County jailers do what they can

On any given day, a fifth to a third of the Cass County Jail's inmates are on psychiatric medication.

Heidi McLean, correctional nursing supervisor with Fargo Cass Public Health, said one recent week was typical. Of 228 inmates, 20 percent were on medication. Eighteen inmates were waiting to see a psychiatrist, while at least 20 already were under psychiatric care. One or two inmates were schizophrenic.

The Jail Intervention Coordinating Committee, a group of local health-care workers and law enforcement people, wants to find a way to keep those people out of the jail and under medical care.

Under a pilot plan the committee has proposed, a person booked into the jail would be screened by trained staff for mental illness.

If needed, a treatment plan, developed in consultation with attorneys and the court, would be offered to the inmate in lieu of incarceration.

The committee is seeking grants to set up the system, which would cost about $391,000.

Jail Administrator Glenn Ellingsberg said the committee would seek a $250,000 federal Justice Department grant, with the rest of the cost coming in state and local money.

The '20-80 rule'

That may not be cheap, but officials say it would be money well spent.

McLean said the most common psychiatric disorders among inmates are antisocial personality disorder, which makes a person aggressive, argumentative, self-centered and manipulative; and depression and anxiety, much of which comes from changes in the brain wrought by methamphetamine and other drugs. Of those inmates who have mental illness, 95 percent also abuse alcohol or drugs, McLean said.

Those with serious, acute mental illness are sent to Jamestown State Hospital. The jail transported 13 inmates there in 2005 and six so far this year.

Mary Geller, the jail's classification officer, said that even if mentally ill inmates are a minority in numbers, they make for a majority of the work.

She called it "the 20-80 rule": "Twenty percent of the people who are mentally ill take up 80 percent of our time."

It isn't that such inmates are necessarily violent or combative. They just require staff attention because of "the questioning, the memory lapses, answering the same question over and over again," Geller said. Others are paranoid and require constant reassurance and attention from guards.

The process of identifying mentally ill inmates already begins with booking at the Cass County Jail.

McLean said incoming prisoners are asked a series of questions about their medical history, whether they're under a doctor's care and whether they have suicidal or homicidal thoughts.

Geller said incoming people also are interviewed to determine if they can be placed in minimum or maximum security or if they should be isolated due to being under the influence of drugs or suicidal thoughts.

"We also look at their vulnerability," Geller said. Inmates who appear timid or odd, or perhaps are at risk because of their sexual orientation, may be segregated from the general jail population. "We're responsible for their safety and security," Geller said.

During the first few days in custody, they are closely watched by corrections officers, McLean said. They are evaluated on everything from how they get along with other inmates to how they react to what television shows inmates watch. Officers note whether inmates eat enough or sleep excessively

Sometimes, the cause of an inmate's odd behavior isn't even immediately apparent. "A lot of times it's a little something," Geller said. She recalls one inmate who could never find his way back to his cell and was later found to have suffered a head wound earlier in his life that affected his memory.

The jail's nursing staff makes sure inmates are taking their medication and seeing mental health professionals.

Jail pays for meds

Ellingsberg estimated that the jail spends $8,000 a month on medicine for mentally ill inmates.

That money generally comes out of the jail budget, he said. If the inmate has medicine paid for by another public agency, like the Veterans Administration, those other agencies stop footing the bill once the person is jailed.

While jail nurses do not diagnose specific mental illnesses, if the inmate's condition is acute they call in Southeast Human Services, which can do a psychological evaluation within 24 hours or less. If the condition isn't acute, but still obvious, like depression, it can take up to two months for the inmate to see a psychiatrist.

"Right now, there's very little, limited resources," Geller said. "These kind of guys are often at the end of the line."

McLean said that if inmates are compliant, the first task for jail staff is to get them back on medication and stabilize them. But even if that's done, it's a problem for jail short-timers. They go back out on their own, don't keep taking their medicine and often self-medicate with alcohol or drugs, causing them to do things that land them back in the jail, she said.

While they're in jail, staff works with inmates on a discharge plan that makes them aware of how and where they can get needed mental health services. McLean said staff are currently working to refine the process by which that is done.

The situation in the Clay County Jail is similar but less formal.

Jail Administrator Julie Savat said she had no statistics on the proportion of mentally ill inmates there.

Incoming Clay County inmates are subjected to a "very limited" medical screening that asks whether they have a mental illness, have considered suicide or are chemically dependent, she said.

Booking officers determine whether an incoming inmate must be watched; if so, he is put into a holding cell. If the incoming inmate takes his medication and appears to be acting all right, he's put into the general population.

The Clay County Jail works with county social services staff and the Lakeland Mental Health Center to provide any needed services that can be done locally. A local solution is attempted first, because while severely mentally ill prisoners used to be able to go to Fergus Falls State Hospital, some of the beds that used to be available there have been spread out to state hospitals in Alexandria and Thief River Falls.

A national problem

Many blame the high number of mentally ill people in jail on deinstitutionalization over the past 30 years, which closed state hospitals in favor of community-based mental health programs. But Sheree Spear, a local representative of the National Alliance on Mental Illness and a member of the Jail Intervention Coordinating Committee, says that's an oversimplification.

Deinstitutionalization was made possible in part by advances in medication; many people who years ago would have been institutionalized can now live on their own with the aid of those medicines.

But they have to take them and sometimes they don't, Spear said. And when poor medication compliance is combined with substance abuse - 75 percent of people with untreated mental illness abuse alcohol or drugs, Spear said - the individual can wind up in jail.

Spear said a diversion program would pay off in keeping mentally ill people out of a revolving door.

"If the objective is to reduce recidivism, to keep them from coming back into jail, then this program makes so much sense," she said.

Some outside the committee take a wait-and-see attitude about whether the treatment program would work as intended.

Debbie Tibiatowski, victim witness coordinator for the Cass County state's attorney's office, said each case is different and the program may work in some cases, but not in others.

It all hinges on how compliant the offender will be with the treatment program, she said.

But beyond any practical considerations like reducing recidivism, some think a diversion program simply is the right thing to do, rather than putting mentally ill people into a jail system aimed more at punishment and public safety.

"If you've ever seen anybody in a restraint chair, it's God-awful," Geller says. "They're in such pain. It breaks your heart."

Readers can reach Forum reporter Tom Pantera at (701) 241-5541