Ronald Gene Given thought someone was trying to kill him.
On a Tuesday morning in January 2019, he went into a Tractor Supply Co. store in Shawnee, grabbed a shopping cart and started to ram it against the shop’s windows. He pulled clothes off racks and threw them onto the concrete floor.
He was trying to make a commotion, he told store employees, urging them to call the police. After all, Given said, his life was in danger.
Shawnee police officers took Given, 42, from the store to St. Anthony Hospital Shawnee Hospital for evaluation, where health care workers cleared him medically but deemed him in need of emergency detention at a state behavioral health center, according to an incident report.
But every state mental health center in Oklahoma was full. Given later died after officers restrained him during a struggle at the Pottawatomie County jail.
Given’s death illustrates the challenges and shortcomings that law enforcement and detention facilities grapple with to care for people with mental health or substance use problems, a group that steadily floods county jails.
More than three years after Oklahoma voters approved a measure to fund county-level mental health and substance abuse treatment services, the Legislature has yet to send any of the promised funds. For years, a lack of resources and funds have plagued both the prevention and crisis treatment sides of Oklahoma’s mental health and substance abuse system, experts and advocates say. By default, many who need treatment end up in the state’s jails.
Tossed into a criminal justice system that is neither designed nor equipped to effectively handle the tide of individuals with mental illness or substance abuse issues, and with little oversight from state regulators, the result is sometimes injury or death.
Sheriffs and jail staff are often the first to admit they are ill-equipped to handle these people, who come with a unique set of needs, such as heightened monitoring and specialized medical care.
The issue is especially acute in Oklahoma’s rural counties where there are fewer treatment options and limited — sometimes nil — emergency mental health professionals to aid people in the throes of mental health crises. Law enforcement officers are typically the lone first responders.
Compounding the problem is a lack of effective oversight over county jails. The state’s jail inspection division, which falls under the Oklahoma State Department of Health, surveys jails and investigates deaths, but can do little to penalize jails when it identifies shortcomings.
The outcomes can be deadly.
With no mental health beds available in the state, Given stayed the night at the hospital in Shawnee.
Officers waited with him, taking turns in shifts until they could transport him to a facility.
About 12 hours into the stay, Given stood up from his hospital bed and decided it was time to leave. He stripped off his hospital gown along with one of his socks and started to walk toward the room’s door.
“Get out of the way. I’m leaving,” Given told officers, according to an incident report.
Officers told the man to get back in bed, but instead Given got into a “fighting stance,” balled up his fists and said he was going to make them move. He stepped forward and pushed one of the officers in the shoulder.
Police arrested Given. As an officer started to lead him to a patrol car, the incident report states, he was “passively resisting” by pushing against the officer and rambling indecipherably. Once in the car, he strained his body in an attempt to break free from the cuffs.
Officers returned to the hospital and obtained a form from an ER doctor stating Given was fit for incarceration, the incident report says.
Given was booked into the Pottawatomie County Public Safety Center for assault and battery on a police officer just before 1 a.m., where he stayed for less than 10 hours before he was released on a medical bond, according to a jail release report. He died in an Oklahoma City hospital about a week later.
Since Jan. 1, 2014, nearly 180 people have died in the custody of a jail, or after becoming injured or ill in a jail, according to a Frontier analysis of data from the state’s Medical Examiner.
At least 52 people died by suicide in city or county jails, which was the second most common cause of death only behind natural causes and medical emergencies. In many other deaths — such as Given’s — the medical examiner noted mental health problems.
About two dozen people died from causes stemming from drug use.
“You’re asking sheriffs in rural counties who operate these jails to take care of, essentially, individuals who have untreated mental illness while they’re in their jail with almost no resources,” said Mike Brose, CEO of Mental Health Association Oklahoma.
The County Community Safety Investment Fund was supposed to offer county jails some relief.
Oklahoma voters passed State Questions 780 and 781 in 2016. While SQ 780 lessened penalties for simple drug possession and theft, SQ 781 directed that the money saved from lessening those penalties go into a fund for counties to provide community-based mental health and substance abuse services.
The Oklahoma Legislature has yet to appropriate any money into the County Community Safety Investment Fund promised by SQ 781.
Though Gov. Kevin Stitt initially called for $10 million to go into the fund, he later signed a budget that instead sent the money to the Oklahoma Department of Mental Health and Substance Abuse Services’ Smart on Crime Initiative, which aims to divert nonviolent offenders living with mental illness and addiction away from the criminal justice system, and into intervention and treatment programs. The program also provides training to law enforcement responding to mental health crises.
ODMHSAS used the $10 million to fund 175 residential substance abuse treatment beds across the state, which are expected to shorten the state waiting list for those beds by 75%, according to the agency’s fiscal year 2021 budget request.
In the agency’s request, the ODMHSAS originally requested $80.2 million to implement Smart on Crime programs, which include treatment and diversion services. The agency later amended the request to about $115.7 million in order to fund misdemeanor diversion programs.
“We have not given mental health and substance abuse issues due attention. In the end, this has led to a fractured and fragmented system of care,” the request stated.
State leaders determined that putting the funds into the initiative would “best achieve everyone’s shared vision,” said Baylee Lakey, a spokeswoman for Stitt, in an email. The program, among other initiatives, aims to expand mental health services and drug courts in each of the state’s 77 counties, she said.
“Both the governor and the Legislature shared a goal of increasing support for programs that give Oklahomans a second chance, that expand access to alternative programs, and that address our high ranking in incarceration,” Lakey said.
Lakey said largely because of SQ 780 reforms, the Department of Corrections has seen a 7.6% decrease in the prison population.
Dewey County Sheriff Clay Sander is on a 22-member council that is chaired by Attorney General Mike Hunter. The council recently recommended SQ 781 funds be distributed on a county level.
“I can tell you in Dewey County we have not seen any benefits from that program,” Sander said of the Smart on Crime Initiative.
The Dewey County jail typically houses 20 to 30 inmates on any given day, Sander said. About half of them have mental health or substance use problems. The county has no treatment facilities, he said. The closest is almost a 40-minute drive away.
“(State Question 781) was supposed to be available locally, but we’re finding it’s not there to provide it locally,” he said.
Between 700,000 and 900,000 Oklahomans need behavioral health services, according to ODMHSAS. However, only one in three accesses treatment.
There are 632 state-operated crisis and inpatient mental health beds across Oklahoma, which are considered the mental health system’s safety net, advocates say. The state also has about 670 inpatient substance use treatment beds. The wait time for those beds recently has stretched up to six months, according to ODMHSAS.
About 10 years ago, ODMHSAS requested state funding for five additional crisis units. So far, the agency has been able to fund three. However, as funding has diminished for outpatient services, the demand for crisis care has grown. The state could now use three more facilities, agency officials have said.
Meanwhile, there are 16,106 spots in the state’s 131 city and county detention and lockup facilities.
“I only speak for myself, but like any sheriff on the face of earth that has the responsibility of running a jail will tell you, jail is the biggest mental health facility in any community,” said Rogers County Sheriff Scott Walton.
“And I certainly don’t like that.”
Agencies offer little information related to Given’s death
Ronald Given lived in Shawnee, a city of a little more than 30,000 people located 40 miles east of Oklahoma City.
His friends called him “Happy” because of the loud, deep laugh and boisterous voice he had, said Glenn Blankenship, director of the Shawnee Rescue Mission, a nonprofit Given received services from.
“He laughed at everything all the time,” Blankenship said. “Everyone loved him.”
The pair met about 10 years ago while Blankenship was running a day center in Shawnee for people experiencing or at risk of homelessness. Throughout the years, Blankenship said, his friend struggled with mental health problems and substance misuse, but for months, Given seemed to be on the road to recovery, only drinking alcohol maybe once per month.
His death “came out of nowhere,” Blankenship said.
It’s unclear what happened to Given at the jail.
A report from the state’s medical examiner found Given died from organ failure caused by cardiac arrhythmia from struggling as officers restrained him. Given became ill or injured at the jail and the death was ruled a homicide, the report stated. The report noted he had a violent mental disorder.
The Frontier requested video and incident reports for Given related to any injury or use of force at the jail, but the jail refused to provide any records other than Given’s booking and release reports, claiming all others were exempt from the Oklahoma Open Records Act.
The jail staff did not report his death or injuries to the state health department’s jail inspection division. The jail was not required to report the incident because Given did not die at the jail, said health department spokeswoman Jamie Dukes.
Breonna Thompson, director of the Pottawatomie County jail, did not return multiple messages from The Frontier requesting an interview.
Cpl. Vivian Lozano-Stafford, a spokeswoman for the Shawnee Police Department, said the department was told there was a struggle between Given and jail staff.
Asked how often mental health facilities are full, Lozano-Stafford said: “There are many times that there is no mental health facility available in the state.”
She added that officers will wait with someone at a hospital as long as necessary until a bed is available.
“It might be several hours,” Lozano-Stafford said in an email.
The Oklahoma State Bureau of Investigation opened an inquiry into Given’s death in 2019 and passed the findings along to Pottawatomie County’s district attorney.
District Attorney Allan Grubb refused to release the investigation’s findings after a spokesman for his office initially offered to let a Frontier reporter review the document.
Grubb has not filed criminal charges in connection with Given’s death.
Many people come into detention centers with serious untreated medical and mental health issues that few Oklahoma jails are equipped to treat.
State jail standards require facilities to complete intake screenings on inmates using at minimum, a medical and mental health questionnaire approved by the Oklahoma State Department of Health. The process does not require medical personnel.
When an inmate shows “significant” signs of mental illness, jail staff are required to monitor them “frequently,” the standards state, and the inmate must be evaluated by a medical professional.
Few Oklahoma jails have in-house health care delivery services, but some have nurses that will visit periodically, advocates and experts say.
Jail standards require facilities to have a plan for medical emergencies, such as identifying a designated emergency room or ambulance service. Determining what constitutes a medical emergency frequently falls to jail staff.
Diana Ortega is a licensed practical nurse and the medical supervisor at the Comanche County Detention Center in Lawton, a city with a population of about 93,000 people in southwest Oklahoma. She said the jail typically houses more than 300 inmates. About half of them receive treatment for mental health issues.
“We’re the last resort,” Ortega said.
Inmates with mental health issues there used to receive free medication from the Jim Taliaferro Mental Health Center, but following budget cuts to ODMHSAS, the clinic stopped in 2017.
Ortega said she and a medical assistant provide the only health care within the facility. It’s difficult to get doctors outside the jail to see inmates, she said. The jail often has to send them to the emergency room.
She gave an example of a mentally-ill man who was awaiting sentencing at the jail who refused to eat. Ortega had to send him to the hospital several times.
“Now it’s back in my lap of taking care of someone who is mental health,” she said. “My thought is, ‘please don’t let him die on my shift.’ I want someone to help me take care of him. I’ll send him back (to the hospital) every day if I have to.”
In 2019, 20 people died after becoming injured or ill in Oklahoma jails, records show. Of those, only one was in jail as a result of being convicted of a crime. The rest were either being held in pre-trial detention or had yet to be formally charged.
The Frontier reviewed five years of jail incident and inspection reports and found many inmates reportedly showed signs of mental health or substance use problems before their deaths.
However, it’s impossible to say exactly how many.
Detention centers are required to report deaths and serious injuries to the state’s jail inspector, but the agency does not require jails to report whether the inmate had mental health issues.
The jail inspection division investigates deaths and may issue reports citing any violations of state jail standards. However, it cannot issue fines or carry out any other punitive action.
Christina Tahhahwah was in the middle of a mental health episode when she was taken to the Lawton city jail in 2014, according to records filed in a lawsuit Tahhahwah’s family brought against the city of Lawton.
Tahhahwah, who had bipolar disorder, was at her grandfather’s home in Lawton when her family called 911 after Tahhahwah threw a cup of milk at a relative on Nov. 13, 2014. Her family, Tahhahwah’s father testified in the federal lawsuit, had asked police to take her to a nearby community mental health center.
Instead, officers took her to jail.
Tahhahwah, 37, was “banging and kicking” the bunk in her cell, court records show. The morning after Tahhahwah was booked into the jail, at about 11:48, officers cuffed her to the cell’s bars with her hands above her head, records show.
Just over an hour later, officers found Tahhahwah unresponsive, according to records. Emergency responders transported her to a local hospital where she was pronounced dead.
Dr. John Buck Hill, an anesthesiologist hired by Tahhahwah’s family to testify in the case, stated in a report that the position Tahhahwah was restrained in likely reduced her lung capacity and left her struggling to breathe. Hill noted that Tahhahwah was severely obese, which made the posture particularly dangerous for her.
The position likely led to a buildup of carbon dioxide in her body that caused her to go into sudden cardiac arrest, he said.
The medical examiner found Tahhahwah died after going into cardiac arrest. The medical examiner’s report noted that she was restrained, but stated it was unclear how it contributed to her death.
Tahhahwah’s family sued the city of Lawton for negligence, failing to provide health care and using excessive force. The case settled for $275,000 in 2018.
The city of Lawton did not return a message seeking comment.
Brose, the CEO of Mental Health Association Oklahoma, said Tahhahwah’s death was “tragic.”
“It represents things that happen in incarcerated settings,” he said. “And it’s a horrible situation, but make no mistake — variations of these happen and we can do a lot better with what we have at our disposal.”
Damion Shade, a criminal justice policy analyst at Oklahoma Policy Institute, a think tank, said the state particularly lacks resources in rural areas and was critical that law enforcement officers are expected to be the first responders to someone in the midst of a mental health crisis.
“A lot of times, it’s very unfair what we do to police. … Many of them want to do the right thing for their community,” Shade said. “They want to do good.”
Shade said there are many cases when officers are “forced” to take people to jail when there are a lack of treatment options in the area.
“If we really value our police officers, if we really value our law enforcement, we should not force them to have to decide what to do with someone who needs treatment when their only option is jail,” he said.
In some cases, advocates and experts say, it’s easier for resource-strained law enforcement agencies to take a person to jail instead of transporting them hours away to a state mental health facility that has a vacant space.
“I know law enforcement doesn’t always like to do transportations across the state because they might not have a bed space available in their region, but we have a bed space available in Ft. Supply or we have a bed space in Muskogee or wherever the place is,” said Durand Crosby, chief of staff and operations at ODMHSAS.
“And I actually get law enforcement’s trepidation to that. They’re tasked.”
‘The system is not equipped’
The Oklahoma Criminal Justice Reclassification Coordination Council, chaired by Attorney General Mike Hunter, released a report on December 31 that listed recommendations on how to improve the state’s criminal justice system, including increased mental health and diversion program access.
Mental health and substance abuse issues were two of the main focuses of the council, which met throughout 2019.
“Throughout the meetings, it became clear the criminal justice system is becoming saturated with individuals with mental health and addiction issues,” the report states. “and the system is not properly equipped to meet all the needs.”
County jails were especially not equipped, the report noted, and council members recommended the state explore diversion programs that would help people avoid jails entirely.
“Cleveland County Sheriff Todd Gibson presented to the Council and explained that the counties are not financially equipped to provide the mental health and rehabilitative services required for inmates at the county level,” the report said.
Gibson also noted in the report that jails were housing an influx of people with mental health and substance misuse issues in jails because of fewer felony possession arrests and more misdemeanor possession arrests following the passage of SQ 780.
The Office of Management and Enterprise Services estimated SQ 780 reforms saved the state $26.8 million in fiscal year 2019. The agency faced criticism when it projected $63.5 million in savings in FY 2018. At the time, the Department of Corrections and others called the estimate calculations flawed and inflated.
Ryan Gentzler is the director of Open Justice Oklahoma at the Oklahoma Policy Institute. He said the FY 2019 calculation was “much closer to reality.”
“But we believe it still overstates the savings associated with SQ 780,” Gentzler said.
He added: “That said, we know that SQ 780 is averting many prison days associated with low-level offenses, and funding treatment services through SQ 781 at a significant but realistic level should be a priority for the Legislature this year.”
When presenting the new calculation at a House interim study at the Capitol in October 2019, OMES acknowledged the actual savings are difficult to measure.
Shade said although counties would likely see some benefits from ODMHSAS’ initiative, much of the programs aim to divert people from going into the Department of Corrections’ system.
Voters passed SQ 780 and SQ 781 because they wanted people struggling with addiction or mental health to get treatment before law enforcement involvement, Shade said. Because the counties were promised those funds, the money should be invested in treatment, he said.
“Because that’s what people voted for,” Shade said. “In the process of decriminalizing, we’re creating a system where more people are in the county jail structure.
“The only way not to be overburdensome is if we invest in treatment that allows many, many more people to go into treatment before jail.”