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At 19, Glen Yerkey notched his first arrest, an act that branded him a criminal. Today, his rap sheet of thefts and petty crimes is so long, his stays behind bars so many, that he sees no meaningful future.

Yerkey is 26.

He can't find a job or a place to live. With few options, he wonders how he can escape a life of crime.

"I can't stand it," Yerkey, who's living with his mother on James Island, said. "I'm disgusted with my situation."

Yerkey contends his problems, in large part, are rooted in his struggles with bipolar disorder. For years, he has suffered manic highs (like the time he took an MUSC hospital bus on a joy ride) and severe lows (which he medicated with alcohol and illegal drugs).

But like tens of thousands of mentally ill people across the nation, Yerkey's troubles are often more apt to land him in a jail cell than in treatment.

Prisons and jails have become the new asylums for those who once might have ended up in psychiatric hospitals or other care, experts say.

"There is a clear consensus that prisons are now the largest mental hospitals," said Dr. Harold Morgan, a long-time forensic psychiatrist in Columbia who examined seriously ill inmates to take part in the recent class-action lawsuit against the state Department of Corrections.

About 40 percent of people with serious mental illnesses today have been in jail or prison at some point, studies show.

In South Carolina, at least five times more are in jails and prisons than in hospitals, a 2010 study by the nonprofit Advocacy Treatment Center and the National Sheriffs' Association found.

Only three states - Nevada, Arizona and Texas - had higher rates.

And when the advocacy center's researchers released a new report about the problem last week, what did they have to say about South Carolina?

"The state ranks near the bottom on availability of public psychiatric beds, efforts to divert mentally ill individuals, per capita state mental health expenditures, and almost every other measure of treatment for mentally ill individuals."

Dueling cuts

Two key factors appear to be fueling a shift toward criminalizing the mentally ill: severe cuts in both overall state mental health funding and psychiatric hospital beds.

Since the 1960s, the state's Department of Mental Health and private hospitals have dramatically reduced their inpatient beds and sent patients to their local communities to receive care. The move was lauded as more humane, and potentially cheaper, than lives spent institutionalized.

But did it go too far?

"Family care became the only option for these patients," said Marian Rzepkowski, Charleston area president of the National Alliance on Mental Illness. "Those with severe mental illness were often not getting proper care and medication. Families were not equipped, nor educated, to handle it all."

Yet, even after closures of entire psychiatric hospitals, the number of state adult inpatient beds continues to drop. In 2000, the state mental health agency had about 1,036. Today, its daily adult inpatient census dips below 490.

"There are people who need a higher level of care but that is not always available, or they have to wait a long time," said Dr. Ana Gomez, a forensic psychiatrist at MUSC who works with mental illness in the corrections system. "That's really what is driving this."

Then the recent economic downturn hit.

State lawmakers have cut the mental health agency's appropriations by 40 percent since 2008, from $220.2 million to less than $132 million in early 2012. Medicaid reimbursements also have decreased, said Mark Binkley, the agency's deputy director and general counsel.

Over the past two years, things have looked brighter. The agency received nearly $44.9 million more in state funds and is on target to receive a boost this year, too.

However, only a fraction of that increase - $15.2 million - replenished the earlier cuts.

Most was earmarked for employee benefits or for specific initiatives such as the Sexually Violent Predator program, which houses the state's most dangerous sex offenders indefinitely for the purpose of treatment. A much smaller amount was targeted at the community services most patients rely on, and no additional funding has gone to new inpatient beds.

Improvements would cost money. And the mentally ill aren't a powerful voting block.

"They're politically neglected," Morgan said. "They don't have the clout and so the legislature turns a blind eye."

But does it just cost more in the end?

Prisoners with mental illness cost the nation $9 billion annually. They tend to cost more, stay longer and are far more likely to commit suicide than other inmates, according to NAMI, a top advocacy group. An estimated 3,500 inmates with mental illnesses are housed in South Carolina's prison system.

"It creates a real burden on the Department of Corrections to treat these people," Morgan said. "And they aren't getting the care they need."

Plus, going to prison means people losing jobs, losing homes, losing contact with family and losing hope for their futures. And just where do mentally ill inmates go after they leave prison or jail?

"They just open the door and let you go," Morgan said. "It's a revolving door."

Florida Southern College criminology professor Risdon Slate, co-author of "Criminalization of Mental Illness: Crisis and Opportunity for the Justice System," agreed.

"People max out after causing all sorts of problems in there, and they're put on the street without being linked to anything," Slate, who worked in a South Carolina prison system in the 1980s, said. "They get no supervision, no controls."

Local mental health experts say their clients, especially those with criminal records, increasingly live on the streets and crowd homeless shelters. Then, they are more likely to trespass, shoplift and lapse back into drug use. The end result: They often get arrested again.

"A lot of people go back to those old patterns of hopelessness about the future. It really does have long-term ramifications," said Dr. Tara Wright, a psychiatrist at the Ralph H. Johnson VA Medical Center.

Many former inmates also deal with psychological residue from their time behind bars.

"If you've got mental illness going in, you'll come out worse," said Gail Gradney, who was arrested last summer on a decade-old bench warrant for writing fraudulent checks for $15 to $20 each.

A magistrate sentenced her to nine months behind bars. She was 61, diagnosed with bipolar disorder and depression and had been hospitalized for becoming suicidal. Under darkness that night, she was shipped off to a lock-up without so much as her dentures.

"They're making you like a clown in front of everyone," said Gradney, a tall, grandmotherly woman. "And you already have mental problems."

Lack of options

Common reasons people with mental illness get arrested? Usually, for offenses like trespassing, shoplifting and simple drug possession.

Rep. Mike Pitts, R-Laurens, has been searching for ways to prevent the mentally ill from landing behind bars in the first place. A retired Greenville police officer, Pitts wants officers to receive more training in dealing with mentally ill residents who are facing arrest.

"They may need to go to the hospital instead of jail, which would be the initial process of getting them into mental health as opposed to ending up under incarceration," Pitts said.

In Charleston, most law enforcement officers work well with mental health staff and have gone through that type of training, said Debbie Blalock, executive director of the Charleston Dorchester Mental Health Center.

"The majority do not want to criminalize the mentally ill," she said.

But they often lack options.

For instance, if they take someone to an emergency department instead of jail, they encounter serious backlogs. Patients who have become dangerous to themselves or others are languishing for days on end in local emergency departments awaiting scarce hospital beds.

And officers may be obligated legally to stay with those patients for security reasons until they are admitted or placed someplace else. Blalock has seen that stretch up to 12 hours.

That keeps police off the streets. "Cops can't wait around in the ED," Blalock said.

But if officers arrest someone, what starts as a minor crime can spiral into major issues. Just ask Paton Blough.

Fully manic

Blough, who has bipolar disorder, spent one-third of his life from 2005 to 2008 behind bars or in psychiatric hospitals.

He's seen the criminal justice system become the frontline of mental health care. He was arrested six times. Three times it went badly. Three times it went well.

"The difference wasn't me. I was fully manic in all six. The difference was the officers who dealt with me," said Blough, now a married father in recovery.

During one arrest, he spit on a detention officer. Another time he yelled threats against a local sheriff's deputy. Both led to felony charges.

Today, he deals with what he deems PTSD from being jolted with a stun gun, strapped to chairs, pepper sprayed and locked in isolation. He also gained a record of felonies.

He blames a lack of hospital beds for those who need it.

"Instead, it's jail," he said. "We criminalize the mentally ill."

Now, he's an advocate and speaks to law enforcement groups and lawmakers.

Blough didn't set out to commit crimes. He believed he was waging nuclear war with China and that former President Bush was obeying his signals from a jail cell. He was trying to save the world.

"It felt as real as the sky is blue," Blough said. "It's all from a mental health basis. It's not a behavioral issue. It's not who I am."

Solutions exist

The mentally ill in Charleston are luckier than in many other areas.

Police, court officials, medical workers and mental health staff who deal with them meet regularly. "The issue affects all of us, and the issue belongs to all of us," Blalock said.

Before a potential arrest, police in the Charleston area also can summon the state's only psychiatric emergency response team.

The Charleston Dorchester Mental Health Center's Mobile Crisis Unit responds into the community when people become suicidal, disturb the public or threaten safety. They have dealt with would-be jumpers on the Ravenel bridge, hostage situations in area neighborhoods and a host of other calls. Police can call the team 24/7.

Yet, it's the only one of its kind in South Carolina. Why? Cost mostly. Its 24-hour emergency function alone costs roughly $181,000 a year.

After an arrest, the local Probate Court offers Mental Health Court, an alternative for people with mental illness charged with non-violent offenses. Participants must undergo drug testing, get mental health treatment and appear in court regularly. If not, they face time behind bars.

More than two-thirds of court participants graduate. During one session, a man with schizoaffective disorder and PTSD graduated to a courtroom filled with applause.

"You've done really well in this program," Probate Judge Tamara C. Curry said, reminding him of his shaky start.

The man, middle-aged, looked sheepish as he promised to stick with the treatment he began here.

"This has really helped me," he said.

Cynthia Roldan and Glenn Smith contributed to this report. Reach Jennifer Hawes at 937-5563 or subscribe to her at facebook.com/jennifer.b.hawes.