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'Call to action' aims to reduce number of mentally ill in county jail

From left to right: Crow Wing County Jail Administrator Heath Fosteson, Community Corrections Supervisor Ann Rivas and Adult Services Supervisor Tami Lueck listen to Commissioner Paul Koering on Tuesday as County Administrator Tim Houle looks on at the Committee of the Whole meeting during a discussion about mental health and county jail inmates. Frank Lee / Brainerd Dispatch

Crow Wing County Administrator Tim Houle is convinced more can be done for the mentally ill in the county jail who either had nowhere else to go or fell through the cracks in the system.

Houle and others would like the county board to "sign on" to a "call to action" to reduce those with mental illnesses in jail by learning from other counties, developing a plan with measurable outcomes and implementing research-based approaches to addressing the problem.

"When we have people that are having an acute mental health crisis and they break down in our community—if there is no place else for them to go—we send them to jail," Houle told the commissioners at their Committee of the Whole meeting on Tuesday.

The strategic shift from jail/detox/hospital to assessment/triage/stabilization and future options such as crisis services and stabilization beds/intensive residential treatment services/chemical dependency and/or mental health treatment and services, respectively, began in 2011.

"It is a crisis in our community," Houle said of mental illnesses. "We see it in the jail, we see it in probation, we see it throughout the criminal justice system, we see it in child protection. We see it everywhere in our system."

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"It is a crisis in our community. We see it in the jail, we see it in probation, we see it throughout the criminal justice system, we see it in child protection. We see it everywhere in our system." -- Crow Wing County Administrator Tim Houle

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'Comprehensive re-entry'

According to officials, jails spend two to three times more on adults with mental illnesses that require interventions compared to those who are not, and without appropriate treatment and services, the mentally ill will continue to cycle through the criminal justice system. "If somebody comes into the jail and they have a broken leg, we take them to the emergency room and treat them medically," Houle told the county commissioners. "If somebody comes into the jail with a mental health crisis, they don't go anywhere. They just stay there."

Based on what other counties are doing, one option is to assess a potential inmate before they are booked into custody by possibly making referrals, rather than simply incarcerating the person.

"What we're looking at now is a 'comprehensive re-entry program' ... what we are providing to them for their mental health and chemical dependency support while they're in jail as well as while they are under probation," County Adult Services Supervisor Tami Lueck said.

"Sometimes, when a person enters the jail, we are trying to use the arraignment list as a way—and we've been working on this—so that we get notified in social services that even one of our individuals that we have an open case on entered the jail; we don't always know that."

Commissioners Paul Koering, Paul Thiede, Rosemary Franzen and Rachel Reabe Nystrom were present at Tuesday's meeting while Commissioner Doug Houge was not.

"As you can see, we're trying to do these community treatment options at the various points in time, so that we don't lose them," Lueck said about possible interventions in the justice system.

For example, those options include assessment, appropriate placement, mental health, chemical dependency treatment, case management and referral before the booking/jail stage.

"We're already probably doing some of this in other areas because they may be court ordered to go to treatment ... but 'should they be in jail' is kind of the question," she said.

Jail Administrator Heath Fosteson said, "If they can be diverted from ever coming into the facility in the first place, they might be able to get those treatment needs that they need better than we can provide ... because if they come in on a Friday night there really isn't a lot that I can do."

Mental health

There were 51 people at the Community Behavioral Health Hospital in Baxter in 2011, for example, but that number has mostly declined over the years to just seven individuals last year.

"Before somebody is in booking, we can use things like we might be able to return the person home ... but right now our current options is ... they could go to jail, maybe detox or might end up at the hospital—typically in the emergency department," Lueck said.

According to Fosteson, there were more than 4,000 bookings in the county jail last year, and 36 percent of them may have been eligible for diversions, such as home, chemical dependency treatment, an acute care setting, detox and more.

"When somebody needs psychiatric care ... they are going out far, but a number of them are ending up in our county jail, though, and are not receiving mental health care from mental health services while they're there," Lueck said.

Houle said, "And it's not because I think the correctional officers in the jail aren't doing a good job; they are doing a fantastic job with what they have, but they're not psychiatrists, they're not mental health professionals."

A design team has been put together to look at how a comprehensive re-entry plan can be developed in the county, a team that includes Ninth Judicial District Judge Earl Maus, County Attorney Don Ryan, the sheriff's office and Northern Pines Mental Health Center, to name a few.

"Some of the people that I think this would help are people who are short term with us anyway, people who are coming in on relatively minor charges like disorderly conduct ... so when they're at the emergency room or group home in the area and act up they come to us," Fosteson said.

"A lot of times we are dealing with situations where we don't even have the ability to help them necessarily but now, once they are in my care and in the facility, I've got to put them out the back door at some point, and now I'm concerned what's going to happen in the community."

Koering said those listed on the county jail website appear to be repeat offenders.

"I see some of these people more often than I see some of my own relatives," Fosteson said. "We've had people in the last eight years booked in 43, 44 times. ... He's come in once where he didn't have alcohol in his system."

Houle estimated that without the county having to deal with issues related to mental illnesses and chemical dependency, child out-of-home placement would be reduced by 80 percent, the number of jail inmates by 80 percent and the number of those on probation by 70 percent.

"This is the impact that we're talking about," Houle said of the sobering figures. "We're talking about millions of dollars we're spending in the wrong way. And we're spending it now in the jail or in probation, and the state is able to reap the windfall at the close of the state hospital."

'Call to action'

According to county officials, prevalence rates of serious mental illnesses in jails are three to six times higher than for the general population and almost three-quarters of adults with serious mental illnesses in jails have co-occurring substance use disorders.

"You need to understand that—in my estimation—mental health is the No. 1 crisis that we are facing in county government. It has legs everywhere," Houle told commissioners at Tuesday's meeting at the Crow Wing County Historic Courthouse on Laurel Street.

"We used to have a state hospital ... 2-to-1 staff ratio, psychiatrists on staff who could help administer medication—sometimes voluntarily, sometimes involuntary—for someone who needed to be committed."

Adults with mental illnesses "tend to stay longer in jail and, upon release, are at a higher risk of recidivism than people without these disorders," according to a draft of a board resolution for a call to action to reduce the number of mentally ill in the county jail.

"You may recall, Paul, when we were over there one time doing a tour and there was a guy in isolation, and he's gnawing on his arm—that's barbaric. And if we can't doing anything with him, then they strap him to a chair, so he can't injure himself or others," Houle told Koering.

"We essentially swapped one asylum model of care for another asylum model of care that doesn't have mental health professionals, and it doesn't have psychiatrists and it doesn't have any mental health workers."

Houle talked about a man currently in the county jail for disorderly conduct in a group home and has been in jail for about 45 days—a man that he and Lueck have been trying to help.

"There's no place that will take him, so he's stuck in jail because we don't have a mental health delivery system that can accommodate a guy with a mental health problem. ... This case is driving me batty," Houle said.

"The jailers, if you ask them, they'll tell you this guy doesn't belong here. He basically spends his day laying in bed. ... If we can divert somebody out (of jail) and we have a place for them to go—and oftentimes it will be home—then that makes more sense than it does to put them in jail."

Koering said he was glad that Houle and others are attempting to make changes, but as a lifelong resident, the commissioner reluctantly admitted to being not so optimistic, being a previous owner of liquor stores and having dealt with the mentally ill.

"They've been in my store when I owned it, and I'm not surprised that they're in jail because they've got mental health issues when I interacted with them, and I don't know how you're going to solve that," Koering said, while Thiede praised the "cooperation" among county agencies.

Houle replied, "We can't eliminate chemical dependency, we can't eliminate these kinds of human maladies. Our goal isn't to eliminate them, our goal is to make a difference. ... It is realistic to think that we might be able to move the needle—and that's our goal."

***UPDATE***

This story should have clarified there were 51 people from Crow Wing County at the Community Behavioral Health Hospital in Baxter in 2011, but that number has mostly declined over the years to just seven people from the county last year.

The Dispatch regrets the error.

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