How one woman survived her mental illness isolated in jail with only the voices in her head for company
Virginian-Pilot - 8/30/2018
Aug. 30--Jan Green picks up a photo of herself at 15 and smiles at the girl she used to be.
Schizophrenia, a disease she has battled her entire adult life, has taken its toll, leaving only a faint resemblance between her and that Minnesota teenager.
Now 56, Jan lives about an hour north of Minneapolis in a small house of her own, surrounded by children and grandchildren who love her.
She leads a quiet life. She walks to the store and rarely drives anywhere. When visitors arrive, she puts out a cheese tray and sodas, showing a kindness to strangers that has not always been shown to her.
Beside her in the photo is her horse, Cindy.
"She was my buddy. She was my best friend," Jan says, a note of melancholy in her voice.
The sadness is always there. Jan battles depression and anxiety, and some days are a struggle.
The voices and sounds from the schizophrenia still plague her. Paranoid thoughts creep in.
She doesn't want her mental illness to rule her life, but keeping it from doing so takes constant maintenance.
"I just get worn out by the disease," she says. "You hit a wall with it."
Horrific deaths, brutal treatment: Mental illness in America's jails
People with mental illnesses in jails around the country are routinely dying in horrific ways and under preventable circumstances, a Virginian-Pilot investigation has found.
But make no mistake, the life she has today -- her house, her freedom, even her ability to speak -- is a victory. The mistreatment she survived in America's justice system has killed or broken hundreds if not thousands of others.
A Virginian-Pilot investigation counted 404 people with mental illness who have died in America's jails since 2010. And those were only the cases that could be documented; the actual number is likely much higher.
What sets Jan Green apart is that she lived and can tell you herself what she endured.
Jan was arrested in July and September 2009 in New Mexico on charges of misdemeanor domestic violence. Once, she hit her husband in the head with a frying pan during an argument, causing a wound that took several stitches to close.
After the second arrest she spent about 2 1/2 years in jail. At least eight months of that was in a 10-foot-by-6-foot cell, with only the voices in her head for company.
Eventually the charges were dropped. She won a $1.6 million settlement from Valencia County.
To begin to understand what Jan went through, find a small room and shut the door.
Don't look at a clock or a phone.
Just sit for a few minutes, alone with the walls and your thoughts.
Now, imagine Jan in her jail cell in the Valencia County Detention Center in Los Lunas, N.M.: She sits on a bench in her tan jumpsuit, her unwashed skin gray and her hair greasy. There is a dark place on her sock where her foot has rotted into it.
She is a grandmother whose family understands her illness and loves her dearly. But that is hard for her to remember right now.
The cell is a converted bathroom. She'd like to use the shower, but the water doesn't turn on. It only drips from the pipe where a shower head used to be. The sink doesn't work well either. She always asks for an extra cup of Kool-Aid to quench her thirst when the jailers bring her food.
She knows she is charged with domestic violence, but she doesn't know how long ago she was charged or how long she's been in jail. She tried to keep a calendar, but time has little meaning when day and night blur together in the glaring fluorescent lights.
What matters are the soap scribblings on the cell walls made by a previous tenant and the centipede crawling out of the shower drain.
Isolation in jail, used for safety and punishment, can exacerbate mental illness
More than 40 percent of the people counted by The Virginian-Pilot as dying in jail with mental illness were segregated from other inmates.
According to the most recent report from the federal Bureau of Justice Statistics, about 18 percent of local jail inmates, nearly 134,000 people, spent time in some form of isolation -- restrictive housing, disciplinary or administrative segregation or solitary confinement -- in 2011 and 2012. The study estimated that 5 percent of jail inmates had spent at least 30 days under such conditions in the previous 12 months.
The report also noted that solitary confinement is more common for those with mental illness -- between 23 and 31 percent of prison and jail inmates with a history of mental-health problems spent time in isolation.
Studies have found being locked up alone can make someone without a mental illness break down, sometimes in a matter of days.
In an often-cited 2006 study, psychologist Dr. Stuart Grassian found that isolation frequently created "an agitated confusional state which, in more severe cases, had the characteristics of a florid delirium, characterized by severe confusional, paranoid, and hallucinatory features, and also by intense agitation and random, impulsive, often self-directed violence."
In Jan's cell, there is no room for a bed. She has to lay her mattress pad down in the shower over the drain. When she sleeps, water drips on her from the pipe.
She fixates on the few things inside the cell that move or change. The leaking pipe, the cold air blowing down on her from a vent in the ceiling, the filthiness of her skin.
In his study, Grassian noted that inmates in solitary confinement get a sort of "tunnel vision." Their attention gets stuck on something unpleasant. They can't stop thinking about it.
There is nothing to distract her from the voices in her head -- the whispers and muddled thoughts that arise from her untreated schizophrenia. The jail has done little to treat her disease.
She has an imaginary friend -- an old boyfriend who was kind to her. They talk sometimes, and he makes her less lonely.
Really, Jan is trapped in a cell within a cell. There's the physical one inside the jail, and there's the once inside her mind created by her isolation and her untreated illness.
Sickness and arrest
Before her isolation, Jan led a full life.
She graduated from college in Minnesota with a computer science degree and was a technical support specialist for years. She also worked shoeing and boarding horses. She raised four kids.
Shortly after the birth of her daughter Jessalyn Middendorf, her first child, Jan was diagnosed with postpartum depression. She heard voices and thought her baby was the devil. For a while the child was a ward of the state.
"It wasn't until I was a preteen or teenager when I realized my mom was sick," Middendorf said. "But I would say primarily she did a fantastic job of raising the four of us. ... She had periods of doing very well."
By 2009, Jan was living in New Mexico with Middendorf's stepfather. She and her daughter, who has lived in Minnesota all her life and is now a mental-health nurse, talked frequently.
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The Virginian-Pilot tracked 404 deaths of people with mental illness in jails since 2010 in a first-of-its-kind examination of what happens to people with such diagnoses in jails throughout the country.
During that time, Jan had a series of episodes. She thought she knew government secrets and was protecting her family from them.
"She thought that there was some kind of danger," Middendorf said. "She would get in her vehicle and drive off, and we had many scary episodes where we didn't know where she was."
On July 5, 2009, Jan was arrested on a domestic violence charge. She was booked into the Valencia County Detention Center. A note was put in her jail file describing her as suffering from hallucinations and recommending that she see a psychiatrist as soon as possible.
But instead of receiving treatment, Jan was pepper-sprayed and put in isolation after refusing to wear jail clothes. She was released about two weeks later but was arrested again in September on another domestic violence charge and placed in isolation.
For a time, Jan says, she was housed with the general population. She could shower and interact with others. But she wasn't on any medications, and that led to trouble. She'd get out of bed and startle sleeping inmates by putting her face right up to theirs.
She was placed in the bathroom cell.
Torment and isolation
Time broke down for Jan.
For a while she was moved to another facility. She knows she was in and out of the isolation cell repeatedly.
"It was broken up, but it became longer and longer. I was in there for months at a time," she said. "It got to be where they didn't put me in population anymore."
Stretches of isolation tend to snowball, said Jan's lawyer, Matthew Coyte, who settled Green's case for $1.6 million.
"Over time you see opportunities to get out of the cell decrease to the point where they stop altogether," Coyte said. "In part that's because the persons in there don't want to come out anymore. They disappear into themselves. I think when you get to that point, any kind of sensory stimuli becomes painful. So you just disappear under the blanket -- to get away from the feeling of cold air coming from the vent, the noise of banging."
New Mexico's jail isolation practices have been something of a crusade for Coyte.
"They make it clinical in prison," he said. "They make sure the cells are clean, that the paperwork associated with the process of putting someone in solitary all appears reasonable and rational. But the results are the same. People fall apart. ... Jails are run in a more amateur way. They can't conceal the horror of it quite as well as prisons do."
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Coyte has successfully sued eight of the state's 33 counties for isolating people in jails. Including Jan's case, he has won more than $30 million in settlements. His goal is to win a lawsuit in each county.
No one acknowledges responsibility for the decision to isolate an inmate for isolating inmates, Coyte said.
"Not the mental health providers, not the jails," he said. "Guards claim it's not up to them, it's up to the medical people. You don't need a medical degree to know that people are suffering. A human being can walk in and see it immediately. ... But the people in the system, they are kind of immune to it."
For years, Coyte pushed the New Mexico state legislature to ban solitary confinement. In 2017, a bill passed prohibiting it for mentally ill inmates, people younger than 18 and pregnant women, but Gov. Susana Martinez vetoed it.
In a letter explaining her decision, Martinez said the bill "oversimplifies and misconstrues isolated confinement in such a way as to eliminate flexibility and endanger the lives of inmates and staff alike." She cited the hypothetical example of someone under 18 who poses a threat to staff or inmates and could hurt themselves or others.
Coyte said Martinez's veto demonstrated a complete misunderstanding of the research on solitary confinement, which has found the practice to be particularly damaging to young minds.
"I get pushback from people -- lawyers, insurance companies -- everyone pushes back and says that I'm crazy," he said. "The implication is I'm doing something wrong because what's a jail to do? That's incredible to me. ... Why would they not want to change? Why would you need to tell them to change?"
"I was sick"
For Jan, the low point came when a male guard taunted her with a menstrual pad.
She was sitting in her cell, miserable, her legs covered in blood. She had been given no feminine hygiene products and was having her period.
She looked up at the window of her cell. A male guard was waving the sanitary napkin at her. This had all happened before. The female guards were usually understanding. The male guards were not.
"The young man was arrogant; he didn't think I needed what I asked for," she said.
Already there were empty food trays uncollected and strewn about. She was using the paper bags from her sack lunch as toilet paper because none had been given to her.
Even when she did get sanitary napkins, she didn't get enough. When she was given one, she'd often need to reuse it. Once, she was even taken to court in bloody clothes. Other inmates laughed at her.
"That was humiliating, sitting in that mess," Jan said. "There's times I'm sure they didn't know. ... I would have to beg for things, and half the time there wasn't anybody that could hear me."
She rocked herself all the time and talked to her imaginary friend.
At times she was given a Bible in the cell.
"I prayed and read a lot when I had it," she said.
She had a hard time talking to anyone who came to her cell window.
"You know, I couldn't help my condition," she said. "I acted out sometimes, you know."
She said she yelled at and threatened the guards.
"I mean, I was sick. I was frustrated and I was in pain," she said. "I was being neglected."
Jan's children had not forgotten about her. Middendorf said they were constantly calling, trying to figure out how to get her medical attention.
Eventually Jan's daughter got in touch with Joe Chavez, the warden at the detention center. Chavez declined to comment for this story.
"My initial approach was to try to get as much information as I could," she said. "I didn't want to damage that very precious connection that I had. ... I had to play nice with someone that I knew was not on my mom's side."
At one point Jan was allowed to return home to Minnesota as long as she complied with treatment. Her family did not realized just how sick she was until she got there.
She was so ill that complying with her treatment wasn't really possible. She'd see the Pepsi logo and think it was an eye, someone spying on her. She missed an appointment because in the clinic parking lot she saw a red car. She was too scared, repeating over and over again the words, "red blood, red blood."
She was ordered back to the jail in New Mexico.
On Aug. 18, 2011, about 23 months after Jan's arrest, Rebecca Granger, a nurse in charge of health care at the jail, came to visit her. She found her in a psychotic state. She asked her if she needed medical help. Jan, her mind consumed by her illness, replied that she was a doctor and did not.
In her file, Granger wrote that Jan "denies mental health complaints" and left her untreated in the cell.
At a County Commission meeting about a year later, Granger explained her thought process publicly.
"You don't do more for your patients than they are willing to do for themselves," she stated, according to Jan's lawsuit.
Finally, after more than two years in and out of solitary confinement at the jail, Jan was taken to the New Mexico Behavioral Health Institute on Dec. 7, 2011. She told staff there that she thought she was Ana Marie Ford of the Ford Motor Co.and that she had been kidnapped.
Within five days she was showing significant signs of improvement, able to watch TV with other patients. She was on medications and being cared for. The delusional thinking stopped.
Learning to live again
About a week into her stay in the behavioral health center, Jan wanted a haircut. She was feeling better. She wanted to be clean. She stayed there and continued to improve through January 2012.
Then she was found to be restored to competency. She could now participate in her own defense and could stand trial. The court proceedings on her frying pan charge could move forward. On Feb. 1, she was sent back to the isolation cell at the Valencia County Detention Center.
By now she understood she needed her medications, and she had to beg to get them.
"They had it out for me, that's how I felt," she said. "I had to beat on the door to get someone's attention and get the guard and tell them what medication I was on and I needed to take it."
One guard took pity on her and opened her cell door. For a little while at least, she was able to walk around and talk to other people.
"You don't belong here," he told her. "I could lose my job for this, but this isn't right."
Finally, on Feb. 9, 2012, the charges against Jan were dropped. Her family pleaded for a five-day supply of medications so that she wouldn't miss a dose before she could see a doctor.
"I did nothing to deserve that," Jan says of her time in isolation. "I was amazed to hear how long I was in that cell. ... You know, it seemed like it was a long time, but there was no way of me knowing exactly."
For a few years, she lived with her daughter, relearning the basics of life.
"Mom didn't even know how to sweep the floor, how to help cook food," Middendorf said. "This is a woman who raised four kids, took care of a mentally ill husband, has a college degree in computer science. She couldn't even sweep the floor."
Now Jan can care for herself. She has her little house in Minnesota.
Along with schizophrenia, she also suffers from PTSD from her time in isolation. It is triggered by a number of things. Loud noises. Locked doors. Police.
Moving to her new house was another trigger. She ended up drinking and in the hospital for a while.
Her daughter and grandchildren live nearby and visit often. She keeps careful track of time, something she could not do in the jail cell, marking every appointment and event on a calendar.
Jan sees her life as sad in a lot of ways.
"I had it rough and I lived it. It was hard," she says. "I still have my fallbacks. I get depressed. ... Every time I have to ask for help it brings me down."
After speaking to The Virginian-Pilot, she said, she had nightmares for three days.
But she's also realizing that good can come from her suffering. Her daughter has told Jan that making people understand what happened to her -- and how it can happen to others -- is now her purpose in life.
Jan thinks that's right. She can speak for many who can't speak for themselves.
That makes her happy.
Marquette University student Rebecca Carballo contributed to this report.
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