That same day Luis Nunez was freed from four-point restraints -- which bound him by the wrists and ankles, spread-eagled on a bare metal slab -- after a change in medication helped him to stop smashing his head against the wall until he bled. And he was better for a while. When I was there, he was on his feet and yelling, "Where are my shoes?!" But last week he was back in full restraints.
As sick as they are, Portelles and Nunez are not in a psychiatric facility. Where they should be.
Instead they are prisoners in the Miami-Dade County Jail, two of more than 325 men charged with felonies and even misdemeanors who are being heavily medicated and warehoused in small, cold, overcrowded and filthy cells in what has become the largest psychiatric facility in the state of Florida. And some have been there for up to two years.
Portelles, who is 40 years old, and Nunez, who is 38, were being held on C-Wing of the ninth floor, the maximum security section of the psych ward, where up to 40 inmates identified as acutely ill and extremely violent are held in 24-hour lockdown. If deemed suicidal, the men are kept in the nude, given only a paper gown or an indestructible nylon vest called a Ferguson garment -- too thick and unwieldy to use as a means of hanging themselves -- for cover. They are permitted no books, no pencil, not a stitch of clothing, nothing that could be fashioned into a weapon or a noose. Visitors are not allowed. The inmates are not taken out for exercise. They have no access to a telephone, nor to any window with a view of the outside world.
At times three and four men are jammed into a four-by-eight-foot cell that has one metal cot bolted to the wall. So some prisoners sleep on the floor. They sleep huddled together. Or sometimes they don't sleep; they babble, they pace, they pull out their hair, they bang their heads. Some spend the day shaking in withdrawal from the drugs they used on the street.
In each cell the overhead neon light is always on. The single bunk has no mattress or sheets. Food comes in Styrofoam boxes shoved through a slot in the steel door. Offered a shower three times a week, prisoners often refuse it. When the stench grows unbearable, guards pull uncooperative inmates out of their cells and slosh them down with a green garden hose.
It wasn't supposed to be this way. But with state hospitals closing, and few community-based health services available for mentally ill criminals considered a danger to themselves and others, three floors of the fifty-year-old jail at 1321 NW 13th St. now serve as the asylum of the new millennium. Thanks to psychotropic drugs that can sedate even the most disturbed prisoner, the jail isn't exactly bedlam. Outbursts of screaming and wailing, bouts of self-mutilation, and psychotic breakdowns where prisoners eat or throw their own feces are frequent but not constant. But even on the best of days, the jail's psych ward is a gloomy, forbidding madhouse.
To get off the elevator and walk into C-Wing is to journey backward, to take a trip to a dark age when mental illness was called lunacy, and lunatics were kept out of sight. The walls are painted bright blue, but there is no cheer. In the center of the tier is a glassed-in command center, where white-shirted medical technicians sit at computers as jacketed guards patrol the cell block, making notations on the condition of the suicidals every fifteen minutes: "Awake, asleep, agitated ..."
The metal doors and Plexiglas cell windows are dotted with the splatter of blood and other fluids. The odor of disinfectant barely rises over the smell of human despair. The stale air is cooled to just above frost, to keep the violence down.
In the cells the inmates curl in fetal balls. Or stare into space. Or at the visitors, blankly.
"It's hell, it truly is," says forensic psychologist Merry Haber. "Medieval. If you saw this in any other country you'd call it a human rights abuse."
Even the jail's staff admits that conditions are horrible, especially for the one-fourth of the jail's 1750 inmates suffering from mental illness. "It's a shocking environment: old, barbaric, archaic," sighs Joseph Poitier, the jail's chief psychiatrist for the past eight years. "Primarily we practice triage, and then it's management by medication. The jail environment is not conducive to traditional treatment. We do the best we can."