Cruel and Unusual

Mentally ill Texans used to go to hospitals. Now, increasing numbers of them go to prison instead.

His face is pasty and pale, a sharp contrast to his greasy coal-black hair. His dark eyes are sunken under a low forehead and thick eyebrows; he frequently jabs, mashes, and grinds his eyes with the balls of his thumbs. When he speaks, he rarely makes eye contact. Even while sitting on the couch in his mother's living room -- and even after 15 months of freedom -- Aaron George looks like he is still in prison. And in a way, as a bipolar schizophrenic, he is: still in the prison of his own mind.

In a monotone, George recounts his recent incarceration in the Texas Department of Criminal Justice system, and he talks fatalistically about the real possibility that he'll return to the special hell that a growing number of mentally impaired inmates inhabit.

"If I have to go back, I'll either let them kill me or I'll kill myself," he says. His voice is flat, emotionless; he is resigned to his fate.

Howard Waffer is an inmate at Texas' Skyview facility for the mentally ill, where he is serving time for sexual assault.
Phillippe Diederich
Howard Waffer is an inmate at Texas' Skyview facility for the mentally ill, where he is serving time for sexual assault.
The Hodge Unit: mentally retarded inmates outside their cells
The Hodge Unit: mentally retarded inmates outside their cells

It's May, and George is waiting to be retried for the 1992 shaking death of his 7-week-old son. In 1996, a jury in Montgomery County in East Texas found George guilty of murder and sentenced him to 60 years in prison. In January 1998, a state appeals court overturned the conviction. Four months later, he was released to await a second trial.

George, a slightly built man, looks younger than his 25 years. During his time in prison, he says, he was raped twice and repeatedly left unprotected from predator inmates. Additionally, he says, he was denied the psychiatric medications prescribed to him by his free-world psychiatrist -- new, relatively expensive drugs that help George and other schizophrenics deal with the voices and signs that only they can detect.

Of course, accusations of barbarous conditions within Texas prisons are nothing new. In 1972, several Texas inmates filed a landmark federal lawsuit that became known as Ruiz vs. Estelle. The lawsuit challenged the constitutionality of almost every aspect of the state's prison operation, from the size of a cell to the use of solitary confinement and employing prisoners as guards. Following the trial in 1978 and 1979, U.S. District Judge William Wayne Justice mandated sweeping reforms within the Texas prison system. Included in Justice's ruling was an order for TDCJ to overhaul its physical and mental health-care systems.

In 1995, Judge Justice released TDCJ from parts of the order, but ruled that its health-care system was still not sufficient. This March, he updated his opinion, ruling that the system's health care is now up to the standards of the U.S. Constitution.

But the judge still has great reservations about the quality of Texas prisons' health care. Even as he writes that TDCJ's treatment of the mentally impaired has improved enough to be "constitutional," he notes that the system is greatly lacking in compassion.

"Simply stated," writes the judge, "large numbers of inmates throughout the TDCJ system are not receiving adequate [mental] health care."

He continues, writing that in light of recent rulings by the U.S. Supreme Court, "the standard for evaluating the constitutionality of medical care in prisons is...unduly low.

"As the law stands today, the standards permit inhumane treatment of inmates. In this court's opinion, inhumane treatment should be found to be unconstitutional treatment."

Unfortunately, a growing number of mentally challenged prisoners are possibly subject to such treatment. In 1972, when the Ruiz federal suit was filed, Texas prisons held approximately 25,000 inmates. Today that number stands at more than 140,000. Mental-health organizations estimate that as many as 17 percent of Texas prisoners suffer from some form of cognitive disability -- that is, as many as 23,800 inmates. But TDCJ designates fewer than 4,600 beds specifically for the mentally impaired.

And it seems ever more likely that a mentally ill person will end up in prison. Over the past 10 years, according to the Texas Department of Mental Health and Mental Retardation, the number of state-funded non-prison beds for the mentally ill and mentally retarded has dropped from almost 8,000 to fewer than 5,500. Among all the states in the nation, Texas ranks a lowly 46th in mental-health funding.

To Sharron Dishongh, the former head of a TDCJ psychiatric unit, the numbers point to the obvious -- and they make her question the state's strategy for dealing with the people whom few others want.

"The people that used to be in state [mental] hospitals are now here in prison," Dishongh says. "But is this the best place for them?"

In third grade, Aaron George was diagnosed with attention deficit disorder and began taking Ritalin. When he was 13, full-blown schizophrenia was added to the diagnosis.

"He found it difficult to accept criticism," says Beverly George, George's mother and protector. "He took everything very personally. You could just ask him to take his foot off of the table and, if it was the wrong time for him, he would just be devastated. He was afraid to go into a store for fear he would make a mistake."

Often he would sit in front of the television for days without moving, talking, or eating. He grew increasingly paranoid and defensive. He suffered panic attacks. He heard voices. He became delusional. The television spoke directly to him. There were messages in numbers. Everything meant something, and it was all bad. He was convinced there was a conspiracy to kill him, or, as he says, "to cross me out."

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