Victorian Asylum or Modern Jail?

By Sara Totonchi, Executive Director

When K.H. was arrested in Atlanta in November of 2018, she was 26 years old, homeless, and experiencing symptoms of schizophrenia. Though she was arrested on charges of criminal trespassing and prowling—both minor offenses that carry little to no jail time—she has been incarcerated in Atlanta’s South Fulton Jail, in solitary confinement, for over 5 months. She has been deemed incompetent to stand trial and is unable to afford her $500 bond. She is stuck on a wait list to be transferred to a hospital.

Women’s rate of incarceration has grown twice as quickly as the rate for men in recent decades, and the growth has been disproportionately located in jails. Fulton is Georgia’s most populous county, and the Fulton County Sheriff’s Office detains more people in its jails than any other sheriff’s office in the state. On any given day, roughly half of all detainees in Fulton County are identified as needing mental health services. The jail is, in effect, the state’s biggest mental health facility, yet it is staffed mostly with people who are neither trained nor remotely prepared to manage people who are experiencing serious mental illness.

When women in the Fulton County Jail system are deemed incompetent to stand trial but capable of being restored to competency, they are placed on a long waiting list for admission to one of the forensic beds at Georgia Regional Hospital–Atlanta, or another state hospital. It’s not unusual for people like K.H. to wait months, or even a year, for a bed. In 2011, recognizing that the wait times for these beds were prohibitively long, Fulton County established a jail-based, 16-bed competency restoration unit at its main jail. Detainees who are admitted to the unit promptly enter a therapeutic environment, with full days of structured programming, counseling, and group activities supervised by on-site psychiatrists and other skilled clinicians. They participate in art therapy and movie nights. The only catch? Under Fulton County’s policies, inexplicably, candidates for the competency restoration program “must be male.”

K.H. is a named plaintiff in a lawsuit filed in April 2019 by the Southern Center for Human Rights (SCHR) and the Georgia Advocacy Office on behalf of women with psychiatric disabilities in the jail. The lawsuit, which seeks a court order demanding that women in the South Fulton Jail be held in safe, sanitary conditions, was filed against Fulton County Sheriff Ted Jackson, Chief Jailer Mark Adger, and other jail officials. The lawsuit alleges that because K.H. has been identified by jail staff as a person experiencing mental illness, she—and others in the same unit of the jail —are locked inside their cells for over 23 hours a day on average. Often, they are left in their isolation cells around the clock for days on end.  Between November 3, 2018, and February 28, 2019, K.H. was allowed in the jail’s outside recreation area only once. To make matters worse, thanks to a perpetually malfunctioning toilet, K.H.’s cell floor is often flooded with standing toilet water. She must either use her sheets and blankets as a sponge, or live with toilet water surrounding her. On the days that she chooses to mop up the water, she is forced to sleep on the metal bed-frame without bedding.

Conditions in the South Fulton Jail’s mental health unit are simply inhumane. Because some women with psychiatric disabilities cannot maintain their personal hygiene, the pods often smell of urine and feces. The building itself is rife with surface mold and rusting metal. Shower mats are covered in scum. In the cells, women can be found lying on the floor; sometimes they smear themselves with feces. Many of the women are unresponsive; some mutter incoherently. With nothing to do all day, many women are curled up in their beds, sleeping, or staring at the wall. Many cells are filthy, with food waste, soiled clothing, and other trash strewn about.

Breakfast is served to the women at about 3 in the morning, through a flap in the cell’s heavy metal doors. They are given four slices of white bread, and some meat believed to be bologna.  Multiple women have complained of food poisoning from rotten bologna.  At a recent visit to the jail, SCHR staff observed a clearly visible spot of blue mold on the meat.  Because of chronic plumbing issues, cells frequently lose all water access. When this happens, the women have access only to what little water they can store in a cup or cereal bowl from the 3:00 a.m. distribution of breakfast trays. Women like K.H. remain caged in these horrific conditions for months on end only because they are too poor to afford their bond, too impacted by their mental illness to resolve their cases, and not deemed eligible to competency restoration services which are offered to similarly situated men.

Solitary confinement can cause anyone to mentally decompensate, but it is particularly harmful for people with psychiatric disabilities. Many women held in South Fulton isolation cells cut themselves, bang their heads against the wall, and even attempt to commit suicide.  The jail is full of women like K.H., whose symptoms could be safely and effectively managed in a therapeutic setting. But in isolated conditions, they deteriorate dramatically. The mental health crises they experience are tragic, predictable, and preventable.

Here is what Fulton County can — and must — do. Eliminate solitary confinement. Ensure that all women at the jail receive sufficient out-of-cell time, 7 days a week, including time for fresh air and exercise, every day, in the outdoor recreation area. Employ a sufficient number of security staff to ensure that all women, including those with mental illnesses, receive out-of-cell time and opportunities for socialization daily. Ensure that all women at the jail have access to reading material to occupy their time and stimulate their minds. Employ a psychiatrist to make rounds and to visit every cell, a minimum of once a week. Create a competency restoration program in the community with appropriate supports for women who can be safely treated in the community. Create a jail-based competency restoration program for women found incompetent to stand trial which provides full days of structured activities and other services equivalent to those provided to men in Fulton County.

Then there are the necessary structural, environmental changes: fix the broken plumbing; provide women with ready access to fresh drinking water; perform daily checks of each cell to ensure that all women have clean sheets, bedding, and uniforms. Perform environmental tests to check for black mold and eradicate it where found; power clean all jail cells on a regular schedule; improve food safety — no more slimy, moldy bologna.

Though it’s 2019, the South Fulton Jail’s mental health units more closely resemble a Victorian asylum than a modern jail. It is unacceptably cruel and counterproductive to isolate people with serious mental illnesses in solitary confinement, and it is particularly egregious to condition access to treatment on a person’s gender. Fulton County is fully capable of implementing the necessary changes. The County can do better, and it must.

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