Time to Step Up

Warren County joins effort to reduce number of people with mental illnesses in jails

Graphic via stepuptogether.org

The Stepping Up Initiative, unanimously adopted by the Warren County Commissioners as a focus of their administration this past July, is a joint effort by the National Association of Counties (NACo) and the American Psychiatric Association (APA) to combat the epidemic of inmates with mental illness.

As a result of the Olmstead Act, which enforced the integration mandate of the Americans With Disabilities Act in 1999, as well as the closing of the Forensic Unit at the Warren State Hospital, the number of people being with mental illness being housed as inmates at the Warren County Jail has risen dramatically.

According to WCJ Warden Jon Collins, as of Monday, August 7, the total inmate population at the facility was 114. Of those 114, said Collins, 79 of them – just over 69 percent – were on some sort of psychotropic medication for the treatment of a mental health issue. Speaking more generally, said Collins, “on any given day I would estimate on average that 65 to0 70 percent of the inmate population are on some type of mental health medication.”

As a result of increasing numbers of mental health consumers becoming inmates, Correctional Officers and jail administration are asked to deal with challenges and issues they may not be particularly well-trained in or prepared for. Among those challenges, said Collins, is the violence that comes with inmates not being medicated as they should be and the jail’s inability to force medications even when they can be procured. Collins said that many of the inmates with mental health issues have criminal records that “more nuisance-related,” but an inability of those inmates to successfully live independently without recidiviating. While their offenses may not be particularly violent or threatening, they are legally punishable behaviors that the individuals, because of their diagnoses, often can’t help repeatedly displaying. “This is happening everywhere,” said Collins. “There are currently no MH emergency housing facilities in this community, which leaves the Warren County Prison as the only place to house these individuals.”

On top of that, said Collins, inmates who are legally incompetent to stand trial before the court for an offense due to untreated mental health issues face wait times of two to four months, on average, to be transferred to Torrance State Hospital and Regional Forensic Psychiatric Center. Transfer to that facility, said Collins, is required to treat the mental health issues and get that inmate competent to stand trial, and commitment there could last up o six months depending on the language in the court order. “Once competency is accomplished,” explained Collins, “the inmate is returned to Warren County Prison to face their charges, which again takes time.” Ideally, inmates who have been deemed competent and returned to the WCJ “continues taking his or her prescribed medications throughout this process. If not, the inmate decompensates and we are back to square one.”

Even when some inmates with MH diagnoses are eligible for release, their violent history makes finding appropriate housing – a requirement before release is granted – difficult for them. “When they have no friends or family to parole to,” explained Collins, “the MH inmate could max out their sentence with no address and no supervision or direction.” That’s especially true when the person fails to maintain mental health appointments and face-to-face interactions with caseworkers. “Oftentimes,” said Collins,” they end up in unsafe surroundings, don’t do well mentally, and often begin using drugs and/or alcohol, and can return to jail quickly on new charges.”

The comorbidity of drug and alcohol and mental health diagnoses with committing crimes and recidivism is well-established.

And it’s not as easy as just getting inmates in need of it to treatment. Inmates not previously or already open for services with area mental health providers or family doctors face “very long” waits, explained Collins. “Currently,” he said, “it can take from four to seven months for an inmate to have a psychiatric evaluation with Beacon Light once they are incarcerated.”

Those inmates who were already receiving mental health services and had maintained their scheduled appointments prior to incarceration, said Collins, do not have much trouble getting their prescriptions in jail. The problem, explained Collins, is that there simply “are not enough psychiatrists, MH physician’s assistants, or MH treatment facilities to care for the MH issues in this community.”

The need for more mental health providers in rural areas is, unfortunately, also well-established.

Another problem, said Collins, is that some inmates deny any history of mental health issues at booking, only to later request treatment for mental health issues. Getting those inmates those requested services requires an intake interview to determine treatment needs, said Collins. Treatment options for inmates include psychiatric evaluation and treatment, individual and/or group therapy, casework services, and medication management after release. Getting through the waitlist to those inmates in need of services is just another thing that ends up adding to wait times, Collins explained.

Some inmates, though, are released before they receive a psychiatric evaluation. The counseling office at the jail regularly schedules follow-up appointments for evaluations and med checks after release, Collins said, for inmates still waiting for psych evals as well as those already open for services at Beacon Light. “Appointment information as well as directions and contact information is given to the inmate before release.

The only requirement of the ex-inmate is to show up at the scheduled date and time. Oftentimes, when those same inmates return,” said Collins, “it is determined that the inmate did not follow through with the scheduled appointments so their case was closed,” putting that person back at square one in the queue.

And simply not treating inmates with mental health issues isn’t an option, Collins explained. “inmates with mental illness have a variety of symptoms which, if left untreated, can become worse causing housing issues and extra stress on the inmate and staff. Some MH inmates can become easy targets for other inmates, requiring protective housing. Some MH inmates are violent and so they are housed separately, and require extra staff to transport them throughout the facility. Assault on officers,” said Collins, “could be daily, which causes continual stress and the potential for injury,” which in turn interrupts the efficient operation of WCJ staff.

“Unfortunately,” said Collins, “with the closing of the state hospital’s forensic unit, we are the correctional facility to hold state hospital patients who commit crimes while being treated at the state hospital.” Sentenced through district magistrates or being held while awaiting further court action, those individuals are recognized as inmates, not as patients, while at the WCJ, said Collins. “We cannot provide the therapy or medical care they need or have grown accustomed to.” Infractions on facility rules subject those inmates to the same disciplinary sanctions as other inmates. “It’s very difficult to see these inmates suffering form a mental health disability and not having the ability to provide the care they need,” Collins said.

Many of the inmates who are receiving psychotropic medications prior to incarceration were paying for those medications through Medicaid. Medicaid is suspended during any period of incarceration, explained Collins, and inmates are able to re-enroll upon their release. But during their incarceration, said Collins. “the county assumes the cost of their prescriptions.”

Stepping up seeks to make positive changes to these problems by addressing six key issues:

¯Is our leadership committed?

¯Do we conduct timely screening and assessments?

¯Do we have baseline data?

¯Have we conducted a comprehensive process analysis and inventory of services?

¯Have we prioritized policy, practice, and funding improvements?

¯Do we track progress?

“Warren County is already doing some of the suggested items in the program and has seen positive results,” said Commissioner Jeff Eggleston. “An example is Judge Skerda’s Treatment Court initiative, which has had a very high recovery rate and has produced a variety of positive results.”

Eggleston said that ongoing focus will be given to working between agencies to try and address other challenges that WCJ administration faces. “These issues will not be solved overnight,” said Eggleston, “and the solutions will require a great deal of work and focus. The next steps will include meetings with major players and influencers to discuss the above questions and start data gathering and reporting efforts in order to develop future plans of action. Similar successful efforts in other counties have produced savings for taxpayers as well as more positive outcomes for the community through inmate rehabilitation and a reduction in recidivism.”

Learn more about the Stepping Up initiative at https://stepuptogether.org.