Mentally ill falling through cracks? — (North Jersey Record)

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North Jersey Record

Sunday, August 5, 2007

By ASHLEY KINDERGAN, HERALD NEWS

Samuel Ramos, 19, has been mentally ill and in trouble with the law for years. One day, he drove to a gas station and tried to drive off in someone else’s car.

He wound up in the Passaic County Jail, charged with carjacking. Within two weeks, his cellmate was dead, and officials say Ramos killed him.

Experts and advocates say the things that Ramos experienced leading to his alleged crime happen all too often.

He had a troubled past, constant movement in and out of the corrections system, difficulty finding help in an outpatient mental-health clinic and imprisonment for a crime that may have had more to do with his mental illness than criminal intent.

Some jails around the state are starting programs to keep the mentally ill out of jails, which advocates say are poorly equipped to care for them.

The state said it is working to beef up outpatient care at clinics, where waits can be long for people who aren’t facing immediate crisis.

But if the system had improved in time for Samuel Ramos, perhaps Ramon Aponte would still be alive.

Troubled at an early age

Maria Diaz said her son was fighting and getting in trouble at age 9 before a school psychologist diagnosed him with depression. He received counseling at a local hospital and was put on psychotropic medication at age 11.

Ramos’ problems worsened after his brother, Juan, was shot to death outside a liquor store in Paterson in 2003. Soon afterward, Ramos, at 15, went to juvenile detention on a drug charge, his mother said.

He would bounce from home to various juvenile detention facilities for the next three years. He came back to live with his mother in April 2006 and stayed there until he was arrested on June 23.

This summer, Ramos started deteriorating mentally, but his family encountered roadblocks when they tried to get him help, they say.

Ramos’ sister, Stephanie, said her brother announced suddenly one day that he had to leave the house and would not wait for her to come with him. He drove his own car to a nearby service station and tried to fill up the tank but didn’t have any money, according to a witness.

When another customer, Purce Farrish, 55, went to pay for his gas inside, Ramos allegedly got into his car. Farrish managed to wriggle into the back window as Ramos started the vehicle. A struggle ensued, Ramos ran over Farrish’s foot and Farrish gained control of the car. Ramos ran.

Farrish said Ramos’ family and the station attendants told him that Ramos was mentally ill. Although unhurt, Farrish pressed charges, because, he said, he thought Ramos could be dangerous and might get help in jail.

Officials say Ramos fought with fellow inmates, both at the Paterson municipal jail, where he was first taken, and the county jail.

At the county jail, he was placed in a special detention cell for “problem” inmates who are mentally ill. His mother said she called repeatedly to ask that he be treated, but does not think he received any help.

Ramos shared a cell with Ramon Aponte, a 50-year-old in for violation of parole for burglary, theft and making terroristic threats, according to the state Parole Board.

Aponte was suicidal and being held in the cell for observation before a mental-health evaluation, Sheriff’s Department spokesman William J. Maer said. The appointment was to have taken place the day Aponte was slain.

Finding outpatient care

Providers of outpatient mental health care say funding has not kept up with increased demand caused by the closing of large state mental health hospitals. Clinics treat the worst cases first, and everyone else waits.

“We get calls a lot where somebody really needs help – they’re not necessarily a harm to themselves or others, so they can’t walk into an emergency room and get help immediately,” said Joanne Green, executive director of the Mental Health Association in Passaic County. “They don’t have private insurance, so they have to go to a clinic, and it’s, like, two months to get an appointment.”

Sybil Schreiber, executive director at the Mental Health Clinic of Passaic, said her clinic has a waiting list and accepts only Passaic city residents because it is often “swamped.”

The state knows the outpatient system is overtaxed, officials said. Kevin Martone, assistant commissioner of the Department of Health and Human Services, said the state funded the increase of 25,000 hours of additional outpatient care for clinics throughout New Jersey last year and plans to keep adding funding.

Jail diversion

Rick Mulvihill, Atlantic County’s head of public safety, said he struggled in his days as a police chief to deal with mentally ill offenders who kept committing minor crimes.

“A lot of people that are in jails should never have walked in the door in the first place,” he said.

In the Passaic County Jail, about 25 percent of inmates are on psychiatric medication or receiving mental-health treatment at any given time, Maer said. National studies of jail populations have shown that 6.4 percent of males and 12 percent of females have serious mental illness.

Atlantic County was one of three counties last year that received state funding to set up a jail-diversion program.

Jail diversion, a tactic that offers mental health treatment instead of jail time, was identified as a priority in the Mental Health Task Force report of 2005, commissioned by then-acting Gov. Richard J. Codey, an advocate for mental-health reform. Programs have begun in Atlantic, Bergen, Camden, Essex, Hudson, Passaic and Union counties, according to the federal Substance Abuse and Mental Health Services Administration.

The current programs are available only to those who commit minor offenses – such as public urination, not carjacking. But cases like Ramos’ are one of the reasons advocates say programs should include serious offenses.

Whether Ramos took Farrish’s car because of his mental illness or whether illness played a secondary role in the criminal act itself will be decided by psychiatric experts and a jury.

But even if he had been diverted from jail into a treatment program, experts debate the efficacy of jail diversion. Nancy Wolff, director of the Center for Mental Health Services & Criminal Justice Research at Rutgers University, said jail diversion programs rely on the premise that mentally ill criminals are not receiving treatment, which isn’t always true.

“We’re getting more and more data that shows that people are in contact with the mental health-system,” said Wolff.

The federal government published a study in 2004 that followed 1,185 people who had been arrested from six different jurisdictions for a year after their arrests. About half were given jail diversion, and half were sent to jail. On average, those given jail diversion were arrested in the follow-up year as often as those who served jail time.

The difference was, those in the diversion program spent more time in the community than in jail or in hospitals or residential treatment facilities. The group that got diverted was more likely to get treatment in the following year.

In Passaic County, St. Mary’s Hospital has started a fledgling jail diversion program. Josh Belsky, the psychiatric emergency services coordinator, said the program screens people at the request of municipal judges and probation officers so judges can decide whether to recommend treatment when they sentence or make probation plans.

“Prior to the program, the only access they had was if someone was a danger to themselves or others and psychiatric services would have to evaluate them for hospitalization,” Belsky said.

Lockup

Even under the best circumstances, providing mental health care to prisoners is difficult. Jails are meant for crowd control – not for treatment, experts say.

Some advocates say the situation in the Passaic County Jail is far from the best.

“We’ve had a lot of folks who have gotten into the Passaic County Jail, and it’s been a very cumbersome and time-consuming experience to try to get them their medication,” said Jay Boxwell, the former housing supervisor at Harbor House, a facility for the mentally ill at St. Joseph’s Regional Medical Center in Paterson.

It’s difficult to know what treatment Ramos received in the Passaic County Jail. Officials there cannot provide specific medical information because of privacy laws, but Maer has said that Ramos saw a medical professional every day of his incarceration.

Diaz said she called several times to ask if her son was receiving his medication (Zoloft for depression and Xanax to help him sleep) and requested that he see a psychiatrist. Twice, she said, she was told that he was on a list to see a psychiatrist, but when she talked to her son four days before he allegedly killed Aponte, he told her that he had not yet gotten help.

“We were trying to prevent this from day one,” said Stephanie Ramos, his sister.

Passaic County Jail officials say they provide adequate care and screen every inmate for mental illness. Jail policy calls for a registered nurse to evaluate every inmate upon arrival for medical and mental health problems.

The nurse decides if a follow-up is needed with a psychiatrist, psychologist or counselor employed by the jail. Inmates may be taken to St. Mary’s Hospital for further evaluation, and those who need to be hospitalized are taken to the Ann Klein Forensic Center in Trenton.

Jail officials say many inmates fake illness.

“The inmate population is a very manipulative group,” Maer said by e-mail. “Many will pretend to have mental health problems for a chance to be moved to a perceived better housing assignment … or to go to Anne (sic) Klein for a month or so, just to be out of the jail for a while,” Maer noted.

Some wonder why Ramos, who had a history of violence, was placed in a cell with Aponte, who was incarcerated for nonviolent offenses.

Officials said the two men were housed together because they had the same classification, had committed similar crimes and were both mentally ill.

In an e-mail immediately after the slaying, Maer said the department did not know of any violent history in Aponte’s past. In a more recent e-mail, he said he could not comment because of pending litigation.

Aponte’s family would not comment on whether they have filed a lawsuit, and nothing has been filed in federal court.

Corrections officers consider mental-health status when classifying inmates for minimum, medium or maximum security using the National Institute of Corrections’ system, Maer said. The classification determines where they are housed.

The jail has a special-watch dormitory monitored at all times by an officer posted outside for inmates who are deemed suicidal or have serious mental-health problems, Maer said.

But the jail does not have individual cells for those who need to be isolated from the general population, although such cells can be created, Maer said. It has nine smaller cells, such as the one in which Aponte and Ramos were housed.

“We are built for 895 inmates, with approval to hold 1,895 inmates,” Maer said. “We are routinely above capacity and do not have the luxury of individual or single-man cells.”

In the meantime, Ramos awaits trial. His family is trying to find him a private lawyer to get him into a hospital. His family wants the same thing they have wanted all along.

“I would feel better if my brother was in the hospital getting treatment,” Stephanie Ramos said.

Reach Ashley Kindergan at 973-569-7164 or kindergan@northjersey.com.