In 2023, Serenity was sentenced to 15 years in a Texas prison after killing her partner, a businessman.
Serenity, whose name I’ve changed to protect her privacy, had begun using the synthetic marijuana known as K2, which caused her cognitive abilities to deteriorate. She started to hear voices that said her lover was cheating on her. The voices nagged her constantly — so much so that she lost grip of reality and killed her partner. She said she thought it might silence the voices.
Serenity used to live near me in our prison, Dr. Lane Murray Unit, about two hours south of Dallas. Over the course of two interviews in January, she told me about her struggles with drug use, mental health and her path to prison.
When Serenity arrived at our facility, she said, medical staff provided her with psychiatric medications. She was also offered infrequent counseling. Each day Serenity headed to the pill line and collected her meds.
But a growing problem in prisons across Texas distracted her from treatment: K2 had become the “drug of choice” inside the state prison system. Serenity began trading her psychiatric medications for the illicit drug that helped land her in prison in the first place.
After using K2 again, the voices that previously haunted Serenity returned. Since I lived close to her, I witnessed her bouts of crying, sometimes followed by outbursts of violence and screaming in the middle of the night. When someone would ask if she was OK, she responded as if nothing had happened.
Inmates reported her behavior to prison staff. Some guards ignored the complaints. Others checked in on her.. But as soon as staff left her area she would begin yelling and throwing items again. One day, Serenity hit a neighbor with an object in the head (the person was not seriously hurt). She said she hit the person to prevent them from sacrificing her daughter to the gods.
Most experts agree that prisons are not adequately prepared to treat people with serious mental illness. But that hasn’t prevented the U.S. prison system from becoming the nation’s largest provider of psychiatric treatment — 43% of people in state prisons have been diagnosed with a mental disorder, according to Prison Policy Initiative. But many people never receive mental health treatment behind bars.
Serenity’s journey represents several problems with mental health care inside Texas prisons. Inmates struggling with mental illness are a danger to themselves and others. But from what I have observed, they generally are not segregated from the general population in a safe manner.
While mentally ill prisoners are able to access some medications, many do not comply with doctor’s orders, or they trade the pills for other drugs, like Serenity did. And in the rare instances when inmates are sent to another facility specializing in mental health treatment, any improvement in their condition tends to wear off after they are shipped back to their original prison.
A safe space to live
In general, inmates with serious mental illness reside in the same living units as everyone else, despite the fact that they are both vulnerable to abuse by other prisoners and can pose a danger to others and themselves.
If an inmate with mental health problems attacks someone, both are often taken to a segregated housing unit, where they each live alone in a cell with less privileges and freedom of movement. In several instances that I’ve observed, inmates who have been attacked were disciplined for trying to protect themselves by fighting back.
Compounding this problem is the fact that Texas prisons, like prisons across the country, are severely understaffed. The Texas Department of Criminal Justice says it is operating at “critical staffing levels” because of retention and hiring issues, according to 2023 reporting from KXAN, a TV station in Austin. (PJP contributor Cesar Hernandez wrote about some of the consequences of this problem in April).
Lower staffing levels mean less protection for inmates, especially those suffering from psychological distress. It also means less care for people who desperately need it.
If we are going to incarcerate people with serious mental health problems, then we need to ensure they are held in spaces that are safe and properly supervised, and provide access to appropriate treatment.
The ‘Ice House’
At my prison, I have observed officers log infraction reports against inmates in mental crisis. In general, there are two possible responses to this: Either the referral is simply ignored or the inmate is sent to what we inside call the “Ice House.”
The Ice House is located in Patrick L. O’Daniel Unit, formerly called Mountain View Unit, about a mile walk north of the main prison where I am incarcerated. It is typically used as an evaluation unit for people in mental health distress and staffed by state corrections employees and some medical workers from an outside hospital.
Inmates are sent to the Ice House naked and provided with only a blanket. They live in one-person cells. Some cells have toilets, while others just have a hole in the ground. A stay at the Ice House can range from a week to multiple months. The cells are freezing cold.
If the inmate is determined to need further treatment, they are sent to Skyview Unit. This co-gender prison, three hours east of my prison, specializes in mental health treatment and has more than 500 beds. There, inmates are assessed and placed on treatment plans. Stays last anywhere from 30 days to six months, according to dozens of inmates I’ve spoken with who have been sent to the Ice House and then to Skyview. Once the plan is completed, inmates typically return to the prison’s general population.
Upon return from Skyview, the inmates have to contend with prison staff who lack adequate medical skills to manage their continued care needs. They cannot continue to provide the same treatment because they simply don’t have the time or enough qualified staff. The Dallas Observer reported on these issues all the way back in 1999.
A search for solutions
Inside prison, mental health care challenges are often compounded by substance abuse. Many inmates on psychiatric medications trade them for food, hygiene items or other drugs.
From Sept. 6 through Oct. 18, 2023, TDCJ issued lockdowns in prisons across the state to search prison cells for drugs and contraband. TDCJ said prison staff seized 2 ounces of fentanyl, 4.94 ounces of PCP, 27.5 ounces of methamphetamine and just over 217 ounces of K2.
The current approach isn’t working. We must assign treatment to people in need, and put them in facilities where they can be monitored and cared for consistently.
There is no quick fix to this problem. It will take time, staffing and awareness. One solution would be to have a separate facility where these folks can get their health care needs met.
Such a facility would have trained staff — social workers, psychiatrists and therapists — on hand 24 hours a day to manage health care needs and make sure inmates on court-mandated medication stay in compliance. Skyview offers this in some ways, but it is only a temporary intervention.
At my prison, there are mental health groups that meet once a month. One-on-one counseling sessions are rarely available. In general, it can take people months to get an appointment. We also don’t have staff focused on making people adhere to treatment. This can be a tricky dilemma anywhere. But in Texas, any inmate can legally refuse mental health treatment unless they are jeopardizing the state’s interest in “protecting and preserving life” or “preventing suicide,” according to TDCJ.
For now, my prison feels like a house of horrors. Severely mentally ill people have exhibited degrading behavior, such as eating out of trash cans in their dorms. Violent outbursts also affect guards and prisoners alike.
Serenity was eventually moved out of the general population unit and sent to the medium custody unit, which is more restrictive than the general population. People are only let out of their cells for two hours a day, and are not allowed to mix with the general population.
It’s a flimsy solution that might protect people in the general population, but it still does not get Serenity the continual mental health care she needs and deserves.
