Imprisoned by mental illness – Mark Ray, homeless and without treatment, represents the failure of mental health reform

From The Oregonian, January 6, 2002 – not available elsewhere online

Mark D Ray died in Washington County, December 15, 2003.

Peer into a tiny concrete room deep inside the Washington County Jail in Hillsboro and you will see, hear and smell unimaginable human suffering.

A 43-year-old mentally ill man howls and paces his cell. He can’t open his eyes, doused with pepper spray by nervous and frustrated jail deputies.

Why don’t you just kill me! Kill me now!” the man screams. Snot seeps into his mouth. Expletives lunge off cinder-block walls.

The man’s legs are red and distorted with infection. Yellow pus weeps from shin wounds the size of half dollars, gouged with his own fingernails. Straps from a nearby restraint chair have branded ominous purple marks around his ankles.

Mark Douglas Ray is hard to look at. But look. There’s a Mark Ray in every jail in the state.

The delusional Benton County inmate who sang for 48 hours. A man with schizophrenia in The Dalles who throws rocks through church windows so he can go back to a cell, the only place he feels safe. A 54-year-old woman with bipolar disorder at the Multnomah County Justice Center, curled naked in the fetal position, calling for her mother.

Ray has cycled through jail 10 times in the past 12 months. He is among tens of thousands of mentally ill people nationwide who have found themselves behind bars in large part because they can’t get medical treatment. The problem is an unintended consequence of a calculated effort to rectify a similar horror.

“Deinstitutionalization” was a nationwide social reform that sought to improve the lives of mentally ill people by treating them in their communities instead of isolating them in dehumanizing, state-run hospitals.

But the services that have replaced thousands of hospital beds the past four decades are underfunded, restrictive and confusing, leaving many who have serious mental illnesses adrift until they wind up in another institution — jail.

On the fourth day in December, the problem lands in the unlikely hands of a 31-year-old Washington County deputy armed with nothing but a community college psychology course and a better-than-average attitude.

Peter Moseler took this job to protect the public from the bad guys.

So on days when it takes nothing short of nine deputies, three sergeants, pepper spray and a stun gun to get Ray , a 6-foot 3-inch, 300-plus-pound mentally ill man, into an isolation cell, the gentle, determined Moseler can’t help but feel like a bad guy himself.

“This is wrong,” Moseler mutters, cramming a jug of water through a cell-door porthole so Ray can rinse the pepper spray from his eyes. “It’s so wrong.”

Moseler can argue the inherent inhumanity of a system that leaves the work of doctors to him. But with Oregon staring down a possible $900 million budget shortfall, the debate doesn’t budge beyond decimal points.

Consider the price tag for Ray ‘s six jail stays in Washington County in 2001. Excess staff time: $40,376. Hospital bills: $45,183. Medications: $8,100. Repairs to jail property Ray has broken: $390. Repeated clean up of biohazards — blood, feces and urine: $421.

The cost to house the average inmate for 81 days: $7,243.

The cost for Mark Ray : $101,713.

Many doctors have offered many explanations for many years. Schizophrenia. Schizo-affective disorder. Bipolar disorder. Borderline personality disorder. Borderline intelligence. Major depression.

If only that were all.

Ray forgot the name of the bank that holds his last $10. He’s been in jail so much lately he lost his Oregon Health Plan benefits, and the federal government halted his $500 monthly Social Security disability checks. He has hepatitis B and C.

Ray ‘s been banned from several grocery stores, the MAX line and his favorite karaoke bar, the Jungle Room Tavern in Cornelius. He’s homeless. The leg infection has reduced him to hobbling.

An IQ that has tested four points below the cutoff for mental retardation doesn’t short-circuit Ray ‘s understanding of the situation.

“I probably need to go back to the state hospital, but nowadays they keep crazy people in jail,” Ray says.

His illnesses have sent him to hospital mental wards more than 20 times since 1981. He once spent two years at the Oregon State Hospital in Salem.

In October, after jail deputies watched Ray eat his own feces, a judge ordered him back to a state hospital. But four days after Ray arrived, a psychiatrist deemed that he wasn’t actively psychotic. He was sent back to jail.

David Otter, a Washington County mental health worker, says diagnosing people with as many problems as Ray is like peering through different facets of a gem. Through one facet you’ll see the flaw. Through another, you won’t.

Today, Ray ‘s in jail for allegedly buying beer for two 15-year-olds at a Safeway in Forest Grove.

Two days earlier he was arrested for misusing the 9-1-1 system after summoning officers to his Jungle Room bar stool and asking them for a ride because his legs hurt.

Before that, the charge was second-degree criminal trespass for panhandling cigarettes outside Tuality Community Hospital in Hillsboro and refusing to leave.

Before that, disorderly conduct and second-degree criminal mischief for pounding on the door of a Gales Creek home at 3:35 a.m. because he thought his mother lived there.

And before that, disorderly conduct and carrying a concealed weapon. Ray, agitated and screaming on a street corner, challenged Hillsboro police to a fight, saying he had a “fifth-degree black belt in Tae Kwon Do.” Officers later found a steak knife in his coat pocket.

Ray spent March through September in the Justice Center jail after a judge revoked his probation on a drug possession charge. Ray admits he prefers heroin to his anti-psychotic prescriptions.

But what brings Ray to jail is rarely as disturbing as his behavior once there.

Files stamped with his name bulge in the records rooms of two county jails. Ray’s been written up for everything from tearing holes in his own flesh and spitting out his medications to jeering at other inmates and vowing to kill jail staff. He’s elevated the use of expletives to an art form.

In Washington County, Ray has spent more time in the restraint chair than any other inmate in memory. At the Justice Center, Ray ‘s uncooperative ways were answered with more than 100 days in “the hole” and occasionally nothing to eat but Nutraloaf — a concoction of pureed vegetables, meat, lard, egg and powdered milk, baked hard so it can’t stick to walls if thrown. Ray lost 150 pounds, down from almost 500.

“Mr. Ray is a threat to himself and all others,” Multnomah County Sheriff’s Sgt. Lewis Cain wrote in a Nov. 7 report. “He is nasty, disruptive, disrespectful . . . unpredictable. He is a walking time bomb.”

Although Ray now illustrates the failure of mental health reform, there was a time, not so long ago, he could have been its poster child.

In November 1997, a judge sent Ray to the Oregon State Hospital in Salem after he threatened to commit suicide, holding police at bay and a knife to his throat for more than four hours at his Beaverton apartment. That one, Ray recalls proudly, made the evening news.

After eight months, Ray was released in June 1998 into the capable hands of licensed professional counselor Debbie Cairns. Her title is program director for Tualatin Valley Center’s Open Gate. Her job is to translate the philosophic intent of politicians into the rock-real circumstances of the mentally ill.

With Cairns’ help, Ray got a studio apartment in Forest Grove, kept cans in his cupboards, balanced his checkbook, swallowed his pills, joined an exercise group, opened up during group therapy and held down a job taking apart used computers — for more than two years.

Things were going so well that Ray decided he didn’t need his medications. “We tried to talk him out of it,” Cairns says. “But it was his right to stop.” Only psychiatric hospitals can force medications.

Ray’s decision to flex his civil rights came about the same time a welfare worker’s eyes fixed on a paperwork error. Since Ray ‘s hospital release, Oregon had accidentally been too generous with his monthly food stamps. By the time the bureaucracy adjusted Ray ‘s benefits and penalized him for the clerical error, he could afford either groceries or his $400 rent.

With Ray biding time on his mother’s couch, Cairns scrambled to find him another place to live. But a nearby halfway house was full, and Ray ‘s 1983 conviction for auto theft in Texas made him ineligible for subsidized housing.

Ray nose-dived before Cairns could type a letter arguing that his felony sprang from mental illness and should be overlooked.

One day you’re a deinstitutionalization success story.

The next you’re bloodying your forehead on a jail cell cinder block, reeling from a blast of pepper spray.

High-five your sergeant! Crack open a Mountain Dew! Mark Ray is a free man today. Washington County Jail deputies, usually a stoic lot, celebrate.

At 9:23 a.m. on Dec. 13, after 11 days and eight incident reports, Ray ‘s 10th incarceration this year grinds, sparks flying, to an end. After all, one can be held only so long on a nuisance crime.

But Deputy Moseler’s relief is Joel Robison’s nightmare.

Robison, Ray ‘s resourceful Washington County parole officer, is fresh out of ideas when he arrives to pick up Ray , who can barely limp the 150 yards separating maximum security from the street.

A legal advocacy center in Washington, D.C., investigated public health systems in 35 states, including Oregon, and concluded what Robison knew long before there was paper proof: There isn’t enough money invested to meet mental health needs.

On Dec. 21, The Bazelon Center for Mental Health Law declared that the nation’s public health systems “have all but disintegrated” and are “headed for total collapse.”

In real life, that makes Ray a hot potato.

Robison loads Ray, whining and swearing, into a county Crown Victoria and zips optimistically east on the Sunset Highway. Robison can buy time if Providence St. Vincent’s Hospital will admit Ray .

Before one swollen foot lands on emergency room tile, a nurse recognizes Ray and glares at Robison.

Jail deputies had taken Ray to the hospital Oct. 14 for a mental health evaluation after he smeared blood from his legs over his cell walls. The hospital sent him back saying they didn’t have enough secure bed space.

But it admitted him Nov. 22 for the leg infection. Because Ray was in jail, Washington County was responsible for his hospital bills and keeping deputies outside his room 24-7. After five days, and overtime costs that passed $30,000, jail officials begged Robison to shorten Ray ‘s parole violation sanction if only to save taxpayer money.

An hour after the deputies were relieved, Ray was discharged with a bottle of antibiotics and a taxi voucher.

Ray rode directly back to the Hillsboro jail and parked himself in the lobby, asking for food, juice, medical attention and, after several hours, a place to sleep. Robison found him a bed at the Joyce Hotel in Portland, but Ray threw a fit and was asked to leave. That night he wandered the streets.

St. Vincent’s admitted Ray for his leg problem again Nov. 29. But he was so nasty to staff that a doctor asked him to sign a special list of rules. Ray , irked and agitated, pulled out his IVs and left against medical advice.

In the face of all this, Robison plows ahead.

He may need to stay overnight, Robison tells a nurse. Look at his leg. It’s disgusting.

Highly skeptical eyebrow raise.

I’m not a doctor, but it looks pretty bad, Robison presses on.

No way, Jose. A fresh bandage wrap and he’s good to go.

“Hospitals won’t even work with the guy,” Robison grumbles later. “You take him in for medical care, and it’s like you’re taking in Satan.”

To Robison, all this is an absurdist government exercise that amounts to persuading strangers to invest major effort in a person so difficult he’s driven his own mother into hiding.

Robison last talked to Ray ‘s 66-year-old mother April 5, the same day four jail deputies and two sergeants spent 35 minutes wrestling her son into a black restraint chair.

“Why can’t you get him hospitalized?” Robison remembers her pleading.

“She still loves him,” Robison says. “I can hear it in her voice. But she’s terrified he’ll find her. He’s threatened to kill her.”

She left a message on Robison’s voice mail Sept. 14 but wouldn’t leave her unlisted phone number. She promised to call back. So far she hasn’t.

Ray crunches into a fortune cookie, ignoring the paper curled inside. A tiny white message falls unread to the floor and lies: “Prosperity will soon knock at your door.”

Today that door is Room 112 of the Travelodge in downtown Hillsboro, a block from a Goodwill store.

Even though Robison’s most impressive smooth-talking couldn’t sway nurses, he caught his boss in a particularly festive mood during the holiday office party and got the go-ahead to put Ray up in a motel.

Debbie Cairns agreed to try again, too. But finding Ray a permanent home will be a monumental task and getting his SSI and medical benefits reinstated will take time. At 48 bucks a night, the clock is ticking.

It didn’t get off to a good start. It was raining when they arrived at the hotel, and Ray wouldn’t walk across the parking lot. So Robison, on hands and knees, wrapped garbage bags around Ray ‘s legs to protect his fresh bandages from puddles. Then Ray leaned on Robison like a bowling ball against a bird as Robison heaved him into the avocado green glory of Room 112.

Robison set down a batch of Rice Krispie bars left over from the office party, and Cairns left a bag of odds and ends she grabbed from an emergency food pantry — fortune cookies, tortilla chips and canned peaches.

Ray has nothing but the clothes on his back, an XXXL shirt the color of a queasy Tweety Bird and frayed jeans slung precariously low. The inside of his pants is soiled but Ray bluntly says that he’s “gotten used to it.” He has one shoe.

A bubble pack of medication rests on the wood-grain Formica motel table. Risperdal for psychosis. Clonidine for aggression. Carbamazepine for bipolar disorder. And Celexa for depression — all prescribed by jail medical staff.

Shaky is an idealistic way to describe this situation. Even if everything goes smoothly — which it never does — Robison knows Ray isn’t long for the Travelodge, with its Christmas lights pulsing innocently in the lobby window.

But this job has taught Robison to live in the present. And right now, late on the 13th of December, at least Ray has somewhere to be.

Maybe, just maybe, he’ll sit tight, stay off his leg and revel in the creature comforts of HBO and a remote control until Cairns can reconnect him to his benefits.

“I want hot food!”

“This hotel sucks!”

“You can’t control me!”

Ray screams and swears at Robison and a mental health worker when they bring him sandwiches and a clean pair of sweat pants.

A nurse scheduled to change Ray ‘s leg bandage backs out, too scared to go to his room alone.

Ray saunters six blocks from the Travelodge to Tuality Community Hospital, where he’s been arrested before. A doctor takes one look at Ray’s oozing leg and admits him. But after two nights, Ray checks himself out, angrily saying he “hates the nurses.” He treads back to the Travelodge, blood and pus spotting the sidewalk behind him.

Then Ray sneaks onto the MAX train, rides to the jail and retrieves his mountain bike from the criminal property room.

He pedals all over Hillsboro: To banks, until he finds his $10 at Wells Fargo. To McDonald’s for their $3.09 special holiday double chili burger combo. To Plaid Pantry for two packs of generic cigarettes and a pepper beef stick. To a park. Back to the hotel.

“What!” Robison shouts Monday morning when he learns of Ray ‘s weekend odyssey. “He could barely walk. Now he’s doing the Tour de France?”

When Cairns shows up, Ray is in no mood for particulars, like why he’s several bubbles behind in his medications. He says he’s going to kill himself.

Robison’s phone shrills. Cairns says she can’t do anything for someone who refuses help. For now, she says, he’s not appropriate for her program.

Robison’s phone shrills again. It’s Ray, barking that he’s going to kill someone so he can get heroin.

Robison has 40 other mentally ill people on his caseload. Several are in worse shape than Ray , men in their early 20s experiencing their first schizophrenic break.

“I get kids with great hearts, great futures and all of a sudden they’re talking to the walls,” Robison says. “They want help so bad but there’s no resources I can offer them, but at least they appreciate my efforts.”

Ray , on the other hand, tells Robison, but not in these words, to get lost.

Without a mental health agency willing to work with Ray , there will be no one to prescribe his medications. So Robison types up a parole-violation detainer with a 25-day jail sanction for refusing mental health treatment. Police are dispatched to the Travelodge.

“Either he withers in jail,” Robison sighs. “Or he rots on the streets.”

It’s Ray ‘s 11th jail stay in the past 12 months. But at least he has access to meds, if he chooses to take them.

The next day, Robison allows himself to sink into what-if land.

“If Ray could just comply and be appreciative, this mental health agency would have gotten his SSI back,” he says with a groan. “But he can’t see far enough into the future to help himself.”

It’s hard to think ahead when you’re busy getting by.

Sitting on the steel toilet in his jail cell, feet stinging in a puddle of urine, Ray ‘s thoughts don’t extend beyond a momentary worry. He shouts through the glass in his maximum-security cell. He hasn’t heard from his mother in a long time. It’s weird, he says, because Christmas is so close.

“I used to buy her presents, and she used to fix Christmas dinner, ham and stuff like that,” he says. “I know she’d call if she could. I think maybe she died.”

On the opposite side of five concrete walls at the 2 p.m. shift briefing, a jail sergeant watches the color drain from Deputy Moseler’s face when she greets him with two words:

“Ray’s back.”