My recovery after a stint in county jail

This is a composite story, drawn from common experiences shared in the schizophrenia community. It does not depict a real individual.

I am 35 years old, a Black man, and I live in a small apartment in Houston. Three years ago I was arrested during a psychotic episode and spent 62 days in county jail awaiting a competency evaluation. The recovery from that arrest, from the time inside, and from everything it did to my life took longer than the recovery from any of my four prior psychiatric hospitalisations combined. I want to write about what happened, because there are not enough first-person accounts of this part of the schizophrenia story.

How it happened

I had been off my medication for about ten weeks. I had moved between two clinics during a job change, the prescription transfer fell through, I did not have the energy to fight the bureaucracy, and the days kept slipping. By week eight I was sleeping three hours a night and was convinced that the man who lived in the apartment above me was monitoring me through the air vents.

The night I was arrested, I had gone outside at 2 a.m. and was shouting up at his window. The neighbours called the police. The officers who responded did not have crisis intervention team (CIT) training. I was, in their language, "not compliant." I was charged with disorderly conduct and resisting arrest. By morning I was in county.

What jail was like

I do not want to dramatise this. People with schizophrenia get arrested every day in this country, and most of those stories are worse than mine. Treatment Advocacy Center data and studies of jail mental health populations consistently show that people with serious mental illness are vastly overrepresented in county jails. I was one of them for two months.

I want to be specific about a few things, because they matter:

• The intake nurse asked about my medications. I told her. The medications I needed were not on the jail formulary. They substituted what they had. I had EPS within a week.
• I spent most of my time in administrative segregation — solitary — because the general population was deemed unsafe for me given my mental status. That meant 23 hours a day in a cell.
• I was scheduled for a competency evaluation. The wait, in our county, was over a month. I was symptomatic for most of that time without my regular medication.
• I was ultimately found incompetent to stand trial, transferred briefly to a state forensic facility for restoration, and the original charges were dismissed.
• My family did not know where I was for the first four days. They had been calling hospitals.

I lost my job within the first two weeks. My landlord moved to evict me by week six. My car was impounded and eventually auctioned because no one was paying the storage fees. By the time I was released, I had no apartment, no job, no car, and three significant marks on my record.

The first weeks out

I was released from the state facility back to county, processed out, and dropped off at a bus stop with a single trash bag of my belongings. I had nowhere to go. My older brother drove the four hours from San Antonio to pick me up. I lived on his couch for four months.

The first week out was harder than I had expected. I had imagined relief. What I felt instead was a kind of frozen disorientation. I could not handle small decisions. I cried at the grocery store the first time my brother took me. I jumped at sounds. I had a recurring dream about the cell door closing that did not let up for several months.

I now know that what I was experiencing had a name — incarceration-related trauma — and that it is well-documented in the post-release population. Schizophrenia and PTSD overlap is significant, and the months after release are when it tends to surface.

What rebuilding looked like

Re-establishing care

The first thing my brother did, on day three, was take me to a federally qualified health centre in his neighbourhood. They got me back on a stable medication regimen — a long-acting injection of paliperidone, this time, so that no future bureaucratic gap would put me in the same situation. The injection schedule was the most important single intervention.

A jail diversion case manager

I was connected, through the FQHC, to a jail diversion program in our county that worked specifically with people with serious mental illness who had been arrested. My case manager, a woman who had been doing this work for fifteen years, became the most useful person in my recovery. She helped me sort out the eviction record, get an ID re-issued, navigate the dismissed charges, and apply for SSI. She knew every form. She knew every clerk.

Trauma-informed therapy

About six months after release, I started therapy with someone trained in trauma-informed care for psychosis (overview here). We worked on the dreams, the startle response, the way I had stopped being able to be in small spaces. It took about a year before I could ride an elevator again without my heart racing.

Slowly rebuilding the practical pieces

I got an ID at month two. I got a part-time job stocking shelves at month five. I got my own studio apartment at month nine. I got my driver's licence reinstated at month fourteen, after a paper hearing about the medical incident. I started dating again at month twenty.

What I want people to know

The system is not built for us

The arrest happened because the police who responded had not been trained in crisis intervention team models. The jail did not have the medication I needed. The competency evaluation took weeks during which I deteriorated. None of this is unusual. It is the default in most American counties. SAMHSA and other agencies have been documenting this for decades.

The recovery from incarceration is its own thing

It is not a hospitalisation. It is something else. The trauma is different. The shame is different. The practical losses — job, housing, money, ID — are larger. Rebuilding takes longer. People should not be told to "get over it" the way they might after a hospital stay.

Race matters

I have to name this. As a Black man with schizophrenia, my interaction with police was shaped by both. Misdiagnosis rates for Black Americans with psychotic symptoms are well-documented in the literature. So is the disproportionate use of force. I am alive. Many people in similar situations are not.

Three years later

I am stable on my injection. I work part-time. I rent my own apartment. I see my brother every other weekend. I am four months into a relationship that, for the first time in a long time, feels solid. I see my therapist every other week and my psychiatrist every two months.

The dreams about the cell door come back about once a month, usually when I am stressed. I have a routine for them: I get up, I drink water, I read for an hour, I go back to sleep.

If you have been through this, or fear you might

• If you can, ask your psychiatrist about a long-acting injection. It removes the daily pill and the prescription pipeline as failure points.
• Have someone in your life who knows your medications, your psychiatrist's name, and where to call if you go missing.
• Carry a card with your diagnosis, medications, and emergency contact. Some people find a medical alert bracelet useful.
• Find out if your county has a crisis intervention team or co-responder model. Knowing the right number to call instead of 911 may, one day, change everything.
• If you have been through a jail stint, look for a jail diversion or re-entry program. They exist in most cities and most people do not know about them. SAMHSA's overview can help.

For more on this topic, see incarceration and schizophrenia and surviving jail with schizophrenia.

This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.