Mental Illness in Jail

1. Mental Illness in Jail JJ Larson, MS, NCC, NCAC-II Manager, Psychological Services Division Greenville County Detention Center Department of Public Safety, Greenville County Presented by Kelly Troyer, Executive Director, NAMI Greenville

2. Bureau of Justice Statistics Sept 2006 • At midyear 2005 more than half of all prison and jail inmates had a mental health problem, including 479,900 in local jails. • This estimate represented 64% of jail inmates. • The above findings in this BOJS report were based on data from personal interviews with State and Federal prisoners in 2004 and local jail inmates in 2002.

3. SO ? • Persons with SPMI often slip through the “judicial” cracks • Largest Psychiatric Facilities in the country • Without planning & community support – can enter the revolving door

4. MENTAL ILLNESS Jail inmates had the highest rate of symptoms of a mental health disorder (60%) (compared to federal or state prisoners) Approximately, 24% of jail inmates reported at least one symptom of a psychotic disorder. SUBSTANCE ABUSE Among inmates who had a mental health problem, local jail inmates had the highest rate of dependence or abuse of alcohol or drugs (76%), Among inmates without a mental health problem, 53% in local jails were dependent on or abused alcohol or drugs. Bureau of Justice Statistics Sept 2006

5. Bureau of Justice Statistics Sept 2006 • Nearly a quarter of jail inmates who had a mental health problem, compared to a fifth of those without, had served 3 or more prior incarcerations. • Female inmates had higher rates of mental health problems than male inmates. • Local jails: 75% of females, 63% of males • Over 1 in 6 jail inmates who had a mental health problem had received treatment since admission

6. Mental Illness and Substance Abuse are prevalent problems amongst today’s criminal offender population.

7. Who is housed out the GCDC ? • Persons who are sentenced to less than 90 days • Persons who are waiting for trial • Persons who are sentenced through family court for child support • Persons with charges ranging from: disorderly conduct to assault and battery to burglary to murder and everything in between • Average daily census = 1400 • Book in & Release 100 persons per day (onaverage) • Annual Booking for 2006 = 22,000 - with 4,000 being repeat offenders in same year

8. Who is housed out the GCDC ? • Average inmate – white male mid to late 20’s, charged with A&B or Burglary 2nd degree • Average mental health inmate – could be any charge from disorderly conduct to assault & battery with intent to kill • Most often male, most often off medication • Of the 1400 inmates – 33% are on prescribed medication • Of those inmates - 40-50% are on psychotropic medications • Most Common Diagnosis appear to be– SCHIZOPHRENIA, BIPOLAR, MOOD DISORDERS • TOP 4 Meds in OCT 07: DEPAKOTE, LEXAPRO, SEROQUEL, & RISPERDAL

9. What GCDC Has undertaken • Improving & Enhancing Psychological Services provided to incarcerated persons • Seeking to enhance community partnerships for improved pre-release and “discharge” planning • Partnering with NAMI with Inmate & Family Support program

10. Staffing vs. Inmate Population 2000 with average of 855 Inmates – • 1 mental health clinicians • 1 psychiatrist, part-time 2007 with average of 1400 Inmates – • 1 mental health administrator • 3 mental health clinicians • 1 psychiatrist, part-time • 1 administrative clerk

11. Psychological Services • Mental Health Emergencies • Inmates who have been identified with suicide distress or other crisis level mental illness symptoms – most often psychosis. • Seen by clinician – may be referred to psychiatrist. • Mental Illness - Crisis Stabilization • Clinician Evaluation/ Assessment of inmates who have active mental health symptoms needing resolve prior to housing • Recommend and implement plan to bring about stabilization • General Mental Health • Inmates who have requested medical services through M360 system. • Seen in their Housing Units; at times seen in Mental Health Office • Substance Abuse Treatment • Groups services offered to male and female inmates of detention center. Must apply and be screened as eligible – by disorders, charges, keep separates, anticipated length of stay • Psychiatric Services • Inmates screened by mental health staff and assessed as requiring psychiatric or pharmacological interventions or adjustments

12. ZONES for Mental Health • On-Call Staff • Weekly rotation – responds to all after hours emergent issues • Conducts Intake Mental Health Triage Care • Inmate Requests • Responds to requests for services in Zone • First responder for Mental Health Crisis in Zone • Emergent/ Phone-In Concerns • Respond to requests by officers/ concerned others • May refer inmate to use of Inmate Request system (M360 form) • Case Management • Troubleshoot medication verification • Assist with discharge planning on inmate request • Coordinate pre-release planning based on needs assessment • Mental Health & Suicide Observation • Monitor inmates on these protocols, monitor stabilization, recommend appropriate possessions and housing as needed • Maintain mindfulness of safety –of self, of staff, of inmates

13. Staff Challenges • Medication- verification & compliance • Housing Issues • Dual Diagnosis & AOD • Discharge/ Pre-release planning • Inpatient Commitment/ Placement • Specialty Field – “correctional mental health” • Security Issues / Behavior • Malingering

14. Commitment to Quality Care • Estelle v. Gambel defined “Adequate Healthcare” for Correctional Facilities at a National Level. In 1976, the Supreme Court of the United States found in the Eighth Amendment to the Constitution that inmates had a constitutional right to medical care. The Court noted that an individual in custody is unable to seek medical care and is totally dependent on the employees of the institution for their health care. Therefore, failure to provide that care would be considered “cruel and unusual punishment.” http://www.health.state.mn.us/divs/cfh/ophp/resources/docs/correctional_health_2006.pdf

15. Commitment to Ongoing Quality Care • Jails & Detention Facilities have become the largest psychiatric hospitals in the nation • Inmate acuity (aka – amount of time it takes to manage an inmate’s psychiatric needs) will continue to increase as the population grows/ages • More Psychiatric Needs = More Staffing Needs • Provision of recidivism reducing treatment

16. Inmates Seen • 2006 – 5319 inmates seen by mental health • 2007 – 3945 inmates seen for 1:1 530 inmates seen in group sessions 4475 • 84% of 2006 total – in just 1st six months of this year

17. Lack of Jail Diversion: Pre-Booking Occurs at at the point of contact with law enforcement officers and relies heavily on effective interactions between police band mental health/ substance abuse agencies. Most entail: specialized training by police and a no-refusal crisis drop-off center Our county lacks crisis drop-off center Post-Booking Mental Health court referrals which entail collaborations with judicial and mental health or dual diagnosis treatment -- Can’t meet all demands – Transition Planning prior to release from Jail is evolving. Not yet a complete “Post-Booking” program; needs to be part of a community collaboration and recidivist reduction effort Other Challenges

18. Contact for more information: • Ms. Jennifer “JJ” Larson jlarson@greenvillecounty.org Main office number: 864-467-2359 • Kelly Troyer kellytroyer@hotmail.com NAMI Greenville 864-331-3300