Ignoring Court Orders, Maricopa County Locks Up Mentally Ill People Too Impaired For Trial


Mario Cruz barely talks above a whisper, avoiding most conversations and mumbling on the rare occasion that he does choose to speak. Over the past three years, he’s spent most of his time staring through windows in Maricopa County’s 4th Avenue Jail.

On the day he was arrested, police randomly knocked on his front door to confront him about a drug house shooting that happened more than a decade ago. Cruz, who was 19 years old when the shooting occurred, didn’t pull the trigger. But two people died and his presence at the drug house landed him behind bars for first degree murder and drug possession.

Although Cruz hasn’t been diagnosed with a specific condition, his family is relatively certain he suffers from mental illness. He was always slower to learn in school — even in his special education classes. By the time he dropped out after eighth grade, he was only reading and writing at a second grade level. He turned to drugs when he was 12 years old, and due to his illness, Cruz has never been able to hold down a job.

His mother, an elderly, low-income Latina woman, could never afford to take Cruz to a specialist to determine what was wrong. She certainly couldn’t pay the $450,000 bond to get him out of jail or hire private attorneys to help with the case. About one year after walking through 4th Avenue’s doors for second-degree murder, Cruz’ mental health deteriorated rapidly. The jail refuses to transfer him to a hospital, and his situation has become so dire that he may get a life sentence because he’s too disabled to answer questions in court.

And he’s not alone.

Maricopa County — notorious for anti-immigrant policing and barbaric jail conditions under Sheriff Joe Arpaio — is neglecting inmates in desperate need of mental health treatment, according to an ACLU motion filed on Friday. Eighteen months after Sheriff Joe Arpaio and county commissioners asked a federal judge to lift a 2008 court order, which required the county to provide adequate medical and mental health services for prisoners, people behind bars are still denied basic care. Arpaio’s efforts were futile, but little has changed.

He started losing his speech very bad. He wasn’t really recognizing us.

Some of those prisoners, including Cruz, are so mentally impaired that they aren’t competent enough to go to court. Their cases can’t move forward, so they’ve been locked up for extended periods of time without a trial. Instead of sending them to local hospitals, Maricopa County jails are keeping them in solitary confinement.


That’s a stark departure from the 2008 court order and 2014 renewal of that order requiring the jails to either give these detainees mental health services or transfer them to another facility that can provide treatment.

“Locked down for up to 24 hours a day, they deteriorate, refusing medication and treatment, living in squalor, and growing more symptomatic by the day,” the motion reads.

For example, a man diagnosed with chronic psychosis smeared feces on the wall of his isolated cell, and experienced hallucinations. Jail staff once saw him stick his head in the toilet bowl. Instead of sending him to a psychiatric hospital, he remained in solitary for nine months. Another patient was similarly tossed into solitary for smearing feces on the wall. Staff watched him pour toilet water on his body and attempt to flood his cell. No medication was offered to him, even after he tore up his mattress and said he was Jesus. When he finally got out, he had nowhere to go but the streets.

A female patient “repeatedly smeared feces and blood in her cell and on her face” and repeatedly pulled her hair out. She spent a year shuffling between solitary at the jail and outpatient segregation, and never took her medicine. She was released a year later.

Friday’s motion is an attempt to have the court rulings enforced and get patients the care they need. If it’s granted, those deemed severely mentally ill and incompetent for trial would be sent to psychiatric facilities outside of the jails.

Mario Cruz with one of his two children CREDIT: Ebelia Cruz
Mario Cruz with one of his two children CREDIT: Ebelia Cruz

Going In Circles

Ebelia Cruz, a Phoenix native, knows all too well that her brother, Mario, is suffering.

“He started losing his speech very bad. He wasn’t really recognizing us,” she told ThinkProgress.

When he’s in court, she says, he becomes disoriented and doesn’t know where he is. “He thinks we’re in the real world,” she said. “He’ll get up and try to walk to me, and then he gets in trouble and thrown out of court.”


Time behind bars has brought Mario physical and mental anguish. What was supposed to be a 20-day stint in solitary confinement turned into a full year, and his sister never learned why. According to emails and medical records obtained by ThinkProgress, his nose and eye socket were fractured, but it wasn’t attended to for over a year.

Mario is now scared and distrustful of everyone except his attorney, so he’s uncooperative with doctors. He also refuses to meet with psychiatrists more than once, so they’re unable to write the report needed to prove he’s not mentally competent to go to trial.

Ebelia has fought tooth and nail to get him the care he needs. She obtained guardianship to make necessary health care decisions for him, since he won’t do so on his own — but the court says she can only get him medicine. That seemed like a valid option, until she was informed that jail staff would have to force it down with a syringe — a painful process that Ebelia won’t cosign.

“He’s been hurt enough,” she said. She’s been given the runaround by lawyers and jail representatives ever since.

Now, three years after his arrest, Mario is unable to comprehend and answer questions in court. Like so many others, he hasn’t been transferred to a psychiatric facility that can help restore competency before court. Despite his impairment, the prosecutor in his case is pushing hard for jail time. The best case scenario he’s offered is a second degree murder plea that would lock Mario away for 10 years — three of which he’s already served.

Given his mental state, that option seems more and more unlikely.

“The judge says he cannot let the prosecutor offer a plea, because Mario is not understanding anything,” Ebelia said. “In order for a prosecutor to offer that plea formally, Mario would have to go through all these questions that the judge asks of him — and answer them right.”


Cruz is unable to take the plea, but the judge is still forcing him to go to trial. “They’re just going to send him to trial and he’s gonna go to jail forever,” she said.

Cruz’s attorney denied ThinkProgress’ request for comment.

A National Failure

The latest ACLU motion may focus on Maricopa County specifically, but jails and prisons have become de facto mental health facilities nationwide, generally with disastrous results. Ever since the 1960s, when the government started slashed federal funding for mental health services, treatment facilities have shut their doors, prematurely released patients, and turned away people in desperate need of care. Unable to access treatment, people who show erratic or unstable behavior end up interacting with police officers more than doctors — and they usually get thrown in jail.

He’s been hurt enough.

The number of inmates with mental illness has skyrocketed as a result.

A 2015 Urban Institute report found that 64 percent of all jail inmates, 56 percent of state prisoners, and 45 percent of federal prisoners have a history of mental illness. Depression, bipolar disorder, anxiety, and post-traumatic stress disorder (PTSD) are the most commonly cited illnesses.

But the criminal justice system is ill-equipped to treat the inmates properly. Prisons and jails are understaffed, underfunded, and don’t have the medical infrastructure that hospitals enjoy. Some simply don’t care. And people like Mario Cruz suffer.

All the while, states and smaller municipalities keep gutting mental health spending. States cut more than $4.35 billion between 2009 and 2012.

Despite the court orders to provide medical and mental health care for inmates in its care, Maricopa County has dragged its feet on funding these services. That’s why the ACLU filed the motion on Friday, and why Ebelia worries so much that she can’t sleep.

“Mario, when he was born, my mother was older. So I was kinda like the mom,” she said. “He’s kinda like my son instead of my brother. I have always taken care of him no matter what.”