It was a chance to lay the issues out from all sides Thursday afternoon.
Elected officials and those involved in mental health and law enforcement across the region met Thursday at Warren State Hospital's Interfaith Chapel to discuss the landscape of mental health services.
State Rep. Kathy Rapp requested the meeting.
"There's a lot of concern for me on how we're handling people with mental illness," Rapp said prior to the meeting. "It's striking that every state prison now has a mental health unit."
"We have some critical issues regarding mental health and corrections," Rapp said to open the meeting. "It's been an ongoing issue."
Rapp cited the closing of the forensic unit at Warren State Hospital and the closure of Mayview State Hospital, near Bridgeville, as having a possible impact on instances of mental health issues in inmates.
"The real push for this meeting is what we've seen happening naturally," Rapp said. "People that can live in the community... that's where they need to be. Unfortunately, with closings of state hospitals, I'm hearing from the community, not just drug and alcohol, but now from corrections.
"Forty-eight percent of women in correctional facilities are diagnosed with a mental health issue. In Pennsylvania, every correctional institution has a mental health unit. It's time to face this. As a society, do we want to see our prisons become our mental health units?"
Mary Kushner, director of Forest-Warren Human Services, said there is a need to divert children out of juvenile detention and into treatment when mental health issues are involved.
"We want to keep people here. We want to keep them out of prison," Kushner said.
Warren County Commissioner John Bortz pointed out the trends he sees in his role as chairman of the county prison board.
"A lot of what we see happening in the jail is indicative of the larger community and we are seeing an increased need for services," Bortz said. "That tells us, at the end of the line, these folks aren't adapting well to the community. I think we have to ask ourselves, 'Do we want to be keeping these people in prison?' and I think we can do better. From a purely fiscal aspect, I'm not sure this is the best policy.
"Folks, it's out there," he continued. "We gotta take a look at it or else we, in the commonwealth, are going to be in the jail building business, and I have to think we can do better."
Warren County Commissioner Chairman Steve Vanco and Forest County Commissioner Basil Huffman also expressed concern.
"I've talked to some corrections officers," Huffman said. "These people don't have the demeanor or the training for this. Our corrections officers have to act as the nurses and doctors in some cases."
Vanco added, "I'm hearing from people in law enforcement that there are people in our prison system that shouldn't be there. It isn't what they need."
Rich Seager, CEO of Beacon Light Behavioral Health, cited an incident in which it took two CEOs, and a representative of the Governor's Northwest Office to move an individual out of incarceration and into a mental health setting.
"You have to wonder when it takes two of the CEOs of two of the largest companies in this field to move one person out of jail when she shouldn't have been there in the first place," Seager said. "We need to start putting in place systems to get people where they need to be."
Department of Corrections Deputy Secretary Shirley Moore Smeal outlined some of the things corrections is doing to cope with the influx.
Smeal said corrections is working on installing a special identification system at State Correctional Institution Camp Hill which serves as the state prison system's classification and diagnostics center.
"Our assessment is lacking. We know that," Smeal admitted. "We're putting systems into place to speed up assessment."
Smeal said the department is also increasing employment of on-site mental health professionals and building with mental health issues in mind.
"(New facilities) are really going to be focused on mental health," Smeal noted.
According to Smeal, the department is also working to ensure continuity of mental health services as inmates transition from prison to the community.
Keith Bell, who sits on Warren State Hospital's board of trustees, suggested looking at the broader picture.
"I'm suggesting you have to look at the substance abuse, the work history issues and do what you can about the (societal) culture," Bell said. "You need to look at those things, consider all you have and come up with a model; preferably at the earliest level... the county level."
Bell advocated for better integration between the criminal justice system and the community mental health system.
"The benefit of the criminal justice system is, somewhere you have a judge," Bell noted. "You have leverage to make them get treatment."
David Mitchell, director of the Governor's Northwest Office, stressed support after inmates return to the community.
Mitchell, who worked in the criminal justice system early in his career, said, "Back then we didn't have the mental health prisoners we do today. They were sent elsewhere. Prisons were for criminals."
"We don't do anything, in real terms, to integrate people back into society," he continued. "It's hard enough working with the criminals to get them back into society and it's even worse for someone with both criminal history and mental health issues. It doesn't do any good to give someone five bucks and a suit of clothes. They're going to be back. We really need to look at this more."
Rapp advocated for taking some strain off of the corrections system by placing individuals with mental health issues into the state hospital system.
"This facility certainly has the space to accept more people," Rapp said. "The room is here. Does the state need to hire more employees? I don't know. I look at this facility as a safety net to keep people out of prison."
Warren County Sheriff Ken Klakamp pointed out how the current system is taxing local resources and how it relates to gun crimes.
"One of the things that hurt us is when the forensic unit closed," Klakamp said. "I have to take two deputies to transport people (to Torrance State Hospital which has a forensic unit). That has added a whole host of issues."
Klakamp also noted that when an arrest is made at the state hospital, the patient is discharged, effectively leaving law enforcement with nowhere to discharge them to.
"They have nowhere to release them to," Klakamp said. "We're warehousing people. In Warren County we have a large number of group homes because these are people who traditionally were in the state hospital."
Klakamp noted that when an individuals are arrested and brought to a state hospital rather than being incarcerated, they are given the option of voluntarily committing themselves. Under Pennsylvania law, a patient who voluntary commits himself can still own a firearm, while one who is committed involuntarily cannot.
"We get them to the state hospital and they give them the option of signing themselves in," Sgt. David Gluth with Warren-based state police added. "They can go buy themselves another gun the next day."
Acting Secretary of the Pennsylvania Department of Public Welfare Beverly Mackereth responded to participants.
"I think it's important to remember most people with mental health issues don't commit crimes," Mackereth said. "Yes, we have a significant population in our prisons who have mental health issues and substance abuse issues and a number of people who have all three. We have to remember that and not compartmentalize."
"We have to focus on prevention and early intervention," she added. "If we don't do anything at the front end, we'll never be able to do something at the back end. We need family engagement rather than government going out and telling people what to do. It's going out and having them (social service clients) tell us what they're going to do."
Mackereth also cited what she sees as society's move away from engagement with neighbors and sense of community and said communities need to restore that engagement.
"That's not government's job," Mackereth said. "There will never be enough money to address all the problems we're discussing. We need to decide where the best use of those dollars is."
"Certainly, whole child development goes a long way," Rapp interjected, "but we need to get to the issue of this facility and connect the dots with corrections."
Dennis Marion, deputy secretary of the Office of Mental Health and Human Services, cited intermediate punishment programs, probation and parole departments and mental health courts as means of dealing with individuals with mental health issues in the criminal justice system.
"It's a matter of communities needing to connect the dots," Marion said. "The state hospital is part of a broad continuum of care and will remain, but it's only a part that targets a certain subset of people within that broad continuum of care."
"I agree with what you're saying, but we cannot lose sight and make decisions ideologically," Bell responded. "We cannot decide to just deinstitutionalize everybody based on ideological goals. What do you do with the prison population that is severely mentally ill, but has serious criminal charges against them?"
Of Pennsylvania's approximately 650,000 mental health patients, between 1,500 and 1,600 are in the state hospital system.
Neither Mackereth nor Marion addressed the issue of inmates with mental illnesses currently incarcerated who do not fall into the specialized subset the state hospital system is designed for.
Rapp moved to the issue of the state hospital's bed cap.
"Would the system be able to say, 'We can take this person right now, without a waiting list'?" Rapp asked.
"We're only certified for that number by Medicare," Warren State Hospital CEO Charlotte Uber said. "So my opinion would be no."
"It's my experience you would do a broader search (for a bed)," Marion added. "What they do is, typically, use another facility. I think if you have a situation where you were regularly bumping up against the (bed) cap, I think the cap drives the (mental health) planning."