The plight of these inmates reflects two decades of breakdowns in Minnesota’s public mental health system. The state once operated several large psychiatric hospitals — the best known in Anoka, Fergus Falls and St. Peter — that housed thousands of patients. Under pressure from the courts and social reformers, Minnesota began closing them in the 1990s and releasing patients to the community.
For thousands of patients, life with medications and transitional services proved a huge success.
But for a small share — those who are aggressive and violent — the state never built suitable new facilities. Today, hundreds wind up in court and in jail.
These patients represent a small fraction of the estimated 200,000 Minnesotans who have serious, diagnosed mental illness. But their numbers are not small: Some 4,000 Minnesotans were committed by judges for state treatment in a recent 18-month period, including patients with severe mental illness, chemical dependency and developmental disabilities.
“We have broken our promises to the mentally ill,” Quam said in an interview. “We’ve closed the institutions down and moved these people out into the community [but] did not give them the places to stay and treatment they needed. They end up in jail, and the conditions are beyond what most people can imagine.”
Many wind up cycling through the system repeatedly.
Schuler, the inmate who stabbed himself in the eyes, is an example. Early last year, after one scrape with the law, he admitted himself to Hennepin County Medical Center for psychiatric care. While in the hospital, he missed a mandatory court hearing for his previous offense. The result: On his release from the hospital, he was immediately arrested and sent right back into the criminal justice system.
Talking to the wall
The Hennepin County jail — a drab, brown cube in the heart of downtown Minneapolis — runs like a huge machine that vacuums up the violent, the passive, the sick and the helpless.
It’s a sterile place, yet one that overloads the visitor’s senses: Fluorescent lights and the lack of windows throw off an inmate’s internal clock. Screaming and threats are often the greetings to the day. People with fragile minds stand and talk to the wall or pace in their own waste until a cleaning team is ordered in. They pound on the metal doors and they shadow box with imaginary opponents. They stare off into a landscape only they can see from a 6- by 10-foot cell.
Injuries among these inmates can be brutal. One man recently jumped over a railing and fell 25 feet, landing face first and fracturing his skull.
Two psychiatrists contracted from Hennepin County Medical Center make weekly rounds, but records and officials say it’s often insufficient to keep psychotic inmates from deteriorating.
Since he was elected seven years ago, Stanek has watched the jail — Minnesota’s only detention facility with national accreditation for psychiatric inmates — become a medical center of last resort. If an inmate had a broken leg, he says, Hennepin County Medical Center wouldn’t hesitate to admit. With mental illness, it’s completely different.
“This is a fairness issue,” Stanek said. “We should not be criminalizing the mentally ill because there’s no other place to put them.”
It’s also an economic issue: The average cost per day to house a jailed inmate is $117; in a state psychiatric facility, the daily cost can exceed $1,000.
‘A huge test’
In late 2010 and early 2011, Ronald Brewer spent several months in the Hennepin County jail before Quam ordered him committed to a state facility. Nearly a month later, the judge got a call from Brewer’s attorney, who said Brewer was still sitting in jail.
Angered, Quam ordered a “show-cause” hearing, at which state officials would explain how they intended to begin complying with judicial commitment orders.