Police and prison guards demand compliance. That only makes situations worse for people with serious mental illness in Pa.
Use of force reports from Bucks County jail offer a glimpse into a criminal justice system unequipped to deal with people who may be having a crisis.
(Doylestown) — The inmates’ names are redacted, but their desperation is spelled out in reports written by the people who oversee their every move.
“I’m tired of everyone yelling shit at me and treating me like garbage,” said one man. “What else can I do?”
He was trying to hang himself with clothes and a blanket, according to a report written by a Bucks County Correctional Facility officer. Guards responded by storming the man’s cell, cuffing him and placing him in a bare cell. After the same man repeatedly banged his head off the wall, they put him in a restraint chair so that he couldn’t move.
In another instance, a man on suicide watch was being moved to a different cell. A corrections officer told him to hold out his hands so that he could be handcuffed.
“Inmate [redacted] refused all directives and OC spray was deployed,” wrote one officer. “A three-man team was suited up and entered [the inmate’s] cell and removed him. This inmate was then placed in the shower for post exposure cleansing.”
One day later, an inmate “threatened to kill himself and started to break the toilet,” according to a report. When the suicidal man didn’t respond to an order, officers in body armor pepper sprayed him, handcuffed him and forced him to take a shower.
Notes from the prison psychiatrist reveal the dire mental states of the inmates. “He is actively psychotic and has been refusing medication,” wrote Dr. Abbey Cassidy, following an incident where four guards in protective gear entered a man’s cell to “extract” him. “Inmate [redacted] has a history of not eating and losing weight when actively psychotic. He has a history of being involuntarily committed based on inability to self-care.”
These tactics are common to many prisons around the country, but behavioral health experts say they demonstrate a prison system unequipped to deal with people in crisis. They say it’s part of a broader failure to take care of people with serious mental illnesses, often leaving the job to police and prison guards instead.
Those experts say communities should have ways that police or others could connect someone in crisis with mental health care. Pennsylvania passed a law to provide such an option, but no counties are using it. That leaves police with few options other than charging a person with a mental illness with a crime. From there, they often end up in jail, where they must comply with the rules or face the consequences.
“The jail has certain protocols they have to follow. They are designed to be effective. I would not say they are designed to be pleasant.”
— Bucks County District Attorney Matt Weintraub
Reports obtained by Transforming Health show that corrections officers at the roughly 720-inmate Bucks County jail used force 44 times from mid-April through mid-June.
In at least 16 of those uses of force, the inmate was either suicidal, hurting himself or herself, or was someone who has a diagnosed mental illness, reports show.
They paint a bleak picture of inmates banging their heads against cell walls and cutting themselves with whatever objects they can get.
In almost all incidents, corrections officers responded by bursting into that person’s cell wearing what looks like riot gear.
Transforming Health obtained the documents after reporting in June that an inmate on suicide watch had been pepper sprayed and restrained. That woman, 28-year-old Kim Stringer, was moved to a state psychiatric hospital five days after the story was published.
Stringer has a long-documented history of serious mental illness. She was arrested in April after allegedly punching a neighbor.
Police are able to ask a judge to commit someone to a state mental hospital for care. They did that with Kim last summer. For several months her situation improved—until she stopped taking her medication.
This time, instead of pushing for involuntary commitment, Falls Township Police charged her with assault and harassment. Police have declined requests for comment.
She was at Bucks County jail for 72 days awaiting trial, while county officials told her parents only that their daughter was “safe.”
Although Bucks County redacted inmates’ names on the use of force reports, sometimes their names were not redacted. Additionally, information such as date of imprisonment and physical description allowed Transforming Health to identify several instances where Stringer was the subject of a report.
Those reports show that Stringer attempted to hurt herself by banging her head against a wall, punching herself, stabbing herself and attempting to swallow a pen.
Officers took away her clothes and possessions, leaving her only with an “anti-suicide smock,” which became soiled in excrement.
Stringer was pepper sprayed at least three times and placed in a “humane restraint chair” at least three times, reports show.
In at least two cases, prison guards put her in leg shackles and handcuffs and forced her to shower after they pepper sprayed her.
After she was moved from the jail, psychiatrists treating her described her condition as “catatonic,” according to her mother, Martha Stringer.
“She went in unwell,” Martha said in June. “She came out much, much worse.”
Bucks County District Attorney Matt Weintraub is quick to say that county jail is not the right place for someone with a serious mental illness. However, he said, the guards were following the rules.
“The jail has certain protocols they have to follow,” Weintraub said. “They are designed to be effective. I would not say they are designed to be pleasant.”
Following public outcry over Kim’s situation, Weintraub launched an internal investigation, and ruled out any criminal misconduct among corrections officers. He said officers “treated Ms. Stringer as fairly as they could.”
Prisons routinely record uses of force on video. Weintraub, who also serves on the prison’s oversight board, described watching one video, which he declined to provide to Transforming Health. He said the video shows prison guards pepper spraying Kim’s cell “to get her to comply.”
“If she were to have complied from the get go, they wouldn’t use the spray,” he said. “But it came to it, they had to use the spray, and she is very anguished.”
According to psychiatrist Jeffrey Lieberman, it doesn’t make sense to expect compliance from people who may have no idea what is going on.
For example, he said, someone with schizophrenia may be living with delusions, hallucinations and paranoia.
“They cannot distinguish external reality from their internal state of mind,” said Lieberman, who is a chair of psychiatry at Columbia College of Physicians and Surgeons and director of the New York State Psychiatric Institute.
Situations like Kim’s are not uncommon. In Bucks County, just after Stringer had been moved to a state hospital, a 24-year-old old man who has schizophrenia, Dudly Ulysse, was jailed while facing charges related to allegedly damaging hospital property and assaulting staff. He has since been placed in a state facility.
Nationwide, about 20 percent of people in jails and 15 percent in state prisons are estimated to have a mental illness, according to Treatment Advocacy Center, a group that pushes for mental health reforms.
People in prisons who have a diagnosed mental illness or who are suicidal should be treated like behavioral health patients, said Lieberman. Instead, they’re treated like “inmates.”
The problem dates back more than 50 years, to when a change in federal law made it more difficult to have someone committed to an asylum because of a mental illness, Lieberman said. The goal was to protect a person’s rights and prevent abuses. However, the result has been that some don’t get help until they break the law or attempt suicide.
“Killing other family members, killing others, or killing themselves,” he said. “It happens over and over and over again.”
Police aren’t trained for this
When a person has a mental health crisis, it’s police who have to respond. Those officers are trained to enforce laws, not to administer mental health care, said Pennsylvania State Police Sergeant Timothy Fetzer.
“From an officer’s perspective, and from the state police perspective, our call of honor, part of that says we will enforce the law without any consideration of color, creed or condition or class,” said Fetzer, who trains police cadets at the academy.
Officers can work with special crisis intervention teams if they are available, and in some cases can take a person to the hospital for short-term mental health treatment, Fetzer noted. However, at the end of the day, police have to protect the community—and situations can turn dangerous quickly.
To illustrate his point, Fetzer played a 2018 police body camera video from Tulsa, Oklahoma, where officers attempted to detain a man who was taking his clothes off in public.
After police failed to handcuff him, that man busted a glass door and entered a bank. Police used stun guns on him more than two dozen times, and the man lost consciousness.
On video, while the man is being shocked by two stun guns, an officer repeatedly tells him to roll over.
“They’re just trying to gain control of him through handcuffs and they’re having a very hard time doing so, and that’s real life,” Fetzer said. “He’s clearly noncompliant with them, he’s still displaying that contaminated type, incoherent thought process, and they’re still struggling to gain control of him.”
While Fetzer presented this as an example of the challenges police face in doing their job, that arrest was controversial.
The man in the video was 25-year-old Joshua Harvey, who had suffered from bipolar disorder and schizophrenia. Harvey died three days later without regaining consciousness.
The coroner ruled his death was from cardiovascular disease made worse by drug use and exertion. However, Harvey’s family said police used excessive force. They’ve sought charges against those officers and sued Tulsa police.
Searching for solutions
At Virginia-based Treatment Advocacy Center, director John Snook pointed to research that shows people with a serious mental illness are 16 times more likely to die in an encounter with police than the general public.
And, with decreases in available psychiatric beds across the country, another study shows that some states are relying increasingly on acute mental health beds inside prisons.
“If you started with what doesn’t work, what’s the worst way we could do this, it would be a jail,” Snook said. Bucks County Correctional Facility didn’t respond to requests for comment.
Snook said it doesn’t have to be this way. His group pushes for states to adopt “assisted outpatient treatment” programs, which he says prevent a person with a mental illness from getting wrapped up in the criminal justice system.
Those programs connect the person in need of care with trained advocates and a judge, who can encourage them to take medication and get treatment. Thirty-seven states have implemented such programs.
The frustrating part, to Snook, is that Pennsylvania already passed a law in 2018 allowing counties to start assisted outpatient treatment programs. However, none of Pennsylvania’s 67 counties has given it a try, with some county program administrators saying that it would cost money at a time when mental health funding was already stretched thin.
At the Bucks County Courthouse, D.A. Weintraub said he is looking for solutions. In early August, he said the county plans to set up a mental health treatment court and a police “co-responder” program, two initiatives he says will help to keep people with mental illness out of prison when possible.
To Snook, states need to move away from a system where a person with a mental illness doesn’t get help until they’ve presented a danger to themselves or others.
“The reality is that mental illness isn’t different [from] other illnesses, and we for some reason have stigmatized this illness,” Snook said. “For every other illness, we will base [treatment] on a medical decision, but for mental illness we’re going to base this on violence—and that’s just unfair to people that are sick.”
Brett Sholtis was a health reporter for WITF/Transforming Health until early 2023. Sholtis is the 2021-2022 Reveal Benjamin von Sternenfels Rosenthal Grantee for Mental Health Investigative Journalism with the Rosalynn Carter Fellowships for Mental Health Journalism. His award-winning work on problem areas in mental health policy and policing helped to get a woman moved from a county jail to a psychiatric facility. Sholtis is a University of Pittsburgh graduate and a Pennsylvania Army National Guard Kosovo campaign veteran.