Cruel and Unusual

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

The Skyview and Hodge Units are located next door to each other atop a hill in Rusk, Texas, with a view of the oldest state-funded mental hospital in Texas. It's one of those places your parents used to threaten to banish you to if you didn't behave.

Both Skyview and Hodge are relatively new facilities. With a capacity of 528, Skyview houses mentally ill inmates of both genders, mostly in a dormitory setting. Hodge has room for 989 mentally retarded male inmates; they live in more traditional security units, behind solid steel doors with a small window and a slot for their food trays. Both facilities include segregation cells.

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

Some inmates come to Skyview and Hodge for extended care, but most are short-timers. They check in for 20, 30, or 60 days before being judged mentally fit enough to return to one of the general-population prison units across the state.

Last May, Warden Sharron Dishongh provided a tour of the two units. She seemed shocked when asked about claims that some inmates had been taken off their psychotropic medications upon entering prison.

"I mean, that's the opposite of what we would want," Dishongh said. "We don't want to take them off of their meds, because if we do, their mental illness is going to pop back up."

In one of the wards, one inmate refused to remove his arm from the slot. Dishongh jokingly asked the inmate whether he had "taken the slot hostage." The wisecrack displeased the prisoner.

"I'm mad at everybody!" shouted the inmate, upset because he had broken the light fixture in his cell. He said he broke it because the guards would never turn it off.

"We could gas him," said Dishongh, only half seriously, "but we don't want to do that." Instead, she squatted next to the slot trying to talk with the prisoner, promising that she would have the light replaced. The slot remained his captive.

No one would mistake either Skyview or Hodge for something like a school or daycare center; razor wire runs along the tops of the perimeter cyclone fences. But even at first glance, something about the two facilities broadcasts that they are different from most other prisons.

Flowers appear in rows and clusters along the fences and in the yards. A crew of prisoners armed with lawn mowers keeps the yards trim. Other inmates tend gardens of tomatoes, peas, and peppers -- all of which are used in the units' kitchens. Still other inmates work in the prison greenhouse or attend the in-house landscape design school. There's also occupational therapy such as barbering. There's animal-assisted therapy, during which, for a few hours a month, volunteers share the affection of their pets with inmates. And there is training in life skills such as cooking. "Some of these guys can't boil water when they first come here," says Dishongh.

Too, the atmosphere here is somehow looser than that of many prisons. The standard armed-guard towers are positioned strategically around the prisons, of course, and violence occasionally breaks out. (During the tour, an inmate attacked a guard, who needed several stitches to close the wound to his head.) But even so, both guards and prisoners seem more relaxed than their counterparts at other prisons. Dishongh says it's that way by design. In addition to meeting the regular requirements to be certified as a peace officer, guards at Skyview-Hodge must take 32 hours of special training on dealing with the mentally impaired, as well as yearly refresher courses. Additionally, Dishongh says, not all TDCJ guards are cut out for her prison; she's choosy about who comes to work for her. She adds that there is also an internal culling process: not all TDCJ guards want to come to Skyview-Hodge.

But inmates certainly do -- at least to Skyview, that is. Like the other three TDCJ psychiatric units where patients receive psychotropic drugs, Skyview is air-conditioned. Regular units are not. Because of that amenity, Dishongh says, her staff has to screen out prisoners who don't need to be there.

"Do we weed them all out?" she asks. "No. And do we sometimes weed out someone we shouldn't? Yes. But all in all, I think we do a very good job."

But she also admits that that job is getting tougher.

Before coming here six years ago, for six years Dishongh, who retired in May, oversaw the TDCJ headquarters for psychiatric services, in Huntsville. Prior to that she worked at the Rusk State Hospital just down the hill. Only half joking, she says she basically followed her clientele here because as the state reduced the funding for MHMR beds, the mentally ill have found their way to prison.

"Our nation, not just our state, has not done a real good job in determining how to manage the mentally ill," she says. "And so what are they going to do when they leave here? They are going to get into trouble. Because the services in Texas are not there for the mentally ill or the mentally retarded."

On that point, former Skyview psychologist Jeri Houchin agrees with Dishongh. But she does not concur with the warden's assessment of the overall treatment provided to the mentally impaired in TDCJ. It's not that Houchin doesn't want disabled inmates to do their time. She just believes they have a right to the reasonable accommodations and care guaranteed to them by law.

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