NC jails house many of state's mentally ill people

From The Citizen-Times in N.C.:

ASHEVILLE, N.C. — As the person in charge of Buncombe County's jail health system, Rich Munger isn't necessarily joking when he refers to the detention center as “probably the biggest mental institution in the county.”

On any given day, Munger said, there are 75 people with mental health issues among the jail's 400 inmates, a figure that advocates say could grow as the state struggles with budget cuts and mental health reform.

“It gets to be very expensive for counties to house people with mental illness who don't need to be there, and it is not very useful or helpful to the person with mental illness,” said Bob Kurtz, program manager for the state division of mental health.

Inmates processed in Buncombe County get a mental health assessment, and the jail keeps a psychiatric nurse on staff.

Officials pointed to that after an inmate's suicide one week ago, a case that raised questions on how the county handles inmates needing special watch.

The county in recent years has beefed up its procedures for assessing and dealing with inmates who have mental illness, putting focus on trying to keep mentally ill people out of jail in the first place.

Buncombe spends more than $2.5 million a year on a system to keep people with behavioral health problems from penetrating further into the criminal justice system and to prevent recidivism.

“We want to do everything possible to get a mentally ill person into treatment,” Munger said.

Buncombe has improved its ability to detect mental health issues among inmates, said Jim Pitts, president of the local Asheville affiliate of the National Alliance on Mental Illness. But like many counties, it could still do better in identifying inmates with serious mental health problems earlier and getting them into treatment, he said.

“All of our institutions could do better,” Pitts said.

A 2007 report commissioned by the N.C. Governor's Advocacy Council for Persons with Disabilities found that many jails operate without procedures to assess and deal with inmates who have mental illnesses and developmental disabilities.

Council executive director Vicki Smith said the situation has most likely gotten worse in the last year because of cuts in services to people with mental illness, and she anticipates it will continue to get worse with more budget cuts expected.

“There is a direct relationship between the availability of appropriate services in the community and the number of people in jail with mental illness,” Smith said.

Kurtz said Buncombe has more jail diversion programs for mentally ill inmates than most North Carolina counties.

Those include the Crisis Intervention Team, which trains law enforcement officers to deal with and identify people with behavioral issues.

Buncombe County implemented the program two years ago, and about 20 percent of Buncombe County sheriff's deputies and 10 percent of Asheville police are trained in crisis intervention.

The county also works to get people with mental illness into short-term treatment centers or to the hospital where they can be transferred to other facilities.
“It's where you get the biggest bang for the buck,” Munger said. “It is very cost-effective to intervene at that level.”

The jail also has a number of pretrial services to help inmates, including three problem-solving courts and the JUST Jail Diversion Program, which seeks to get people with severe mental illness out of jail under the supervision of a case manager.

Diversion programs have kept people out of the detention center and reduced the average time they spend in jail, Buncombe County Sheriff Van Duncan said. People with mental illness often stay in jail longer than other inmates.

“I think we are way ahead of most counties in what we are doing,” Duncan said.
Jail programs

If a person with mental illness does end up at the jail, usually because he or she has committed a more serious crime, the county assesses them for any mental health problems.

There are nurses and a doctor available to do further assessments and prescribe medications. Local mental health agencies also are contacted to see if an inmate is a client there.

Inmates can join educational groups for mental health, substance abuse and other issues while in jail.

Case managers also help inmates connect to services they may need once they are released, which Munger said has been proven to lead to fewer arrests.

But the county still lacks a mental health court, which could help divert more people with mental health issues from going to jail.

Buncombe County also does not have counseling services for inmates, who are usually treated with medications. Munger said that is because inmates are usually not in the jail long enough to warrant those services.

“I think we have got a program that stands out in North Carolina,” he said. “We're moving in the right direction.”