“Do you understand what these charges mean?”

“No.”

I’m trying to imagine the scene of this inmate being interviewed to determine his competency for trial.  I’m trying to imagine how he’s processing everything that is going on around him.  I’m trying to imagine how he’s handling the highly ordered court proceedings, the complicated legal words, the strangers and what it all means.  I’m trying to imagine how he’s handling the noise, the isolation, the rules, the clanging of the doors, the orders, the lights on, the lights off, the yelling and screaming at night, the snoring, the cursing, the breakfast tray at 4am, the only coming out at certain times.  The complete lack of control over, well, anything.  How does anyone handle this, really,.. we know we incarcerate more people than anywhere else so it is true that life in the legal system becomes somewhat “normal” for inmates, but let’s just talk about this young man, who is essentially mentally disabled and likely autistic.  That’s right, autistic.

People with autism need routine, in fact, deviations from routine can be completely overwhelming.  Likewise noises, lights, and other stimuli can be overwhelming.  Let me just say that jails are overwhelming for people withOUT autism, I am at a loss for how this young man is dealing.  Everything is completely new- no family or friends, no home, new foods, new sounds, new rules.  Lots and LOTS of rules.  New people yelling commands at you.  New people that are used to inmates misbehaving, giving attitude, and challenging rules.  New people who have mace, hand cuffs, and other restraint devices, and are short on patience and long on years of experience dealing with defiant prisoners.  New people who don’t know or understand that this young man has a mental disability, and even if they concluded that he was different, are very unlikely to know or care about how to work with people with autism.  This is a JAIL.

But you can’t yell and demean autistic people into submission.  People with schizophrenia may have hallucinations and paranoia but they may at least understand what goes on in a jail, and can at least follow rules, especially if they’re on antipsychotics.  But these drugs are not used for autism.  There’s no pill that’s going to unlock  the mysteries of the autistic mid to the expectations of a jail setting.  People with autism take an enormous amount of patience, love, and time.  These things are not readily present in a jail.

This young man is likely not severely autistic, however he definitely has mental retardation.  Therefore, autistic like behaviors paired with a low functioning IQ set him up for being misunderstood, mistreated, abused in any setting, especially a jail.

When I think about my friends who either have children with autism, or work with special needs kids, I am floored by the way that they pour their whole selves into loving those kids.  They are not perfect and struggle, but not a hair on those kids is not loved or nurtured.  Enormous patience and thought is put into EVERYTHING, from how to handle a trip to the store to routines at home.  Those kid are loved and served, even though their little minds may not be able to comprehend that.  They will be loved their whole lives, and will likely be provided with whatever services and resources that they need, whether they live at home as adults, or transition to group homes, or even learn to function independently.  They have the best possible chance at success and a happy life as people with autism given that they were born into families with resources.

Contrast that with my patient.  He was born into poverty.  His mom is out of the picture.  He was in and out of foster care as a child.  He may or may not have been abused.  He’s spent time in the homeless shelter now that he’s over 18.  His dad is involved but it’s unclear if his dad is able to provide the housing support and stability that the kid needs.  I’m calling him kid here, because he functions as one.  And now he’s in jail, for a crime he does not understand.

There are no therapists for autistic inmates in jail.  We have a great mental health team, but this is different than bipolar, depression, schizophrenia.  Repeatedly, he has shown that if he becomes overwhelmed with what is demanded of him, or if he’s frustrated, he shuts down, and refuses to talk.  And why would he?  He doesn’t understand.  I mean, thank God so far he hasn’t shown any behaviors of self harm, but that sort of behavior does occur in those with autism.

Interacting with him is like interacting with a child.  I remember chatting through the window of his cell door.  He was fixating on a spork.  Twirling it in his hands.  Picking at the mini tines. He answered my questions, but I had no answers for his.  I frequently don’t.  I don’t know when you’re getting out.  I don’t know where your lawyer is.  I don’t know when you can make a phone call.  I don’t know what on earth is going to happen to you.

And this is the thing- what WILL happen to someone like him?  Someone who is mentally disabled and broke the law?  Someone who doesn’t have a rich family who can post bail so he can go home to his life-saving routines in the familiarity of his own home?  Someone who for all intents and purposes, society has forgotten about?  Someone for whom there is no long term plan?  He can’t live on his own.  He can’t take care of himself.  He has no skills.  He has low comprehension.  He is homeless.  He broke the law.  He can’t be let off the hook, he will be in limbo until he’s “fit to stand trial.” But without intensive therapy, he has zero chance of competency, and even if he did have those resouces, there’s no guarantee.

His fate was sealed the moment he was born.  Like so many kids, born into poverty, the barriers to his escape are high, but he’s moving through a world that sees him as a thug and a menace and he has the menal fortitude of a prepubescent adolescent.  His barriers are beyond insurmountable.

I have no answers here.  I really don’t.  Could they release him??  I guess,.. but to where?  To what?  To the streets?  Where he will inevitably get arrested for something else he doesn’t understand?  Is his long term plan incarceration?  Is that the long term housing plan for adults who aren’t independent and have no money?

There is a place for mental institutions in our society.  Because jail is NOT an appropriate solution for the issue of mental illness in our country.  Kids like him are sheep thrown to the wolves in prison.

What is humane for him?  What is justice for him?  What is justice for the victims of people with mental illness?  I don’t think we have an answer right now.  I think we think of ourselves as having a just society with appropriate rules and regulations.  How often do people say things like, “if you can’t do the time, don’t do the crime”?  All the time. But crime is so much more complicated than people simply choosing to act in an evil manner.  We over incarcerate those with all their faculties intact.  And the fact is, that our answer for them is the same answer we have for the mentally ill.  If you are somewhat controllable, into jail you go, and society forgets about you.  And a lot of people make a lot of money off of keeping them there.  And it would cost a lot of money that people DON’T want to pay to provide the services they actually need.  So, we are here.  The mentally ill cannot always speak for themselves, and nobody cares even if they could.  So this young man will just fill another cell.  Line the pockets of correctional corporations.  Without an enormous change in policy, he’s just at the beginning of a long life in and out of jail.  And it’s just so damned sad.