From The Oregonian, November 6, 1993 – not available elsewhere online

“I’ve been hearing voices. I feel like there’s evil around me. I see writing on the wall.”

She begins to cry.

Midkiff hands her a tissue.

“Tell me what the voices say,” Midkiff says.

“They were telling me to hurt myself,” Katherine replies.

Welcome to the psychiatric wing of the Multnomah County Justice Center jail, where Bill Midkiff and two other psychiatric nurses practice what they wryly describe as M.A.S.H. mental health.

It’s an inside joke.

A M.A.S.H. is a Mobile Army Surgical Hospital — front-line medical care for the wounded. That’s how overwhelmed the jail nurses feel. Usually only one psychiatric nurse is on duty at a time — and there are usually 125 to 150 seriously mentally ill inmates in the jail.

Katherine, who is being held on prostitution and drug charges, appears delusional and suicidal, but Midkiff can’t do much to help her. He’s too busy during his 10-hour shift checking on all the inmates whose bizarre behavior has caught the attention of the jailers.

“In the Justice Center, we operate the third-largest mental institution in the state,” says Multnomah County Commissioner Sharron Kelley. Only the Oregon State Hospital and Dammasch State Hospital have more mentally ill inmates.

Jails are bearing the burden of the nation’s swing away from big mental institutions. Since the 1970s, Oregon has been forced steadily toward a situation like something out of the 18th century, sending its mentally ill to jail instead of to a hospital. And there isn’t enough room in jail, so the insane who seem to be no physical threat to themselves or others spend most of their time wandering the streets, getting arrested now and then.

When the public can no longer stand to watch a ragged beggar eat from a garbage can or urinate against a storefront, the police pick him up. But because he has too complex a mix of problems, crowded private mental health agencies won’t accept him. So he bounces in and out of jail.

The number of mentally ill prisoners in Multnomah County jails has increased by 25 percent in the past four years.

But jail staffing hasn’t kept pace, and the attitudes and funding structure of the mental health community haven’t adjusted to this change.

Midkiff and his overworked partners attempt triage every day on a corps of inmates that includes psychotic murderers, teen-agers who want to die, the schizophrenic and depressed, alcoholics and drug addicts, as well as veterans of the Vietnam War and victims of sexual abuse, who live a post-traumatic stress nightmare so debilitating that they can’t sleep or eat, much less hold a job.

Their illnesses range from severe schizophrenia to brain damage. Their crimes range from minor vandalism to murder. Often they are too violent to be placed in community mental health programs, and yet the state doesn’t have enough money to keep them in its mental institutions.

“It just flies in the face of what we’ve always believed to be the purpose of the jails,” Kelley says. “We think of predators going to jails, not people who are mentally ill. We need completely different kinds of support services.”

Midkiff checks on an inmate who was jailed the night before. The man says he won’t eat because the Bible tells him he must be strong. He is writing with his own blood on the cell wall. He wears nothing but a towel around his head.

Why have jails become the dumping ground for the the mentally ill?

Kelley believes that the mentally ill are simply being rotated out of Dammasch and into local jails, where they pick up the additional burden of a criminal record.

Four years ago there were 400 patients in Dammasch. Now there are only 270. Next summer that will shrink to 132.

“Is this what the state intended?” Kelley asks.

George W. Bachik, the superintendent at Dammasch, denies that people coming out of Dammasch are going to jail. Before they leave the hospital, they must have a contract to be treated by a community mental health agency, and they must have housing, Bachik said.

“There’s no doubt that there are a lot of mentally ill, homeless people, but I think that’s a different group of people,” Bachik said. “I think the people who function on the street are higher functioning than those we deal with at Dammasch.”

Facing reduced budgets brought on by Measure 5, the Legislature decided that only those with serious mental illnesses who represent a danger to themselves or others could be treated in state facilities. “That eliminates those with alcohol and drug addiction, people with severe personality disorders and depression,” said Richard Lippincott, director of the state Mental Health Division.

“It’s a question about whether people consider it important enough,” Lippincott said. “Mental illness does respond to treatment. If it’s not treated, it gets worse and costs go up. It has been almost impossible to get the body politic to understand this.”

Oregon spends less per capita for the mentally ill than most other states.

Lippincott estimates that there are more than 40,000 mentally ill adults in Oregon who aren’t getting the help they need.

Those who can’t qualify for or can’t afford community mental health programs often must fend for themselves on the streets. They don’t take medication regularly; they get confused or angry. They drink or take drugs. Many commit crimes.

Jennifer says she hears a woman’s voice calling her name. For several months Midkiff has suspected that Jennifer suffers from multiple personalities.

“Is the voice Lulu?” Midkiff asks.

“No, I don’t like her,” Jennifer replies, “and she wouldn’t call my name. She would call me something else. She calls me bad names.”

“Well, you have to share the same body.”

“I don’t care. I don’t like her. She gets me into trouble.”

Midkiff tells Jennifer she is doing better than before. But Jennifer only shrugs.

“I’m angry. I’ve got a lot of hate in my heart. I’ve got to get out of here before I hurt somebody,” she says.

Kelley says the county’s Public Safety Council has begun laboring toward a better system than jailing the mentally ill who commit minor crimes but are not a danger to themselves or others. She wants to set up a facility separate from the jail where disturbed offenders can be treated.

“Other jurisdictions have set up a completely different system,” she says, pointing to Norristown, Pa., where Montgomery County Emergency Service Inc. set up a 53-bed emergency psychiatric, drug and alcohol hospital and a 200-employee crisis-intervention system last year.

The Pennsylvania system includes counselors, forensic liaison among justice, emergency service and treatment agencies, courtrooms, trained ambulance workers and social workers, alcohol and drug diagnosis and detoxification — even day care for employees’ children.

Kathy Page, director of mental health for the Multnomah County jails, wants the county to open an outpatient clinic operated by the Justice Center’s psychiatric nurses and parole and probation officers. The staff could rotate between the clinic and the jail, she said. The clinic could treat the inmates’ alcohol and drug problems, as well as their mental illnesses.

Kelley also wants to take a regional approach to finding a solution. She has discussed alternatives with Washington and Clackamas county officials, whose jails also are overcrowded.

Multnomah County recently received a federal grant to pay for a study of the Justice Center’s population. Armed with information from that study, county officials expect to confront the state Legislature in 1995.

“We need to be courageous enough to ask questions and to respond to the new challenges,” Kelley said. “This could be a total rethinking of how we do business within the criminal justice system.”