Trouble in MindMore in this series
RICHMOND — When a skinny, shaking and psychotic Andre Thomas arrived at a Texas Department of Criminal Justice psychiatric facility in December 2008, he told mental health staff that his wife — whom he had murdered, along with her two children, four years earlier — was still alive.
“I keep seeing her,” he said, an attempt to explain why he had pulled out and eaten his left eye on death row, rendering himself blind. “I want out of this false reality.”
Thomas had pulled out his right eye in 2004, just days after stabbing to death his wife, Laura Boren, their 4-year-old son, Andre Lee Boren (known also as Andre Jr.), and her 1-year-old daughter, Leyha Hughes, in an effort, he said, to obey God and purge demons from their hearts. He ripped out the children's hearts and in a failed attempt to remove their mother's heart, removed part of her lung. After failing to also kill himself, Thomas put the organs in his pocket and walked home.
Thomas is among thousands of mentally ill inmates in the state’s sprawling prison system, which is struggling to keep pace with the increasing need for mental health care. After years of state budget cuts that resulted in trimming staff and reducing programs, leaders at the University of Texas Medical Branch, which provides much of that care, say they need more state funding to provide adequate treatment. And some lawmakers want the prison system to adopt policies that may help alleviate some inmates’ mental health problems by reducing the use of solitary confinement, where more than 8,000 inmates now find themselves, according to prison officials.
After being convicted of murder in 2005, Thomas, then 22, was sent to TDCJ’s death row at the Polunsky Unit in Livingston. On the health status form that medical staff from the Grayson County Jail sent along with Thomas when he was transferred, they wrote that he was a “paranoid schizophrenic,” that he had “enucleated” his own eye, and that he was wearing mittens to prevent him from ripping out the other eye. (Click here to view an interactive timeline of the case.)
Like the rest of the condemned, Thomas spent 23 hours a day confined alone in a 6-foot-by-10-foot cell. There, his mental illness worsened, his lawyers say. The conflicting voices of God and demons echoed relentlessly in his ears, made worse by a nearby inmate who taunted him. Thomas couldn’t understand why he was imprisoned. He tried slitting his wrists and once cut his throat. On Dec. 1, 2008, he threatened to hang himself. Eight days later, Thomas gouged out his left eye and ate it.
Fellow death row inmate Larry Swearingen said in a letter that he recalled the weeks leading up to the eye incident, including officers struggling to restrain Thomas after he sliced his throat.
Swearingen, who has been on death row since 2000 for a murder conviction he is fighting, said staying sane on death row is tough.
“I myself have slowly developed issues; cut my wrist a few times, battled with depression, am now forced to take medication to help out that,” he wrote. “I’ve been able to keep most of my sanity because of my wife and children.”
More than 20 percent of the 290 inmates on Texas death row are diagnosed with some type of mental illness, according to TDCJ. Eight death row inmates, including Thomas, are now housed at the Jester IV unit in Richmond, one of three psychiatric facilities in the prison system.
Anthony Graves, who spent a decade on death row before he was exonerated, told a congressional committee examining the effects of solitary confinement last year that he lived under “the worst conditions imaginable.” He described filthy cells and food contaminated with rodent waste. Inmates deteriorated to the point that they lit themselves aflame, smeared feces on their faces and took their own lives. After two years of freedom, Graves said he still hadn’t recovered.
“I only sleep about two and a half to three hours at night. And then I'm up,” he said. “I have mood swings that just causes emotional breakdowns.”
In a Texas Tribune interview in February, Graves urged lawmakers to require more humane treatment of inmates, particularly in light of exonerations like his.
“Imagine all the cruelty you put me through,” he said. “You sentenced them to death, but you didn’t sentence them to be punished every day until you put them to death.”
It’s not only those condemned to die who often live for years in isolation. In the last five years, TDCJ officials report that an average of 8,500 inmates were housed in solitary confinement — what the TDCJ calls “administrative segregation,” or “ad seg.” Those inmates spent an average of three years apiece in ad seg, a disciplinary tool for the most dangerous or troubled offenders.
Like the men and women on death row, most of those inmates have no access to rehabilitative programs. They spend 23 hours a day alone in a cell and get one hour for recreation and a shower. In fiscal year 2012, more than 830 inmates were discharged from ad seg directly to the streets, according to the TDCJ. Another 613 were released on parole and mandatory supervision.
“One day we open the door and say, ‘Go out and sin no more,’” said Michele Deitch, a jail conditions expert and professor at the University of Texas' Lyndon B. Johnson School of Public Affairs, who wants such inmates to receive transitional assistance. “Do you want that person living next door to you?”
Prison officials say providing regular treatment for inmates in ad seg — who are considered some of the toughest criminals in the system — is challenging because it could put other inmates at risk.
Some lawmakers have serious questions about how often and how long TDCJ officials use solitary confinement as a disciplinary tool. State Rep. Ryan Guillen, D-Rio Grande City, has filed House Bill 1266, which would create a task force to examine ad seg policies in both TDCJ and the Texas Department of Juvenile Justice. State Rep. Marisa Marquez, D-El Paso, has filed HB 686, which would require TDCJ to report to lawmakers detailed information about when and why inmates are placed in ad seg and what happens when they come out.
After a spate of violence and suicide in a maximum-security facility in Mississippi in 2007, that state reduced its use of solitary confinement by 75 percent, and saw a 50 percent decrease in prison violence. By 2010, Mississippi had closed that maximum-security unit, a savings of some $5 million, The New York Times reported. The state of Colorado has recently implemented similar reforms, and this month, the Federal Bureau of Prisons agreed to conduct an assessment of its use of solitary confinement nationwide, the first such study of federal segregation policies.
Thomas lived for three years in ad seg on death row before he removed his second eye. His eyelids are now surgically closed over his empty eye sockets. For the last four years, he has lived at the Jester IV Unit, one of three psychiatric units in the state’s prison system, each housing about 550 mentally ill convicts. On any given day, Jester IV and the two other units — the Montford Unit in Lubbock and the Skyview Unit in Rusk — are about 90 percent full. The UTMB clinicians who provide care at Jester IV say that if Texas built a fourth psychiatric facility, it would be filled as soon as it opened.
Dr. Joseph Penn, UTMB’s director of mental health services, said he hasn’t seen a causal relationship between solitary confinement and mental health crises. Most prisoners have the same life stressors that affect mental health in the free world, he said: family problems and financial struggles. Some prisoners also feign insanity to get away from unpleasant situations, clinicians at Jester IV say, particularly in the heat of the summer. Psychiatric facilities are air-conditioned, and most of the other prisons are not.
Prisoners in ad seg are monitored regularly by nursing staff, said Dr. Philip Farley, a psychiatrist at Jester IV. Some people have the coping skills to handle isolation. Those who don’t struggle in ad seg.
“Their concept of reality gets a little distorted,” he said. “That does occur, but not everybody is like that.”
Most inmates come to Jester for a few days in the throes of a psychiatric crisis. After intensive treatment, they are stabilized and sent back to their assigned units.
Many of the inmates prison health officials see have long suffered from untreated mental illness on the outside, leading them to cycle in and out of prison.
“Unfortunately, outpatient services have just been cut to the bone in Texas,” Penn said. “They cycle between homelessness, psychiatric hospitals in the free world.”
But prisons struggle to meet inmates’ needs on the inside, too. As mental health challenges have increased, state lawmakers have cut UTMB’s budget for correctional care from $428.5 million in fiscal year 2010 to $397.6 million in 2012. At Jester IV, there’s no longer a dentist. Vocational training programs were cut. The kitchen where occupational therapists used to help inmates learn life skills like cooking is dark. The room where inmates once had musical therapy is now a briefing area for nurses.
Choose a graph: Texas Inmates Receiving Mental Health Treatment | Percent of Texas Inmates Receiving Mental Health Treatment | Spending on Psychiatric Medication for Texas Inmates | All Spending on Texas Inmates' Health Care
* The University of Texas Medical Branch serves a large portion, but not all, of Texas' inmates.
UTMB officials have dealt with staff cutbacks in a novel way, developing one of the largest telemedicine delivery systems in the country. In 2012, psychiatrists in three hubs across the state conducted 40,000 mental health visits with prisoners via videoconferencing.
Telemedicine has helped save money and resources, said Dr. Owen Murray, UTMB’s vice president of offender health services. And the system is working — for now. But lawmakers need to devote more resources to the system, which he said has been neglected for almost a decade.
While Murray and other UTMB officials fight for more funds, lawyers for Thomas are fighting to keep him in the psychiatric facility that has been his home since he pulled out his second eye. Early this month, prison officials briefly transferred him back to death row without alerting his lawyer, Maurie Levin, co-director of the University of Texas School of Law’s Capital Punishment Clinic. Thomas was there for about a week before Levin persuaded TDCJ officials to send him back to Jester IV, where she said he continues to hallucinate but is regularly monitored to ensure he takes medication and doesn’t harm himself.
“I don’t think Polunsky [death row] is an appropriate place or capable of humane care for Andre or anybody who is severely mentally ill,” Levin said. “Andre has a propensity for self-harm. Others just simply rot.”
Interactive graphs by Becca Aaronson
This story is part of a collaboration with Texas Monthly magazine. Read the long-form narrative tale of the Andre Thomas case here.
Tomorrow in the Tribune: Criminal justice advocates say Thomas’ case raises questions about how courts determine whether someone is competent to stand trial and, most starkly, forces careful consideration of whether the state ought to execute the mentally ill.