For Alabamians with mental illness, incarceration can be life-threatening

by Ralph Chapoco, Alabama Reflector
February 3, 2025

The worst moment for Stacey Fuller came at a Jefferson County jail prior to a scheduled transfer to a state prison.

“It was way overcrowded, the conditions were bad, the anger was building and the depression,” said Fuller, who was being held on a drug-related charge. “I started having really toxic thoughts about hurting other people.”

She filed a complaint and a request for mental health services to address her anguish.

A guard learned of the complaint and entered the cell block screaming, she said.

“She wanted to know who put this in and why, just screaming, ‘Who is the dumb hoe who put this in?’”

The guard pulled Fuller aside for a conversation.

“I stood up and walked down those steps,” Fuller said. “I think that was probably the worst moment. She took me down the hall and told me we don’t complain about stuff, that by putting in a request, they would deal with it when they dealt with it.”

Attorneys who litigate cases that involve people who deal with mental illness or a mental health crisis, along with advocates seeking to improve treatment and conditions for those with mental illness state that people suffering from mental illness who are incarcerated in Alabama’s jails are placed into harsh environments that can exacerbate their suffering and, in the worst cases, can result in their death.

According to experts interviewed, comparing the treatment of people dealing with mental health conditions and substance use disorders — in which people cannot control their use of legal or illegal drugs, alcohol or medications —  across the nation is difficult because there is no standard for care, with local corrections officials left to decide the treatment options and protocols when they are in custody.

The number of people incarcerated with a mental illness in Alabama and around the country, as well as the types of mental illnesses those people have, is difficult to determine, because the data collection is not robust.

A 2009 study estimated that about 14.5% of the male population in jail nationwide and 31% of the female population had a serious mental health condition, from major depressive disorder to bipolar disorder and schizophrenia.

States have latitude in establishing the system to assist people in crisis in a carceral setting. Alabama leaves it up to the individual counties, particularly sheriffs’ departments, to decide on treatments, and more importantly, how much care people should receive.

But incarceration presents serious issues for people going through a mental health emergency.

“Prisons and jails are not built, just generally speaking, are not built to be places that address, effectively, a person’s mental health concerns,” said Latasha L. McCrary, a staff attorney with the Southern Poverty Law Center.

Fuller said she suffered from chronic pain stemming from a vehicle crash in 2007 while working as a nurse in hospice care. During that time, nurses were allowed to call in prescriptions for patients, and she said she began calling into the pharmacy to obtain pain medication for herself when she got caught as part of a traffic stop in October 2008.

“I was speeding and made a wrong turn,” Fuller said. “They saw them on the floor. ‘Can I see that pill bottle?’ Stupidly, I didn’t know what to do. Next thing I knew, there were five cop cars, and I was going to jail.”

According to court records, Fuller was booked into Cullman County jail on a possession charge, and state law required her to stay in custody for at least 24 hours. She said the nurse who spoke to her during intake allowed her husband to deliver medication for depression and post traumatic stress disorder while she was incarcerated.

“And that was actually, I didn’t know it at the time, but a very kind, gentle, introduction,” Fuller said.

Fuller said she was then assigned to drug court and entered rehabilitation. But a month later, according to court records, she was arrested in Jefferson County, this time for fraudulently obtaining the medications that she was arrested for earlier in Cullman County when she was charged with illegal possession.

The Alabama Reflector found two cases pertaining to Fuller. The first was a recreational drug possession charge in October 2008 filed in Cullman County. That was followed by five charges that were filed in Jefferson County for conspiracy to fraudulently obtain controlled substances by fraud.

“They stick you in the jail population,” Fuller said. “Stick you in these cell blocks like animals, and then forget about you. There are no questions. You don’t ask any questions. You don’t have any complaints, and there you are.”

Fuller survived a month in the Jefferson County jail before getting transferred to the Tutwiler Women’s Correctional Facility in Wetumpka where she endured another six months, without medication, before she completed her sentence. 

‘They actively conspired to neglect and abuse him’

In January 2023, Steve Mitchell visited his cousin Anthony in Carbon Hill Jail in Walker County. According to a later lawsuit, Steven had not seen Anthony in several months, and Anthony had physically transformed.

“Tony, who was six foot three or four, had previously weighed around two hundred forty pounds. Now, Steve at first took Tony for an old man. Tony was haggard and emaciated, weighing no more than a hundred forty or a hundred fifty pounds,” according to the lawsuit.

Anthony Mitchell was experiencing a mental health episode, Steve said, when he was taken into custody.

He was placed in isolation at the Carbon Hill Jail, in a cell with a cement floor and a drain to be used as a toilet, according to the lawsuit. The cell, according the was not meant for long-term custody, only during the booking process.

According to the lawsuit, Tony was given a mat to sleep on and was not provided with a jail uniform. The lawsuit alleges he was naked for most of the time he spent in jail. It wasn’t clear whether Mitchell received any kind of mental health treatment.

Two weeks after being taken into custody, at 4 a.m. on Jan. 26, 2023, Mitchell was found lying unresponsive in his cell.

A physician at the hospital who treated Tony indicated that he had a body temperature of 72 degrees, according to the lawsuit.

“The cause of this hypothermia is not clear,” the lawsuit quoted a physician stating. “It is possible he had an underlying medical condition resulting in hypothermia. I do not know if he could have been exposed to a cold environment. I do believe the hypothermia was the ultimate cause of his death.”

Multiple messages were left with both the Walker County Commission and the Walker County Sheriff’s Office seeking comment.

The attorney representing the Walker County Sheriff’s Office declined comment, citing the ongoing litigation. In court filings responding to a lawsuit from the Mitchell family, attorneys for the sheriff’s office called the allegations “the definition of scandalous,” alleging that “ the entire complaint is built upon a false premise that Mitchell was placed in a freezer.”

“Based on nothing but speculation, plaintiff accuses the defendants of murdering plaintiff’s decedent, Tony Mitchell (Mitchell) by placing him in a freezer until he suffered and died from hypothermia and then accuse the Defendants of covering up the murder,” the filing stated. “These allegations intentionally created a firestorm of derision that swept not only these Defendants but law enforcement in general and caused criminal investigations to be opened against the Defendants.”

In a lawsuit filed in 2023, Mitchell’s family accuses jail personnel of restraining him and keeping him exposed to cold conditions starting the evening before his death. The lawsuit states surveillance footage shows Tony raising his head, peering out at deputies pleading for help.

The suit alleges that it was nearly 8 a.m. when jail staff were seen with a uniform for Tony. Then, at 8:30 a.m., they entered his cell with a wheelchair, the first time in several hours that staff tended to him, according to the lawsuit.

“After initially placing him in the chair, deputies pick Tony up and drag him back inside the cell, evidently to conceal his presence as a new female detainee is brought into the booking area and processed, further delaying Tony’s access to the emergency medical treatment he obviously urgently requires,” the lawsuit states. He was pronounced dead that afternoon.

Eight corrections officers have pleaded guilty to one count of deprivation of rights, according to CBS42. One nurse pleaded guilty to denying Mitchell care resulting in his death.

For roughly a year and a half, Ryan Cagle and several others have been regular attendees at Walker County Commission meetings with a single message: Walker County Sheriff’s Office should be held accountable for jail deaths like Mitchell’s, or those that occurred with law enforcement present.

“Watching how the sheriff’s department treated someone who had clear mental health issues, they didn’t just not provide him care, but they actively conspired to neglect and abuse him,” said Cagle, a resident and advocate living in Walker County.

“We spent countless hours, every month, for the past year and a half, all but yelling at the county commission to regulate and hold the sheriff’s department accountable, but also to use the opioid money, the national settlement opioid money, to fund a non-police response team so that we can stop allowing police to be the first line of response to mental health needs,” he said.

At least two other lawsuits have been filed against the Walker County Sheriff’s Office, according to court records.

In September 2021, Frederick Hight filed a lawsuit against the Walker County Sheriff’s Office after a deputy shot and killed his son, Fredrick Hight Jr., when he was dispatched to the scene as part of a mental health call in February 2021. The parties eventually settled the case, according to media reports.

The second lawsuit was filed in June 2023 by Chris Hambric after his son, Greg Hambric, was shot and killed by a Walker County Sheriff’s deputy in June 2021. That case is ongoing.

Dangers of incarceration and mental illness

While the alleged incidents in Walker County are extreme, multiple experts interviewed stated that placing people with mental health conditions into custody and housing them in jail is problematic because of the chaotic nature of the environment.

“Every type of mental illness is disproportionately represented in people in jails than it is in the community,” said Lauren Kois, a clinical and forensic psychologist who worked in Alabama but is now at the University of Virginia studying serious mental disorders in prisons and jails.

A report published in 2016 by the Public Citizen’s Health Research Group and the Treatment Advocacy Center based on surveys of 230 sheriffs’ departments in 39 states, found that almost 96% of the facilities reported having some individuals within their custody with a serious mental illness between September 2010 to August 2011.

Roughly 75% of the facilities reported a larger number of people with serious mental illness compared with five to 10 years before.

A study of 1,300 people incarcerated at an unnamed jail in the Midwest published this year found that 20% of those surveyed suffered from some type of mental illness and another 78% had a substance use disorder.

Access to mental health care has been a focus of an ongoing lawsuit in Alabama state prisons. A federal district judge ruled in 2017 that a lack of access to adequate mental health care in state prisons violated incarcerated Alabamians’ Eighth Amendment rights and ordered the Alabama Department of Corrections (ADOC) to institute reforms.

The judge also ordered that the ADOC intensify its recruitment of corrections officers to increase staffing within the facilities. Staffing was identified as one of the key reasons that people incarcerated were not receiving adequate mental health services.

“In the context of mental health, that means that a person could be in a crisis and not have a correctional staff person near or around to be able to observe that fact that they committing, or attempting to commit suicide, or that they harm themselves in some way, that they are having some kind or crisis or breakdown that needs immediate attention,” McCrary said.

People with a mental illness can get into contact with the criminal justice system in a variety of ways. For example, individuals with mental illness who are homeless may be caught violating rules and regulations that deal with loitering or trespassing.

“Jail is going to be more for lower-level offenses, so they are going to be more associated with quality-of-life offenses, things like criminal trespass, criminal mischief,” Kois said. “It could be sleeping in a place where you are not supposed to be sleeping or urinating in public because Starbucks wouldn’t let you go to the bathroom anymore because you scare people.”

Ideally, medical personnel would conduct a thorough evaluation of a person with a mental illness facing incarceration, according to Lisa Dailey, executive director of Treatment Advocacy Center (TAC), a national nonprofit that focuses on improving the lives of people suffering from mental illness.

That evaluation would determine which type of treatment is most appropriate, with medication readily available that can be administered relatively quickly.

The individual would then be placed into an area of the facility dedicated to individuals with either medical or mental health needs separate from the general population because they are vulnerable to abuse or harm.

The person would then be transferred to a medical facility as soon as possible and removed from jail while remaining in custody.

In most cases, though, jails and prisons assess individuals in a rudimentary process that can be delayed, Dailey said. Many times, the initial determination of a person’s mental health is done at a court proceeding when a person raises an issue of the defendant’s mental health, according to Dailey.

If a psychiatric facility is full, a person could wait in a correctional facility for months before being admitted, all while struggling with illness.

Treatment can also be costly, according to John Hollingsworth, director of Alabama Crisis Intervention Training, who trains law enforcement and other personnel for how to deal with mental health emergencies when encountering it in the field. Some medications can cost upwards to $1,000 per prescription, which people who are homeless cannot afford.

“It is a complex group of symptoms,” Hollingsworth said. “There is not a blood test that says you are bipolar. You have to show certain symptoms over a certain period before they diagnose you. Once they diagnose you, there are different levels.”

Treatments available in the state’s jails are also limited, and those who need specific medications may not be able to get them.

Most jail settings are chaotic and harmful for people undergoing crisis.

“Sometimes they are just fighting to get the medication they already know that they need,” McCrary said. “You combine that with the feeling of, ‘Here I am in a place that I don’t want to be with people I don’t want to be around,’ or if I have severe anxiety and I am in a dorm with 50 other people, my anxiety just magnifies.”

‘You cannot thrive and survive at the same time’

Fuller has since been released after fulfilling her obligation to the criminal justice system.

Despite that, she had trouble finding a job for a few years, which included stints working in hazardous cleanup and cleaning buildings at night.She also got work picking blackberries and making bracelets to sell.

Her therapist recommended she become a certified peer to help others who have been involved with the criminal justice system. She went through training before working with people who have a substance use disorder.

“I used my lived experience to help others get into recovery,” Fuller said. “What I did was act as a public liaison between the judge, the public defender’s office and the jails.”

Fuller is currently a case manager for Birmingham Reentry Alliance.

“I help people help themselves by finding resources. Because if you are just looking for food and shelter, you are just surviving,” she said, “and you cannot thrive and survive at the same time.”

Alabama Reflector is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Alabama Reflector maintains editorial independence. Contact Editor Brian Lyman for questions: info@alabamareflector.com.

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