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Cycles of incarceration persist as North Dakota jails lack resources for mentally ill inmates, officials say

By failing to treat mental illness or addiction among criminal defendants, the system in North Dakota is essentially releasing people from jail and hoping they get better, a Cass County leader says. A regional, multi-county approach with state support could address the problem.

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The Cass County Jail is seen Nov. 3, 2021, at 450 34th St. S. in Fargo. Alyssa Goelzer / The Forum
Forum Communications Co.

Editor's note: This is the third of four stories on the mental health challenges straining North Dakota's criminal justice system . Read the rest of the "System under stress" series here: Part 1 , Part 2 and Part 4.

FARGO — A lack of capacity for treating mentally ill defendants is among the many challenges the criminal justice system is facing. A 32-year-old man's repeated trips between the Cass County Jail and North Dakota State Hospital illustrates the growing problem.

While in jail, the man sometimes ate or stockpiled his own feces. He could not maintain personal hygiene or be kept safely with other inmates. He exhibited signs of acute mental illness.

Capt. Andrew Frobig, administrator of the Cass County Jail, outlined the unidentified man’s history before an interim legislative committee while making a plea for more resources to adequately treat the mentally ill to prevent recurring cycles of incarceration due to a lack of treatment.

Since 2014, the man had been arrested 21 times and spent 1,025 days in jail as of Sept. 28, when Frobig testified before the Legislature’s Acute Psychiatric Treatment Committee.

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After the man was arrested in early December 2020 for burglary, a judge ordered him to undergo a psychiatric evaluation to see if he was mentally fit to proceed in court.

In mid-January 2021, the judge ordered the man to be evaluated to determine if he was criminally responsible.

The inmate was transferred to the State Hospital in early February after an emergency committal for acute psychiatric needs.

Three days later, he was returned to the jail. The hospital’s report: “Lack of cooperation. Unable to render an opinion.”

An attempted telemedicine session in mid-April for the court-ordered evaluations was scrapped because the man refused to cooperate.

By early June, he was sent back to the State Hospital to try to complete the evaluations. He repeatedly refused to cooperate and by mid-July was back in jail. In mid-August, the judge dismissed burglary and trespass charges against the man for lack of a competency finding.

The man was released from jail. Once on the street, he became homeless.

Three days after he was released, the 32-year-old man was arrested on charges of burglary and possession of methamphetamines, Frobig said. He worries that the cycle is starting over.

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'Constantly triaging'

The Cass County Jail has more resources than any other jail in North Dakota, including services for inmates struggling with mental illness. Even so, the jail is overwhelmed by inmates with special needs.

And the problem keeps getting worse, according to Frobig.

The jail recently lost access to a nurse practitioner with some experience in treating low-level psychiatric illness, he told The Forum.

Southeast Human Service Center, located a few blocks away, can meet with some inmates in need of mental health services, in person or via telehealth visits. But, Frobig said, “We have more patients than they have time to meet with.”

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The Cass County Jail uses iPads to allow inmates to meet with mental health service providers via video. Michael Vosburg / Forum Photo Editor
Forum Communications Co.

The jail contracts with an independent psychiatrist for supplemental care. “This resource is limited, though, and we are constantly triaging new patients based on severity,” Frobig said. “It is not uncommon for a new arrival who is in need of services but not current with their psychiatric care or medications to wait six or eight weeks until they can be seen.”

The lack of mental health services in North Dakota has long been a recognized crisis, and even urban centers like Cass County struggle with overwhelming demand for services.

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“The problem is one that is growing worse each year,” Frobig told legislators.

The Cass County Jail struggles with significant delays in hospital beds for acute cases, including a lack of capacity at the North Dakota State Hospital in Jamestown.

Because of the shortage of beds at the State Hospital, Frobig sometimes withholds paperwork seeking admission for a patient until a bed opens.

This year, for the first time, mental health referrals exceeded the number of inmates booked into Cass County Jail — the result of multiple referrals for inmates because they were previously denied admission to the State Hospital.

The jail is hampered by a critical lack of space for stabilization care for inmates, Frobig said. Emergency rooms release patients to jails as soon as possible, turning jails into de facto psychiatric emergency rooms, he told The Forum.

Even when a screener at Southeast Human Service Center and a psychiatrist agree that an inmate needs hospitalization, a bed isn’t always available, Frobig said.

“That is a capacity issue,” he said. “What we’re seeing is a result of that. The Legislature’s the one that can solve that.”

As a result of hospital bed shortages, the Cass County Jail becomes the holder of people the mental health system can’t handle.

Once released from jail, there often are no services for inmates with mental illness or addiction, Frobig said. “They just go back to the street,” unlike those with developmental disabilities, who can receive help in group homes.

Leaders at the Cass County Jail meet weekly to discuss the special needs of inmates, who recently included three on suicide watch.

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Cass County Jail staff meet Oct. 15, 2021, to discuss inmates with special needs with Lt. Chad Violet, right, in Fargo. Michael Vosburg / Forum Photo Editor
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The weekly meetings help to coordinate the medical needs, including mental health needs, of the jail population, about 40% of whom take psychiatric medicines — a percentage that doesn’t include those who refuse medication, Frobig said.

“It’s just a way for all of us to stay on the same page,” he said.

The coronavirus pandemic has exacerbated problems, adding to strains on people’s mental health. Telemedicine, while helpful, doesn’t work for all, Frobig said.

A viable system would provide “high-intensity assistance on the street,” he said. “A social worker can do that type of thing,” but large caseloads probably wouldn’t allow that at current staffing levels.

Ongoing, individualized case management of released inmates would allow a case manager to intervene before a crisis flares up and the person ends up back in jail, he said.

The ideal solution would be something like the mental health crisis center established a few years ago by Hennepin County in the Twin Cities, essentially a mental health emergency department, Frobig said.

That sort of center, which could serve a region including Fargo, would better enable authorities to deal with people who are acting dangerously while in a mental health crisis, such as a person threatening to jump off a bridge onto the interstate, as recently happened , he said.

Law enforcement officers could drop off patients to be stabilized and treated during short stays, typically 18 to 24 hours, then released for follow-up provided by community services, Frobig said.

“That could be a stopgap,” he said. Given what’s currently available, “Everybody in the system is doing what they can.”

Chad Peterson, chairman of the Cass County Commission, believes a regional approach is required to deal with the complex and multifaceted problem.

A good model of counties working together is the Juvenile Detention Center in Moorhead. Clay and Cass counties are among 13 counties that joined to not only house troubled juveniles but also provide education and counseling.

“That’s what I want to replicate,” Peterson said.

He believes if policymakers and the public knew the full cost of untreated mental illness — in both human and financial terms — they would support significant investments that would provide cost-effective solutions.

“They need a bed, a buddy and a job,” he said. “We just wind up putting them in jail and release them, hoping they get better.”

Society pays the cost in ways that aren’t obvious and are often invisible but significant. It costs about $45,000 to house an inmate in jail for a year, Peterson said. Other costs add up, including hospital emergency room visits and the incalculable harms to people caused by people with mental illness or addiction.

“Investing in mental health is doing the right thing for less money,” he said. He’d like to see regional treatment centers, with financial support from the state, for each quadrant of North Dakota.

The state, with its petroleum riches and robust economy, can afford it, Peterson said. “We have the resources.”

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