♪ ♪ (indistinct chatter) DILLON LEDFORD: I've been in jail probably, like, 40 times.

I grew up in foster care and group homes.

My mother passed away.

My dad's in a mental hospital.

He was on drugs and he started huffing gas.

(indistinct chatter) It first started when I was a child.

In arts and crafts, I was putting in a little eye with glue and I heard a voice in my head say, "I've got my eye on you."

(speaking indistinctly on P.A.)

And I called the Secret Service, the N.S.A., the F.B.I., the A.T.F, the D.E.A., no one's done anything.

♪ ♪ If I'm being terrorized, if I can't get help from the police...

I've got over 100 police reports and no one's done anything.

I don't want to be held responsible for whatever type of attack that might be next because I'm trying to stop it and nobody wants to help.

♪ ♪ Appreciate you guys for taking the time to listen to me.

(car rumbling) ♪ ♪ DANA MILLER ERVIN: For the last two years, I've been investigating the plight of jail inmates living with mental illness for the Charlotte, North Carolina, NPR station, WFAE.

Some of those inmates are too sick to understand the charges against them.

(lock clicks) That means they are unable to stand trial.

They can wait many months, sometimes more than a year, just to get the care they need so their cases can move forward.

I've gotten to know a number of those inmates.

One is Dillon Ledford.

He's a 32-year-old man who'd been living on the streets of Gastonia, outside Charlotte.

He's got a long record of crimes, including larcenies, drug possession, even soliciting sex with a minor online.

His latest arrest was in June of 2022.

Ledford is still in jail, waiting for a bed in a state psychiatric hospital.

I first met him a month after he was arrested.

♪ ♪ About two months later, we met again.

This is our third meeting.

His lawyer is present.

Like, what are they telling you about why you've been here so long for?

Um, for...

I'm not getting any information.

They're not telling me.

They're telling me that there's a long wait for the hospital.

Um, I'm being patient.

I'm not, I'm not really trying to rush the process.

But there's a lot of stuff legally in my case that hasn't been brought to light yet.

As far as, you know, my mental health and, 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.

Like, it's right here, right beside my ear.

And it's, it's a tape.

So like, when I look at something, like if I look at that restroom sign right there, it, it would say "restroom."

It's like playing a recording of what it is and it knows I'm going to be looking at it before I look at it.

It's like predicting me to looking at it.

ERVIN: Ledford was arrested for allegedly calling a school to warn that there was a bomb on the property.

(electronic beep) 911 OPERATOR (on phone): Nine-one-one, five-three-three.

What's the address of your emergency?

CALLER: A person has called the building today, Give his name, identified himself and said, "We have explosives buried on the ground at Bessemer City High School."

He said they were under a pile of dirt near a bus.

We're not sure where he's talking about.

ERVIN: No explosive device was found.

According to Ledford's attorney, an evaluation stated that Ledford appeared to have delusions and paranoia associated with schizophrenia.

Like many inmates who live with serious mental illness, Ledford doesn't think he needs medication.

I've seen two doctors on, on the computer here.

Now, there's, there's a lag delay.

And what this artificial intelligence is capable of doing, it's capable of changing the conversation and spoofing the entire conversation.

So, when I'm talking to, to the screen, it's capable of changing what they're saying and what I'm saying.

I really don't think that it's medicine that I need.

Like, I need resources to defend myself.

You know, I need, I need defense.

ERVIN: Oh.

All right, I guess this is you.

Listen, thank you again.

LEDFORD: Thank you.

ERVIN: We'll be in touch.

LEDFORD: All right, thank you so much.

ERVIN: After he had been in jail for about seven months, a judge said that Ledford's mental health prevented him from understanding the charges against him and assisting in his own defense.

So under the U.S. Constitution, Ledford was found to be incapable to proceed to trial, or ITP.

VERONIKA MONTELEONE: There is a common understanding that if you are not able to understand the nature of the proceedings and if you are not able to assist in your own defense and you have a mental health diagnosis, then you cannot go forward in court.

We, we don't hold those people accountable for their conduct in the same way that we would for someone who doesn't meet that criteria.

(talking in background) ERVIN: This is Dillon Ledford's file.

And... (shuffling papers) You can see in this picture just how much better he looks than he looked yesterday.

He wants so badly for people to understand what he believes is endangering everybody.

(voiceover): Before they can stand trial, ITP inmates like Ledford need to have their mental capacity restored.

That typically happens in a state psychiatric hospital.

They get medication if they need it and lessons like these about the court system.

MAN: Once both sides have presented their case, it is then up to the judge or jury to decide if the accused is guilty or innocent.

ERVIN: Restoration is not full treatment.

Restoration is getting you to the point where you can work with your attorney.

After you enter the courtroom, you can go up to the in-court clerk who will be seated to my right.

MONTELEONE: They have to be able to answer some basic questions about the legal system.

It's court education school so that they understand enough to go forward.

(traffic humming) ERVIN: After Ledford had been in jail for almost a year, his attorney asked the judge to dismiss the charges against him.

MAN: All rise.

The Honorable David A. Phillips, judge presiding.

You may be seated.

Good morning, y'all.

ALL: Morning.

(indistinct chatter) PROSECUTOR: With the court's permission, the first matter will be Dillon Ledford.

You can find this on the green calendar, page 12, margin 43.

JUDGE PHILLIPS: Okay.

MONTELEONE: Good morning, Mr. Ledford.

LEDFORD: Morning.

PROSECUTOR: Uh, Your Honor, with the court's permission, there is a motion in the file.

It was filed by Ms. Monteleone.

JUDGE PHILLIPS: I have it.

PROSECUTOR: And that is why we're here today.

MONTELEONE: Thank you, Your Honor.

The procedural history of this case is, is something that we see unfortunately, all too often, and that is Mr. Ledford was booked into our jail about a year ago.

(voiceover): I'm kind of at my wit's end with some of these cases, with my clients being in custody for as long as they have been.

So in Mr. Ledford's case, I filed a motion to dismiss.

Um, it's kind of like... throwing a bomb out there, basically asking the judge to dismiss a case.

They don't want to risk anything happening in the community.

There was nothing else for me to do.

Mr. Ledford has had two evaluations.

Both of those evaluations agreed that he is not capable to proceed.

He's been committed to a state hospital, but he doesn't have a bed date.

Mr. Ledford is being deprived of his due process rights.

His case isn't moving anywhere and nothing is happening.

And I think he's being held beyond a reasonable amount of time.

JUDGE PHILLIPS: Ms. Monteleone, if the Court were to dismiss this case today, what would happen to your client?

MONTELEONE: Your Honor, I would hope that we could get an involuntary commitment order, have him potentially taken to our local hospital and evaluated there.

JUDGE PHILLIPS: Is he taking the medication that's prescribed for him now?

MONTELEONE: He is not.

And the jail has a policy, I believe, of not forcing the inmates to take the medication.

So if they refuse to take it, they won't make them take it.

JUDGE PHILLIPS: Ms. Hamlin?

PROSECUTOR: I do appreciate Ms. Monteleone representing her client, but she has no solution in place right now.

She says in the jail, he is not receiving the treatment he needs and he won't take his medication.

And then when Your Honor asked her what her plan was, she said, "I hope to get him involuntarily committed."

So this is a great concern for the state because we not only have to protect him, we have to protect our citizens.

LEDFORD: So you're saying I'm not being represented properly?

PROSECUTOR: That's not what I'm saying.

LEDFORD: I think that's what you're saying, ma'am.

JUDGE PHILLIPS: Sir.

LEDFORD: Thank you.

So that's, that's all, that's all we need to see here, to say today, that I'm not being represented properly.

She's incompetent.

She needs to be fired.

She's incompetent, sir.

JUDGE PHILLIPS: Would you, would you please be quiet, sir?

Okay, I'll give you a chance to talk if you'd like to.

All right, the court is looking at the charge as well, which is false report of mass violence on educational property.

Under the statute, he can be held for 39 months, which would be the maximum sentence on a class H felony.

In the aggravated range he's not to a one-year level now.

The court has concerns where this young man could possibly get the help that he needs.

The statute also says that if there's a possibility that he could be restored-- we don't know if he can be restored because he won't take his medicine.

And his evaluation stated that they believe that he could be restored, with help through Broughton Hospital.

Therefore, for all those reasons, your motion to dismiss is denied.

MONTELEONE: Thank you for hearing us, Your Honor.

JUDGE PHILLIPS: Thank you.

ERVIN: So... MONTELEONE: That's exactly the way I anticipated it would go.

ERVIN: Yeah, I know.

You spoke with Ledford yesterday, right?

MONTELEONE: Mm-hmm.

ERVIN: What did he say?

MONTELEONE: He was pretty agitated yesterday.

Um.... he wouldn't really address anything that I wanted to talk to him about.

He had an agenda of what he wanted to talk about.

ERVIN: Right.

MONTELEONE: And I think that's where his frustration today came from.

ERVIN: Yeah.

(voiceover): His aunt and uncle didn't show up today.

Did they even know?

(exhales): I have no idea.

I have no idea Um, you know, the D.A.

was right.

He really doesn't have a support system, so... ERVIN: Yeah.

MONTELEONE: Frankly, it's not really up to me either.

Like, I'm not a medical professional.

I can't go up there and dictate what he needs.

ERVIN: Right, right.

All I know is that what he needs is not jail.

ERVIN: Right.

MONTELEONE: Right.

So none of this is helping him.

Yeah.

(voiceover): As of November 2023, there were 166 ITP inmates in North Carolina waiting for a bed.

Our investigation found that half of those charged with felonies, like Ledford, are behind bars more than 313 days before they're transferred to a hospital.

GPS VOICE: In half a mile, turn right onto Fox Hill Drive.

ERVIN: And I've learned that long waits are a problem throughout the U.S. ♪ ♪ At least 17 states have been sued over inmate wait times.

A federal appeals court has ruled it's unconstitutional for inmates to wait more than seven days after a court's finding of their incapacity to proceed.

But my reporting shows that in many states, inmates are waiting months.

And those wait times don't include the number of days inmates sit in jail before they're found to be ITP.

♪ ♪ SPENCER MERRIWEATHER: It's important to say that the long waits, to basically have their capacity restored, or even to get a bed, that's kind of the lesser problem.

ERVIN: WFAE hosted a town hall on the problem of people living with mental illness who end up in the criminal justice system.

MERRIWEATHER: The bigger problem is that we didn't have what we need to treat the mental illness that actually led that person to the criminal justice system in the first place.

KODY KINSLEY: As bad as we are describing the level of care for behavioral health services in incarcerated settings, it is worse in community.

It is much harder to find people care because we have had 1.2 million people in North Carolina without health insurance... MERRIWEATHER: That's right.

KINSLEY: And poverty and mental illness are often co-occurring.

And this is why I need the legislature to hurry up and pass the budget so I can expand Medicaid to begin to try to fill this gap.

But I just want to be clear that we are making up for a past sin here where we have never treated behavioral health like, on equal measure with health broadly.

And we have never prioritized it as part of primary care.

ERVIN: A lot of these people don't have family anymore, right?

So their family members may have tried and given up, and after a while, they're just burned out.

In the '60s and '70s, during JFK, big promises that we were going to move from these large institutions to these more community-based settings, and large institutions started to downsize and some closed, but the community settings never came.

JOHN KENNEDY: Under this legislation, custodial mental institutions will be replaced by therapeutic centers.

♪ ♪ ERVIN: In 1963, John F. Kennedy signed a law that funded community mental health care, so people could get treatment outside of large institutions.

KENNEDY: It should be possible within a decade or two to reduce the number of patients in mental institutions by 50 percent or more.

The new law provides the tools with which we can accomplish this objective.

♪ ♪ ERVIN: Despite JFK's initiative, community mental health care was vastly underfunded and those with severe mental illness faced care and housing challenges.

And many states found they'd cut too many beds.

North Carolina eliminated nearly half of its state psychiatric beds over the last two decades.

By 2016, the state was ranked one of the lowest in the nation in hospital beds per population.

Staffing shortages during COVID only made wait times worse.

I spoke to dozens of people about the issue.

Everyone told me they were frustrated: the judges, the D.A.s, the health care providers.

(elevator chimes) Jail staff too.

They're also on the frontlines of this mental health crisis.

MONTELEONE: Thank you.

MAN: You're welcome.

DURWIN BRISCOE: Hello.

ERVIN: Hey, how are you?

(voiceover): I met with Durwin Briscoe, the chief deputy of the Cleveland County Sheriff's Office, about an hour outside of Charlotte.

BRISCOE: So, we're going to go down this hallway to the housing.

ERVIN: Okay.

BRISCOE (voiceover): We house 324 inmates on a daily basis.

ERVIN: What percentage of the inmates you have here now do you think have a mental illness?

BRISCOE: In some form, um, I would say, I would say close to 40 percent.

ERVIN: And this guy, he's hit, beating the wall or hitting the wall.

I don't know what he's doing.

I don't know what he's doing.

(computerized voice speaking indistinctly) ERVIN: How many would you say, what percentage of serious mental illness, like a psychosis or something?

BRISCOE: Probably about the ten percent of the individuals that we have in our facility.

Those are inmates that are either on some type of isolation, where it may be because if they're suicidal or if they have clothes on, they're not suicidal.

He didn't have any clothes on, so he has a suicide smock.

So that tells me that he is... ERVIN: And suicide?

BRISCOE: Suicide.

(computerized voice speaking indistinctly) BRISCOE: So, with these individuals, the officers have to physically see them four times an hour, to make sure that they're okay.

(computerized voice speaking indistinctly) I, I've seen a study that indicated people with serious mental illnesses are more likely to be arrested for low-level crimes.

Is that what you see?

I do.

Um, and it's, it's because um, they're not getting the, the help that they need on the outside.

They're committing very small crimes.

Second degree trespassing or disorderly conduct.

And they will end up getting arrested time after time after time.

How many people right now do you have who are incapable to proceed?

Currently, we have about six individuals that are incapable.

How long have they been waiting for a bed?

We have an individual that's been waiting about eight months.

But we had one that was... been here for over a year, that was waiting.

So, long waits are pretty common.

It is.

This is personal for you, right?

You told me you have a nephew here who is incapable to proceed.

Yes, ma'am, I do.

What's that like for you?

Um... it's, it's very difficult because I know this individual and I know the things that his family has tried, numerous approaches at him-- involuntary committed, taking him to outpatient care to get him the treatment that he needs.

(lock clicks, cell door closes in distance) ERVIN: Chief Briscoe's nephew, Devonte Watson, is 31 years old.

He's facing three charges, including assault on a law enforcement officer, which allegedly occurred when he was arrested for stealing his mother's car.

Watson has been in jail since July of 2022.

He was declared ITP four months later.

Like Ledford, he's waiting for a bed at Broughton Hospital.

They feel that the system has failed them.

Not only has it failed them, it has failed him, so much so that it got to the point where now he's inside of our facility, because of not being able to get the help that he needed on the outside.

♪ ♪ (lock clicks, cell door opens in distance) (cell door closes in distance) (man yells in the distance) BRISCOE: I do believe as it relates to mental health or individuals inside our detention facilities, of course, race is going to have a portion in it.

And, and I say that because economics trickles down to race status.

Oftentimes, I feel like, um, based on your race, you, you may get offered less things than anyone else may be.

And, and that's not just mental health, that's a whole lot of things.

And if I don't have the funds because I'm not offered the same things because of my race, then of course I'm not going to get the same treatment as anyone else.

Nationwide, I think race has some, some impact on it as well.

ERVIN: Data show that African Americans are overrepresented in jails across the country.

It's the same in North Carolina.

After we spoke, Chief Briscoe took us to the floor where inmates are housed.

(banging on door) It was quiet when we entered but we were warned inmates might get riled up when they saw the cameras.

(banging doors, men yelling) INMATE: Clean my room.

Please clean my room in two weeks.

Please clean my room, in two weeks.

(inmates yelling indistinctly) ERVIN: Most detention officers work 12-hour shifts.

And a growing number of the inmates they work with live with mental illness.

OFFICER: That one?

OFFICER: Yeah.

(inmates yelling indistinctly) ERVIN: What's the emotional impact for you of dealing with people who are mentally ill?

I mean, it's definitely not easy, you know, it's something you have to deal with on a personal level and then try not to be able to take it home with you.

Sometimes you're going to leave your family just to come here and may have feces thrown on you, get cussed out just for little things.

Try to care for people who don't even care for themselves.

We've had officers here injured, you know, from people that suffer from mental illness.

ERVIN: What kind of injuries have you seen?

I've seen, you know, I watched a guy got kicked in the neck and that got him pretty good.

He wasn't able to come back to work.

Do you think detention officers have to deal with PTSD because of the job?

I mean, I can give you an example of one of mine.

Like, if I go into a room, I need to be able to see the door.

We're not proficient to deal with mental health people.

That's not, that's not our... GABRIEL TITECA: Job title.

O'BRYANT:... our job title.

I think there needs to be more mental health facilities and mental health professionals to help with some of this because the jails are getting full of them, I mean.

TITECA: And the system really needs to take a hard look at it, because the longer that they spend in here, the crazier they're going to get.

Jail is not a mental facility.

Mental facilities are built for a reason, and that's where those individuals need to go.

(lock clicks open) (men yelling in distance) ERVIN: While county jails are required to provide health care, many don't have much funding.

Without proper treatment, inmates can get worse.

♪ ♪ (traffic humming) It's been nearly four months since I visited Dillon Ledford.

His last attorney switched jobs and his new attorney, Matthew Hawkins, called to tell me that Ledford's mental health has been deteriorating.

(lock clicks open) LEDFORD: Thank you, sir.

MAN: You're welcome.

LEDFORD: How're you doing?

ERVIN: Good, how are you?

LEDFORD: I'm okay.

ERVIN: Good, good to see you.

LEDFORD: Yeah, it's good to see you.

How're you doing, Matt?

Mr. Hawkins, sorry about that.

HAWKINS: No, you're fine.

(chair scraping) Why, why, why are you here now?

What brought you guys here today?

Did someone tell you to come?

Well, what we, Mr. Hawkins, your attorney, he said he's going to try to get you into safekeeping.

Do you know what that is?

Safekeeping?

Right.

I'm not sure what it is but I'm, I'm all for it.

If my attorney says that that's what needs to be done, I'm behind him, 100 percent.

Okay, so it's to, to take you to some place so you can get some medical care.

LEDFORD: What is, what is the protocol for that?

HAWKINS: Well, we file a motion, okay, that a judge signs off on, it's actually an order, okay?

And the jail here agrees to it.

They contact Raleigh, okay?

ERVIN (voiceover): Hawkins is trying to get Ledford transferred to a safekeeping unit at a state prison.

That's where they house inmates who are considered too dangerous, vulnerable, or sick for jails to manage.

LEDFORD: Yeah, they can't get books here either.

ERVIN: So tell me, who's been visiting you?

Anyone?

Nobody's came and visited me.

Before you come and see me, I'm interrogating myself and being interrogated.

ERVIN: Mmm.

LEDFORD: So, this is a, a chance for me to... voice the things I've been being interrogated about.

ERVIN: Yeah.

LEDFORD: On camera.

ERVIN: Yeah.

LEDFORD: So, you understand?

ERVIN: Yeah.

LEDFORD: If I'm being interrogated and then no one's coming to see me, and then you come and see me, with a camera, that means that now that I've been interrogated, I got my story straight.

And I know this is facial recognition, and I have to say exactly what they tell me to say.

ERVIN: Okay, you think we're going to use facial recognition though?

LEDFORD: They, this is... ERVIN: No, no, okay.

DILLON: ...this is facial recognition.

ERVIN: Okay, I got it.

LEDFORD: I can't tell a lie.

ERVIN: Okay, I understand, I understand.

LEDFORD: And the reason why I can't lie is because they're using facial recognition and I'm not a liar.

Yeah, and this is the thing... ERVIN (voiceover): Dillon, last time you saw him, he was like this?

HAWKINS: Yes.

ERVIN: When you send him for safekeeping, what's going to happen?

HAWKINS: In safekeeping, they just have better medical facilities up there, especially when it comes to dealing with people with severe mental health issues.

Uh, so he would stay at safekeeping, hopefully until his bed at Broughton is ready.

He's still, you know, ten to 15 people deep on that waiting list still.

To me, there's nothing worse than where he is now.

And so, I think it only makes sense to try to at least give him a little bit of a springboard to getting to Broughton, because we simply don't know.

Ten to 15 people deep on the waiting list could mean a couple of weeks, it could mean a couple of months, it could mean six months.

We have no idea.

Thank you, sir.

♪ ♪ (door clicks shut) ♪ ♪ ERVIN: Ledford was transferred to safekeeping about a week later.

Chief Briscoe's nephew, Devonte Watson, has been in jail for almost a year and a half.

He's still waiting for a bed.

♪ ♪ BRISCOE: I truly feel that the longer he sits in jail, it changes his mental status and he's going to continue to go downhill.

It's difficult for me to see that he's inside the jail, not getting the proper care that he needs.

And it's no fault of the jail.

Jails are not designed to give the proper care for mentally ill inmates.

♪ ♪ ERVIN: After 531 days behind bars, Ledford finally got a hospital bed.

But many more across the country remain stuck in a fractured system.

♪ ♪ MONTELEONE: People who are in this process of being found incapable and being committed to state hospitals, I think there should be a heightened responsibility for those people.

Those are people who may not even understand that what they are doing is wrong.

If we want to have a community that is functional, that prioritizes everyone's success, then we need to look after the most vulnerable people.

And that's exactly who these people are.

(indistinct chatter) ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪