RANEY ARONSON-RATH: For two years, reporter Dana Miller Ervin has been investigating the mental health care system in North Carolina. What she found was ultimately a broken system. Nowhere has that been more evident than in the state’s treatment of jail inmates living with severe mental illness.
DANA MILLER ERVIN: What are they telling you about why you’ve been here so long?
DILLON LEDFORD: I’m not getting any information…
RANEY ARONSON-RATH: Inmates who are too sick to stand for trial can spend months in jail waiting for space in the state’s strained psychiatric hospitals.
VERONIKA MONTELEONE: I think he’s being held beyond a reasonable amount of time.
DURWIN BRISCOE: They’re not getting the help that they need on the outside.
RANEY ARONSON-RATH: Fractured is a new film streaming online. It’s also an eleven-part radio series from WFAE in North Carolina, produced with support from FRONTLINE’s Local Journalism Initiative. I spoke with Dana Miller Ervin from WFAE and the film’s director, Débora Souza Silva, about their work on Fractured. I’m Raney Aronson-Rath, editor in chief and executive producer of FRONTLINE, and this is the FRONTLINE Dispatch.
RANEY ARONSON-RATH: Débora and Dana, thanks so much for being on The Dispatch.
DANA MILLER ERVIN: Thank you.
RANEY ARONSON-RATH: So Dana, let's start with you. You've been reporting this story as a series on WFAE in North Carolina for the past two years. What actually led you to begin this project focusing on mental health in North Carolina?
DANA MILLER ERVIN: Well, I'd been a health care reporter and I heard about inmates who cycle between the jail and the hospital for years before they can ever stand trial.
RANEY ARONSON-RATH: Right.
DANA MILLER ERVIN: And I live in a town with one of the state's three psychiatric hospitals. So I was able to get confirmation from a hospital attorney that this was a really big problem and that, in fact, people can sometimes get better in the hospital and then go back to jail to await trial and get so much sicker that they're hard to help a second time.
RANEY ARONSON-RATH: So, you were basically hearing that there are people who live with mental illness being cycled in and out of the hospital and the jail. Did you get a sense in the beginning of how big the problem was, and like, how did you even attempt to understand, beyond the anecdote, what was going on?
DANA MILLER ERVIN: Well, that was a big problem. There was no data, right? There was no data. We ended up having to go out and collect the data. I started out just meeting with public defenders and trying to hear from them. I tried to meet with public defenders all across the state. And it was astonishing because you go into these meetings and they're going, oh yeah, this is a problem. And we see this over and over again. And, oh by the way, have you been told about this story? And have you been told about this story? And each of these things, I realized we had a series.
RANEY ARONSON-RATH: Hmm. I mean, that, that's really fascinating that as an investigative journalist, your first question is, okay, how do you go beyond the call that gets made to you to be able to say something about systemic failure really comes down to the data that you and WFAE were able to collect and that's how it got on our radar at FRONTLINE. Okay, so Débora, I want to ask you, you came in through the door of our Firelight Filmmaker Fellowship – which, we're so thrilled you joined us and thank you for doing that. And we really said to you, you could choose the film that you want to make with FRONTLINE and you chose this film. Tell me about why you felt inspired by this territory to take it on.
DÉBORA SOUZA SILVA: Yeah, well, first of all, thank you so much for having me. So I came on board on this project about a year ago. That's when Dana was still working on her radio series. She and I had many conversations about the stories and sources that she came to. To me, each and every story from her 11-part radio series, they were urgent stories that were crying to be told. But the one that was particularly striking, in my opinion, was the segment on the defendants who are too sick to stand trial. They are waiting many months just to get a hospital bed. And in some cases they are getting sicker as they wait. So I immediately thought, as a filmmaker, I know those are the voices that are not often heard just because it's so, it can be so hard to get cameras inside of jails.
RANEY ARONSON-RATH: That was going to be my next question. You know, getting cameras inside of jails is increasingly hard. I think it's really important to talk about access in this film, um, you know, because I think all of the film really hinges on the level of access the two of you are able to negotiate to get cameras and even to the hearings. You know, we were really struck by that because, you know, frankly, seeing is believing, right? When you see that court scene, you're like, oh, right, this is, this is why it's so difficult for the lawyer, for the, the person who's in jail, for the judge, you know, it's a very complex scene.
DANA MILLER ERVIN: So, so when I started with the radio series, I very much wanted these to be personal stories. That was, that was critically important to me that you heard from the people, that you heard from the defendants, that you heard from the family members. And so I sort of, the way I planned it all out was I spent five months really just meeting with people and meeting with people and getting them to trust me, um, and meeting with them over and over and over again…
RANEY ARONSON-RATH: Yeah, you can feel that.
DANA MILLER ERVIN: …until they, until they were willing to give access. And I have to say that part of that was also being trustworthy for them. That if someone said to me, I can't give you access to whatever, and if I let you in, please, avoid that. That's what I stood by, right? And so that, over time, earned trust. And then, once the first radio stories came out, it was really amazing. I mean, I got a call from someone in a state psychiatric hospital who said, we're all just cheering for you. We're so grateful that you did this.
RANEY ARONSON-RATH: Oh, right. I can see that. Right, because they were so desperate for actual information and data to help them understand what was going on, right? Um, so back to, back to access. Let's talk about Dillon. We meet Dillon Ledford in the film.
DILLON LEDFORD [FILM CLIP]: As far as my mental health and everything like that, I'm doing a whole lot better. I'm still hearing noises, of course, but—I'm still hearing voices. And it's just like a tape. It's like they're playing it on a tape…
RANEY ARONSON-RATH: Why did you decide to focus on him and why has he been in custody for so long?
DANA MILLER ERVIN: I was going to these various public defenders, and this is not the story that we did in the film, but one public defender told me of another story, which was inmates who serve life sentences on the installment plan because they're serving of their mental illness, that they just go cycling in and out of jail, in and out of jail, sometimes on very minor crimes, for years. And so I said, I have to do that story. And they gave me a list of names of people they expected back in the jail. And one of them was Dillon. And so when I met with him, one of the good things about Dillon is he's very smart. So, I felt that he could actually give informed consent, that he could actually do this. And, um, because that was also a very important point, that whoever I interviewed had to know that I was a journalist, I wasn't a lawyer, I wasn't a doctor.
RANEY ARONSON-RATH: Mm-hmm.
DANA MILLER ERVIN: And so, um, he was one of the people I suggested to Débora.
RANEY ARONSON-RATH: And so, Débora, what did you see in him?
DÉBORA SOUZA SILVA: Yeah, you know, I had many conversations with Dana and his name would always come in the conversations, you know, she had already interviewed him for her radio series. Once you see him, you hear the things that he says, you realize this is a man who urgently needs mental care. And yet, he's stuck in jail waiting for a bed without being able to move on with his case because he's incapable to proceed, right? Which is the issue that we focus on the film. One of the earliest scenes that we filmed was the court scene, right? Dillon's attorney, Veronika Monteleone, uh, she filed a motion to dismiss his case and she argued that he was being held beyond a reasonable amount of time in jail. We got our cameras inside of the courtroom. It was like a 10-minute process. You know, her motion was denied. And I remember leaving that courtroom and I looked to Dana. And we were like, now I understand why this is going on.
RANEY ARONSON-RATH: Let's go back for one minute, and Dana, maybe you can help us with this. What does it mean to be ITP– incapable to proceed?
DANA MILLER ERVIN: So, under the U. S. Constitution, defendants have to be able to understand their charges and to assist their attorneys with their defense. And if they can't do that because of a mental illness, then they're considered to be incapable to proceed, or ITP. In some places they call it incapable to stand trial. That puts the case on hold, and nothing can happen at that point until their mental capacity is restored. And that's the problem. So, these cases are on hold, and then if you have a long time to wait for a state psychiatric bed, you're just waiting. And if you go to a state psychiatric hospital and you get restoration, that's not full treatment. That's not getting you well so you can go on with your life. It's getting you to the point where you can work with your attorney. Now that can often, usually I think, involves some medication. But it's really a lot of education about the court system. This is a judge. This is a jury. And that's, and so, so these people are, they're not ready to just go and go on with their lives once they're restored. And that's why when they get back to the jail, they can decompensate so quickly and then get worse and have to go back to the hospital.
RANEY ARONSON-RATH: How does somebody become or be designated as ITP?
DANA MILLER ERVIN: So, someone is charged, they become a defendant, and at that point, the defense attorney will interview them and meet with them. If the defense attorney, if later the DA, if the judge, if anyone starts thinking they don't understand the charges, they can't assist in their own defense, then they'll go and they'll ask for a psychiatric evaluation and then they have to be evaluated. If the evaluator says, “we agree, they're probably not capable of standing trial,” then that evaluation goes to the judge and he makes that decision. Sometimes, I will tell you, and this is part of why the process is so long, sometimes the defense attorney will call and evaluate, ask for an evaluator. The evaluation will say he's incapable to proceed. But the prosecutor says, “I want another evaluation.” And so, now you have to wait for a second evaluation. And, the process can take a long time.
DÉBORA SOUZA SILVA: Yes, you know, one of the first interviews that we did was with Veronika Monteleone. She's, uh, Dillon's, uh, first attorney. And one of the things that she told me is that once a client is found to be ITP – incapable to proceed – this can be a really, really frustrating process for attorneys because those are folks who cannot move forward to trial. They cannot take a plea deal. There's nothing that can happen in this case. So she knows once she takes an ITP client, they're going to be sitting in jail for a long time.
RANEY ARONSON-RATH: Dana, I know this was, of course, a local story, but for listeners all across the country, what do you think your investigation reveals about the ITP system in other parts of the country?
DANA MILLER ERVIN: Well, so first of all, it's a national problem. I found at least 17 states had been sued over inmate wait times. I called all 50 states to ask how long their defendants waited for restoration. And about 40 of them responded to me. Um, there were about a half a dozen states with substantially longer wait times than we have in North Carolina, and pretty much most of them, most of them, the wait time was more than 30 days. You know when we started this, there was no data in North Carolina on how long people actually waited. The state had collected the data, but they hadn't analyzed it. That went on for months. And so we went about collecting the wait time data ourselves. And because health information is typically protected by law, we had to find a way of doing it with things that were in the public record. And what we found is that we had to go to each of the county courthouses and ask for their lists of pending cases of ITP defendants, of incapable defendants. Then we took those lists and went to each county jail and said, when was this defendant incarcerated and when were they finally transported to the state psychiatric hospital for a bed? Okay. What we measured was the full time that people are incarcerated, right? That's not what any state measures as far as I can tell.
RANEY ARONSON-RATH: Right.
DANA MILLER ERVIN: What they measure is just the time that someone's on a waitlist for a bed, but they can wait months just for that psychiatric evaluation. So, when a state tells you “our wait time is 30 days,” it may be substantially longer, and why that's so important is if people are deteriorating behind bars, nobody really knows how long they've been there. So, we felt that what we did, I believe we're the only ones in the country to do this, what we did contributes to the whole understanding of this process.
RANEY ARONSON-RATH: Yeah. And it's really, it's a really profound question to ask when you're looking at the fine print and it says the wait time is 30 days, to then ask, but actually is that the case, right? And I think that's what your film really does a great job of doing. Both of you, you know, work so hard to help us understand the problem. What do you wish you could have included that you couldn't get access to film or that you just wish had found a place in the film?
DANA MILLER ERVIN: So, in the radio series, I have a guy – it's been almost six years he hasn't had a trial yet. He was restored once, and then came back, and then waited. It got, got very much worse. When he got worse, and this is, I think, fairly typical, he started to act out, right? Throwing feces and doing things like that. So, then the jails isolate people like that because they can't control them. He was in isolation for a long time as far as I can tell. And the American College of Correctional Physicians warns that prolonged isolation of people with serious mental illness could make them worse. I want to know how many of these people are being isolated. Because, can you imagine, you're in a however-big cell, it's a pretty small cell, you're hearing these voices non-stop, and you're alone, 23, 24 hours a day.
RANEY ARONSON-RATH: Are there any people out there that are talking about what would be a system in which, um, people who experience mental illness, who are being charged with a crime, who have to be on trial, how this could work a little bit better even?
DANA MILLER ERVIN: Yeah, so for the radio series, I looked into this and there's, you know, increasingly people are thinking, look, if you're charged with a low-level misdemeanor. Why are we even charging you? Why isn't the police officer just taking you to a crisis clinic and getting you into treatment? People are now talking about that deflection from the criminal justice system. These are now being discussed as some alternatives.
RANEY ARONSON-RATH: Right, right. And then, Débora, when you were ending the film, I'm curious, like, what were you hoping people would take away? What was your hope?
DÉBORA SOUZA SILVA: Yeah, well, we talked a lot about it and despite Medicaid expansion and you know a budget was allocated for those programs, right? Those pilot programs, at the end of the day, like, you know, people are still waiting for a long time and Dillon finally got a hospital bed. But that was not until after 531 days. To me, like the fact that he might have gotten worse as he waited in jail, I think this is problematic. Uh, so we definitely didn't want to be like, oh, this is a, this is a happy ending. Like we passed the budget. We have those programs. I feel like those are positive moves, you know, to address the problem, but we must keep watching, right?
RANEY ARONSON-RATH: Right, right. And you were saying as well, that, you know, this is really the beginning of an inquiry, right? If, if this is the ground, the ground level is finding the data, asking the questions, and then the stories start to come out. So I appreciate both of you. Thank you for being on the Dispatch. Thank you for your great work.
DÉBORA SOUZA SILVA: Thank you for having us.
RANEY ARONSON-RATH: You can watch Fractured on FRONTLINE’s website, FRONTLINE’s YouTube channel, and the PBS App. You can also stream our Academy Award-winning film, 20 Days in Mariupol.
