Editor’s note: This is part of a series called Plaguing Prisons that examines how the coronavirus pandemic is impacting jails, prisons and the criminal justice system.

There is nothing more painful for a parent than being unable to help their child in a time of need. Ecaurio Pérez does not see himself as an activist. He is just a father who is hurting, whose daughter needs help and knows that countless other families do too.

His daughter has struggled with mental illness, which has led to stints in the Smith County Jail. With few resources available in Tyler’s Hispanic community twenty years ago, his family was at first unsure of what was happening.

In the years since he has been able to get his daughter Luz a degree of help, but after running out of medication she was again arrested and has remained in the Smith County Jail.

This time was different though. It would be more than two months before Eucario finally heard from his daughter. With the spread of the coronavirus threatening to overtake jails and prisons, facilities have taken measures to prevent outbreaks. Every day he called or went to the jail after work, hoping to see or hear from her.

And when he did, he immediately knew something was wrong.

“The first time I saw her, she was really bad,” he said. “She didn’t recognize me. She would just talk about different things that I didn’t understand. Things that didn’t make sense.”

In a letter the family sent to state representatives, her sister Mayra, describes Luz as sweet, kind and attentive when they were younger. At 16 years old though something began to change. She began making statements they didn’t understand, and was convinced she was being followed. To make matters worse, Mayra said she also began to struggle with addiction.

When Eucario sat across from his daughter that day, he said she kept insisting people were bothering her.

“During the visit, maybe five minutes into the visit, and she gets into a fight with someone (else),” he said. “That’s when I knew that my daughter wasn’t fine, and that’s when I also knew that she wasn’t on her medication.”

He had been able to bring her medication to the jail the year before after a separate incident, but after she was released she had run out of medication and was told she had to go for a visit in order to have it refilled. Now Pérez had no way of getting medication to her.

Systemic shortfalls

In 2015 more than 55,000 people incarcerated in Texas received treatment in the public mental health system before their arrest, according to the Policy Research Project on Correctional Oversight by the LBJ School of Public Affairs at the University of Texas at Austin.

Today the burden of mental healthcare is stressing what resources county jails and prisons have available. The research shows that since the 1970s the rate of incarcerated people with a severe mental illness, such as major depressive disorder or schizophrenia, went from about 1 in 20 to 1 in 3 by 2015. More than two-thirds of incarcerated people in the United States are believed to have a mental health problem.

A 2016 state report from the Joint Committee on Access and Forensic Services recommended to lawmakers that the state should have at least 4,400 psychiatric beds available, which is 1,400 more than what the state actually had.

The most recent semi-annual Reporting of Waiting Lists for Mental Health Services, from April of this year, shows more than 900 people on waiting lists for forensic beds, the category used for incarcerated people. The average waiting list, once approved for that type of care, was 76 days for non-maximum security, and more than 280 days for maximum security inmates.

With the spread of COVID-19, waitlists were impacted as facilities began to make procedural changes in anticipation of the virus. A spokesperson for the Texas Department of Health and Human Services said transfers were briefly delayed earlier this year in order to allow for the creation of isolation units and introduce social distancing to the hospital units.

Finding help

Pérez just knew his daughter needed help, and he didn’t know enough about the system to get it for her. He reached out to Dalila Reynoso, a childhood friend of Luz and community activist, to help him advocate for his daughter. Reynoso, an outspoken critic of immigration policy and the treatment of undocumented residents, frequently engages with lawmakers and law enforcement from the local to the state level.

“It’s been very frustrating, because I know my daughter is suffering,” he said.

Reynoso said Sheriff Larry Smith agreed to sit down with them to figure out how they could work together. She said the sheriff and jail captain tried to get the help, but there was only so much they could do. Smith was not available for comment at the time of publication.

The next step was lobbying lawmakers. They had no luck locally.

“She is here physically, but not mentally. I miss her. I am begging you to please help her,” Mayra wrote in a letter to lawmakers. “Please help us get my sister back … He needs his daughter back”

Reynoso said the office of one state representative told Pérez they would meet with him, but he could not bring her as his advocate.

Pérez said it was particularly frustrating being told he couldn’t bring someone to help him navigate this complex process.

“It hurts my heart a lot because the people in power that can help don’t do anything to help, but they have the power in their hand,” he said.

Eventually she was able to find the right contacts and they finally got Luz on a waiting list for transfer to a state hospital, but at a minimum it would be months before a bed was available.

To make matters worse, the Smith County Jail has experienced a COVID-19 outbreak impacting dozens of jailers and inmates. As of Friday, Smith County had 46 inmates with active confirmed cases of COVID-19, one related death and 13 jailers positive. Those numbers do not include inmates or jailers who have recovered.

Pérez said his daughter does not understand what is happening.

“I don’t believe that she knows anything about what’s going on,” he said. “She’s scared of being in there. She tells (me) all the time that she hears voices.”

He said that as a father, it is incredibly painful not being able to help his daughter.

“It brings me sadness,” he said. Pérez struggled through tears to convey the sense of helplessness he feels.

Reynoso said the sheriff’s office and jail is going above and beyond to help Pérez keep in contact with his daughter, but they know the longer she waits for real mental health treatment, the harder it is going to be for her to recover.

Greg Hansch, executive director of the National Alliance on Mental Illness (NAMI) said that incarceration already was disastrous for mental health before a global pandemic.

“There’s a mental health impact of incarceration itself, and when within the incarceration setting a person is completely isolated … that mental health impact is going to be significantly more severe,” Hansch said.

He said research shows that the longer a patient has to wait to be treated for severe mental illness, the less likely they are to make a full recovery.

“I’m very concerned about the long term impact of COVID-19 on everyone’s mental health because it’s a traumatic event for society,” he said. “The longer an inmate has to wait behind bars for the long-term health they need, the less likely they are to experience long-term recovery.”

Michele Deitch, executive director of the LBJ School of Public Affairs, said jails were not designed for a population of people that are primarily in need of mental health services, but they become that by default due to a lack of services within the community.

“That’s not what (jail employees) were trained to do or the jails were designed for,” Deitch said. “It is inconsistent with treatment and a therapeutic approach.”

Deitch said that inmates with serious mental health issues are more likely to struggle with following rules or orders, as well as more likely to have run ins with other inmates.

“They are less likely to be able to follow rules or orders so they have more conflicts with the staff,” she said. “Their interactions are more likely to escalate. The jails have so few tools for people who aren’t following the rules that they tend to put people in solitary confinement or other punitive settings.”

Deitch said mental heath care needs to start long before a person is incarcerated.

“It should start long before that, we need to have the mental health resources in the community so it doesn’t become a criminal justice issue at the start,” she said.

Deitch referred to the Sequential Intercept Model, which is a community wide program that is designed to divert people from being arrested with intervention at multiple stages, beginning with de-escalation techniques.

She said communities also need resources to treat patients in place of taking them to jail.

“The problem is a lot of times you have communities that don’t have those facilities,” Deitch said. “When they are brought to the jail if someone clearly doesn’t have the capacity to follow orders or be safe, they ought to be rejecting them and telling the police you need to send them somewhere else.”

She is particularly concerned about how sweeping measures to prevent the spread of coronavirus is going to impact the people in jail.

“I think it’s really important to recognize that throughout the country, just in the free world, the rates of mental illness are skyrocketing during the COVID crisis. People are dealing with anxiety, stress and depression ... When you start thinking about people who are incarcerated, where already people with mental illness are overrepresented, it’s an explosive issue,” Deitch said. “I think the number of people facing mental health challenges is going to be an explosive issue right now, but it’s not an issue at the forefront because jailers are focusing on (screening and spread). The mental health issue is absolutely something that needs to be addressed at the same time.”

Deitch said that in a setting with already limited resources, the loss of in-person interactions or professionals visiting patients, is a cause for major concern.

Deitch said the problem won’t simply go away for people incarcerated. Even upon release, they’re going to be coming back to a world that has lost millions of jobs and face incredible challenges reentering society.

“These issues are going to be lasting for a long time,” she said. “If we don’t start dealing with it up front we’re going to start paying the price.”

Without effective intervention, treatment and long-term plans in place, she believes suicide rates, attempts and mental health crises will only be exasperated.

Pérez hopes that by telling his story, he is able to help other families find resources to help get their loved ones the mental healthcare they need.

“(I want) for there to be places available for people to not go to jail, but to somewhere that can assist them. A jail is not a place where they need to be. (What is needed is) a place where they can get the attention and care that they need,” he said. “There’s a lot of people suffering from mental illness. They aren’t the only ones suffering. Their families are suffering as well. Maybe they’re people that have children and you care for them and love them, just like me when I’m dealing with this situation. I love my children and my daughter,’’’

Hansch said NAMI has resources available for people looking to find help for their loved ones struggling with mental illness. He also wants families to know that NAMI is here to help them as well.

“Resources for family members is something our organization specializes in. That’s a really difficult situation to be in, to not to be able to visit with a loved one who is behind bars,” he said. “We’re here to support those family members, we’re here to let them know they can talk with family members who are going through the same thing.”

For more information about finding help visit NAMI.org. For help finding resources to advocate for a loved one in jail, visit TexasJailProject.org.