Three weeks in county jail with untreated schizophrenia

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

I am 30 now. I am writing about something that happened to me at 24. I have spent six years thinking about it, and I want to write about it because it is a story that happens to a lot of people in the United States and almost never gets told from the inside. I was arrested during a psychotic episode for trespassing. I had wandered into the lobby of a building I believed I had been summoned to. I spent three weeks in county jail before anything resembling psychiatric care reached me. I want to tell what those three weeks were like and what eventually changed.

How I ended up there

I had been living in my own apartment, a year into a college degree I never finished. My voices had been getting louder for weeks. I had stopped sleeping. I had started believing I was being recruited for a job by a company whose lobby I had walked past. One morning I walked in, told the receptionist I was there to start, and refused to leave. The police were called. By the time they arrived, I was shouting. I do not remember most of it. I remember the handcuffs. I remember saying, "I have a job here," over and over.

I was charged with trespassing. I had no prior record. In a county with a working crisis intervention team (CIT) and a mental health diversion program, I might have gone to a crisis stabilisation unit instead of a jail cell. In my county that day, I went to jail.

Booking

I was screened during booking. I told the nurse I had been told once I had "schizophrenia symptoms" but had never been formally diagnosed or medicated. She wrote it down. She gave me a booklet I could not read. I was put in a holding cell and then in general population. Nobody started any medication that night. Nobody started any medication for fourteen days.

I was scared in a way I did not know was possible. The voices got louder, not quieter, in the noise of the cell block. I did not understand the rules. I was certain other people in my pod were communicating about me. I curled up on a top bunk and did not move for almost two days. Other people in the pod left me alone. One man — and I want to name this kindness — brought me water and told me when meals were happening. He did not know me. He did it anyway.

Day three: my mother

My mother had been calling around all night. She had eventually been given the jail's information line. She put money on my commissary account. She called the public defender's office. She called the jail's medical contractor and asked, in writing, that I be evaluated by a psychiatrist. None of this happened immediately. The system did not move because she asked. But she put it on the record, which mattered later.

The medical pod

On day six I was moved to the medical pod after I refused food for two days and was visibly disoriented. The medical pod was quieter and there was a nurse who came around. She tried to ask me questions. I could not answer most of them coherently. She put my name on a list to see the visiting psychiatrist. The visiting psychiatrist came every two weeks.

I have thought a lot about that gap. The Treatment Advocacy Center and other groups have documented that a person with serious mental illness in a US jail often waits days to weeks for any psychiatric evaluation, and even longer to start medication. See SAMHSA's criminal justice resources for the broader picture. My experience was not unusual.

Day fourteen: medication

I finally saw the psychiatrist on day fourteen. He was kind and exhausted. He spent about ten minutes with me. He started a low dose of an antipsychotic. By day eighteen the voices started to soften. By day twenty I could carry a short conversation. The shift from psychosis to even partial clarity, in the middle of an environment designed for punishment rather than treatment, was disorienting. I had two days of being clear enough to fully understand where I was, which was almost worse than being psychotic.

Court and the public defender

My mother had been working with my public defender, who turned out to be the difference between this story ending in three weeks and this story ending in months. She filed for a competency evaluation. She advocated for diversion to a mental health court. She got the trespassing charge ultimately dismissed in exchange for my agreeing to enrol in an assertive community treatment program for six months. I was released on day twenty-one.

Not every public defender will know to do this. If your loved one is in jail with mental illness, asking the public defender directly about mental health court and jail diversion programs is one of the most useful things you can do. See incarceration and schizophrenia for a broader walkthrough.

What I lost in those three weeks

• My apartment. I could not pay rent from jail. I came out homeless and stayed with my mother.
• My job. I did not have one anyway, but I lost any chance of returning to school that semester.
• Trust in my body and my judgment. The episode had been bad. The jail made it worse. I was scared of myself for a long time.
• Roughly nine pounds. The food was bad and I did not eat much.

What I gained

• A diagnosis, finally — schizophrenia, on the discharge summary
• An ACT team that, for six months, made sure I had medication, appointments, and a place to live
• A public defender who became a quiet advocate for me even after the case closed
• A clearer sense of how vulnerable I am if I am untreated, and how seriously I now take medication and sleep

What I want family members to know

If your loved one is in jail with mental illness:

• Call the jail medical contractor in writing. Document every request for evaluation.
• Contact the public defender immediately. Ask specifically about competency evaluation, mental health court, and jail diversion.
• Bring or send the person's medication list and prescriber's contact information. The jail may or may not continue the same medications, but having the information speeds things up.
• Use NAMI's helpline. The NAMI Helpline can connect families with local resources, including legal advocates.
• Document everything. Dates of calls, who you spoke to, what was said. This becomes useful in court and, if necessary, in later complaints.

What I want clinicians to know

When I came out of jail and tried to re-establish care, several outpatient clinics asked about my "criminal history" in ways that almost made me give up. The trespassing charge had been dismissed. My record was supposed to be clean. The questions made me feel like I was being screened out. Eventually I found a clinic that asked about hospitalisations and incarcerations together, in the context of treatment history, and that made all the difference. The way the question is asked matters.

Six years later

I am stable. I am back in school part-time. I work two days a week at a peer support program where I sometimes meet people who are coming out of jail. I tell some of them this story. I tell them what helped me — a mother who would not stop calling, a public defender who knew the diversion options, a nurse who put my name on a list. I tell them what almost did not — fourteen days without medication in a place built to punish what should have been treated.

If you are reading this from a cell, or from outside one waiting on a person who is in one: do not give up. Document everything. Ask for the diversion options by name. The system is hard but it has doors.

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.