Inside The US's Largest Mental Institution

On a recent morning, we took a visit to the floor devoted to the "sickest of the sick." As we arrived, a dozen deputies were working to restrain a patient and inject him with an anti-psychotic drug. The entire ordeal was videotaped — to protect the patient as well as the deputies. It was the first hint at the complexities that emerge from creating a mental hospital inside a jail.

The End Of Public Mental Hospitals

Until the 1970s, the mentally ill were usually treated in public psychiatric hospitals, more commonly known as insane asylums.

Then, a social movement aimed at freeing patients from big, overcrowded and often squalid state hospitals succeeded. Rather than leading to quality treatment in small, community settings, however, it often resulted in no treatment at all.

Mornings at Twin Towers begin with a meeting of medical staff from the county's Department of Mental Health; case workers and guards, who often function as de facto case workers, sit in a large circle.

An inmate who won't eat is the first order of business on this particular day.

"He says there are ants in his cereal," a case worker explains.

Dr. Arakel Davtian, one of the psychiatrists sitting in this large circle, takes a moment to explain just who they are dealing with; about half those locked up at the Twin Towers are in for serious crimes, he says.

What he finds striking, however, is how little it takes for the other half to end up there: "Indecent exposure, having open containers, something very, very minor — peeing on the street, disturbing the peace."

Not everyone is so open to treatment. An inmate named Lawrence (Twin Towers requested his last name be withheld for privacy reasons) says he was picked up for stealing sweaters out of a car on a very cold day.

"In order to get a lesser charge, I pretended I was nuts. So ever since then, I've been hooked up with the mental facilities."

Claiming to be crazy is a problem here. There is a perception that life in the "insane" tower is easier than life in the "sane" one — partly because the cells in the mental health side are newer than cells in the other side. Consequently, inmates are carefully screened before they are admitted to the psychiatric wing.