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SAN ANTONIO (AP) — For Bexar County Sheriff Susan Pamerleau, mental illness is personal.
The San Antonio Express-News (http://bit.ly/1Eixf8Q ) reports her introduction to the challenges — and sorrow — of mental health problems started when she was young, the daughter of a minister who also was a counselor.
She learned sensitivity for mental illness from him and from a brother who was bipolar, long before there was a name for the condition. As an adult, she endured emotional and physical abuse from a husband who committed suicide the day she finally left him in 1978.
So when recent data showed the Bexar jail had the highest number of suicides in the state, Pamerleau was taken aback. While it's acknowledged that in previous years, the jail had difficulty handling inmates with mental illness concerns, Pamerleau's administration has made numerous changes to help improve the situation.
"When people say there are (a lot) of suicides and they don't think we go to extraordinary measures, they have no idea of the role and critical nature of what a detention officer does every single day," Pamerleau said.
James Keith, a spokesman for the Sheriff's Office, said before Pamerleau took office, the situation was dire. Deputies often used physical force to control inmates in a mental health crisis.
"There were some problems in the jail that required extra attention, specifically in the way we screen inmates," Keith said. "Now, we make sure all inmates are evaluated before they are incarcerated."
Today, the jail has a mental health unit with medical and mental health staff that is 250 strong. Staff members trained in working with the mentally ill are available 24 hours a day. A deputy and a nurse are on duty seven days a week specifically for suicide prevention, officials said. Also, every inmate receives a mental health assessment when he or she enters the jail, and all deputies receive training on how to spot someone in crisis.
"When we see signs and symptoms, we take them (inmates) to the mental health unit," said Deputy Chief Raul S. Banasco, who as jail administrator is responsible for all jail operations, including the supervision of the staff of 900. "Officers are trained to see an inmate acting peculiarly; they have an obligation to call mental health."
Sheriff's officials said more than 800 of the jail's estimated 4,500 inmates are being treated for some type of mental illness. Bexar County spends nearly $2.3 million annually to provide treatment, medications and counseling and assessment for those inmates.
"The staff always is looking for signs (of possible suicides) in general population," Banasco said
Since September 2009 when state regulators began tracking the statistics statewide, 15 people have committed suicide while in Bexar County Jail. Statewide, there were 140 who died at their own hand during the same time period.
When five Bexar inmates killed themselves in 2009, an independent consultant found officers weren't following protocol concerning mentally ill and suicidal inmates, which became an issue when Pamerleau ran for office in 2012.
Though Bexar County did not have a suicide in 2013, the county logged two in 2014 and three so far this year, records show. No suicides have occurred in the jail's mental health unit.
The most recent suicide in Bexar County Jail occurred July 5, when Rodolfo Palafos, 54, used a bedsheet to hang himself. He had been booked in November on a charge of aggravated sexual assault of a child.
Palafos was not on a suicide watch and, the Sheriff's Office said, he had not appeared to need it. The case still is under investigation.
Banasco said the county has spent a quarter- to a half-million dollars from 2013-2014 on removing and retrofitting equipment in the 26-year-old jail. For example, grates on jail vents had to be fitted with plates that have smaller holes so that they could not be used for hanging, Banasco said. Other changes have been made, too.
"We went throughout the entire jail removing towel hangers because they (inmates) started using them as weapons or to hang themselves," he said.
Even the beds had to be changed. Once made of steel, the beds now are completely made of foam, Banasco said, also adding that inmates at risk of suicide also are given clothing made of paper to reduce the chance of hanging.
The Sheriff's Office also has implemented crisis intervention training, which teaches deputies to recognize signs and symptoms of people in crisis.
Banasco said training includes an exercise where deputies wear a headset that gives them an experience much like an inmate who hears voices.
Such training helps sensitize deputies to the reality of people with mental illness in the jail, said Lloyd B. Potter, a professor at the University of Texas at San Antonio.
"That gives them (deputies) some orientation that this is the real thing that they have to deal with," said Potter, who previously was director of the National Suicide Prevention Center.
The training has been helpful, Deputy Andrew Garza said. He's been with the Sheriff's Office for seven years and works periodically in the mental health unit.
He said training helped him "deal with all their triggers and what sets them off."
"After training, I was able to de-escalate situations," Garza said.
Despite all the improvements, however, the treatment of inmates who suffer from mental illness remains a growing challenge for law enforcement personnel across the board, Pamerleau said.
"We are trying to cope, adjust, and make sure we have safety in the jail," Banasco said. "But if an individual wants to do it (commit suicide), they will find the opportunity."
Pamerleau recalled a story about inheriting an inmate who had been arrested in another county who had warrants out of Bexar.
While in custody, the man stabbed himself twice. He was taken to a local hospital and, to clean his wounds, doctors had to cut vertically down his torso. After he was returned to his cell, Pamerleau said, the man managed to get a mattress spring and snake it through his incision. Once that was repaired and he was returned to jail, he stabbed himself again, with a pencil.
Still, state and local officials are focused on finding better ways of handling inmates with mental illness, particularly those who are at risk of suicide.
After the recent death of Sandra Bland, who was found hanging from a noose made of a plastic trash bag in her cell in rural Waller County outside Houston, state legislators launched a special inquiry on jail safety.
Bexar officials are hopeful facility upgrades, increased observation and assessment and staff training continue to help them spot — and stop — those who could be at risk for suicide.
"Society doesn't realize what it takes" when dealing with inmates who suffer from mental illness, Banasco said. "We take that seriously."
Information from: San Antonio Express-News, http://www.mysanantonio.com
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