When criminal justice systems have to deal with mental illness
The vast majority of violent crimes aren’t committed by people living with mental illness. Studies show those with serious mental illness are many times more likely to be victims of crime than victimizers.
Erik Ramsey is learning about that dilemma. He was arrested on April 1, 2019. Police say Ramsey covered his face with a black bandana, armed himself with a .22 caliber handgun and held up four convenience stores in Mecklenburg and Iredell counties. After one attempted robbery, he allegedly fired a shot, but no one was hurt. Prosecutors say Ramsey confessed to his parents, and they went to the police.
Ramsey pleaded guilty to common law robbery in Iredell County, where two of the crimes occurred. He served more than a year in jail, then got three years probation.
But he’s still awaiting trial in Mecklenburg County, where the remaining crimes occurred. That’s because a Mecklenburg court found he didn’t have the mental capacity to stand trial. So he had to go to a state psychiatric hospital for treatment first.
WFAE met Ramsey last July in the Mecklenburg County Detention Center. He’d just returned from the state hospital where he’d been diagnosed with schizophrenia and given medication. The hospital said he was doing better and that his case could finally move forward.
With his lawyer present, Ramsey explained through a plexiglass divider that his problems began when a woman who said she was being held hostage messaged him on his phone. He spoke of these delusions as facts.
“I was talking to this female, and she said something about demons,” Ramsey said. “And then I was like, ‘Are you OK?’ And I felt I needed to help her.”
The next message he received was from the Illuminati, Ramsey said.
“I'm like, ‘Can you help me out?'” Ramsey said he asked. “She's in jail. They said, ‘Give us this amount of money… And then she's free.’”
Ramsey told WFAE that the voices stopped after he received treatment.
“I told them at the hospital I heard that voice,” he said. “They gave me medication for it. I haven’t heard any voices since.”
But Ramsey’s attorney, Jason St. Aubin, and the Mecklenburg prosecutor couldn’t agree on a plea deal. St. Aubin said the prosecutor wanted Ramsey to serve at least two and a half years in a state prison in addition to the time he’s already served in the county jail. But St. Aubin worries the prison won’t provide the care Ramsey needs to eventually return to society.
“These violent crimes aren’t going to keep somebody away forever,” St. Aubin said. “That person will be back out on the street, and they're going to need a framework for success.”
St. Aubin wants Ramsey to get the kind of care that other defendants receive in Mecklenburg’s mental health court. Under the supervision of a judge, defendants can avoid prison as long as they are able to stay on medication, get therapy and stay clean.
Mental health court data shows graduates of its program are less likely to reoffend. But Ramsey wasn’t eligible. St Aubin said the staff told him Ramsey’s charges were too serious.
“They didn’t feel like the level of supervision they could provide was adequate, that they’d be setting him up potentially for failure,” St. Aubin said.
Mental health court staff told WFAE they admit some defendants charged with violent crimes into the program, but only if staff believe the benefit to the defendant outweighs any safety risk.
Even though Ramsey wasn’t eligible for mental health court, St. Aubin still wanted to convince a judge that Ramsey can live safely in the community. Last November, he persuaded a judge to allow Ramsey to live in the community under house arrest. Ramsey has to wear an ankle monitor, take his medicine and go to therapy — all conditions of his release.
Ramsey was playing video games when WFAE met up with him a few weeks after his release. He’s now living with his stepbrother, Austin Holland. They’ve been spending some time together. “A lot of our childhood was spent bonding over video games,” Holland said.
Ramsey’s first therapy appointment was the following week. But it was clear that Holland, who is a pastor, is providing a lot of care too. When Ramsey was asked about upsetting topics, Holland would remind him to take a deep breath.
“I can pretty quickly identify whether we're in an episode or whatnot,” Holland said. “And his demeanor changes and his speech pattern…his breathing pattern changes.”
Ramsey’s fortunate to be receiving the kind of help many families can’t provide.
Holland says Ramsey’s mental health issues were aggravated by an internet scammer who’d been bilking him for money before the crimes took place. He said he tried to tell Ramsey he was being scammed, but his stepbrother wouldn’t listen.
Now he’s trying to help Ramsey distinguish that reality from the voices he said he heard. While Ramsey said he doesn’t hear voices anymore, it's clear he still thinks the woman’s pleas for help came from a real person contacting him through a video, not a voice in his head. Although Ramsey says he no longer hears voices, his experience of the voices remains real to him.
“The voice that I heard. You can’t explain it unless you were there,” Ramsey told his stepbrother. “It didn’t come from inside my head … I was watching a video on the internet and [it came] from the video.”
“Yeah, it said a line that clicked in your brain that made you start thinking that that was said to you,” Holland said. “But it wasn't said to you.”
But Ramsey agreed he needs to work on his mental health. He said he’s going to continue taking his medicine and that he wants to get a job.
Holland says Ramsey worries about the people who were inside the stores he’s accused of robbing. “The first time we talked about it, he just kept saying how bad he felt for the people,” Holland said.
Dr. Neal Gowensmith, from the University of Denver, is a national expert on mental illness and the criminal justice system. He hasn’t met Ramsey, but he pointed out that mental health care in most U.S. prisons is poor.
“If he goes to prison, he’s almost certainly going to get worse,” Gowensmith said. “I mean mental health treatment in prison is awful. He may not have the same medication regimen available to him (once) in prison. He may not have any interest in taking it after he’s been sentenced. He’s going to be far more likely to be victimized than a victimizer in prison, and he’s going to come out worse.”
The risk that someone will re-offend declines when criminal defendants take their medication, live at home and try to put their lives back together, Gowensmith said. But courts need to make sure defendants stay on their medication.
“If there’s a concern that he’s not going to adhere, then you monitor him closely,” Gowensmith said. “And if things fall apart, then prison is still there as an option.”
Having things fall apart worries Mecklenburg County District Attorney Spencer Merriweather. He won’t comment on Ramsey’s case. He says he does consider a defendant’s mental health when offering a plea deal, but has to balance that with concerns about public safety.
“The community doesn’t necessarily want those folks out of custody until they’ve figured out whether it is only accountability they need, or accountability and treatment, or just treatment, and that has to be figured out,” Merriweather said.
Merriweather is frustrated that many defendants get their first mental health diagnosis afterthey’re behind bars. The courts aren’t the right place to help someone with mental illness. And it can be hard on the victims, too. In some cases, a defendant deemed too ill to stand trial will wait so long for a hospital bed that they end up serving the maximum sentence for the crime while they wait. Then the law requires their release.
“That is a hard thing for someone to take if they’ve had their house shot into. If they’ve been stabbed a number of times, if they've had a gun stuck in their face,” Merriweather said.
And if mental health care isn’t available when defendants are released, Merriweather said they sometimes commit another crime.
“And do we end up repeating that cycle over and over again? Absolutely,” he said.
The churn of dealing with defendants living with mental illness adds to the court’s backlog, Merriweather says. He blames chronic underfunding of the state’s mental health system.
“Every single day people throughout our criminal justice system are victims of crime, and the family and friends that love them are seeing the price of not giving the attention that we really need to give to mental health,” Merriweather said. “And at some point, that’s got to change.”
Merriweather is hopeful that things might be changing. In March, the North Carolina General Assembly passed a bill that expands Medicaid coverage to everyone earning less than 138% of the poverty level, about $20,000 a year for an individual. That won’t go into effect until there’s agreement on a state budget, and there’s no guarantee when that will occur. If it does go into effect, some lawmakers of both parties want to spend $1 billion of federal money on mental health.
“That is a significant investment in public safety,” Merriweather said. “A significant investment in wellness in our community that has an exponential impact on everything that I do.”
But if North Carolina doesn’t invest in a stronger mental health system, Merriweather says the problems will continue. Courts can monitor defendants to make sure they’re taking medication when they’re out on bond, but at some point, their jurisdiction ends.
“Then you are left with the same person who has the same need, who could potentially create the same level of danger,” Merriweather said. “So there's got to be some other level of support system that's an alternative to judicial authority that can provide this thing that everybody in the community knows this person needs in order for all of us to be safe and for that person to be well.”
As for Ramsey, there’s one person who doesn’t want him in jail: the clerk at a Huntersville Quick Stop that Ramsey is accused of holding up. Richard Billings says he is glad Ramsey is doing better.
“If he can get the help he needs, he should get the help he needs,” Billings said. “He shouldn't be stuck behind bars, you know, making things worse.”
Ramsey’s family has been making sure he’s getting help. Ramsey’s application for disability benefits was denied, so his family was paying out-of-pocket for Ramsey’s therapy and medication up until a few weeks ago.
Now Ramsey has a job picking up trash around a number of apartment buildings, and he’s able to pay for his medication himself.
WFAE visited Ramsey again in May. He looked healthy and said he was doing great. He said the medicine is helping him, and he’ll keep taking it so he can go back to school and get a better job.
But Ramsey’s situation is far from resolved. St. Aubin isn’t a public defender anymore. So Ramsey will be starting over with a new lawyer when he goes to court later this month. Then he could learn whether he’s finally headed to trial.
Mona Dougani contributed to this story.
“FRACTURED” is part of a collaboration with the PBS series “FRONTLINE” through its Local Journalism Initiative, which is funded by the John S. and James L. Knight Foundation and the Corporation for Public Broadcasting.