talked about voices in his head, one doctor gave some credence to his illness, but only five days later, another doctor diagnosed him as having no significant disorder. "I see or hear things," said Inmate E when he was interviewed for the suit. "A bunch of people come up to me and talk about why I have to kill myself. Things I've thought of, things I've seen, animals and stuff like that. It's frightening. They tried to kill me. They used sounds, send emotions through my body, and my body shakes. I'm tired of people talking in my head." Problems in treating the mentally ill behind bars were not isolated to Pelican Bay. In 1993, the state lost a landmark case, Coleman v. Wilson, which showed a history of poor treatment of mentally ill inmates throughout California's entire prison system. During the case, inmate James Alva O'Donnal testified that in nine months of incarceration, his symptoms were virtually ignored. O'Donnal, a diagnosed paranoid schizophrenic who had been taking medication for 10 years, described the symptoms he suffered. "Voices say to hurt people before they hurt me," he testified in March 1993. "They tell me to play with my feces. They say to rub it on me to get the life force from it." When O'Donnal entered the California prison system at Donovan in San Diego, he did not get a visit from a psychiatrist for a month, despite medical records showing he was taking psychotropic medication. When he finally did see a psychiatrist, O'Donnal was recommended for transfer to a medical facility. But for six months O'Donnal went nowhere. He fought with other inmates and was placed in administrative segregation, where he was deprived of his medication. When he was finally transferred, it was to Folsom State Prison, not the medical facility. "I was scared [about going to Folsom], I heard it was pretty tough, and I just didn't want to be around people. I was afraid I would get hurt," O'Donnal testified. At Folsom, O'Donnal waited two to three months before seeing a mental-health staffer, all the time without receiving any medication. At the time he testified in the trial, he had not yet been transferred to the medical facility. Despite the changes implemented as a result of the Coleman case, critics still contend that problems persist. Though new inmates are screened for mental illness before entering prison, that test has never been validated. And inmates already in the system are not screened. Mentally ill prisoners are still punished like any other inmate for breaking rules, even when the behavior is a manifestation of their illness. "If a psychotic inmate hits a guard, they say he is violent," says Terry Kupers, a psychiatrist who testified in the Pelican Bay case. "But the inmate is acting out because of his psychosis. There is no basis in psychiatry to say otherwise." Mentally ill inmates are also still subjected to cell extractions, a process where an inmate is forcibly removed from his cell. A team of guards armed with riot shields, pepper spray, clubs and often a 37mm block gun will rush into an inmate's cell, violently subdue him and haul him off to administrative segregation. Only if the cell extraction is planned are mental health staff required to talk with the inmate before the extraction. "You can't run a mental health program where you are trying to get someone better when the guards keep beating them up," Kupers says in exasperation. In Loving Memory: Pauline Bermudes holds a picture of son Andrew Barnett, a troubled young man who she says "loved life" despite his depression. Christopher Gardner Altered States SANTA CLARA COUNTY has had its own share of problems with mentally ill inmates. In July 1995, Joseph Leitner was arrested for the kinds of offenses that routinely land the mentally ill behind bars: He was acting strangely on a street corner because he was off his medication, and he had warrants out for drinking in public and failing to pay bus fare. Though Leitner told officers about his illness, he was taken to jail instead of Santa Clara Valley Medical Center. Once in jail, Leitner became nervous and began hitting his head and bit his tongue. When Leitner began spitting blood, five guards cuffed his hands and legs, wrapped his head in a thick blanket and carried him to the psych ward, where they left him alone on a table. In the following minutes, Leitner suffocated and nearly died. Today he lies in a bed in Los Gatos Community Hospital, unable to speak, eat or move. His immune system is low, and he contracted an infection, so that now when Rita Leitner, his mother, visits, she has to suit up in a surgeon's outfit to see him. It was this kind of treatment that terrified Barnett, and those involved with his case are outraged that he was sentenced to prison at all. Dr. Jules Burstein, the forensic psychologist who evaluated Barnett, expressed shock at the court's decision. "Since there was evidence of mental disorder, and no one was hurt, my evaluation focused on treatment," he says. "With proper treatment the odds were that nothing like the incident that got him in trouble would have happened again," Burstein says with confidence. "The tragedy could have been averted if the focus had been on treatment." But it is rare that mental-health needs prevail in the criminal court room. "The criminal justice system and the mental health system are supposed to accomplish different things," says Jennifer Green, an attorney with the Santa Clara County public defender's office who handles criminal cases involving mental-health issues. The justice system was designed to assess guilt and mete out punishment, not to treat and heal. Ironically, it is often in the bureaucracy of the jail where people are first diagnosed or exposed to medication. "The mental health system does not really kick in unless someone is gravely disabled and poses a danger to themselves or others," says Green. "There may be warning signs all along, but often there is not any help until after someone is in jail." Mind and Matter ANDREW BARNETT displayed warning signs for decades, but for reasons common to many who have mental-health needs, they were not enough to save him. When Andrew was a teenager, he threatened suicide. Afraid for their son, his parents admitted him to a hospital, where he was held for a few weeks. But the doctors had no diagnosis, no name for what was wrong with him. Even back then, Bermudes says, "you could see there was a lot of trouble in him." Rather than medication or treatment, the doctors prescribed rest and time away from the family. The Barnetts sent their son to live with his grandmother in England, but his peculiar behavior only seemed to intensify. He wrote home about how his grandmother spied on him, rifling through his trash to read his letters. Bermudes says that Andrew's perception was so wildly off the mark that she could hardly believe he was writing about his own grandmother. "He inflated things, his perception was so different," she says. While traveling in Germany, Barnett met a Mormon and was converted before their train reached its last stop. When he returned to the United States, he shed his new religion for a mohawk and a leather jacket and moved to San Francisco. "It turns out," Bermudes says, recounting the numerous books she has read about mental illness in the last year, "that these wild fluctuations are symptomatic of his illness." But at the time, no one knew what was wrong with Barnett. And because of his intelligence and energy, he was able to live on his own and get by just fine. "People loved Andrew," says his mother. "He knew so much. He was always talking about things he had read." It was after moving to San Francisco that Barnett had his first brush with the law. He worked as a teller in a credit union on Van Ness Avenue. And though he passed the training course with flying colors, he was unable to balance the books at the end of the day. He was more interested in the burglar-alarm system than his job, often hinting that the bank would be easy to break into. Finally, the bank had to let him go. "He got fired, got angry, broke into the bank and defeated the whole damn alarm system," says Edward Barnett. After a short time on the run, Andrew was found in Oakland. "He was in the back of a truck surrounded by gas bottles. He was raving, saying he was going to blow himself up," Ed Barnett says. After police defused the situation, Andrew was put in psychiatric care while awaiting trial. In the end, with help from the bank manager, Barnett was offered a reprieve from jail--probation with a stint at a community mental-health facility. But, Barnett says, "Andy took one look at these places and said, 'No way am I going to do this.' " He rejected the deal and chose to take six months in the San Bruno Jail over any kind of treatment. "I pleaded with Andrew to get help," Bermudes says. But Andrew, time after time, refused treatment. "What was I going to do, throw a bag over his head and take him down to counseling? He would not accept his diagnosis," his father says, echoing his ex-wife. "Many people are unwilling or unable to acknowledge their own mental illness," says Dr. Burstein, pointing out how common Andrew's reaction was. "Consequently, they do not stick with their treatment and they stop taking their medication." Group Therapy IN THE YEARS FOLLOWING his release from jail, Barnett lived with a group of artists in a warehouse in Emeryville, where he spent time rebuilding cars. He got an associate's degree in diesel mechanics and worked for a trade-show vendor in Sunnyvale. "I think he would have been happy to live in Emeryville for the rest of his life," says Andrew's father. He became involved with the union at work and was promoted. But all that time, even through these years of stability, he was distant. "With Andy, there was a wall that you could never break through," says his mother, motioning in front of herself with her hands. "He never had a lifelong friend; you could not really get to know Andrew." He hid his depression from his parents, displaying only the manic side. "In his manic state, he would build things," she says pointing outside to her yard, where two-foot-tall planters hold young trees. "Andy made those for me in a 12-by-10-foot room. They weigh 500 pounds each." He also built a deck at his father's house that is held together by pegs and joints. "When Andy was manic, he just did things. He'd work like mad for days straight and would then collapse," says his father. In 1996, the city evicted Andrew and his friends from the warehouse, and things took a turn for the worse. After Barnett moved in with another friend in Oakland, his condition began to deteriorate. He became more and more delusional, and his father asked him to return home. "You had to try to wrap yourself around him, and not stress him," he says of his son's last stint at the house. "Andy needed to be in a quiet space, and living at the house was a comfort for him emotionally." But it was only four months later that Barnett headed out for the overtime hearing with a gun in his pocket. In another 11 months, Andrew would take his life. "He's done what we all dreaded he would do. It's like hanging onto the back of a bloody great juggernaut," his father says. "I wanted him to survive, and he slipped through my hands." "I really feel the system failed him," Bermudes says. "He deserved a chance to get his life together." But because his illness was viewed as a criminal problem rather than a health issue, Barnett was not given that chance. No one disputes that Barnett violated the law. He was charged with five separate offenses all relating to the gun he brought to the meeting. He had been convicted of a felony for breaking into the bank and was therefore prohibited by law from having a gun. He filed the serial number off of the weapon to protect his friend who loaned it to him. He had the gun concealed in public and he brought it to a public, politically charged meeting. But all of these offenses were committed in an attempt to kill himself, something recounted by witnesses, argued by his attorney and even acknowledged by the district attorney's office. Barnett was in no way trying to harm anyone but himself. He had never, in any of his criminal records, tried to harm others. Yet he still faced numerous and serious criminal charges. Though the prosecutors were sympathetic to Barnett's mental illness, they were not in a position to let him out on the street. He was an ex-felon caught with a gun in a public meeting. He looked bad on paper. And so his attorney's efforts to get him released were unsuccessful. Systemic Failure THOUGH SANTA CLARA County Superior Court Judge LaDoris Cordell has never heard of Barnett, she knows his situation intimately. Cordell first became familiar with the intersection of law and mental health during the two years she presided over civil commitments, the hearing process by which someone can be institutionalized. When she was transferred to criminal court, she carried her interest in mental health with her, familiarizing herself with different diagnoses and taking a psychology course at Stanford University. In her chambers in Department 10 of the court building on St. James Street, Cordell pushes prosecutors and defense attorneys to settle cases of insurance fraud, battery, even murder, under the watchful of Dr. Martin Luther King Jr., whose photograph hangs over her desk. About 20 percent of the time, these discussions revolve around mental-health needs and the balance between treatment and punishment. Cordell, fascinated by the issue, is frustrated by the ignorance around her. "We need more judges that are highly educated on mental-health issues. Education should be mandatory," she says and then laughs. "There is no mandatory education for judges for anything. We are an arrogant group of people." But in Santa Clara County, education and communication about mental illness and criminality is beginning to happen, and Cordell is one of the many figures at the center of the discussion. Members of the Alliance for the Mentally Ill had tried to bring this issue to the attention of county government for years, but their efforts were largely unsuccessful until the much publicized incident in July 1995 when a manic-depressive Leitner suffered his permanent and severe brain damage at the hands of county jail guards. Outraged at the incident, alliance members put pressure on county government, and Supervisor Jim Beall responded. Before long Beall created the Jail Diversion Task Force, a group that is working to keep nonviolent mentally ill people out of the criminal justice system. "The purpose of the task force was to try to provide therapy instead of criminalizing mental illness," Beall says. "We try to divert them before they get into the court system." Thanks to Beall's group, there is now some dialogue between prosecutors, case workers, judges and defense attorneys on many of these cases. "We look for crimes where there is no victim, property damage, petty theft, where releasing the person will create little risk to the community," says Dana Overstreet, the deputy district attorney who works with the task force. "A lot of these people can be housed out of jail," she adds, an uncommon sentiment to come from the district attorney's office. Erika Toth, an AMI vice president and chair of the county mental health board, says the group is trying to stem the tide of mentally ill people flowing into the jail by pushing the police department to educate officers about mental illness. Stopping the flow at its source will do the most to keep the mentally ill out of the criminal system altogether. This, says Toth, makes sense from a mental-health point of view, from a criminal justice point of view, and even from a financial point of view. The county estimates that it spends $62 a day for each person it holds in jail. Mentally ill inmates require medication and more attention than the average prisoner, which inflates the overall cost. In court, psychiatrists must be hired to evaluate the prisoner, who, if found incompetent, is moved at taxpayer expense to a state hospital, where he undergoes training aimed at teaching him about the court system so he can stand trial. This entire process is time-consuming and expensive. The county jail's budget alone is $104 million, $2 million more than the county's entire public mental-health budget. "Money spent on jailing the mentally ill should be spent on care in the community," Toth says. While Santa Clara County, because of its affluence and because of the work of advocates, has more options for the mentally ill than many counties throughout the state, a dearth of programs and lack of housing are major problems. "There is not a lot of bed space," Overstreet says. "If the district attorney, public defender and judge all agree not to send a person to jail, the person can remain in jail for weeks while we are trying to place them." Lock and Key WHILE MOST PEOPLE involved with mental-health issues agree that more treatment facilities are needed, there is some debate over what kind. Kyra Kazantzis, directing attorney for the Mental Health Advocacy Project, a San Jose watchdog group that provides legal services for the mentally ill, says more open residential facilities are needed in the community. While those facilities, with proper regulation and oversight, can provide stable living and treatment environments for people, they ultimately may not keep people like Barnett out of jail. As much as Judge Cordell is sympathetic and knowledgeable, her role is still to protect society, not to provide mental-health treatment. "People can be locked up with a conservatorship or go to Jacob Center, which is not locked. There is no in-between," Cordell says with a sigh. "If they hurt someone, or take property, I've got to lock them up. I do it. There are no other options." The missing links are short-term locked treatment facilities says forensic psychologist Jules Burstein. "An entrepreneur could make a fortune setting up intermediate facilities, something between a state hospital and seeing a doctor once a week," he says with excitement. "We need residential treatment facilities where people are held from three months to a year. We need an alternative to prison." While it seems to be a feasible solution, Burstein cannot identify any such program in the U.S. No one has yet taken the step to build a net beneath the crack that swallowed up Andrew Barnett and the crack that thousands of people fall into every year. These days Pauline Bermudes takes solace in cups of hot tea, in spending time with old friends and trying to move on. She talks hopefully of the day that she will be able to start looking through Andrew's belongings, paging through some of his journals, getting to know a little bit more about her son. Meanwhile, she reads about the disease that dominated Andrew's life, that drove him to kill himself. On her kitchen table, one of these books lies open to keep the page; bright white letters on a black cover read "Suicide." [ San Jose | Metroactive Central | Archives ]