Georgia prisons became psychiatric hospitals of last resort

Updated 2 years ago on November 23, 2022

Nova Jaswan would like to stop using cocaine. She would also like help with some of the other problems she says contribute to her cocaine use, such as schizoaffective disorder and post-traumatic stress disorder.

But she has no health insurance, no income or transportation. There is not even a state identification card. The only place she could get mental health care was in jail or prison.

She said she was so ashamed of her situation that she left her son with relatives instead of letting him know how his mother was going through difficulties.

"I said: 'Well, I'd rather be a jailer than a street rat, and I'd rather be in jail than do drugs on the street,'" Jaswan said.

Unable to find adequate resources elsewhere, Jaswan, now 29, went through Georgia's criminal justice system from 2015 until her last release from prison in May 2021. Until earlier this year, she was waiting to be transferred to a mental health program, where she could access a psychiatrist, help find housing and employment.

She is not alone in her cyclical situation.

The accountable Fulton County court claims that a third of all defendants incarcerated in its jail receive some type of psychotropic drug, and over 75% are tested for illegal drugs on arrival (or refuse to be tested).

Former prison medical administrator George Herron estimated that 60 percent to 80 percent of inmates in the county's jails suffer from mental disorders, leading him to call the Fulton County Jail "the new psychiatric hospital," writes Mab Segrest in his book Administrative Institutions of Madness: Racism and the Ghosts of American Psychiatry at the Milledgeville Psychiatric Facility.

The Fulton County Jail has been called Georgia's largest de facto mental institution because of the large number of mentally ill inmates. Often they have nowhere to go until a crime is committed.

Jaswan struggled to cope with the first court-ordered program, and when she left treatment early, she said, she deliberately ended up behind bars again, breaking windows "the size of doors."

"I didn't hurt anyone, thank God," Jaswan said.

She committed the same crime seven times, repeatedly ending up in the Fulton County Jail.

The cost of incarceration

One way to calculate the average cost per inmate is to take the state's total prison costs and divide them by the average daily number of inmates. Jail (as opposed to prison) is for people convicted of crimes and sentenced to more than one year in prison.

According to a 2015 report by the Vera Institute for Justice, the state of Georgia spends about $20,000 annually, on average per inmate, to maintain and service prisons and provide all prison services.

This figure does not include the collateral consequences, such as the financial burden on the offender's family, the difficulty of finding employment after release, and the increased likelihood that they will reoffend after release.

In addition, judges are not always fully informed about people arrested and the potential financial and social consequences of their sentencing decisions, according to a recent study conducted by researchers at Georgia State University.

Instead, according to researchers, judges receive reports prepared by prosecutors prior to sentencing that speak only of the benefits of incarceration.

The GSU study found that judges imposed significantly shorter sentences in the hypothetical case when they were told of the potential negative costs and social consequences of incarceration than those who were not told.

Prison conditions

According to Jaswan, she continued to commit crimes despite knowing how bad prison conditions were. She was one of the plaintiffs in a civil lawsuit filed against then-Fulton County Sheriff Ted Jackson, Chief Jailer Mark Adger and other jail officials in 2019.

Georgia Advocacy Office, a Decatur-based private nonprofit for the disabled in Georgia, partnered with the Southern Center for Human Rights to file a lawsuit on behalf of itself and its constituents who suffer from mental illness and have been incarcerated or threatened with incarceration at the South Fulton Municipal Regional Jail.

The Union City jail houses pretrial detainees and can hold up to 325 people, about 40 of whom are women. It has three wards for women with mental illness, and many of them live in solitary confinement because they are considered too sick to share space with another person, the South Center said.

The lawsuit also alleges that many women with mental illness had their psychological condition worsened while they were held in solitary confinement in the South Annex of the prison.

In May 2019, Sarah Totonchi, executive director of the Southern Human Rights Center, wrote that a 26-year-old woman incarcerated on misdemeanor charges of criminal trespass and loitering was allowed to go outside for recreation only once between Nov. 3, 2018, and Feb. 28, 2019.

"To make matters worse, thanks to the perpetually malfunctioning toilet, K.H.'s cell floor is often flooded with standing toilet water," Totonchi writes. "She is forced to either use her sheets and blankets as sponges or live with toilet water around her. On the days when she prefers to wipe off the water, she is forced to sleep on a metal bed frame with no bedding."

Jaswan described her experience in prison in a similar way, and added that once the heavy metal door to her cell caught her finger.

"And then I saw the blood and I was like, 'What?' I looked at it, and it was just the tip of my finger, you know, a little bit more than just the tip that was gone," Jaswan said. "And I, you know, went into shock."

The guards called an ambulance, and the emergency room reattached her finger, but the tip could not be reattached.

Many of the women held in South Fulton lockups cut themselves, banged their heads against the wall, and some even tried to commit suicide, the lawsuit says.

The case was settled earlier this year, and the court order now requires that the women at South Fulton Prison be held in safe, sanitary conditions, said Devon Orland, legal director of the Georgia Advocacy Office.

"Giving them time to rest, giving them therapeutic interventions, clothing," Orland said. "Being able to bathe. Not spoiled food. Some pretty simple things."

In addition, the prison must eliminate solitary confinement and ensure that all women in prison have sufficient time out of their cells seven days a week, including time for fresh air and exercise, every day in the outdoor recreation area.

Lack of resources

Georgia consistently ranks among the top in the country for access to mental health care, and that includes a lack of services for minors.

Schroeder Stribling, president and CEO of Mental Health America, says about 60 percent of young people with mental health problems are not receiving services.

"We also know that most of the young people who receive mental health services do so in school, so having school-based services is something that's especially important for young people," she said.

A growing percentage of young people in the country are living with major depression, and 15.08% of young people experienced a major depressive episode in the last year of data, according to the latest Mental Health America report.

Children who grow up with unrecognized and untreated behavioral health problems can easily enter the criminal justice system as adults.

Achieve parity

Georgia House Speaker David Ralston acknowledged that mental health issues affect nearly every family in Georgia when he sponsored Bill 1013, which passed with unanimous bipartisan support earlier this year.

"Mental health intersects with public safety," Ralston said. "It robs our economy of productivity. At the most basic level, it allows hopelessness to win the battle for the future and bring pain to those who are left to suffer the consequences."

The law is expected to improve mental health services in Georgia by giving the state Insurance Commissioner more authority to enforce the federal Mental Health and Substance Abuse Parity Act of 2008. The law requires that mental health and physical health services be paid on an equal basis, or parity.

Group health plans and health insurance issuers that provide mental health or substance use disorder benefits are not allowed to set less favorable limits on those benefits than medical/surgical benefits.

For example, if a person breaks a bone three times in one year, that injury would be covered as an emergency each time. But this is not always the case when a person with a substance use disorder relapses or overdoses.

"For too long our mental health care system has been inadequate," Ralston said. "The availability and accessibility of treatment has been extremely limited."

Microcosm of society

Orland said what's going on in the Fulton County jail is a microcosm of what's going on in the community, and the solution is to improve the security system for behavioral health issues.

"We could reduce the pressure and burden on prisons by creating a full community-based mental health system," Orland said.

The Cobb County Sheriff agrees and says that many of the inmates would not be in jail if they had access to quality mental health services.

That's why a full-time psychiatrist and nurses trained in behavioral health were added to the detention center staff last November. Cobb Prison is the first in the state to do so.

"From intake to discharge, we are committed to giving our inmates the care they need so they never have to walk through our doors again," Cobb County Sheriff Craig Owens said in a statement.

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