County jails not fit for mentally ill

Counties develop approaches to deal with mentally ill offenders as jail populations, problems rise

By Todd McGee
Director of Communications

Chronic overcrowding isn’t the only problem facing North Carolina’s county jails. Sheriffs are experiencing part of a growing national trend – an increasing number of prisoners in county jails who suffer from mental illness.

Rep. Verla Insko (left) of the Joint Legislative Oversight Committee for MH/DD/SAS offers a suggestion at the meeting as Chatham County Commissioner Mike Cross listens in. Insko requested that NCACC staff present a summary of findings at the committee’s March 6 meeting. (Photo by Todd McGee)

Two Association steering committees – Justice and Public Safety and Human Services – met Feb. 26 to hear presentations from experts on the problem.

Jennie Vaughn and Anna Scheyett of the School of Social Work at the University of North Carolina at Chapel Hill reported that a recent survey by the Bureau of Justice Statistics (BJS) estimated that 64 percent of jail inmates nationally had mental health problems. The duo conducted a point-in-time census of the county jails on June 30, 2005, and found 17,171 inmates, meaning if the national figure applied to North Carolina, approximately 11,000 inmates had mental health problems.

The two researchers cited several studies that showed prisons are not an ideal setting for people with mental illness. They are more likely to be abused by other inmates, and the stark setting often exacerbates their symptoms. Being confined in jail also increases the risk of suicide among mentally ill inmates, who often do not receive their medications.

“When people with mental illness are in jail, they don’t understand the rules, so they don’t follow them,” Scheyett said.

This misbehavior often leads to the inmate staying in jail longer than others who committed similar crimes.

Vaughn and Scheyett surveyed 93 county jails in the state to determine how inmates with mental illness were treated as inmates. They received responses from 80 of the 93 jails.

The researchers wanted to know if and how jails screened inmates for mental illness, who conducted the screenings and where they were conducted. They also wanted to know how jails dispensed medications.

The survey showed that nearly all jails screened for mental illness, but that nearly half conducted their screenings in the booking area, making the screenings significantly less effective.

“Privacy is a huge issue,” Scheyett said. “People don’t always self-identify. There is a tremendous stigma attached to mental health. Information from families can be really important.”

Scheyett said that privacy was also critical for inmates who take medication for their condition. Their survey showed that medication is not dispensed privately in 79 percent of jails.

“Most medication is given in the cell block, so everybody in the cell block sees you get the medication and that you don’t look sick,” she said. This discourages people who need the medication from taking it.

Jails are also ill equipped to handle mental health crises, according to Scheyett. When an inmate has a crisis, it often takes one deputy eight to 12 hours – an entire shift – to get the inmate admitted to a facility where he can receive treatment. Limited resources are a major concern of sheriffs around the state, said Eddie Caldwell, general counsel of the North Carolina Sheriffs’ Association.

“The perception of the sheriffs is that a lot of people who are in jail would not be there if they had received adequate treatment outside of the jail,” he said.

The researchers made several recommendations, including to adopt a standard evidence-based screening tool for mental illness, mental retardation/developmental disability and suicide. The duo also suggested that jailers receive additional and ongoing training in mental illness and that counties improve privacy strategies for inmates to increase the likelihood that an inmate will let his condition be known.

Bob Kurtz of the Division of Mental Health/Developmental Disabilities/Substance Abuse Services (MH/DD/SAS) discussed some jail diversion strategies designed to keep the mentally ill out of jail. He noted the state had mental health courts in Mecklenburg and Orange/Chatham counties and that a third has been established in Guilford County but is not yet operational. This approach is still evolving nationally, Kurtz said, and their effectiveness has yet to be determined.

Another approach is to keep the mentally ill from entering the court system through specialized Mobile Crisis Teams (MCT). When a law enforcement officer encounters a situation with a mentally ill person, the officer is often not trained on how to recognize the symptoms or respond appropriately, and the situation frequently results in the person being arrested.

Some cities have developed MCTs to respond to these situations. These specially trained personnel can often intervene and get the person to a treatment center before they are arrested, thereby averting any contact with jails. But even in cities with this resource, Kurtz said the police are often reluctant to ask for their assistance.

“It often takes a while for the MCT to arrive on the scene,” Kurtz said. “Unless that team can arrive very, very quickly, the police are reluctant to call. The person will usually end up in jail.”

But Kurtz said there are successful approaches and pointed to Memphis’ Crisis Intervention Team (CIT). The CIT program combines the resources of the police department with mental health resources from the community. The program was begun in 1988 as a partnership with the Memphis Chapter of the Alliance on Mental Illness (AMI), mental health providers, and the University of Memphis and the University of Tennessee.

The partners developed a training program for police officers. Today, the Memphis Police Department has approximately 225 CIT officers who undergo the specialized training, enabling the city to maintain coverage around the clock.

According to Kurtz, Memphis Police Department officials say the program has helped reduce injury rates for officers and consumers, reduced incarceration rates for the mentally ill and provided officers with knowledge of community resources.

Several North Carolina communities have studied the Memphis CIT model and are in various stages of implementation. The Wake County Sheriff’s Department and several police departments in the county have developed a CIT certification program with Wake Technical Community College. The first CIT class graduated in September 2005, and 200 officers had been CIT certified as of October 2006.

Kurtz said CIT trainings have been held in Pitt, Vance and Forsyth counties, and that it is in development in Buncombe, New Hanover and Durham counties.

Rep. Verla Insko (Orange) attended the committee meeting and urged the Association to make some recommendations to the Joint Legislative Oversight Committee for MH/DD/SAS.

“I am very grateful for and impressed by the comments about treatment,” she said. “Nobody here is talking about building a facility to house these people. They are recognizing that these people can be treated and returned to society.”