http://www.miami.com/mld/miamiherald/8735116.htmThe voices are relentless. They insult him, threaten him, tell him to slit his wrists. Raymond Santos is 30 years old and exhausted, run ragged for most of his life by a biochemical tempest in his mind.
A year ago, he grew so desperate for the voices to shut up that he tried to appease them by taking a large, serrated kitchen knife and digging it four inches into his stomach. Two weeks later, with 31 staples in his abdomen, he landed in Florida's largest psychiatric facility.
The Miami-Dade County Jail.
He was locked up in a wing where psychotic inmates sleep on the tile floor or rusted metal bed frames, without sheets, blankets or mattresses. They stay in their cells for 24 hours a day. No books, no TV, no visitors, no toothbrush, no eating utensils, no clothes. They screech and cower at unseen demons. They pace furiously and rip their paper gowns off. They urinate on the floor and bathe in the toilet. The noise never stops, the fluorescent lights mask the passing of days, and the psychiatrist treats patients through a three-inch-wide ''chow hatch'' in a steel door.
''I don't even try to describe to people what's going on up here,'' said Dr. Joseph Poitier, the jail psychiatrist. ``It's beyond talking about.''
The scene is just one consequence of a nationwide failure to care for the severely mentally ill, a situation created over the last 40 years by the closing of psychiatric hospitals in Florida and other states. Those institutions -- often bleak warehouses for the ''insane'' -- were supposed to be replaced by local treatment centers that would get patients functioning in the community. But mental health experts widely agree that the new system never received enough funding and has offered fragmented services at best.
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