To his probation officer, Stephen Raul Bertrand Jr. is a violator who belongs behind bars.
To the Pima County Sheriff's Department, Bertrand is a discipline problem who must be kept in solitary confinement.
To the psychiatrists who have evaluated him, Bertrand suffers from a bipolar disorder that's compounded by the fact that he's deaf.
To his mother, Marcia Rocha, Bertrand is a troubled young man who can't get the help he needs. Unfortunately, when she reached out to try to get him that help last year, she set in motion a series of events that has left Bertrand behind bars, facing a new assault charge, with his probation revoked.
Bertrand's story illustrates the difficulty of treating people who have a mental illness once they've been caught up in the justice system. His dual disabilities, combined with a history of criminal activity, have him spiraling into deeper legal difficulties with little hope on the horizon.
STEPHEN BERTRAND IS sitting in an orange jumpsuit in a visiting room at the Pima County Jail, his hands cuffed behind his back. Just 25 years old, he's thin and wiry, with a tangled mass of black hair slicked back and reaching his shoulders. His eyes are alert, watching whomever is speaking so he can read their lips. When he talks about how he ended up behind bars, the words pour out in a thick enunciation that's hard for an untrained ear to understand.
Bertrand doesn't look particularly dangerous, but a trail of paperwork shows that since he entered Pima County Jail during the last week of December, he has fought with his fellow inmates, struggled with and spit on guards, and even tossed water on a psychologist who was visiting him. The various infractions have left him in administrative segregation, meaning he's in a cell by himself 23 hours a day. He says he spends his days walking around the cell and writing rap music.
Ask him why he keeps getting into trouble, and Bertrand says only: "I don't know."
Bertrand has been in some kind of trouble most of his life. His mental illness can manifest in violent outbursts. He's had a drinking problem and been busted for marijuana possession. He did prison time for car theft and has faced a number of assault charges.
Born deaf, Bertrand was formally diagnosed when he was about 2 years old. "I knew something was wrong with him, but I couldn't put my finger on it," says Rocha, who was left to raise her son as a single mom after she split with her husband when Bertrand was 4 years old.
Even before he was 10, Bertrand was getting out of control. Rocha remembers her son exhibiting explosive behavior while he was attending the Arizona School for the Deaf and Blind. He got into fights and other mischief, such as firing off a fire extinguisher at the school.
"Academically, he did well, but he was always getting into trouble," she says. "Once in elementary school, while we were attending a meeting in the principal's office, he started throwing chairs around."
Home life was difficult as well. "He was unpredictable," Rocha recalls. "We tried time-out; we tried spanking him; we tried numerous behavioral programs with him."
The experts couldn't agree on a diagnosis, labeling him with attention-deficit hyperactive disorder at one time and Tourette's syndrome at another. To make matters even more confusing, Rocha got conflicting medical advice. Some doctors suggested drug therapy; others warned her not to put a deaf child on medication. Bertrand was finally diagnosed as bipolar when he was 15 or 16 years old.
Once Rocha felt comfortable putting her son on medication, he often resisted taking it. Through his teen years, his life grew increasingly unstable. He got into numerous scrapes with the law, eventually ending up on juvenile intensive probation. Rocha says she tried to work with the authorities, hoping her son would learn the consequences of his actions as a child rather than as an adult. But nothing seemed to work.
Bertrand left the Arizona School for the Deaf and Blind to attend public school, but dropped out before he got his diploma. After Bertrand turned 18, Rocha finally took a tough-love approach and told him he couldn't live in her house unless he could control himself. For a time, he lived on the streets, until a neighbor took him in. Eventually, he got an apartment of his own, getting by on disability checks.
A month before his 20th birthday, Bertrand finally went too far: He stole a pickup truck. The cops busted him the next day.
Bertrand was sentenced to a year in the state prison in Florence. Behind bars, he had no medication to regulate his bipolar disorder. He racked up 33 formal disciplinary write-ups, including 11 incidents of disruptive conduct and two fights. He went from a minimum-security prisoner to lockdown in solitary confinement under maximum security.
When he got out of jail in April 2000, Bertrand returned to living with his mother, but he hadn't been prescribed any medication and his behavior remained erratic. "It was your typical bipolar mania--a walking time bomb," Rocha says.
After an altercation with his mother and stepfather, Bertrand was back in Pima County Jail for violating the terms of his probation. While Bertrand was behind bars, Rocha talked to a police officer who steered her into the choppy currents of the state's mental-health system. She petitioned the court to have Bertrand undergo a psychiatric evaluation. He was transferred to Kino Community Hospital, where doctors agreed he was bipolar and prescribed medication.
Because of Rocha's legal action, Bertrand was placed under the supervision of La Frontera, a nonprofit organization that delivers mental-health services in Southern Arizona. With the help of social workers, Bertrand found an apartment and tried living on his own. "It was really hard to find a place because he's got a criminal record, violence and mental issues and no credit," says Rocha.
Bertrand was in trouble within a year. In August 2001, he was arrested on assault charges. The acquaintances who called police said Bertrand threatened them with a kitchen knife; he maintained he'd waved around a pen and held a rock. Police were unable to locate a knife, but they reported finding a bag of marijuana on him during the arrest.
After close to a year of legal proceedings, Bertrand pleaded guilty to the assault charges and drew a three-year probation sentence. He was also ordered into the state's program for the seriously mentally ill and prohibited from using alcohol and illegal drugs.
By this time, Bertrand was living with his mother, taking his medication regularly and attending classes at Pima Community College to get his GED. "I wanted to make my mom proud," he says.
Rocha remembers that he finally seemed to be responding to treatment. "It was the longest I'd seen my son stable his whole life," she says.
But Bertrand again began exhibiting troubling behavior, including a disturbing tendency to mutter to himself. Rocha met with La Frontera officials, and together, they tried to get him to try a new medication, but without even trying it, he complained that it made him too sleepy.
Last October, after Bertrand got into a shoving match with a younger half-sister, Rocha decided she needed to take action. With the help of Bertrand's La Frontera caseworker, she filed paperwork to have Bertrand committed, hoping he'd stabilize on a new medication.
The psychiatrists who examined him agreed Bertrand was bipolar and could pose a danger to others. But after less than four weeks in the hospital, the staff determined he had stabilized. Rocha says she unsuccessfully fought to keep Bertrand in the hospital, but he was released under the supervision of La Frontera social workers, who placed him in a downtown apartment. After about a week, police picked him up wandering the streets, incoherent.
La Frontera officials got him out of jail and put him in a group home. But after less than three weeks, on Dec. 26, Bertrand got into an altercation with a staff member. Bertrand's parole officer came to investigate, took him back to the Pima County Jail and filed court papers to revoke his probation.
It didn't take Bertrand long to get into more trouble in jail. On Jan. 14, he got into another scuffle with guards, resulting in an assault charge and a transfer into administrative segregation, where he remained alone in a cell for 23 hours a day.
Bertrand's public defender, Darlene Armbruster, persuaded Pima County Superior Court Judge Virginia Kelly that her client needed to undergo a psychiatric evaluation to determine if he was competent to stand trial. In March, Bertrand was found incompetent and ordered into the Arizona State Hospital in Phoenix.
But the hospital had a two-month waiting list, so Bertrand remained in isolated confinement at the jail for another month before being transferred to Kino Hospital on April 27. He stayed there for about a month before being moved back to the jail to prepare him for the transfer to Phoenix.
On June 3, Betrand entered a forensic program at the state hospital designed to make him competent enough to assist with his own defense. One month later, on July 3, hospital officials determined he was stable enough to face trial. He was transferred back to Pima County Jail, where he returned to his segregated cell.
In his most recent court appearance last week, Armbruster argued that Bertrand remained incompetent to assist in his own defense. Judge Kelly ordered a delay in the proceedings so that he could be evaluated yet again by a psychiatrist with experience treating deaf patients.
ROCHA ACKNOWLEDGES HER son's problems, but she sees another side as well--a smart young man who was doing well in his GED classes while he was stable last year. He enjoyed a few trips to the lake on the family boat, especially when he got to ride a jet-ski. He's a talented breakdancer--he can sense vibrations from the music--and dreams of someday becoming a rapper.
Rocha complains that state officials and social workers often fail to take Bertrand's hearing disability into account. Like many deaf people, his enunciation makes him hard to understand, but La Frontera caseworkers don't always bring along an interpreter. When the social workers first set him up in an apartment, they didn't equip him with specialized devices such as a doorbell or an alarm clock. During his recent time at the Arizona State Hospital in Phoenix, staffers couldn't hook up a TTY device that would have allowed Bertrand to talk to Rocha on the telephone.
Rocha believes her son belongs in a secure environment, but she wants to see him receive treatment--not punishment. She says she tried to work within the system by stepping in when she saw signs of trouble last fall. Since then, over her objections, her son has been released from Kino Hospital and left to live on his own for a week until he became incoherent and incarcerated. Then, he was placed in a group home where his disorderly conduct got him tossed behind bars. Now his fights with jail officials have him facing an assault charge.
Earlier this year, Rocha retained attorney David Bjorgaard to attempt to push the state to provide mental health care that's consistent with his hearing disability. Bjorgaard helped her get guardianship of Bertrand because of his mental instability.
Bjorgaard, who is consulting with Bertrand's public defender, says the state doesn't provide the kind of facility where Bertrand can get the help he needs. "Stephen needs to be in a secure setting for an indefinite period of time," says Bjorgaard.
But Bertrand says he wants to return to a La Frontera group home or his mother's house. "I would prefer not to go back to the state hospital," he says.
Even if he did want to go back, he'd have a hard time finding a vacancy. Arizona State Hospital CEO Jack Silver says his facility has a cap of 141 beds available for people who have been civilly committed. Currently, it's close to capacity. The hospital also has 60 beds in the forensic unit where Bertrand stayed earlier this year and an adolescent unit that has 16 beds. Both of those areas are often full, leaving people who need treatment on waiting lists at local facilities.
Rather than institutionalizing the mentally ill, social service agencies attempt to allow them to live in the community with the least number of restrictions, according to Silver.
The first avenue, he explains, is usually medication. Breakthroughs in drug treatment have allowed many mentally ill people to overcome their symptoms.
But that approach doesn't work when the patients fail to take their medicine.
"Typically, what happens with folks who suffer from bipolar disorders, when they get into the more grandiose phase, they decide they don't want to take their medicine, and they may get increasingly out of control, if you will," says Silver. "So then the decision that needs to be made at that point is, is the person safe in the community? Are there services that can be provided to them while they're living in the community, or does the person need a spell of acute hospitalization to get them regulated on their medication again?"
If a mentally ill patient is hospitalized, doctors work to get them stable and back out as soon as possible, Silver says. Then case workers are supposed to develop a plan that can include frequent monitoring or placement in a group home.
If patients don't stabilize while they're at Kino Hospital or another facility, or if there's a reason to suspect they're still a danger to themselves or others, it's possible to have them committed to the state hospital, according to Silver. But with the limited number of beds, that's a last resort.
Silver couldn't comment specifically on Bertrand's situation, but he says that treating someone who is both deaf and bipolar can present a complex challenge. He recently learned about a Massachusetts program specializing in such patients.
"I wouldn't say that we're highly competent to deal with a dual disability," Silver says. "We do our best; we bring in experts, but we certainly don't have the resources or experience that this institute in Massachusetts has."
Silver adds that once mentally ill people find themselves behind bars, they often tend to become unstable.
"Even if the meds are available, the primary mission of the correctional setting is not psychiatric care," Silver says. "It's punishment. They do offer a lot of psychiatric care, but that's not their primary mission. ... There are lots of pressures that go on in prisons, and I think just living in that environment can promote somebody becoming unstable."
Like Silver, La Frontera CEO Dan Ranieri couldn't comment on Bertrand's case, but he says the agency uses several facilities, including Kino Hospital and a 16-bed unit at St. Mary's Hospital, to house patients who have the potential of becoming dangerously unstable. The average stay is seven to eight days, although some people stay as long as 30 days.
"One of the things we don't ever try to do is to have somebody we feel is potentially violent or could hurt somebody in the community unsupervised," he says.
Staffers are trained to recognize and defuse potentially dangerous situations, but when trouble erupts, police may need to be called in.
"When push comes to shove and they attack another person, it's possible they can be taken to jail," Ranieri says. "You have people who have a mental illness who will violate a law or a community standard because of their mental illness. But you'll also have people who commit criminal acts who also happen to have a mental illness. Sometimes you have to make that distinction."
La Frontera's social workers haven't had to deal with many deaf clients, but when they do, they're supposed to bring along an interpreter, Ranieri says.
Bertrand praises La Frontera for the work they've done with him. "La Frontera helps out a lot," he says.
La Frontera gets funding from the nonprofit Community Partnership of Southern Arizona, which oversees mental health treatment for an estimated 20,000 clients in Pima County, according to Neil Cash, the organization's CEO. Rather than directly delivering health care services, CPSA contracts with groups such as La Frontera, COPE and CODAC.
"Our networks are responsible for making sure that these people who are very, very sick are receiving the best care possible and receiving it in a way that meets their needs best," says Cash. "The ultimate goal is to get people back into a healthy reintegrated environment where there's a sense of recovery."
Cash says the vast majority of people with mental illness are served well by the local agencies, especially given growing demands and stretched resources. But when seriously mentally ill people crash up against the justice system, he says the result is often "tragedy."
"Often times, people who are seriously mentally ill start committing nuisance crimes," he says. "They may be disorderly or shoplift or do something to get the attention of the legal authorities; they'll respond, and then it will compound and spiral and get worse. That's really where the system fails."
Marcia Rocha believes the system has failed her son. She thought she was doing the right thing by reaching out to get him some help last fall, only to see him bounced from facility to facility until he ended up behind bars. While fighting for him, she's lost her job because she's spent so much time dealing with legal issues.
"Had I known it was going to come to this, I probably would not do this ever again," says Rocha.
In a courtroom last week, she fought back tears as she watched her son being led out in shackles to return to solitary confinement at the Pima County Jail.
She held a finger and her thumb together.
"I just keep clinging to this slender thread of hope," she says.