Silent screams

Ryan Partridge stands in his North Boulder kitchen making pour-over coffee for himself and his parents. His eyelids are closed as he feels around for the mug, places the coffee filter on top, and carefully swirls hot water over the fresh grounds. He’s open about growing up in Boulder and his days now spent navigating the world without sight.

In December 2016, Ryan blinded himself in the throes of a psychotic episode at the Boulder County Jail. Diagnosed with schizophrenia, he had been on and off medications and in and out of law enforcement custody for more than a year. 

Now he’s suing Boulder County, Sheriff Joe Pelle and about two dozen other jail staff for what happened. “Alone in his jail cell, curled up in a ball, with fingernails that had not been cut for six weeks, Ryan Partridge wedged his thumb and fingernails behind both of his eyeballs and plucked them both completely out of his own head,” the lawsuit states. “His delusions compelled him to do it.”

Unfortunately, Ryan’s story is emblematic of a larger problem in the state of Colorado, and the country as a whole. Mental Health America rates Colorado 43rd in the nation, for high rates of mental illness and lower rates of access to care. An estimated 48 percent of jail inmates around the country have significant mental health needs. In Colorado, it’s about 39 percent according to the Department of Corrections. Colorado has very limited resources at its state mental facilities to address this growing need. As the state’s legislature, agencies and politicians seek appropriate solutions, local law enforcement and jail staff are often left to house the mentally ill, many of whom face only minor charges that nonetheless keep them incarcerated.

“[Ryan] was incarcerated on very minor charges, all of which arose because of his mental illness,” says prominent Denver civil rights attorney David Lane, who is representing the Partridges. “It’s symptomatic of the fact that in our our society, jail is the answer to mental illness frequently.”

As one behavioral health professional at the Boulder County Jail put it: “These are community problems but they become legal problems.”

•  •  •  •

“I’ll never forget that call,” Richard Partridge, Ryan’s father, says of the night he and Ryan’s mom, Shelley, found out their son had lost his eyes.

Ryan was raised in Boulder and Nederland, attending Boulder High School and Front Range Community College. Now 31, he first started showing signs of mental health issues several years ago.

“When he was showing early signs, we didn’t know exactly what was going on, but we knew something was happening,” says Busime Shekanena, a high school friend of Ryan’s, who moved in with the Partridges in August to help with Ryan’s care. “I thought there was a lot of emotional issues. But overtime I noticed that there’s something really, truly going on mentally.”

His parents also began noticing changes in behavior. At times they tried to get him help, but soon he became erratic and even violent, leaving them little choice but to call law enforcement.

“As loving parents sometimes you don’t see problems in your kids. But we did do things in stages early on when we started seeing what we thought were behavioral problems or attitude problems or alcohol problems,” Richard says. “You don’t become schizophrenic overnight. It’s usually about a 10-year process.”

Plus, diagnosing schizophrenia can be challenging, as it requires multiple thorough assessments and persistent signs of disturbance for at least six months, according to the National Institute of Mental Health. Approximately 40 percent of the 2.8 million Americans who experience schizophrenia go untreated.

It wasn’t until mid-2015 that Ryan was first diagnosed with the disorder.

But by that time, Ryan had already been in and out of the jail on misdemeanor charges and had even found himself homeless at times.

It was while in custody in early 2016 that Ryan first talked about gouging out his eyes. At one point he smashed his face into the toilet in his cell, bloodying his face and breaking seven teeth. He tried to jump from a second floor railing two different times. He was successful once, falling headfirst into a metal table and breaking a vertebra in his back. Another time he repeatedly made himself vomit, while telling jail staff they were poisoning his food.

Unmedicated and experiencing severe delusions, Ryan often didn’t trust the jail staff.

“They had to move me because I wouldn’t let them take my trash. They had to move me from one cell to another and then that would cause kind of a rebellion because I didn’t trust them for that. I thought everything meant things, like having access to the light or not; I thought it was a mini-conspiracy,” he says. “I just didn’t trust them and I didn’t know why they would do things. I had all sorts of conspiratorial (thoughts). Like I didn’t trust the vents or the air flow.”

Ryan was often held in a restraint chair or taken to solitary confinement, which exacerbated the situation he says. “It’s like a silent scream,” Ryan says. “You think sometimes that you can almost see your scream reverberate off the wall.” The cycle often exasperated Shelley and Richard. She repeatedly called the jail asking for information about her son, asking for them to get him help.

“I said, ‘You’ve got to get him out of here, you have to make a change because you’re making it worse. He doesn’t know what’s going on, somebody needs to talk with him,’” Shelley says. “The jail said, ‘Our hands are tied, our hands are tied.’ They certainly made no effort to address any of these concerns or problems. And we were there, we were willing to do whatever it took.”

“When the state takes control of you by incarcerating you, they are obligated to treat your serious medical needs, and psychiatric conditions are considered serious medical needs,” Lane says. “Boulder was completely indifferent to Mr. Partridge’s psychological issues. They did nothing except beat him and tase him.”

The Partridges are suing for excessive use of force, indifference to serious mental illness and failure to provide medical care and treatment. The lawsuit also names Boulder County for “unlawful discrimination and failure to accommodate” under the Americans with Disabilities Act.

The lawsuit alleges that jail staff used excessive force in handling Ryan while he was actively psychotic. They would tackle, punch and tase him in an effort to get him to cooperate, it says. When he was threatening self harm, they would place him in a restraint chair, and cover his face with a spit sock, a mesh-like head cover used to prevent people from spitting on officers.

Although mental health staff at the jail repeatedly reported Ryan’s mental instability, and at times took him to Boulder Community Hospital and Colorado Mental Health Institute Fort Logan, each time he was returned to Boulder County Jail. Several times he underwent competency evaluations, once being let out on bond, only to be arrested, and taken back to the jail several months later for violating probation. Even if he was taking medication at the time of his arrest, he stopped taking it for the most part at the jail, paranoid about what the jail staff was giving him.

The lawsuit suggests jail staff could have gotten a court order to force Ryan into taking antipsychotic medications, which could have helped stabilize his mental health.

“You know they are very inconsistent about what they could do or couldn’t do and what they were more than willing to do and what they weren’t willing to do,” Richard says. He questions why they could put him in a restraint chair and spit sock but couldn’t make him take medicine.

“If you get transported in the ambulance you have to take a sedative and you don’t have a choice in that,” Ryan adds.

In the days leading up to Dec. 17, 2016, Ryan was increasingly delusional, refusing to wear clothes, sometimes going days without sleep, sometimes sleeping all day. Jail staff asked the courts to bump him to the top of a priority list for a bed at the Colorado Mental Health Hospital in Pueblo. The day before a judge ordered an “emergency procedure” to get Ryan psychiatric help.

According to the lawsuit, jail records show that more than 24-hours later Ryan was still alone in his cell at the jail. Sometime that evening deputies began noticing dried blood on his face, but it wasn’t until after 9 p.m. that he was taken to medical. When he refused to cooperate, he was punched and tased, the lawsuit alleges. He was then transferred to Denver Health Medical Center where he was diagnosed with “self-inflicted ruptured global and retinal detachment, psychosis, schizoaffective disorder, chronic psychotic illness,” according to the lawsuit.

“Last time I talked to him,” before he gouged out his eyes, Richard says, “he asked if he was going to die in the jail.”

•  •  •  •

Boulder County Jail is notoriously overcrowded and understaffed, making resource-intensive inmates like Ryan challenging to manage. Neither Sheriff Pelle nor anyone else from the county would comment specifically on Ryan’s case, given the pending litigation. However, they all quickly acknowledge the inadequacies of the criminal justice system to take care of mental health needs, while explaining a variety of solutions at both the state and local level that seek to address the issue.

“The jail is not built to deal with mentally ill folks,” says Jeff Goetz, division chief at Boulder County Jail. “We’ve got hard fixtures, we have no padded cells here. We’re not designed to house that type of an individual. … And yet that’s what the expectation is.”

An October 2016 report on jail overcrowding by outside consultants found that on average Boulder County Jail sees more than 200 people a day with serious mental health problems. In late January 2017, a snapshot report provided by the Boulder County Sheriff’s Office states that of the 417 people at the jail that day, 43 percent had some sort of diagnosed mental illness.

“The goal is to get them out of here, not keep them here,” Goetz says. “Those are the worst folks to be in jail, they require the most resources, they are staff intensive.”

It costs the county $133 a day per inmate at the jail. The price is on average 20 percent higher for someone with a mental health issue.

While the population has only been growing over time, staffing hasn’t grown proportionately.

“We’ve been asking for more staff for 25 years,” Goetz says. A county commissioners’ review a few years ago revealed the jail was short-staffed by 30 people. Since then, the County has slowly allocated funding for new positions, but staffing is still nowhere near capacity.

Additionally, of the roughly 120 or so deputies who work at the jail, Goetz says only about a third of them have gone through the Crisis Intervention Training (CIT), which specifically addresses how to interact with people in a variety of mental health states using live role-playing.

The 40-hour trainings are conducted throughout the state with limited space for every law enforcement department. The Sheriff’s office gets about 10 spots a year, Goetz says, and jail staff only two or three of those. Plus, given staffing concerns, it can be difficult to pull deputies from jail rotation to complete the course.

In the mental health unit, the jail had the same two clinician positions since opening in 1987 until four years ago, Goetz says. Now, using a combination of in-house mental health clinicians and those contracted through Mental Health Partners (MHP), there’s funding for five full-time clinicians, one part-time position, a mental health supervisor and 16 hours of psychiatric care a week for diagnosis and prescriptions. However, three of the clinician positions are currently open.

Unlike other mental health jobs, jail clinicians don’t have a regular caseload and the work is often unpredictable. Some of the clients are “frequent flyers,” those who cycle through the system and know mental health staff. Others are new, from Boulder County or elsewhere. The jail clinicians aren’t conducting therapy sessions or counseling, rather they are assessing inmates as they come in, and, if need be, referring them to an MHP psychiatrist for diagnosis and prescriptions. They can have multiple people on suicide watch and others threatening the safety of jail staff, themselves or other inmates, causing them to be housed in a solitary cell for security reasons.

“Part of our dilemma is because staffing has been so short, [clinicians] don’t have time to eat lunch. It’s on the go, there’s no breath taking,” Goetz says. “You’re constantly going from person to person to person to person; you can only be here so many hours. And then when you’re not here, guess what’s waiting for when you get back? Six additional [cases], like the ones who came in last night.”

All of this can make it difficult to find adequate candidates for open mental health positions at the jail.

“The jail is a unique environment when it comes to being a mental health professional,” says Matt Jaeckel, the program manager at MHP. “It takes a skill set to be really adaptable, flexible at the drop of a hat. … The jail clinician role is really about triaging crisis immediately.”

Additionally, there are several other limitations the jail’s mental health staff faces. Privacy laws make sharing information between different agencies, facilities, parents and doctors impossible unless the inmate signs off on it. If an inmate is in a severe state, mental health staff can refer the person to a hospital on a mental health hold, which often allows treatment to help their mental health stabilize. But as soon as that occurs, the inmate is sent back to the jail, where they often regress. And jails aren’t licensed medical facilities, making things like forcing medication and/or treatment out of the question without violating the inmate’s rights.

“If they refuse, there’s nothing we can do. We can provide encouragement, but we can’t force those meds on them,” says Melanie Dreiling, the medical supervisor at Boulder County Jail. “Would it help to be able to force meds in the jail? Yeah, it would, because then we don’t have to wait for them to go to the state hospital to stabilize, we can try and stabilize them here. What would that take? Twenty-four-hour psychiatrists in mental health, which we don’t have the funding to do.”

Given all these limitations, there’s a certain point where jail staff simply can’t do anymore, Jaeckel says.

“Sometimes you just get to a place where the best thing we can do is try to contain [them] because we have no more interventions. We’ve reached our level of care, what’s in our scope, and that’s an interesting challenge,” he says. 

It can be easy to “feel helpless” at times, one clinician at the jail says. “It can be extremely heart wrenching for us, too.”

Statewide mental health resources are lacking as well, with inadequate space in state facilities, which are really the only option for jail and prison inmates.

“If you have an income and insurance and are willing to be treated, there are a lot of options,” Pelle says. “If you’re not one of the above, there are very few.”

The courts can order competency evaluations and/or treatment to ensure a person can aid their lawyers in their defence. But there is a severe statewide backlog as there aren’t enough resources in the state mental health hospitals to meet the demand. This year the state is promising $20 million to fund more beds for competency evaluations and restorations in jails and hospitals, increasing capacity by a few dozen or so. But with a 47 percent increase in requests for competency evaluations from 2016 to 2017, critics argue this is far from enough.

In Boulder County, the number of orders for competency evaluations has been rising from a low-point of 10 in 2002 to 99 last year. Jail staff says some inmates have been waiting 80-90 days for a bed to open up in a treatment facility, despite a 2012 settlement that requires inmates in Colorado to begin this process within 28 days of the court order.

“If someone has a heart attack we call for an ambulance and we send them to a hospital where they can be cared for at a trauma-care level. That doesn’t exist for mental health crisis,” Pelle says. “So we’re trying to take care of what we can take care of inside these walls, and sometimes it’s not enough.”

In addition to increased funding, the state is also working on a strategic plan to address mental health in the criminal justice system through a mental health and jail task force, on which Sheriff Pelle sits. He also works with a senate subcommittee on the issue as politicians try to find solutions through legislation.

“It’s such an incredible burden on our law enforcement and public safety professionals to be offering these kinds of services when it really needs to be in the public health space,” says Adam Zarrin, Gov. Hickenlooper’s policy advisor on justice, safety and transportation. “This is a public health problem and it needs to be addressed with those kinds of responses.”

The statewide task force is currently working on a 15-year strategic plan to address mental health in a way that keeps people out of the criminal justice system and, if they do end up in custody, ensuring access to adequate mental health services both while in jail and/or prison as well as upon their release. Additionally, the strategic plan addresses short term solutions within 3-5 years that mainly focus on building cross-agency collaboration. The report should be made public by the end of the month, Zarrin says. Then there’s the challenge of implementing and funding the strategic plan in the coming months in the midst of a governor’s election and changing administrations.

Despite these constraints, the Boulder County Sheriff’s Department, with state grants and community and County partners, have a number of programs to address mental health needs in the overall community. The EDGE program pairs mental health professionals with patrol officers in the hopes of de-escalating situations that result in law enforcement intervention and diverting people from jail. Despite its effectiveness, the program isn’t funded all hours of the day and isn’t available for certain parts of the county like Louisville, Lafayette and Erie. The PACE program is a resource for people with serious mental health and substance abuse issues and currently saves the County about 10,000 days of jail time a year by serving approximately 50 people with habitual tendencies, according to Pelle. Through the department of Health and Human Services, the Jail Based Behavioral Health Services provide resources for inmates with less acute mental health needs, including one on one and group therapy, case management and discharge planning.

“There’s more momentum and understanding behind this now than any time in my career. And there’s leaders in the legislature and state government that are interested and it’s getting everyone’s attention,” Pelle says. “And hopefully with an economy that has continued to be strong, hopefully there’ll be some funding at the state level to try and do things.”

In the end, none of these solutions provided Ryan with the necessary treatment to prevent him from severe self-harm. 

“Once he gouged his eyes out, then they got him out of there,” Shelley says. “But that’s the thing, they didn’t do anything until after, after it’s over. After it’s too late.”

•  •  •  •

Ryan’s memories from the two-and-a-half weeks he spent at the Denver hospital are “disjointed.” Still filled with conspiratorial thoughts and delusions, it was hard to really know what was going on. Although his parents were at the hospital, they say they weren’t allowed to go into the room with Ryan or touch him. It wasn’t until they visited him at the Colorado Mental Health Hospital in Pueblo weeks later that they finally were able to give him a hug.

“This was the first time we actually touched our son after all of this,” Richard says, as both he and Shelley tear up. “They bring Ryan out to the room and we’re hugging. He’s sitting down in the sofa, I’m rubbing his shoulders, he hasn’t had any touch. He’s talking to us…”

But the moment was short-lived. Soon someone came over and told the family not to touch each other. “They wouldn’t even let you hold hands,” Shelley says.

After roughly three weeks of treatment, including medication, Ryan’s mental health stabilized.

“I came back to myself there at Pueblo,” he says.

“It’s a lot for Ryan to digest — when he says he came back to himself, it means coming back to himself as he is now,” Shelley adds.

Ryan returned to his childhood home in North Boulder in mid-February last year. He continues his mental health treatment, including medication, at MHP. His parents, who have been separated for years, moved back under the same roof to care for their son. Shelley asked Busime to move in six months later to be an additional resource. She says it takes all of them just to make it through each day.

Ryan tries to keep himself busy: He works out at the rec center with either Richard or Busime. He often comes back and lifts weights at home, as well. He’s learning to play the ukulele and speak Spanish. He gives his family massages on a massage table in the basement. Sometimes he meets up with friends, or goes to a concert downtown with Busime. The two often sit and listen to music together.

“He’s really good at being out and being social,” Busime says. “I understand it’s not always easy for him but he’s open to it.”

Those are the good days.

The mornings are the most difficult, as Ryan often wakes up with painful muscles spasms around his eye sockets as tears run down his cheeks. Although he tends to get up early, sometimes he’s back in bed by early afternoon, spending the majority of the day sleeping. 

“It’s just a reprieve. It’s better than something else,” he says. “And I’m just physically tired, too.”

Comedy can also provide respite: Ryan has started listening to Dave Chappelle and Seinfeld, while his parents listen to him laughing from upstairs.

But in all reality, “His enjoyment of life is so altered by the blindness,” Shelley says.

In general, Ryan is more comfortable in his house than anywhere else. It’s the house he grew up in and he can navigate around its corners and through the doorways without using his white cane.

“We’re always trying to encourage him to come outside and get some fresh air and feel the sun,” Shelley says. “But he said to me once, when he’s in the house, his eyes are just closed. When he’s outside, he really knows he’s blind.”

The whole family has had to adjust, as both Shelley and Richard say their friend groups and social lives have drastically diminished. For now, the goal is simply to make it through each day.

“It’s one of those situations where it’s a day to day thing. You can’t really look too far into the future,” Busime says. “I never really give up hope, but I just try to maintain what can we do right now to not only make life a little easier for [Ryan] but also what can [he] do to enjoy it.”

Shelley adds, “I don’t think there’s a point right now to going beyond each day.”

“Unfortunately, the concept of justice doesn’t really exist in our justice system because no matter what the outcome of the case is, Ryan Partridge is going to be blind for the rest of his life,” Ryan’s attorney David Lane says. “The only thing that the American civil justice system can do is spit money out to try and make it as easy as possible.”