Inside The Nation's Largest Mental Institution The largest mental institution in the U.S. is actually a wing of Twin Towers, an L.A. County jail. The sheriff says it doesn't make sense to incarcerate the mentally ill, but as long as it's the only option, he's trying to make it work.

Inside The Nation's Largest Mental Institution

  • Download
  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript


It's MORNING EDITION from NPR News. I'm Renee Montagne.


And I'm Steve Inskeep. This morning, we're going inside the largest mental-health institution in the country.

(Soundbite of banging)

MONTAGNE: Here, they're not only patients, they're inmates.

(Soundbite of banging)

Unidentified Woman #1: Clear.

We're entering the Los Angeles County Jail, known as the Twin Towers. The name comes from its two hulking structures, one of which mostly houses the mentally ill - about 1,400 arrested for a range of crimes: trespassing to murder.

This is a stop in our series on who's behind bars in America. That's one out of every hundred adults, a sizable percentage severely mentally ill.

Unidentified Man #1: (unintelligible)

MONTAGNE: At L.A.'s Twin Towers, there's one floor devoted to what they call the sickest of the sick.

Unidentified Man #2: (unintelligible)

MONTAGNE: In every respect, this floor resembles a mental hospital. This man was brought in delusional and combative.

Unidentified Man #2: (unintelligible)

MONTAGNE: More than a dozen deputies restrain him until he can be injected with a short-acting dose of an antipsychotic drug. The entire ordeal is videotaped to protect him and the deputies, to make sure everything is done according to procedure.

Unidentified Man #4: The inmate was placed in four-point restraints without incident, given medication by a 342 medical staff - includes the restraint in the tape, please.

MONTAGNE: Until the 1970s, the mentally ill were usually treated in public psychiatric hospitals - insane asylums, as they were known at the time.

Then a social movement aimed at freeing patients from big, overcrowded and often squalid state hospitals succeeded. What didn't happen, mostly, was the emergence of better treatment in small community settings. So, says L.A. County Sheriff Lee Baca, tens of thousands of mentally ill ended up on the streets.

Sheriff LEE BACA (Los Angeles County): The fact of people walking the streets that were in need of mental care became the subject of criminal activity, where law enforcement had to pick up that role and thereby put them in jail for minor crimes. And some were major crimes, but most of it's minor.

MONTAGNE: Sheriff Baca has become an unlikely advocate for the mentally ill, and as long as they're housed in his Twin Towers, the sheriff is determined to treat them.

Unidentified Man #5: All right, 171?

Unidentified Man #6: We have two inmates to bring up.

MONTAGNE: Every morning here begins with a meeting of the medical staff from the county's Department of Mental Health, case workers and guards who often function as de facto case workers.

Unidentified Man #6: I guess a nurse is talking to him right now. He was saying that he still didn't want to eat. He says there's ants in his cereal.

Unidentified Man #5: Has the psychiatrist ordered weekly weights on him?

Unidentified Woman #2: Not to my knowledge.

Unidentified Man #5: You probably want to make sure that they have that.

MONTAGNE: Arakel Davtian is one of the psychiatrists sitting in this large circle. About half of those locked up at the Twin Towers are in for serious and sometimes violent crimes.

What strikes Dr. Davtian is how little it takes for the other half to end up here.

Dr. ARAKAL DAVTIAN (Psychiatrist, Los Angeles County Jail): Indecent exposure, having open containers, peeing on the street, disturbing the peace.

MONTAGNE: Often, the crimes these people commit are the result of their mental illness, he says, thinking of one inmate in particular who was arrested for false identity. The police wanted his name, and he gave them a series of different ones.

Dr. DAVTIAN: In the court, he does the same thing. You know, he talks this gibberish thing. The judge said, go. You are incompetent to stand trial. Next court date: six months from the time he got arrested.

MONTAGNE: Dr. Davtian said when the man came in here to the Twin Towers, he started treating him for schizophrenia.

But he came in, and you worked with him, put him on medication, got him to the point where you could make sense out of his story and so could he. In a strange way, is that a positive?

Dr. DAVTIAN: Absolutely that is, and this is the place for them. I mean, how many times I get a phone call from the family member saying please, don't let him go. Keep him in jail. Start treatment, because he is not going to take medications. He's not going to any psychiatric facility. So it's a very, very important place.

Unidentified Man #7: (unintelligible)

MONTAGNE: Just outside a rec room where other inmates are playing basketball, we're sitting talking to two inmates. Scott is here for shoplifting. He's 21 and didn't want to give his last name, but he's fully aware that he needs help.

SCOTT: I have a lot of mental problems, mostly caused just by, through life, just what I've been through. I got ran over when I was 7. I'm schizophrenic-paranoid, where I think everybody's watching me and I'm being judged and all this stuff is going on, which is kind of true and kind of not.

MONTAGNE: An older inmate sees himself quite differently. Lawrence says he was picked up for stealing sweaters out of a car on a cold day. [POST-BROADCAST NOTE: Twin Towers requested his last name be withheld for privacy reasons]

LAWRENCE: They wanted to give me burglary of a vehicle, a felony. So - because that's the charge, I pretended I was nuts. So ever since then, I've been hooked up with mental quarter - facilities.

MONTAGNE: In fact, inmates claiming to be crazy is a problem here, which is why they're screened to keep out those looking for easier time in the psychiatric wing. Lawrence's story seems plausible until I ask him what he's going to do when he gets out.

LAWRENCE: Try and go - I'm going back East. I'm going back to New York because I have some financial friends there. I know Mr. Carl Icahn, the billionaire.

MONTAGNE: Mr. Carl Icahn.

LAWRENCE: He's my friend, yeah. So I got some money. You know, I've got a lot of money. I've been working with him since 1968, you know, helping him - trying to help him build his empire. I have a little bit of his empire, so I'm going to go back there and just live real good, you know.

(Soundbite of laughter)

Unidentified Woman #3: So you're going to breathe in, everyone. Breathe in, not - slowly. Breathe in, and go…

MONTAGNE: We're now in an area where high-observation inmates are housed and where, to help them cope, the jail offers socialization classes, this one held in a common area.

Unidentified Woman #3: So, okay, I'm upset. Whatever it may be, I'm upset. I'm not getting my way, or I don't feel I'm being treated correctly. You - relax.

MONTAGNE: About a dozen inmates are fully engaged in these exercises. Others sit listlessly at tables, some wearing ponchos that deputies call suicide gowns. Those still in the cells that line the back wall stare out at us, and from the security of a glassed-in station, William Hong and other deputies keep an eye on them day and night. It's an unsettling sight.

Deputy WILLIAM HONG (Los Angeles County Jail): A lot of these inmates do have a chain around their wrist that I tie to the bench for the civilian workers' safety.

MONTAGNE: There are cells, and I mean, I say cells, but these are doors with glass on them. I can see inmates who seem to be nearly naked.

Dep. HONG: Yeah, it looks like he is naked up there, and you'll see that often up here. A lot of them, they just don't want to get dressed.

MONTAGNE: Do you think differently about these inmates than you do about an inmate who is in full command of his mental state? Do you find yourself having more sympathy for these guys?

Dep. HONG: I'd like to think that I'm just doing my job, you know, with the task that's given to me. You know, these people require not necessarily a sympathy, but it's more of a compassion.

You work with them every day and, you know, you start realizing that these are people also.

MONTAGNE: Deputy Hong and the medical staff here take pride in this facility. Still, L.A. Sheriff Lee Baca says it shouldn't be this way.

Sheriff BACA: Incarcerating the mentally ill, for a large portion of this population, is not the right thing to do. Now they're here, and they're going to be cared for, but is this what we want in the way of a policy?

Are we saying, literally, that the legal system is the solution for the mental-ill problem? I don't think so. Criminals are the ones that belong in jail, not the mentally ill.

MONTAGNE: Sheriff Baca has been saying this since he took over the Twin Towers a decade ago, and the psychiatric wing still has all the inmates it can handle.

INSKEEP: We've been reporting this week on the nation's expanding prison population, and as we've heard, that population includes many women and the mentally ill.

A huge proportion of prisoners are placed in custody on drug charges, and tomorrow, we will find out why Texas is experimenting with a court aimed at keeping drug offenders out of jail.

Unidentified Man #8: A person who relapses on drugs needs further treatment. The least-effective thing you can do is put them in jail for jail's sake. The research is clear on that.

Copyright © 2008 NPR. All rights reserved. Visit our website terms of use and permissions pages at for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.