Feeling Crazy?
In Miami, Better Keep the Voices to Yourself

In one instance an annoying nut was handcuffed and then punched several times in the kidney area.

By Rebecca Wakefield

I don’t usually do book reviews, but this week I found myself uncomfortably transfixed by Pete Earley’s Crazy: A Father’s Search Through America’s Mental Health Madness. Earley, an author and former journalist for the Washington Post, delved into this bottomless pit as a way of coping with his adult son’s mental illness and his utter helplessness in the face of civil rights laws that regard insanity as if it were an inalienable privilege.

He wanted to know why this country treats its crazy people like animals, criminals, and profitable widgets in the psychotropic drugs-and-institution business. He looked for a place that would illustrate just how little we’ve learned since the era of The Snake Pit and One Flew over the Cuckoo’s Nest. Naturally, he came to Miami.

In Miami-Dade County’s jail system, Earley found the modern-day asylum, where officials estimated about ten percent of the 7,000 people it imprisons on an average day were taking antipsychotic drugs. That’s 700-plus lunatics in an already chronically overcrowded county jail system. (A Miami-Dade grand jury report released in 2005 estimated 800 to 1,200 of the daily inmate population had some form of mental illness.)

“It really is horrible to be a person with mental illness in Miami,” Earley told me. One of the attractions of Miami as a study subject, he added, was its dubious status as the place with the highest percentage (about 9 percent) of mentally ill residents in the country. He attributed that to an influx of mental patients from the Mariel boatlift in 1980 and the warm weather that draws nuts just as it does tourists. I would speculate that Miami’s bustling industry of Medicaid and Medicare fraud is also a factor.

Earley spent about a year, between 2003 and 2004, periodically visiting the jail, where he was granted remarkable access to the primary psychiatric unit on the ninth floor of the main jail. This is where the worst cases are warehoused — in freezing bare cells, monitored by overworked health care professionals and under-trained corrections officers, some of whom see no issue with periodically beating problem inmates. “I think jail officials realize that the ninth floor is a horrible place,” Earley said when I expressed surprise at the access he got. “They are being asked to do a job that jails should not be asked to do. There was an attitude of ‘This is reality. You wanna come see it? Go ahead.’”

Here is Earley’s description of our lovely downtown sanatorium: “The air in C wing [where the suicide risks are kept] stinks. It is a putrefied scent, a blending of urine, expectorant, perspiration, excrement, blood, flatulence, and dried and discarded jailhouse food. When the jail’s antiquated air conditioning breaks down during the summer, which it often does, some officers claim C wing’s pink walls actually sweat. It’s decades of filth and grime bubbling up, rising through coats of paint.”

Also grimly bubbling up was the effect of a lack of training and equipment for corrections officers. Early said that on four separate occasions he was asked to leave a wing of the ninth floor so officers could beat an inmate unobserved. In one instance an annoying nut was handcuffed and then punched several times in the kidney area while his arm was twisted behind his back. The officers were even “nonchalant” about it when he questioned them later. They felt that occasional beat-downs were a necessary part of controlling the uncontrollable. “The thing that shocked me was everybody knows what’s going on and the attitude is that’s the way it is,” Earley said. “One of those incidents took place when a Miami Herald reporter was on the floor. They do that knowing a reporter is wandering around? That really shows you’re not too afraid of what’s going on.”

While Earley’s book goes over a lot of previously treaded ground, one of its strengths is the documentation of several inmates he shadowed to find out what happened to them as they were bussed from jail to treatment facilities to the streets and back again, endlessly. One guy he wrote about, whom he calls Ted Jackson to protect his privacy, turns out to have been responsible for all those “Jesus 2007” graffiti tags plastered throughout South Beach in 2003.

Earley writes that Miami Beach police got tired of Jackson’s antics and during one arrest, beat him so badly he was transferred to a hospital with injuries including a broken arm. Charges against Jackson were dismissed. But when Earley tried to follow up on this story, he found that Jackson’s arrest record had mysteriously disappeared. “At Miami Beach Police there were no records of him ever being there,” he said. “I found it very odd that his arrest record disappeared.”

Another case involved April Hernandez, a young girl who, like most of the mentally ill, adhered to prescribed medicines only erratically. She instead attempted suicide and self-medicated with cocaine, marijuana and alcohol, generally paid for with sex. I probably passed her a hundred times, sitting with other sad cases on Lincoln Road, and never knew it. She was homeless for periods and was gang-raped twice, among other horrors.

Miami’s circuit court is busy, the fourth largest in the nation. Its mission became more complicated in the early 1980s, when the effects of a national push to close most state mental hospitals (following numerous exposés on their generally medieval conditions) were felt on the streets of South Florida. Nearly overnight, thousands of the mentally ill were dumped into marginal existences as homeless people or as residents of poorly regulated assisted living facilities.

Many of these people ended up in a cycle of committing crimes, usually of the public nuisance variety, then being jailed until they were crazy enough to be sent to a psychiatric facility. That facility would then pump them full of drugs and try to train them to act straight enough to be able to stand trial. Rinse with a high-pressure hose and repeat.

The conundrum, worthy of a Joseph Heller novel, was that these people were not getting any real treatment, so they could never get any better. For most, the trigger for interaction with the system was always a criminal act. Besides being pointless, this cycle was also ridiculously expensive for taxpayers. The grand jury report stated that it costs $125 a day to keep a mentally ill inmate versus $18 a day to keep a sane one.

Steven Leifman is the associate administrative judge who started up and runs the county’s mental health project, which is attempting to change this. The project includes crisis intervention teams and diversion programs for mentally ill people who commit misdemeanors. “In Miami, thank god they have a reformist judge,” opined Earley.

Leifman told me that the project is beginning to have an effect. A thousand police officers in 22 local police agencies have received crisis intervention training aimed at preventing them from shooting the mentally ill quite as often as they used to. Leifman said the recidivism rate has dropped from 70 percent to just 22 percent this year. He has high hopes for a new facility — a special jail for inmates with chronic and severe mental illness — that county voters approved in 2004 with a $22 million bond. “The Miami-Dade jail is the largest psychiatric institution in Florida by far,” he said. “It’s tragic and it’s expensive and inefficient. But we’ve come a long way.”

Judy Robinson, another character from Earley’s book, begs to differ. She is a leader of the Miami chapter of NAMI, the National Alliance for the Mentally Ill. Earley called her the Dr. Phil of Miami. Robinson thinks the money should go into treatment programs that hit the mentally ill long before they enter the justice system. “The money is flowing in the wrong direction,” she complained. “The 22 million should have been put to the front end of this not the back end. You have to be arrested to get help and when you get through with the system and are put out into the community, there’s nowhere to go. A handshake and a pill isn’t going to do it.”

Earley said it is sad that mental illness has been criminalized rather than treated as a medical condition. “The brain is an organ just like the heart,” he said. “It can get sick.”

Earley will read from his book at 6 p.m. today (May 4) at Books & Books in Coral Gables.

Comments? E-mail wakefield@miamisunpost.com.