Showing posts with label COPING with dual diagnosis. Show all posts
Showing posts with label COPING with dual diagnosis. Show all posts

Monday, May 12, 2008

The changing face of homelessness

By LISA BIAGIOTTI
and TOM DAVIS
NYC24.com

[For an interactive web version of this story, click here.]

Growing up, Joe Wallinger had a distinct image of homelessness: drunks shuffling through the Staten Island Ferry Terminal begging for money and turning benches into beds.

But that image changed in 2005. Wallinger, a 56-year-old accountant and former resident of Tottenville in Staten Island, N.Y., now counts himself among the homeless.

Homelessness now hides behind shelter doors, walks in designer clothes and carries cell phones. Many homeless people are working-class, college graduates, parents or the elderly, according to Project Hospitality, a private nonprofit organization that operates Staten Island's homeless shelters and many food assistance programs.

Homelessness has blended into communities that still hold on to the image of the drunken or mentally ill nesting in the ferry terminal and don't "see" the new image.

Dennis Dell'Angelo, longtime resident of southern Staten Island, said homeless advocates and city officials manipulate the image of homelessness so they can justify expanding their services.

"If all the city agencies say we have a rise in the homeless, then the people who have facilities that deal with this will build them," said Dell'Angelo, 64, president of the Pleasant Plains/Princes' Bay/Richmond Valley Civic Association, a neighborhood watchdog group.

Staten Island, as a microcosm

But Staten Island now has the second-highest percentage of homelessness in the New York City, and the number of people seeking shelter has doubled since 2001. Fewer homeless people are living on the streets, but approximately 311 people crowd into Staten Island’s seven emergency shelters every night and wait in long lines for soup kitchens and food pantries.

"We've had people come in who've had condos and because they lost their job, they lost their condo and all their means of income," said Mamie E. Daniels, 76, who has run a soup kitchen at the Stapleton Church on the island since 1987. "Before you knew it, they're in a shelter."

Contrary to the worn image of chronic homelessness, today many people are either close to finding a home, or on the verge of losing one.

Almost 62,000 Staten Islanders eat at emergency food programs--up 300 percent since 2004, according to Hunger Safety Net 2007, a report produced by the Food Bank for New York City.

People gather outside the Stapleton Church Soup Kitchen at 3 p.m. on Mondays and Fridays for a prayer before mealtime.

Staten Island's nine soup kitchens serve 4.8 million meals a year. Lines for the island's 30 food pantries wind down church steps, and still, 70 percent of these food pantries and soup kitchens run out of food.

"The food pantry or soup kitchen is the last step of desperation," said the Rev. Will Nichols, director of Project Hospitality's communications and community outreach. "People who are coming here are homeless next."

It's not always obvious who is homeless unless they are walking into the Central Avenue “drop-in” center.

On a near-freezing April night, men and women wearing dark-blue Levi's, velour jumpsuits and sports jerseys signed-in to the center as "clients," before sitting upright in plastic-covered chairs. They covered themselves with thin, white blankets.

The city rejected Project Hospitality’s application for a permit to convert the facility into a full-scale, sleep-away shelter under pressure from local officials and residents.

Cassidy Mojica, a 9-year-old Staten Islander, knows about homelessness: Her cousin can't find a shelter.

Wallinger, an accountant with 72 credits toward his master's at Baruch College, calls the Central Avenue shelter home.

Wallinger left his apartment three years ago when he couldn’t feed himself, pay his rent and the $440 a month he owed in child support.

"This is what I have to do to make a living," said Wallinger, who lost his accounting job less than a year ago.

Wallinger was clean-shaven and wore an "Izod" brand pull-over and a clean pair of jeans when he fell into his "bed" -- a chair that resembled an airplane seat. He closed his eyes behind wire-framed glasses.

At 11 p.m., the lights went out and the cell phones popped open, glowing and bleeping amid the chatter of the dark room.
[Editors note: The writers put together this story as part of an interactive web magazine, NYC24.com, that's affiliated with Columbia University].

Wednesday, February 13, 2008

Britney and Heath needed more help, and less pain

By ANDY BEHRMAN
Featured Blogger


There's been so much in the media lately about two celebrities - Britney Spears and Heath Ledger - and about their mental health conditions.

I'm not a psychiatrist or a mental health care professional, so I'm not qualified to say whether Britney has bipolar disorder, or if Heath's death was a suicide. I was encouraged to hear that Ms. Spears was seeking treatment by qualified psychiatrists at one of the best mental health care facilities in Los Angeles. But now that she's been released, who knows what will happen to her?

Perhaps the most horrifying piece of Ms. Spears's story (not to minimize her own suffering) is how the media has turned her erratic and often risky behavior into a joke and her psychological problems into a circus event. If she is diagnosed with a bipolar disorder, she - like any one else - deserves our best wishes, because she will struggle with this invisible and insidious disease for the rest of her life.


At the least, we can be hopeful that perhaps she will eventually get the help that she so clearly needs. And today, there is so much support available to people with mood disorders and their families. If you visit "About Bipolar Disorder" on my website, www.electroboy.com, you'll find some helpful information.

With more than 6 million people suffering from bipolar disorder in this country, it's finally time to take mental illness seriously. It's not a laughing matter, regardless of how famous you may be or how much the media spins the story of this "crazy" pop culture figure.

More and more people are becoming aware of the fact that mental illness is so rampant because of cases involving celebrities - but this particular case increases the stigma of the illness as one which is defined by the media with terms like "crazy" and "lunatic." I even was shocked to read that someone couldn't believe that "someone with all of the resources of Ms. Spears couldn't just control herself." If it was only that easy.

Heath Ledger's death, according to the medical examiner, was caused by a combination of six prescription drugs - two sleep medications, two anti-anxiety drugs and two narcotic painkillers. Hopefully, we're waking up to the fact that the abuse of prescription medication is a huge problem in this country. Coincidentally, tomorrow is the first anniversary of Anna Nicole Smith's death.

The real tragedy of all of these stories is that people are still ashamed of mental illness and addiction and would prefer to sweep them under the carpet by saying that all three of these celebrities were unfortunate victims of being in the spotlight. Mental illness and addiction doesn't discriminate, and perhaps their being in the spotlight is a blessing in disguise.

Andy is a mental health writer whose autobiographical book, "Electroboy: A Memoir of Mania," has been translated into six foreign languages. His articles have been featured in The New York Times Magazine, and he was recently featured on CNN's "360" with Anderson Cooper. He currently lives mania-free in Los Angeles with his wife and daughters.

Wednesday, February 6, 2008

Heath Ledger's autopsy results could be revealed; what will the public learn?

The answer to why Heath Ledger died could be revealed as early as today, according to the Melbourne Daily Sun.

But a public that has been clamoring for information regarding the late actor may not get all their questions answered - not right away, at least.

The New York Chief Medical Examiner's Office, responsible for Ledger's autopsy and deciphering tests undertaken on his blood and tissue, confirmed today it was close to announcing the cause of the 28-year-old Australian actor's death, the paper reported.

"We're expecting something in the next two days,'' Ellen Borakove, director of public affairs at the New York Chief Medical Examiner's office, said.

But other questions, such as the official estimated time Ledger died, will not be made public, according to the Sun.

The Sun reported there has been speculation since Ledger's body was discovered in the bedroom of his rented Manhattan apartment on Jan. 22 that the actor may have been saved if medical help was called earlier.

New York police have said masseuse Diana Wolozin, who found Ledger's lifeless body, called Hollywood actress Mary-Kate Olsen several times before alerting paramedics.

NYPD investigators who inspected Ledger's apartment, however, said there were no signs of foul play or evidence to suggest he committed suicide, according to the Sun. They also dismissed reports illegal drugs were found.

Police did find six different types of prescription drugs in the apartment, including pills to treat anxiety and insomnia.

That claim has inspired the media to do more than implicate that drugs contributed to his death (see New York Daily News cover, above) - despite the fact that much of the drug-death evidence is circumstantial.

The media frenzy has inspired many to do a Google search and ask questions that have led them to this blog. They've asked: Can anti-anxiety and anti-depressants be mixed? Was Heath Ledger a drug addict? How will Michelle Williams, his actress-girlfriend, cope?

Based on what's been said, we may never know.

Thursday, January 24, 2008

Heath Ledger was battling drug addiction, depression and paparazzi before his death

Once again, the media vultures are swooping overhead over a fallen Hollywood figure. Unlike Britney Spears, however, this time they've captured their prey: Heath Ledger.

Much like Britney, his every moved was captured by a snapping camera or a shouting tabloid journalist who wanted to know about his romances, his break-ups as well as his reported drug abuse and mental illness.

Their pursuit came to an end Tuesday, just as the media and paparazzi attention was picking up. Is it any wonder that the intense media pressure could have been the tip of the iceberg that broke this promising young actor?

As I wrote earlier in the week - in a post about Britney - mental health professionals such as Debra Wentz, chief executive officer of the New Jersey Association of Mental Health Agencies, said common sense dictates that media pressure "can certainly stress anyone out, and so that added pressure on someone who is vulnerable can lead to more symptomatic behavior."

"I don't envy anyone in that position and believe they get more than they bargain for, as part of their fame," she said.

That added pressure of media attention pushes the behavior to a level that's frightening, dangerous and self-destructive.

"Often people say, 'If you can't stand the heat, get out of the fire,' " Wentz said. "But a young, vulnerable person who has an illness may not be able to exercise such good judgment.

From the Herald Sun of Australia:

Heath Ledger was battling drug addiction and depression in the lead-up to his tragic death yesterday.

The acclaimed actor was found naked and unconscious in his $26,000-a-month Manhattan apartment, surrounded by prescription anti-anxiety and sleeping pills.

Ledger's parents, Kim and Sally, and his sister, Kate, said his death was a terrible accident.

"He was a down-to-earth, generous, kind-hearted, life-loving and unselfish individual who was an inspiration to many," his father said outside the family home in Perth, Australia.

New York police sources said the signs pointed to either an accidental overdose or suicide.

Ledger, 28, reportedly spent several days at a drug rehabilitation clinic, battling an addiction to heroin, after his split from fiancee Michelle Williams in September.

The couple met on the set of "Brokeback Mountain," the film that netted Ledger an Oscar nomination for his role as a gay cowboy.

Last night, Williams was on a flight from Sweden to New York with the couple's two-year-old daughter, Matilda. "It has just broken everybody's heart," said her father, Larry Williams.

After the split, Ledger moved into a luxury Soho loft boasting a private lift. But neighbours said the apartment was only partly furnished and his bed was just a mattress on the floor.

Police said they found prescription anti-anxiety and sleeping pills in the bedroom, including generic forms of Valium and Xanax.

They could not confirm reports Ledger had pneumonia.

In November, the reclusive actor said he suffered from insomnia and was regularly taking Ambien sleeping pills. Ambien, marketed in Australia as Stilnox, is not recommended for people with respiratory disease.

Ledger had just finished playing The Joker in the latest Batman movie, "The Dark Knight" -- a role that looked certain to set him up financially for the rest of his life.

Hollywood was in mourning for the intense, brooding star, who was named after Heathcliffe in "Wuthering Heights."

Cate Blanchett
, who has been nominated for two Oscars next month, said she was very saddened.

"I deeply respect Heath's work and always admired his continuing development as an artist," she said.



Neil Young - Needle And The Damage Done Lyrics

I caught you knockin'
at my cellar door
I love you, baby,
can I have some more
Ooh, ooh, the damage done.

I hit the city and
I lost my band
I watched the needle
take another man
Gone, gone, the damage done.

I sing the song
because I love the man
I know that some
of you don't understand
Milk-blood
to keep from running out.

I've seen the needle
and the damage done
A little part of it in everyone
But every junkie's
like a settin' sun.

Friday, October 12, 2007

From homeless, to jail, to......worse?

“Can I stop talking now?”

Yes, Ron was told. You can stop talking.

“Can I hang up?”

Yes, Ron. Go ahead.

So Ron Troche got off the telephone, and went back to his “pod,” a big cell at the Bergen County Jail with no bars. He would go back to the bunk beds that were packed closely together, and sharing space with guys who, he said, “don’t play with a full deck.”

He’d go back to reading some book he’d enjoy - Tom Clancy, Stephen King. But in jail, there weren’t enough of them. So he’d play cards. Or maybe some television, and some boring program.

Or he’d eat. If he wasn’t hungry, he’d pace. He’d go to his closet, and arrange his clothes.

Then the lights would dim, and he’d got to his bunk. The other inmates would sleep, and even snore. Ron? He’d just sit there, in the near-dark, for hours, fussing and fidgeting. When he got anxious, he’d scrape his bottom lip against his teeth.

“My bed is right under the light,” said the 40-year-old, back in October. “And I have to get up in the middle of the night for my medication.”

Sitting there, he could feel his blood pressure rise, and his mind race. Other people called it “demons.” But Ron didn’t think they were “bad” - he thought everybody had them.

But they didn’t. Even the people in his “pod” - the so-called mental health unit at the jail - thought he was weird. Other inmates would poke fun at him, even though they had the same issues.

Ron was an easy target. He’s a short guy - about 5 foot 4. In jail, he was sort of quiet, and often looking scared and nervous. He was always asking for permission to do things.

“They don’t understand,” he said. That made Ron feel lonely.

“I read again and again … my eyes get tired. I read a chapter or two a night,” Ron, who suffers from bipolar and obsessive-compulsive disorders, said in October. “That’s the only way I go to sleep.”

But every night was the same. Eat, drink, get anxious. All because he tried to steal tools from a Jeep. He’d get these feelings that made him sad. He missed the heroin that made him feel “normal.”

And then, by the grace of God, Ron got news that “shocked” him: He was getting out.

And the other inmates heard this, and watched him pack, in amazement. This was a guy who paced and fussed, a lot. This was a guy who talked about how he felt like crying, but had to stop himself.

How did he do it?

Ron’s ticket was “jail diversion,” a program that provides alternatives to jail for inmates with mental illness. With few community resources available to them, the goal is to steer non-violent offenders away from a life of crime, and repeated stints in county jail or state prison.

Under the program, they may get a lighter sentence. They may even get an early release, and transfer to a treatment program. The bottom line, however, is they get something that’s rarely available in a steel-and-concrete prison cell: Help.

“We need to stop the bleeding,” said John Molinelli, Bergen County prosecutor, who spearheaded the creation of the local program. “It’s just a constant revolving process.”

Years ago, the state awarded a two-year $250,000 grant to Bergen County officials and a mental health care agency, Care Plus NJ of Paramus, to establish jail diversion, manage the program, and provide guidance to inmates deemed fit to enter it.

And Ron became one of the 1-year-old program’s model prisoners, agreeing to treatment and doing what’s necessary to adjust to life on the outside.

“I’m very anxious. I’ve been here nine to 10 months,” Ron said, in October. “I’ve done everything I possibly can. I’m ready to leave.”

But not everybody can be Ron. The rules for entering the program are strict. Funding is limited, and with few other resources available, the program turns away many more people than it helps.

Bergen County, N.J. officials, however, see progress. Sure, it may be slow. But they have a simple philosophy: If you can’t save everybody right away, then save one person at a time.

“I think this is something that is going to work,” Molinelli said.

Left: Ron Troche

Nationally, mental health experts - as well as law enforcement - say jail diversion is becoming a more effective and humane way of treating inmates with mental illness than locking them away in jail.

About 16 percent of the nation’s jail population suffers from a severe mental illness, according to the federal Justice Department. But that number is growing.

Ron Honberg, legal director for the National Alliance on Mental Illness, pointed to surveys that show as many as 30 percent of the nation’s jails hold people with mental illness who have not been charged with a crime. The reason, he said, is there is no place else to put them.

“The folks who are, by and large, served by the jail diversion programs - they’ve committed low level crimes,” Honberg said. “These are, by and large, not hardened criminals. These are people who attract the attention of the police for whatever reason.”

With judicial systems burdened by heavy caseloads, law enforcement is desperately searching for ways to reduce the population of prison inmates with mental illness.

Hundreds of jail diversion programs, as a result, are popping up across the United States. Law enforcement boasts it as a way to reduce overcrowding in the courts, probation offices, and prisons that are over capacity.

In San Antonio, Florida, and Atlanta, public officials, judges, and police officers are bragging about the success of programs that have steered hundreds of people into treatment programs and other services.

Some critics deride such programs as “get-out-of-jail-free cards” that don’t effectively deter crime. But jail diversion advocates say they’re limiting - and, in some regions, reducing - the number of repeat offenders returning to prison. The main goal, they say, is to treat people before they do something worse.

“The point of jail diversion is to stop the cycle of having them return to jail,” said Michelle Naples, whose organization, the TAPA Center for Jail Division, coordinates jail-related mental health services across the country. “There are lots of people with mental illness in jail who don’t need to be in jail, and they need a program that allows them to link with the right services in the community.”

When he served as chairman of Care Plus’ Board of Trustees several years ago, Molinelli said, he became sensitive to the plight of prisoners with mental illness. He heard stories from people who struggled to survive in lock-ups that lack the counseling, medical, and rehabilitation services of the outside.

As prosecutor, he has had no interest in “locking up” people with mental illness if they can be treated elsewhere, he said.

In 2002, Molinelli formed a task force that consists of local representatives of the judicial, law enforcement, and criminal defense fields. Their brainchild was jail diversion, even though Molinelli knew it came with some risk.

As prosecutor, Molinelli’s sworn duty is to prosecute criminals and punish them for their crimes. But his support was critical, he said. Without the backing of law enforcement, the program wouldn’t work.

Besides reducing the caseload for law enforcement, Molinelli views it something that’s simply the right thing to do.

“My ass is on the line if we make the wrong decision,” Molinelli said. “If one of those people in the program pushes somebody into a railroad train, then that’s the last you’ll hear of me. I’m done.”

Right now, it’s a pilot program, receiving about 10 percent of the funding that San Antonio and other regions have received. The state grant, which expires in July, also helps pay for mental-health awareness training for probation officers and judiciary officials.

Next year, Molinelli hopes to obtain a federal grant - perhaps as much as a $1 million - to expand the program. Until the county gets more money, however, the program will be small, progress will be slow, and the rules for entering will be strict.

“We just took a baby step,” Molinelli said. “I will never see the benefits of this program. This is 10- to 20-year program. I’d like to think by then it [jail diversion] will be the norm.”

Other jail diversion programs serve hundreds of inmates at a time; Care Plus, on the other hand, had about 17 active cases by the end of December. Many more inquire about the program, but they fail to qualify.

Only non-violent offenders can participate, and they must be Bergen County residents. While other programs assist inmates at the point of their arrest, Care Plus intervenes when they’re within a few months of their release.

Since the Bergen County Jail is a temporary holding cell for prisoners before they’re sentenced, the program helps some inmates steer clear of a stiffer penalty - such as a transfer to state prison. The goal is readjusting to society, and avoiding a return to jail.

“Our goal was to provide a level of service,” said Gary Dock, manager of the Care Plus program. “It is a level of service that’s effective so they don’t end up back in jail.”

Mostly, Care Plus provides an “infrastructure” to inmates with mental illness that’s not normally available to them, Dock said. Case managers drive them to the doctor, help pay their fines, accompany them to court, and serve as a liaison to their families and lawyers.

They talk to counseling programs and search for space for inmates with a history of substance abuse. They reinstate their benefits that they received on the outside. They make sure they have housing, and that they can pay the rent.

They meet with the inmates on a weekly basis - at a minimum - and learn early who’s ready for the program, and who isn’t.

Every Tuesday, members of Care Plus’ jail diversion staff - which consists of a supervisor, two case managers and an intern - sit in a small, pale room at the jail’s mental health unit, and chat with the prisoners. They’re particularly anxious to talk to Mike Lang, a case manager, and worry when he shows up late.

“The jail has been extremely accommodating,” Dock said. “I have done suicide-awareness seminars at the jail and they [corrections officers] have been extremely receptive.”

Inside the small meeting room, Lang and the inmates set up chairs. A television sits there, turned off. Stacks of books are packed into case, untouched.

As the inmates walk in, Lang assesses who has an interest in helping themselves. If they’re up to it - and they satisfy the rigid conditions - he signs them up.

If they don’t qualify, they’re politely turned away. Inmates with schizophrenia and bipolar disorder get frustrated - even angry - when they hear of the program, but discover that it’s not for them.

Right: Don Cardinali

Take Don Cardinali, a 53-year-old inmate with bipolar disorder. He was arrested after he threatened to rob a Ridgefield bank last July. He also was witnessed using inhalant outside.

In the jail, however, he followed the rules, and attended the weekly group meetings with Care Plus representatives. Initially, he displayed a genuine interest in helping himself. But when Care Plus offered to help get him into a treatment program, Don balked.

Don stayed in jail. Weeks later, he got in a yelling match that landed him in “lockdown,” separating him from his unit. Don said he was “stripped naked” and put in a sleeveless outfit that looks like a blue pleated blanket. He calls it “a chicken suit.”

“I’m in a chicken suit, freezing my ass off,” Don said in December, “and I’m being punished for sticking up for myself.”

For Ron and Don, the process began - in earnest - in the summer and early fall. Ron was arrested in January 2004; Don in July. But every week, they had to sit in the same, small room with 10 other inmates in the Bergen County jail’s mental health unit, and share their troubles.

Others would walk by, wearing orange jumpsuits, and sandals or high-tops with Velcro straps. They’d walk by the tables with the painted checkerboards that were never used.

They’d quickly glance through the big picture window outside the room where Lang and his group met. Then they would keep walking.

“How are you today?” Lang would say. And then he, and his partner, Jennifer Stratton, would sit and listen.

Usually, Lang and Stratton would only speak when they were asked a question. In some cases, Lang - a former probation officer - knew the answer before he was even asked. The inmates would be impressed.

“I have my ways,” he once quipped.

When the meetings began, the inmates would slouch in their chairs, and fold their arms. A moment of uneasy silence would quickly pass. When the time was right, they would unload - big time.

It usually came in rants and rapid-fire outbursts - usually about the food, their fellow inmates, and their strong desire to get out.

Their lawyers weren’t calling them back, they’d say. They’d call others - including family members - collect. But they wouldn’t accept the charges. They’d complain about not getting their medications - or getting too much.

They’d hear talk that they were heading to a psychiatric facility, when they thought they’d be released. They were being “screwed,” they’d say. They’d get so frustrated, some would talk about how they wanted to “hurt” somebody.

“I had all this anger,” Sherod Mair, 37, an inmate accused of assaulting a cop, told the group in August. “Marijuana was my thing. But right now, I don’t want to put anything in my body.”

They would ask Lang for help. They wanted to get back on their feet. They wanted to avoid a state prison sentence. Most had been there, they said. They didn’t want to return to the place with the “roaches and the rapists,” they said. They’d rather be in the county jail, the “country club.”

Lang would offer suggestions. Keep trying, he’d say. If you have a complaint, file it. But they wanted more: They’d ask to be a part of the diversion program.

If they were qualified, Lang would offer to do an intake, and ask a list of questions that addresses their readiness.

Most of the time, however, they weren’t ready. But Lang would politely listen to them, anyway.

During an August meeting, Don sat, looking frustrated and glum. He was clutching his arm, and slouching in his chair. His blonde hair was long, and needed a comb. He was in a room with 10 other guys, but he looked cold and alone.

For Don, it was the same old story. For some time, he wasn’t hearing from his lawyer, or anybody else he could reach on the outside. That week, somebody threw his underwear behind the washing machine. He was frustrated, angry, confused. He was rambling.

He carried his honeybuns in a pillow sack because an inmate picked on him, and tried to steal his food. He would keep his coffee grounds in a plastic bag, roll it up, and stick it in his sock.

“I lost my job. I lost everything,” Don, a self-described musician who worked in radio and recording studios, told Lang. “I appreciate you coming here, but I feel like I hit a brick wall on a motorcycle going 100 mph … No wonder I’m mentally ill, because I feel like I’ve been beaten to a pulp.”

Then he went silent, and waited for the others to finish. He had to wait a long time. He would raise his head, or his hand, and get ready to speak. But somebody would butt right in. They had similar issues, but they rarely felt compelled to include him.

The others spoke about how they had everything, too. They were ex-stockbrokers who lost money in the 1987 crash, they said. Or they lived in nice houses “near golf courses,” they claimed, and didn’t belong in jail. They wanted out.

“I knew what I was doing when I did it,” said Phillip DeMarco, 44, who was accused of threatening a state Superior Court judge. “I don’t like to take medications, second. I don’t like to be around people with mental health issues.”

Many of them - but not Don - had a history of violent offenses. Or they were non-Bergen County residents, and had other issues that disqualified them from the diversion program.

Most thought there was nothing wrong with them. They were framed. They were innocent. It was a conspiracy. In that August meeting, they went on and on about it. For two hours, Lang politely listened. Besides offering some advice, that was about all he could do.

“We can’t physically case manage them,” Dock said. “But it’s [the meeting] our opportunity to guide them through the system.”

By the time Don finally got to speak, again, he was tired. He kept apologizing for what he was saying, or what he was about to say. He didn’t want to keep Lang there too long. But it was his only opportunity, he said. He just wanted some attention.

“I just screamed out loud from the other end of the room,” said Don, complaining about the underwear incident. “I just scared the hell out of everybody.”

Then he went silent, again. Five minutes later, he left. Just minutes later, Lang did, too.

Every week, Lang came back. And every week, he got the same crowd. Nevermind that most of them didn’t qualify for jail diversion. They still attended the meetings, and they were still hopeful they could find a way in.

By mid-September, however, some hurt their chances of ever getting any kind of help. They were arguing with the other inmates. They got into fights, and found themselves in “lockdown.”

When Lang visited on Sept. 14, one inmate stood outside his cell door, pulled his “chicken suit” down to his waist, and waved through the meeting room window. Few were amused by the gesture, and most ignored him.

Inside the meeting room, there was tension. Phil was complaining about how everybody - his attorney, his family - was stealing his money. He was bitter, paranoid. There was nothing wrong with him, he said. Yeah, he used cocaine before. But he was fine. Everybody else was crazy.

“I don’t have any compassion for people going around robbing people,” he said.

Phil was talking quickly, and loudly. Others struggled to get a word in, but Phil would raise his voice, and drown them out.

Bill Lillo, another inmate, told him not to monopolize the time. But Phil kept going, leaning forward in his chair, staring at Lang, gesturing with his hands, and ranting and raving about his sorry life.

“My life has been sh-t,” he said. “I’m sitting here in jail, and it’s not fun. … I really try to write letters on my behalf, but it’s getting nowhere.”

Even Lang had had it. Normally, he let people talk. But he got tired of Phil and his rambling. “Where are we going with this, Phillip?” he said. “Because it’s not going anywhere.”

Phil finally quieted. Then he acknowledged something obvious: His mouth always got him into trouble.

Within minutes, the tension abated. The give-and-take got better. Some inmates even joked. A few started to smile. Phil just sat there, quiet.

Some asked Lang if they could meet with him later. One of them was Bill. He had a laundry list of issues. When the meeting ended, Lang gave him the benefit of his time.

Bill told him everything: He was busted for drugs. He had been in a car accident, and he was still suffering from the lingering effects. His pain felt like a “toothache in my eyeballs. That’s why I started smoking marijuana,” he said.

The 51-year-old had been in therapy with a psychologist. But why would his eyes swell up whenever he stood near a vacuum? Maybe he wasn’t getting the right medicine.

“My body is in atrophy. I’m curling in up into a ball,” he said. “It’s unfair. It’s unfair treatment.”

He and Lang shook hands, and Bill left. Afterward, Lang was asked if he could help him. He shook his head, no. He wasn’t a county resident.

Weeks later, Don was getting ready to leave. The Care Plus people were ready to help him, and spoke of getting him into a treatment program.

Don just wanted out. He still hadn’t heard much from his lawyer. He had fines of more than $4,000. What if he got out, and he couldn’t find a job? He’d go crazy.

Maybe Lang could help him with that. He and others from Care Plus met with him, and talked to him about his options. Don listened politely, but didn’t agree to anything. But to Care Plus, he seemed receptive.

Care Plus offered promise - certainly more than any other program. No other program talked about release. That’s all Don cared about. He didn’t want to consider anything else.

Don looked forward to a new life, even if he didn’t know what it was going to be like. For once, he felt good enough to laugh, and joke a little.

“I’m just praying that everything takes shape,” Don said.

He was to be sentenced on Oct. 12. Prior to that, Care Plus helped him get everything in order. The organization would provide him the safe landing, help him pay his bills, and possibly get him in touch with his family.

His attorney, Diane D’Alessandro, was working on a plea deal: The charge of fourth-degree possession of methadone would be dropped. Fourth-degree public alarm would stick. Maybe he’d get probation, and no additional jail time.

On Oct. 12, around 9 a.m., in Superior Court Judge Eugene Austin’s courtroom, his name was read aloud. Only Don wasn’t there.

There was a snag: The assistant prosecutor, Susan O’Donnell-Voorman, wanted him in treatment, and she needed an answer immediately. Without an agreement, he would stay in jail until the matter was resolved.

Care Plus hadn’t nailed down that end of the bargain yet. In the courtroom, Stratton sat in the audience, talked to D’Alessandro, and tried to work something out. The attorney asked: What about partial hospitalization?

“We could get him into a program, but this may not be what he wants,” Stratton said. “We have to get him somewhere.”

Later that day, Care Plus dispatched Brad Storey, an intern in the program, to talk to Don in jail. He discussed his options. This time, Don didn’t like any of them.

Don had gone through several rehabilitation stints over the past two decades. Forgive him, he said, for being skeptical.

“It’s like - what is it? - checkmate,” Don said later.

After Storey left, Don went back to sleep. Hours later, he rose from his bunk, and looked straight ahead. His stare was blank, and empty. He was angry. He was frustrated.

Seventy-six days in jail, he said. Another 30, 60, 90 in rehab. Hell no. He had it. He wanted out.

“I had my expectations high. They’re dashed … That’s a curveball,” he said, later. “You know what that means? Another institution. I don’t really need to do that again … I’ll go find some dive hotel for $40 a night.

“Right now, I’m 76 days clean. I don’t need to go back to these street drugs,” he said. “We’ve gotten beyond the point of fairness. I can’t allow this to keep going on.”

On Tuesday, Oct. 18, it was raining hard. The sky was dark and gloomy. Inside the meeting room, the mood was worse.

No basketball today at the court with the barbed-wire fence. No sunshine coming through the window. Just darkness and depression.

On this morning, the inmates were peculiarly quiet. This time, they had to be prodded to talk.

“Every one looks so gloomy,” Stratton said.

“It’s a gloomy day outside,” Perry Jackson, an inmate, said.

Don was there, too. But he showed up very late. At first, he quietly waited for everybody else to talk. But when he spoke, he didn’t stop. This time, he didn’t roll over.

Right off the bat, he kept pointing at his stomach, saying it “it hurts. It hurts!” He didn’t know why. He was still angry, and a bit manic. He felt like he was “screwed,” he said.

He hoped to be on the outside, he said, taking care of his sick mother. Now he’s feeling sick, he complained. He was convinced that he was going to spend the rest of his life behind bars.

“They tell me, ‘In three weeks you’re going home.’ Then they say ‘three more weeks, you’re going home,’ and then ‘three more weeks your going home,’Ÿ” he told Lang. “I don’t believe it’s fair. I believe I’ve served my time here … If I have to go to a funeral in a jumpsuit, then that’s going to be a very bad thing.”

Lang said he’d try to help, but he didn’t offer much else. Don thanked him, and then apologized. Then he went silent again.

Later, Sherod Mair spoke. He asked if he was qualified for the program, or a related program. But Mair had a violent offense on his record. This time, Lang didn’t mince words. He looked a little weary himself.

“No,” he said. So Sherod left.

Ron was there, too. He was the one guy who was alert and ready. His eyes were wide open. He sat straight up in his chair, and fiddled with his fingers.

Ron was entering the jail diversion program. His focus was on leaving the jail, and what he planned to do on the outside.

This wasn't supposed to happen. He pushed a guy out of the way while he was robbing a car in Carlstadt. He faced a five-year state prison sentence for his offense.

But Ron has a 21-year-old son, and a mother who was worried sick about him. If that meant he had to swallow his pride, and comply with the terms of jail diversion, so be it.

He admitted he had a problem. While in jail, he didn’t raise his voice. He didn’t complain about the food, or getting beat up. If he kept doing everything right, he was told, he’d get out.

“I’m ready to leave,” said Ron. “I can’t sleep on top of that.”

For Troche, Lang agreed to do an “intake.” On Nov. 3, the day after Election Day, he arrived, holding a stack of papers. This time, no one - other than Ron - would meet with Lang.

Ron sat there, his tattooed arms resting on his thighs. His leg was shaking. Occasionally, he glanced through the window. But mostly, he stared straight ahead, and waited for Lang to guide him along.

Lang handed him one form after the other. Ron glanced briefly at each, and signed what he could.

“If you had some goals,” Lang asked, “what would they be?”

“To get my license back,” Troche said. “My father’s got no tombstone on his grave. I want to put that on.”

They put together a plan that would help map out the next few months of Ron’s life. They talked about treatment programs. They talked about jobs.

If it was agreeable - and for Ron, it usually was -he simply nodded “yes,” signed the form, and moved on.

On the other side of the meeting room window, the other inmates grabbed their food. Don was one. He was carrying his pillow sack, and later, a food tray.

At one point, Don slowed up a little, and made a quick glance through the window. He saw Ron and Lang. His eyes were sad-looking, and he was frowning. Then he picked up his pace and, carrying his tray, disappeared from sight.

Lang kept asking questions. He asked who won the presidential election the day before. “Bush, right?” Ron said.

Lang asked him whether he felt somebody was following him. Ron said he’d heard voices before, but not lately.

Lang then quickly glanced through the windows. Ron kept looking out there, so Lang was curious.

“Are they holding a tray for you?” he asked.

“Yeah,” Ron said. “I hope.”

“Eating OK?” Lang asked.

“I’m not even hungry,” Ron said.

Lang went back to writing. Finally, Ron stopped shaking his leg, and looked right at Lang. His stiff look loosened.

“My mother - I don’t know if she’s helping me,” Ron said. “You’re the only one who is.”

“I’m trying,” Lang said.