Advocates Work To Keep Mentally Ill Out Of Jail

Too many mentally ill people who aren't criminals go to Arkansas jails.

It costs taxpayers because a jail bed and jail medical care are more expensive than a treatment bed. It frustrates law enforcement who aren't trained and equipped to handle the mentally ill inmates. And it incarcerates people for being sick.

At a time when state legislators are considering a new, $100 million prison, mental health advocates offer a partial solution to the overcrowding problem: a statewide network of regional crisis centers with Northwest Arkansas serving as a pilot program.

These centers would be staffed 24-7 and be a place law enforcement officials could take people in mental crisis. Individual could go there for help. Each center would include up to 16 residential beds for patients, which would be partially paid for with Medicaid dollars.

Sen. Uvalde Lindsey, D-Fayetteville, is working with Sen. Jon Woods, R-Springdale, on a proposal to create a $150 drug court fee, which would double the number of drug courts in Arkansas. Mental health programs such as the crisis centers could also be partially paid for through the fee, Lindsey said.

"This is a lot less expensive way to divert some people from the criminal justice system than building a new jail," he said. "I think prisons are the best training grounds for criminals."

Charlie Green, interim director of the Arkansas Division of Behavioral Health Services, said the agency is requesting an additional $3.8 million to expand services, including crisis intervention, which could include the crisis centers. He said the state spends over a half a billion dollars annually on mental health services.

"We like to divert people away from more expensive and less effective care," he said. "We're going to work hard to educate our new and returning legislators on the importance of intervening as early as possible."

Wrong Place

Many of the mentally ill inmates in county jails face low-level misdemeanor charges such as disturbing the peace or terroristic threatening, who could benefit from early intervention programs. Many are repeat visitors to local jails, jailers said.

Washington County Sheriff Tim Helder said a 2007 study of the jail's inmates showed 25 percent had a mental illness.

"That was just how many told us about an issue or knew they had a diagnosis," he said. "Who knows what the actual number is."

Jails and prisons nationally house more than 10 times the number of mentally ill Americans than state psychiatric hospitals, according to a 2014 report by the Treatment Advocacy Center, a nonprofit group that advocates for effective treatment for the mentally ill.

Mental illness affects nearly one in five people annually, according to the U.S. Substance Abuse and Mental Health Services Administration, with about 4 percent of Americans suffering from severe mental illness each year.

Nancy Kahanak, a retired case worker at Ozark Guidance, said the situation creates community and taxpayer burdens everyone must face. It can cost up to twice as much to incarcerate a mentally ill inmate after factoring in the costs of medication, therapy and medical costs. Ozark Guidance is a nonprofit, community mental health center based in Springdale.

"This is not just a Washington County or a Benton County problem. It's a statewide problem," she said.

Mindy Bradley, associate professor at the University of Arkansas' Department of Sociology and Criminal Justice, said the recidivism rate among the mentally ill population is about 10 percent higher than that of the general inmate population.

She said the average inmate with mental illness has been through the criminal justice system four or fives times compared to two or three times for others. Bradley said the criminal justice system is often a place of last resort for people with mental illness.

"Diversion programs save money in the short and long term," she said, adding it costs taxpayers about $20,000 a year to incarcerate someone.

Diversion programs can cut that cost about $1,500 per person annually, she said.

Bradley wanted to get a better look at the role of mentally ill in the Washington County jail and took a sample of about 1,000 people arrested for disorderly conduct. She said about one-third had behaviors pointing to a mental health problem, such as talking to themselves or yelling.

She figured the cost to hold these four or five disorderly conduct prisoners daily could run more than $100,000 annually.

Call To Action

Kahanak is one of the leaders of a Northwest Arkansas group working to change the state's system of treating the mentally ill. The group, Judicial Equality for Mental Illness, hopes to educate the state's lawmakers and community members about the need for change. Membership includes current and retired mental health professionals, law enforcement representatives and community members.

Judicial Equality for Mental Illness started two years ago following the death of Benton County Jail inmate Faith Denise Whitcomb. She died of undiagnosed pancreatic cancer May 3, 2012, while awaiting a bed at the State Hospital.

A judge committed Whitcomb to the State Hospital after declaring her unfit to stand trial because of a mental illness. She suffered from schizophrenia. Whitcomb spent 178 days in a segregated cell in the jail because she was HIV positive and couldn't make bail on drug charges.

Jon Comstock, a former Benton County circuit judge, also saw problems with housing the mentally ill in jail. He held a public forum in 2012 examining mental health and the criminal justice system. He said at one point he sent an order for someone to receive a mental health evaluation at the State Hospital. Six months later, he learned the inmate was still waiting in the jail.

"They just didn't have a bed," he said.

They held the first Judicial Equality for Mental Illness meeting a few weeks later.

"Everyone agreed the mental health system was broken," Comstock said.

The situation has improved at the State Hospital, which has 96 beds dedicated to forensic services. The unit's goal is to assess and treat people with mental illness who are accused of a crime. All patients have been court-ordered for either an evaluation or treatment secondary to the legal charges they face.

Dr. Steven Domon, Arkansas State Hospital medical director, said the waiting list for a bed was about 100 people in 2012. The waiting list is about 10 today.

Domon said crisis intervention beds would provide the immediate help someone needs just by getting them back on medication or providing them with a good night's sleep.

Comstock said the mentally ill issue challenges society's views on punishment.

"We, as a society, want people to be held accountable for their actions, but we need to do that in a smart way," he said. "We need to look at the best way to spend our tax dollars."

Essential Training

Green said part of his division's proposal includes increased training for police officers.

"We are becoming more educated on the front end," Helder said. "I think we are getting better."

Community mental health centers statewide offer classes to anyone interested in better handling mental health situations, Domon said.

Ozark Guidance is offering Improving Outcomes to Northwest Arkansas law enforcement personnel. The two-day training program focuses on interactions with mentally ill and developmentally disabled people and includes a lot of role playing, Domon said.

Lt. Anthony Foster of the Washington County Detention Center attends the Judicial Equality meetings.

"We've always worked with mental health agencies, but JEMI has vastly improved communications," he said. "We now know what everyone's roles are."

Dealing with a mentally ill person often means keeping the inmate from injuring himself or a detention worker, said Dan Livermore, Washington County jail detention captain. That can mean strapping someone to a chair or placing them in one of the jail's padded isolation cells.

He recalled an inmate who would cram any object he could get up his nose.

"If he gets hurt, he may have to go to the hospital and that takes officers away from watching other prisoners," he said.

Jeremy Guyll, captain at the Benton County Jail, said prisoners who act out may wear a suicide smock that keeps them being able to move their arms.

"Here's the deal: We are cops and not trained medical professionals. We are not equipped to strap someone down and check their vitals," he said. "That is why we pushed for the medical contract."

Judicial Equality for Mental Illness members also want to make sure people who are incarcerated receive mental health treatment.

Washington and Benton county jails each recently started contracts with Southern Health Partners to provide inmate health care services. Each contract provides the counties with a mental health professional a couple of days a week.

Guyll said a mental health nurse started working 16 hours a week in September and, the need is so great, he hopes to find money to pay for her services one additional day per week.

Helder said Washington County's mental health nurse is at the jail 18 hours a week. She started Nov. 1.

"If money were not an object, I would like someone on staff full time," he said.

A Family Battle

Nancy Mooring is caught in the mental health and judicial system web. Sage, her 42-year-old son, was diagnosed about 20 years ago with a bipolar disorder. Bipolar disorder is a mental illness associated with mood swings ranging from the lows of depression to the highs of mania.

She said his symptoms include paranoia and delusions. Sometimes he claims to hear people screaming, and he will try to help them or call the police for assistance. The family lives about 20 miles west of Clinton in central Arkansas, and Nancy Mooring said police have made many trips to her son's home.

Medication helped him cope with his illness for many years. Nancy Mooring said about five years ago he stopped taking his prescriptions and turned to alcohol. He's been arrested three times in the past 13 months.

The last arrest was the most serious. He faced charges of aggravated assault.

"When he went to court in November, they said all charges would be dropped as long as he want to the State Hospital," she said.

He finished a 30-day evaluation at the Arkansas State Hospital last week. A judge will now decide what's next for Sage. His mother hopes to see either an inpatient or long-term outpatient program to help her son.

"People who don't live with mental illness have no idea what it is like," Nancy Mooring said.