Colton Wilson has a tombstone tattooed on his right forearm. On a recent late-winter day, the 21-year-old moves constantly inside the visitor center at Shelby's Crossroads Correctional Facility. He picks at his fingers, clenches his hands and shifts his feet. He runs his hands through his dark, wavy hair.
The worst part of prison, he says, is being put in administrative segregation. Wilson and the other inmates call it "the hole."
"There's no distraction, it's just you and the walls, everything goes through your mind," Wilson says. "Some people it doesn't affect very badly...But it's hard for me."
Wilson's always had a hard time taking direction. That's why he lands in the hole.
In 2005, he was diagnosed with attention deficit hyperactivity and bipolar disorders. "I flipped out," he recalls.
His parents hospitalized him after he threatened to kill himself. Psychiatrists put him on a series of medications that made him tired, incoherent and, sometimes, more angry.
He stopped taking the prescribed medications. In March 2007, Wilson, then 16, was caught with his girlfriend robbing vehicles in his hometown of Charlo. Witnesses tried to apprehend them. Wilson stabbed a man in the neck.
Prosecutors in Lake County charged Wilson with felony assault with a weapon. He pleaded guilty and was sentenced to a 90-day boot camp overseen by the Montana Department of Corrections and a six-year deferred sentence.
At this point, it would be easy to write off Wilson's story as typical: A messed-up kid screws up, hurts someone and gets put away, for his own good and others'. Yet it's what happens next, not just to Wilson but to many others like him, that raises some eyebrows about the fate of people with severe psychiatric problems in Montana's jails and prisons.
During the past three decades, as state psychiatric hospitals have curbed services, prisons have become home to a record number of mentally ill people. Of the 2,490 people in custody with the Montana DOC, 703, or 28 percent, are taking psychotropic medications.
Experts say prisons and jails simply aren't equipped to handle people with severe mental illness. Many contend that Wilson and other such inmates actually get worse in prison, leaving communities to foot an even larger tab for jails and hospitals. It also leaves people like Wilson more likely to commit another crime.
"They grabbed my meds"
In the months before Colton Wilson was slated to attend boot camp at the Treasure State Correctional Training Center, in 2009, he was prescribed three drugs: Lamictal, a mood stabilizer; Abilify, an antipsychotic; and Vyvanse, a stimulant.
The drugs worked. His mother, who had always gone out of her way to fend off her son's mood swings and paralyzing fear, was shocked. "It took almost a year and a half to get all of the pieces of the puzzle put together," Donna Wilson says. "Once we got to that point—night and day difference with this kid."
The judge who presided over Colton's case ordered that he take the medications while at Treasure State. Colton's nurse practitioner warned boot camp staff that Colton wouldn't make it through the Training Center if he didn't stay on the medications.
Colton's mother filled his backpack with family photos, a Bible and his prescriptions. The family drove Colton to Missoula. He was then transported to the camp, at Deer Lodge. Colton remembers that day. "They grabbed my meds and my Bible and shackled me up and we hit the road," he says.
In a lawsuit filed in February against the Treasure State Correctional Training Center, the DOC and the state, the family argues that Treasure State employees withheld Colton's medications for nearly a week.
The suit alleges that six days after Colton arrived at Treasure State, DOC psychiatrist Dr. David Schaefer prescribed Abilify but didn't approve the other drugs.
Schaefer did not respond to the Independent's request for comment. The DOC, citing pending litigation, declined to comment on the specifics of Colton's case.
Colton again became combative. He called the guards names. His behavior got him kicked out of boot camp and a subsequent DOC program. The court rescinded his plea deal and he was re-sentenced to 20 years in DOC custody, with 15 suspended.
The Wilsons' suit contends that the DOC's failure to provide prescribed medications for Colton violated his constitutional right to receive adequate medical care while incarcerated. "It's just like if you have someone who's a diabetic...and they need insulin, it's a serious medical condition," says Colton's Missoula attorney, Terance P. Perry, of Datsopolous, MacDonald & Lind.
Colton would not be incarcerated today had he been given his medication, his family argues.
His case is similar to those in two other lawsuits filed since 2000, which allege that mentally ill inmates were punished with increasing severity because they didn't receive proper mental health treatment.
In 2003, the Montana Supreme Court issued a sharply worded opinion against the DOC for its treatment of mentally ill prisoner Mark Edward Walker. Last year, a district judge intervened on behalf of a lawsuit filed by the ACLU; that suit involved Raistlen Katka, a mentally ill inmate who, as a minor, had been placed in administrative segregation in the high-security unit at Montana's Men's State Prison. Court documents in both cases allege the DOC violated constitutional protections against cruel and unusual punishment. Both Walker and Katka made suicide attempts while in custody.
The problem, says National Association on Mental Illness Montana Executive Director Matt Kuntz, is that prisons are designed to curb the bad behavior of rational people. The premise may seem simple: Behave, and you don't get in trouble. But people with serious mental illness don't always think rationally. There's a tendency to act out, which, in a prison setting, can lead to progressively harsher punishments.
"They commit crimes for different reasons than people who don't have serious mental illnesses," Kuntz says. "It's a disruption of neural circuits. That affects how they think, feel and act."
Kuntz says stories like Wilson's and those of other Montana inmates reflect a system that's ill equipped to handle the complexities of mental illness. "As long as the prisons are a place that we rely on to house our mentally ill, the Department of Corrections is going to fail," he observes. "It's like asking someone to hold water with a strainer—they don't have the right tools...Eventually somebody, and maybe it's going to be the Wilsons, is going to make the state of Montana pay for it."
"We definitely have a problem here"
The details of Colton Wilson's case are worth a closer look, if only to understand how such a person falls through the cracks in Montana's corrections system.
His mother, Donna Wilson, sensed something was wrong with her youngest son early. "He was just temperamental and very emotional," she says. "It was real hard to settle him down."
Colton slept in his parents' bed many nights. It helped alleviate the little boy's anxiety. She home schooled him, breaking lessons into bite-sized increments, sometimes just 15 minutes. But his moods worsened. Colton was cited for being a minor in possession of alcohol and for possession of dangerous drugs. Fights at home escalated. He accused his mom of trying to poison him.
Colton started Saint Ignatius High School in 2004, where he was aggressive toward other students and prone to angry outbursts. A school counselor asked to meet with the family. "She was very kind," Donna recalls. "She said, 'Oh, Donna, you've got to get him into Ronan Mental Health, we definitely have a problem here. I can see it.'"
In 2005, Colton was diagnosed with ADHD and oppositional defiant disorder. That year he was hospitalized twice for his threatening and self-destructive behavior. During the second hospitalization, in 2005, Saint Patrick Hospital diagnosed the teenager with bipolar disorder.
They sent Colton to a residential treatment center in Utah. He went through neurobehavioral testing. He saw psychiatrists and nurse practitioners.
Donna was dumbfounded. "I really didn't know anything about mental health," she says. "I thought he was a temperamental kid, I can't control him. He's a good boy, but yet he's a bad boy."
After Colton was charged with stabbing the man in Charlo, the Wilsons worked desperately to stabilize him. Donna read everything she could find about bipolar disorder. She made phone calls to treatment programs that had months-long waiting lists. They sent him to another treatment center, this time in Idaho.
Donna says no combination of drugs, confinement or encouragement seemed to work. "We were left having to deal with this very difficult psychiatric case on our own."
That's why the Wilsons were so pleased when Colton responded to the three medications prescribed by Missoula psychiatric nurse practitioner Kiely Howard. (Howard declined to comment for this article, citing privacy constraints.)
It made it all the more devastating to see Colton again fall apart in DOC custody. Donna could only watch in shock as the judge revoked his plea agreement and sentenced him to more incarceration.
Colton was put in the Montana State Prison at Deer Lodge. Donna told mental health staff there that Colton needed his full complement of medicines to function, but her pleas seemed not to matter, she says. She was especially frustrated when Schaefer, the DOC psychiatrist, called her in January 2010. He told Donna that Colton had antisocial personality disorder, which, unlike bipolar disorder, is not commonly thought treatable.
Schaefer told her that he saw no evidence of bipolar disorder or ADHD, she says. He cited prison safety concerns when saying that the Vyvanse Colton was taking, an amphetamine, would not be prescribed. Instead, he gave Colton the antidepressants Celexa and Wellbutrin.
Donna says the drugs caused Colton to unravel further. He threatened a guard and was written up for getting jailhouse tattoos. DOC put him in the Maximum Security Unit. "He ends up in isolation," Donna says. "He was totally freaking gonzo."
Schaefer prescribed lithium in July 2010. It made Colton ill and feverish. He's not currently taking any medications, nor is he in counseling. He's slated to get out March 14, 2014. He says he can make it until then, but, he says, other inmates seem worse. Sometimes he hears men screaming at night inside the Crossroads Correctional Facility, in Shelby. He says they have conversations with people who aren't there. "There are some people with pretty bad mental illness. I feel sorry for those guys."
Chances are, those men don't have the support that Colton does. His family continues to fight a legal battle on multiple fronts. In addition to the civil suit filed last month, they're asking Montana's Ninth Judicial District Court to order his release based on the allegation that he would not be incarcerated today if the DOC had provided proper medical care. A hearing is scheduled for April 26 to debate that complaint.
The Montana Supreme Court already denied one such appeal. But Donna is persistent. She wants to hold DOC accountable. She believes people should at least know the horror that her mentally ill son faces while alone in administrative segregation. She's written letters to Gov. Brian Schweitzer and DOC Director Mike Ferriter. She testifies before lawmakers and listens to the stories told by other parents during legislative proceedings. Too many of them, she says, sound like Colton's.
"This is so much bigger than my kid," she says. "This is a tragedy."
"Heaven into hell"
Some early American settlers believed demons lived in people who exhibited ungovernable behavior. The afflicted were called "lunatics" and "madmen." Doctors treated them with ice baths, malarial infections and lobotomies, a surgical procedure in which nerves in the frontal lobe are severed.
Those unable to manage mood swings and hallucinations were cared for at home. Unluckier ones lived in almshouses—overcrowded and dirty taxpayer-funded public homes—or in jail.
In the early 1840s, Unitarian reformer Dorothea Dix was shocked at what she found in Massachusetts almshouses and prisons. She would later tell policy makers that ill people were "chained, naked, beaten with rods and lashed into obedience." They were held in "cages, closets, cellars, stalls, pens..."
Dix first encountered cases of what she called "transcendent madness" in 1841, while volunteering to teach Sunday school at an East Cambridge jail. She was so shaken by what she saw that she resolved to embark on a more than two-year tour of Massachusetts' poorhouses and prisons. Her goal was reform.
She documented a long list of unsanitary and inhumane conditions. One woman in particular stood out. She defied "efforts for controlling the contaminating violence of her excited passions," Dix said. "Every form of polluting phraseology, was poured forth in torrents, sweeping away every decent thought and giving reality to that blackness of darkness which, it is said, might convert a heaven into hell."
Dix told legislators that more hospital beds were needed. They agreed and funded an expansion of the state asylum in Worcester. Before her death in 1887, Dix went on to help create dozens of new state hospitals across the east and into the Midwest.
In 1877, Montana's Territorial Legislative Assembly awarded Dr. Charles F. Mussingbrod and Dr. A. Mitchell a contract to care for the "insane of the Territory of Montana." That first year, in Warm Springs, the facility housed 13 patients. Gardens, a greenhouse and a dairy dotted the site.
The state purchased the institution in 1912. Warm Springs State Hospital that year housed 854 patients.
By the mid-20th century, psychiatric institutions across the nation were outgrowing their capacity. Funding did not match needs. State hospitals became overcrowded warehouses.
In 1954, the first effective anti-psychotic medication, Thorazine, became available. The drug revolutionized how society, the ill and their families coped with mental illness. Within eight months, more than two million patients were taking it.
President John F. Kennedy's presidency further revolutionized the nation's strategies for combating mental illness. Kennedy had an intimate knowledge of the challenges wrought by such maladies. His sister Rosemary was developmentally disabled and mentally ill. She was lobotomized at 23.
In 1963, Kennedy told Congress that he aimed to completely overhaul the country's mental health apparatus. Rather than "social quarantine, a prolonged or permanent confinement in huge, unhappy mental hospitals where they were out of sight and forgotten," Kennedy said ill people should be returned to their communities. He laid out a plan for new mental health centers. They would be places where people could find support while remaining independent.
Fewer than half of the community mental health facilities Kennedy planned for came to fruition.
In 1955, there was one psychiatric bed available for every 300 Americans. Today, that number is one per 3,000.
Warm Springs State Hospital in Montana housed 1,890 people in 1954. Roughly 200 are treated there today. The state's population during that same period grew by more than 400,000.
On December 13, 1994, Cascade County Prosecutors charged Mark Edward Walker with felony forgery, arson and two counts of criminal mischief.
Walker had been diagnosed with ADHD. He admitted to forging his brother's signature on several checks. The other charges stemmed from a fire that he started in his parents' garage.
In exchange for dismissal of the criminal mischief charges, Walker pleaded guilty to negligent arson and felony forgery. The Eighth Judicial District Court sentenced him to five years with the Department of Corrections.
The sentence was suspended. However, Walker violated the terms of his probation, prompting the state to revoke the original sentencing agreement. Walker fled. In 1997, he was arrested in Colorado.
For seven months, Walker remained incarcerated in the Colorado Department of Corrections. Psychiatric staff in Colorado diagnosed him with bipolar disorder and prescribed Lithium. The Montana Supreme Court would later find that Walker received no major disciplinary write-ups while in Colorado.
In November 1998, Walker was extradited to Montana and re-sentenced to five years with the Montana DOC. He was transferred to Montana State Prison on February 5, 1999. Five days later, Walker asked David Schaefer, the Montana DOC psychiatrist, to ensure that he received food with his lithium to ease nausea. Court documents allege that Schaefer learned of Walker's request as early as Feb. 20 but did not meet with Walker until March 11. By then, Walker had stopped taking his lithium.
When Schaefer finally reviewed Walker's file, he diagnosed him with antisocial personality disorder with narcissistic traits rather than bipolar disorder. Schaefer did not prescribe lithium.
Between August 1999 and January 2000, Walker averaged 11 major disciplinary write-ups a month. He spit on guards and covered his cell walls with ketchup, mustard and mayonnaise. On Oct. 8, 1999, he tried to hang himself with a sheet. Four days later, he tried to hang himself again, this time with his prison overalls.
Prison officials placed him on a behavior management plan. It included being placed in a cell alone without his mattress, pillow and personal belongings. His clothing was also taken away.
Walker was on disciplinary detention in January 2000. Because he had no paper or pen, he asked a neighboring inmate to help him draft a legal filing. Walker alleged in that petition that MSP officials were subjecting him to cruel and unusual punishment. He asked the court to intervene on his behalf.
The Montana Supreme Court reviewed the case on appeal. In 2003, after Walker had already been released from DOC custody, the court issued a strongly worded opinion against the state. It noted that Montana's constitutional right to human dignity mandates even greater protection than the federal constitution's Eighth Amendment protections against cruel and unusual punishment.
"If the particular conditions of segregation being challenged are such that they inflict a serious mental illness, greatly exacerbate mental illness or deprive inmates of their sanity," the justices wrote, "then [prison officials] have deprived inmates of a basic necessity of human existence—indeed, they have crossed into the realm of psychological torture."
In a landmark decision, the court directed DOC to adjust its policies and report back in 180 days. A court-appointed monitoring committee, composed of a retired psychiatrist, an attorney and an investigator, scrutinized prison procedures during multiple visits to MSP in 2004.
The committee noted that MSP altered its policies after the Walker decision. DOC, for instance, opened the Martz Diagnostic and Intake Unit in 2004. The unit basically serves as a reception area, where mental health staffers take inmates' histories before they enter the prison. Behavior management plans were changed, too. A mental health evaluation is now required before such a plan can be implemented. Similarly, psychiatric staff now have authority to pull an inmate off such a plan if they feel the inmate is worsening.
According to the report, "MSP appears to have taken significant steps to ensure that the behavioral management plans do not exacerbate the inmate's mental health condition and do not inflict serious mental illness or deprive inmates of their sanity."
"This person doesn't really need treatment"
Raistlen Katka's father beat him with belt buckles and wire hangers. Court documents filed on Katka's behalf say his father encouraged the little boy's half siblings to beat him with baseball bats and locked him in his room for days at a time.
Katka was diagnosed with post-traumatic stress disorder, mood disorder and major depressive disorder. Doctors prescribed a variety of psychotropic medications. He lived with multiple family members and in foster care before he acted out and got sent to the Pine Hills Youth Correctional Facility.
Katka got into a fight with two Pine Hills guards. He later pleaded guilty to two counts of assault on a peace officer. His plea agreement stipulated that he be transferred to adult court and sentenced to DOC custody for five years.
As with Colton Wilson, the district court recommended that Katka be placed in a three-month DOC boot camp. He would then be eligible for parole. In 2007, DOC sent him to the Missoula Assessment and Sanction Center for evaluation. The center is housed in the Missoula County Detention Facility. Inmates taken into DOC custody are sent there to evaluate appropriate placement.
A center psychologist recommended that Katka receive ongoing mental health treatment and mood-stabilizing medication.
One month after Katka arrived at the center, staffers placed him in the facility's maximum-security unit. During the six months Katka spent there, he was placed on suicide watch at least once. He didn't make it to boot camp. He was transferred to Montana State Prison in February 2008, just after his 16th birthday.
Katka damaged a fence at the prison, prompting DOC to send him to a restricted segregation unit. Five days a week, he spent 23 hours a day in his cell alone. He didn't get out at all on the other two days. His mental state worsened. He acted out. The prison placed him on a behavior management plan that included dressing him in a gown and putting him in a padded cell with no running water that remained lit through the night.
The ACLU of Montana intervened on Katka's behalf, filing a lawsuit against the state and the DOC in 2009. The suit alleges that DOC placed the teenager on behavior modification plans at least six times between September 2008 and September 2009. The lawsuit also claims that Katka was pepper sprayed and shot with an electroshock gun.
Katka attempted suicide four times. Twice, he bit through his wrist until he punctured a vein. His attorneys say that during his last suicide attempt, Katka used a shaving razor to slit his wrists while he was in the shower. Emergency personnel had to resuscitate him.
As with the Walker and Wilson lawsuits, the Katka case alleges the state violated constitutional protections against cruel and unusual punishment.
Dr. Terry Kupers is a clinical psychiatrist and professor at the Wright Institute Graduate School of Psychology in Berkeley, Calif.. He's also a forensic mental health expert who's consulted with the U.S. Department of Justice and Amnesty International. He testified during the Katka and Walker legal proceedings. The DOC's use of behavioral management plans, even after the Walker decision, exacerbates mental illness, Kupers says. He maintains:
"What happens is a series of worsening punishments. They reach the point where they're both unconstitutional and cause human breakdown. That's what happened in both the Walker and Katka cases."
Kupers says long periods of stress and anxiety actually alter how the mind works: People in their teens and early 20s, like Wilson and Katka, have rapidly developing brains. Neural pathways are blazing emotional trails that the mind will follow for years to come. When young people experience repeated cycles of disorganized thinking, hallucinations or depression, they become more prone to that, as pathways in the brain that are triggered by psychotic episodes or manic episodes become habituated. "It's like a rut in a road," Kupers says.
There are other similarities among the cases, including the antisocial disorder diagnosis. Kupers says that while some studies show that approximately 15-25 percent of any prison population has antisocial personality disorder, that number plummets when doctors evaluate a more extensive list of diagnostic criteria that includes, for instance, the inability to empathize with others.
Kupers says institutions can use antisocial personality disorder diagnoses and another classification, "malingering," which means exaggerating or faking, to skirt constitutionally mandated treatment responsibilities.
"What the psychiatrist is essentially saying is this individual does not warrant mental health services," Kupers says. "They actually should be treated as just an ordinary prisoner and punished when they do something wrong...I believe what's going on is the budget for mental health services within [a given corrections department] is relatively very inadequate. And then the psychiatrist justifies the inadequacy by saying 'This person doesn't really need treatment.'"
DOC declined to comment on that allegation, citing pending litigation.
Katka's attorneys, including Ron Waterman, who's filed multiple cases against DOC, say they also see an inordinate number of antisocial diagnoses in the state prison system.
"Oftentimes, those people who come through the system somehow or another are magically cured of those diseases and those mental health issues and they all end up as an antisocial personality," Waterman says. "It is a pattern that is remarkable in the frequency."
District Judge Jeffrey Sherlock intervened in the Katka case last August. He prohibited DOC from placing Katka in solitary.
Katka is now on parole, living with his grandfather outside of Havre. Waterman says he's responding well to the ongoing mental health treatment he's had access to since the ACLU intervened.
"Security comes first"
The Montana State Prison in Deer Lodge houses murderers, thieves and rapists. Some of the men who live there aren't welcome anywhere else.
"We do not have a choice who comes to us," says Montana State Prison Health Services Bureau Chief Cathy Redfern. "We get what we get. And we deal with who we have."
DOC staff declined to comment on the Wilson and Katka cases. However, Redfern and some of her colleagues agreed to talk to the Independent about the overall challenges that come from housing—and providing medical careto hundreds of mentally ill inmates.
Since the Walker decision, the men's prison has increased its mental health staff significantly. It now has 21.5 mental health positions; one of them is a psychiatrist. Other facilities contract out for psychiatric services. The Crossroads facility, where Colton Wilson is now, uses tele-medicine.
Montana State Prison Mental Health Program Director Jill Buck says even the slightest staffing increase helps. In 2010, MSP received funding to hire three temporary mental health staffers. "We found that just having those mental health techs on night shift decreased those acting-out behaviors," Buck says. "It helped with counseling, de-escalating situations."
They've since lost funding for two of the three positions.
Montana State Prison is the only DOC facility with specific accommodations for inmates with psychiatric problems. Two mental health units at the Men's Prison accommodate 25 prisoners. Buck says she has to be selective about whom she admits there. "We don't like to put straight behavioral problems on the unit, because we do have severely mentally ill people in our unit," she says. "We do have to make sure we protect them."
DOC Senior Legal Counsel Diana Koch says that courts sometimes sentence severely ill prisoners to the Warm Springs State Hospital. But that facility isn't secure, meaning if inmates are dangerous, they'll likely end up in the prison.
"Some of them come to Montana State Prison, even if they have not reached maximum benefit at the hospital," Koch says. "When they start acting out at the hospital, the only place that they can go is to the prison."
In 2007, DOC and the Montana Department of Public Health and Human Services, which operates the Warm Springs State Hospital, asked the Montana Legislature for help. They proposed creating a "Secure Treatment and Examination Program," a forensic unit on the Warm Springs campus. It would have been a place where violent offenders could receive treatment for mental illness in a secure hospital setting.
Disability Rights Montana, which advocates for people with mental illness, criticized the proposal, which would have cost $3.8 million to get off the ground and an additional $4.6 million in new funding annually. Disability Rights attorney Anita Roessmann argued that legislators would be wiser to put that money into community programs such as facilities that stabilize people in crisis, "so folks don't have to be driven across the state in the back of a police car."
The bill died in a House legislative committee during the 2007 session.
Lewis and Clark County Prosecutor Leo Gallagher echoes Roessmann when saying part of the reason people end up in jail is that there are too few services. "There's not a good mental health system in the communities," he says. "There's a dearth of psychiatric care." For instance, Gallagher says, there's a three-month wait to even get a pre-sentence mental health evaluation at the state hospital.
Lewis and Clark County doesn't yet have a mental health court. Missoula does. And it helps keep offenders with psychiatric illnesses out of prison, says Deputy Missoula County Prosecutor Leslie Halligan.
Mental health court participants voluntarily participate in a judicially supervised treatment plan developed by a team of court staff and mental health professionals. A lot of what the courts do is simply help people access hard-to-find services.
Buck, at DOC, says that many inmates at the Men's Prison haven't received any mental health care prior to being incarcerated. "A lot of inmates cannot afford mental health care in the community," she says.
"They come here and they get top-notch mental health care."
Buck's worked for the Men's Prison for 13 years. She bristles when asked if prison care is inadequate. The facility is accredited by the National Commission on Correctional Health Care, she points out, and employs licensed professionals. "We care about these inmates. We care about their mental health issues. We want them to succeed."
There are actually some benefits to receiving treatment in prison, Buck says. It offers time for people to work through mental health and behavioral challenges while abstaining from alcohol and drugs.
But, Buck adds, "When you're trying to provide therapy in a secure environment, that's a challenge in and of itself. Security comes first. And that's our motto."