This day at Rockingham County jail, Kenneth Pratt feels neither too high nor too low.
The middle is a good place to be for a person with bipolar disorder. Jail and its 8-by-12 cells is not, he said.
Pratt, 46, is among an estimated 15 percent of the county jail population with severe mental illness. Many others are affected but less debilitated, jail officials say.
And, they add, the number of those with severe mental illness like schizophrenia, bipolar disorder and clinical depression is growing among the 310 inmates at the sprawling block-and-steel complex in Brentwood.
Half of the 310 Rockingham Jail prisoners are being held prior to their trial for charges ranging from shoplifting to murder. The other half, those sentenced by a judge to Rockingham, are serving sentences of one year or less per conviction.
More severely mentally ill inmates at Rockingham mean more disruptions for the 83 corrections officers, more stress for other inmates and hard times for those who are suffering, said Superintendent Al Wright, who sometimes feels like he's running a psychiatric ward.
"I tell people I'm the superintendent of Rockingham County jail, the biggest provider of services for the mentally ill in the county," he said.
Landing in jail
Many mentally ill people arrested on trespassing, alcohol or petty theft charges are brought by police to Brentwood because they can't make bail, according to Helen Watkins, the jail's mental health counselor.
Often they arrive for minor crimes, ineligible for personal recognizance bail because they have no job, family ties or place to live.
Also, there is a shortage of psychiatric beds at the state hospital - down from 3,000 beds in the 1960s to 300 today. This leaves police little choice but to transport mentally ill suspects to jail.
Watkins said many jailings could be avoided if there were peer-support programs or drop-in centers, where someone would recognize when symptoms are worsening.
She pointed to a recent case involving a 23-year-old man committed to the state hospital in early April. He spent three days there before doctors referred him to an outpatient community mental health center, she said. But there he was confronted by a month-long waiting list.
A week before the appointment, Watkins said, he had a second psychotic episode that resulted in his arrest. He was catatonic by the time Watkins saw him under suicide watch in a jail cell, she said.
"It's way too difficult and way too many doors are shut," Watkins said.
Watkins and Pratt think Pratt's incarceration could have been avoided, too.
Pratt was hearing voices and having hallucinations on Oct. 7, 2005, when he set fire to a wood pile in a driveway near a home in Portsmouth.
"I don't even remember doing it," Pratt said
He was sentenced to 345 days pretrial confinement, 12 months in jail and two years probation. After serving 18 months of his sentence, he was released to CrossRoads shelter for the homeless in Portsmouth in early May.
Here and elsewhere
Rockingham County jail isn't alone in incarcerating people who may be better served elsewhere.
According to the most recent report from the Justice Department's Bureau of Justice Statistics, about 283,800 mentally ill offenders were held in the nation's state and federal prisons and local jails in 1998. Additionally, 547,800 mentally ill people were on probation, the report said.
In New Hampshire, an estimated 27 percent of the 2,670 inmates in the prison population have some form of mental illness and are taking medication. Additionally, about 35 percent of incarcerated men and 50 to 60 percent of women may have mental health issues for which they are not being treated, said prison spokesman Jeff Lyons.
Lyons wouldn't say the system is breaking down, however. It has a trained staff of 20 psychologists and social workers to help mentally ill inmates, he said.
Nationally, however, the corrections system is being crushed under the weight of caring for the mentally ill, said Ken Braiterman, a coordinator with the National Alliance for the Mentally Ill in New Hampshire.
Treatment has never been better for mental illness, but it has never been harder for those in need to get it, he said. Funding shortages leave community mental health centers understaffed with underpaid workers who are buried beneath heavy caseloads.
Braiterman said jail is the worst place for the seriously mentally ill. They are isolated, ostracized and vulnerable, he said.
"Nobody wants to be their roommate," he said. "They sometimes act out or don't know how to act or how to talk to people."
Effects on other inmates
Two county jail inmates not diagnosed with a mental illness and incarcerated for the first time agree that life is hard in the cell blocks for those with psychological problems.
Some unafflicted inmates make fun of or bully them, said John Skorich and Larry McCrum. Some, alarmed, keep their distance.
A disturbed man who shaves his eyebrows and cuts himself is reason for concern, said Skorich, 51, a Seacoast-area resident who is doing time for failure to pay alimony.
"Let's face it, you think 'What's next?'" he said. "You are already not having a great day and this on top of it just adds to it."
McCrum, 56, of Derry, jailed on alcohol-related charges, said the odd behavior of disturbed inmates is stressful, especially to new inmates. And stress has a ripple effect on corrections officers, healthier inmates and others who are afflicted with mental illness.
Some mentally ill inmates cover themselves with feces or food, McCrum said.
Skorich described this behavior as "war paint mode." He thinks inmates whose mental problems are that severe need a special facility.
The state prison has a secure psychiatric unit but it can accommodate few, Rockingham Corrections Capt. Stephen Church said. It can take weeks to find room for a new inmate, he said.
Church said the number of severely mentally ill at the Rockingham facility has swelled in his 19 years. It's much more common now for an inmate to physically attack someone or threaten to do so.
What was infrequent now occurs almost daily, he said.
Suicide is every superintendent's worst nightmare, Wright said.
Rockingham County Jail has had two suicides in 25 years, but there are many more attempts, a dozen a year by Church's estimate.
Pratt, the inmate with bipolar disorder, said an inmate in a cell across from his unsuccessfully tried to commit suicide in the spring by hanging himself from his bunk with strips of bed sheets.
Wright said prisoners in danger of hurting themselves at Rockingham Jail are moved to cells in the booking area where they can be constantly observed.
Typically these are for new arrivals, but at times as many as five of the seven cells are occupied by people on suicide watch, Wright said.
The narrow L-shaped booking area processes some 4,000 inmates in and out of the facility each year. While calm expedites the work, chaos sometimes reigns as those under observation scream, kick and take swipes at officers.
In a tour of the area, smelling strongly of cleaning agents, a corrections officer pointed to scratches on a cell's plexiglass window made by a disturbed inmate.
Often after mentally ill inmates are released from Rockingham County Jail, they have nowhere to go. They end up on the street and reoffend: shoplifting out of hunger or trespassing out of homelessness.
Wright said he knows of at least one person jailed there five times in one year.
Many of the mentally ill people depend on Social Security benefits for income. When incarcerated for more than 30 days, the benefits stop. It can take a long time for reinstatement, Watkins said.
Without cash, it's hard to find housing or to afford a telephone or transportation to apply for food stamps or mental health services, she said.
Wright and Watkins want change. They are meeting with community mental health and other agencies, as well as police and judicial officials as they seek prevention programs, more psychiatric beds and alternatives to jail for the severely mentally ill.
Watkins said prevention is less expensive than incarceration, both in human and economic costs.
Their work, and that of others, is bearing fruit.
A drop-in center run by the mentally ill for the mentally ill recently opened on Islington Street in Portsmouth.
The state has two mental health courts open; a third pilot program is in the works; and there is interest in starting one in Rockingham County.
In these courtrooms, people accused of a misdemeanor, nonviolent crime can be sent to treatment instead of jail. The purpose is to speed up treatment for those in need and to reduce recidivism
"Getting them help, getting them stabilized can head off reincarceration," Watkins said.