Civil commitment leaves Hennepin County offenders languishing

Mentally ill inmates wait months for evaluation, treatment

It didn't take much to set Yusef Warsame off.

Warsame approached his 14-year-old brother, Ayoub, who was sitting on the couch at their parents' house in Robbinsdale last summer. Warsame wanted his brother to clean the dishes. When Ayoub refused, Warsame slapped him in the face and tackled him to the ground. He eventually wrestled his brother in a guillotine chokehold.

Just before things went black, Ayoub managed to slip away and call 911.

In the years prior to anti-psychotic medications, Minnesota's mental health system focused on long-term institutionalization
courtesy of the MN Dept. of Human Services
In the years prior to anti-psychotic medications, Minnesota's mental health system focused on long-term institutionalization
Judge Jay Quam believes that the civil commitment system needs to be reformed
Craig Lassig
Judge Jay Quam believes that the civil commitment system needs to be reformed

Warsame was already a frequent flyer in the mental health court. In 2007, he threatened to shank a University of Minnesota student near the West Bank campus. "I'm going to fucking kill you," he told the young man. Police arrested Warsame and found two knives in his back pocket. Warsame was diagnosed with severe bipolar disorder and committed to a state hospital for intensive psychiatric care.

But because of the way the system is set up, offenders who have already been committed don't raise any sort of red flag with the mental health court, so no one knew he had been arrested again. Warsame was simply charged with assault and dumped in jail with everyone else.

"There should be a way of red-flagging somebody who's already been in the mental health system," says Mark Gray, Warsame's attorney. "They just don't cross reference things."

Warsame's condition spiraled downward in jail. He became convinced that the guards were conspiring against him, and filed grievances on a semi-daily basis. He was what the guards colloquially refer to as a "shit spreader," which is pretty much just what it sounds like. Warsame was eventually charged with fourth-degree assault for throwing his feces at the guards.

"I think if they would have caught the case a lot sooner, he would have been on medication, possibly, and that crime might not have happened," says Gray.

For mentally ill people like Warsame, jail can be the worst possible environment. If identified as mentally ill by the jail staff, an inmate is brought up to a maximum security wing on the third floor of the facility. Those in mild condition are allowed to interact with each other in a common room for part of the day, but the more disruptive ones are locked in solitary cells for 23 hours a day.

To its credit, the Hennepin County jail is progressive when it comes to mentally ill inmates, at least relative to other facilities in the state. The jailers are trained in how to deal with the mentally ill, and the medical staff can offer inmates their most recently prescribed medication, providing it's not a narcotic. Patients can also request to see a nurse or psychiatrist from the Hennepin County Medical Center.

But the jail is no substitute for a hospital, and security is the primary concern. Without civil commitment, treatment options are limited, and completely voluntary for the inmates. As a result, many go without medication, mentally decompensating in their cells while waiting to be committed.

"Decompensation can happen in a matter of days or weeks or a few months," says Philip Krasowski, a nurse at Hennepin County Medical Center who works with the mental health court. "The longer you're off treatment, the sicker you get, and the harder it is to bring you back."

With such long stays in jail awaiting commitment, inmates frequently leave in a far worse condition than when they arrived, says Doug McGuire, attorney coordinator with the mental health defense project.

"It's not only a deprivation of liberty and failure to treat, but also you have people who are ending up worse off than when this whole thing started," says McGuire. "And that's very unfortunate."

The issue also puts jailers in an unfair position, interacting with mentally ill inmates who often resist them. In 2010, a young man named Antwain Mitchell was arrested for a probation violation. Mitchell sat in jail for months, all the time suffering from paranoid schizophrenia that brought on grossly disturbed hallucinations. In December, Mitchell punched a guard in the face. Two months later, he took a bite out of a guard who was trying to attach a spit hood to him.

When Mitchell was finally committed, a doctor determined that he had "a proclivity towards violence and is apt to use violence particularly when he is experiencing symptomatology of his mental illness." Mitchell was ultimately determined to be not just mentally ill, but also dangerous.

The added "dangerous" diagnosis makes no small difference. On average, a patient diagnosed as simply mentally ill is committed to a six-month treatment program, which is frequently completed through outpatient care. A mentally ill and dangerous patient generally receives an indeterminate sentence, often three to seven years in a maximum security hospital.

"That actually happens much more often than I'd like to see it," says Judge Quam. "It makes perfect sense. They're mentally ill, they're very disruptive, they're in a relatively antagonist environment. If you haven't committed an overt act, it sure can happen in jail."

Prior to December 2009, Quam had virtually no familiarity with mental health court. As an attorney, Quam had worked at the same private firm for 18 years, practicing a range of civil litigation and criminal defense law. Gov. Tim Pawlenty appointed him to the bench in 2006, when Quam was only 44.

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