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Mental illness among inmates a growing challenge for county jails
Times - 8/12/2019
Aug. 11--Jail populations in Lake and Porter counties have fallen in recent years as corrections staff have made changes in response to various addiction epidemics, but mental illness among inmates remains a rising problem.
Lake County Sheriff Oscar Martinez said his department continues to take the final steps toward being fully compliant with a 2010 settlement with the federal government that required improvements, including suicide prevention and mental health treatment.
In Porter County, the issue presents a difficult challenge in a facility that was never intended to serve inmates with mental illness, Sheriff Dave Reynolds said.
Nationally, suicide remains the leading cause of death among jail inmates.
The statistic hit a high of 50 deaths for every 100,000 inmates in 2014, the latest year for which the federal government has released data, The Associated Press reported.
Locally, the Lake and Porter County jails have recorded 11 in-custody deaths since 2013. All were from natural causes, not suicide.
Three people have died in custody at the Porter County Jail since 2013, with one death every other year, said Ron Gaydos, assistant jail commander. All three were medical-related.
The Porter County Jail does not have a mental health unit like the Lake County Jail, Reynolds said.
"All we have is padded cells. We're very organized. It's clean. It's well-monitored. But it's not built for mental health. It's just not."
Eight people have died while in custody at the Lake County Jail since 2013, including three in 2013, one in 2014, one in 2015, two in 2016 and one in 2018. All of the deaths were determined to be from natural causes, department spokeswoman Pam Jones said.
The Lake County Jail's Y Pod was renovated in 2014 or 2015 to serve inmates with mental health issues, Martinez said.
"The Y Pod is the largest inpatient mental health facility in Northwest Indiana," he said.
'We have a problem'
The Lake County Jail's mental health department includes 27 staff members, three supervisors, one full-time psychologist, two full-time nurse practitioners, seven full-time master's-level therapists and seven full-time bachelor's-level counselors.
The staff members serve 200 to 250 inmates with mental health issues, though an average of only 35 of them are housed in the Y Pod each day. The Y Pod has 80 beds.
On average, the Y Pod houses just more than 4% of the jail's total daily population. About 25% of inmates are on the mental health department's daily caseload, said Dr. William Mescall, the jail's mental health director.
The average daily population at the Lake County Jail was 752 in 2018. That's down from an average daily population of 874 in 2013. The jail has a total of 1,048 beds.
In Porter County, the jail recently has housed just more than 300 people a day. When the facility was opened in 2002, the daily population was more than 400. The jail can hold a maximum of 450 inmates.
Corrections staff in Lake and Porter County screen incoming inmates for various factors, including suicide risk, history of mental illness, legal use of medications and the possibility of withdrawal symptoms.
In Lake County, inmates at risk for suicide or potentially dealing with mental health issues are sent to the Y Pod.
Of the jail's $25.6 million annual budget, about $1.4 million is spent on mental health staffing. The jail spends about $283,325 a year on mental health and psychological medications, Warden Michael Zenk said.
The Porter County Jail's 2019 budget totaled $3.5 million, records show.
Porter County corrections officers confine inmates with mental health issues or at risk of suicide in padded cells in the jail's "God pod," officials said.
The conditions are not ideal, Reynolds said.
"We have a medical section for physical ailments," he said. "We have padded cells. But, really, is that the answer for mental health?"
Reynolds said he's not alone.
Sheriffs throughout the state are saying their facilities are not equipped to handle inmates with mental health issues.
"We have a problem," Reynolds said. "We're not set up to deal with mental health."
The jail holds at least one person in its padded cells on any given day throughout the year, he said.
'It's like a revolving door'
Officials in both counties said there is a high rate of recidivism among the mentally ill.
"It sort of harkens back to the lack of treatment options in the community," Mescall said. "You get to know all these patients very well. It's like a revolving door."
The high suicide rate among jail inmates nationally is commonly attributed to the fact that more mentally ill people are landing behind bars, a trend that began after state psychiatric hospitals began closing in the 1970s and promised alternatives failed to emerge, the AP reported. More recently, jails have been overwhelmed with those addicted to drugs or alcohol, many of whom struggle with depression and withdrawal.
Mescall said he recently conducted a study at the Lake County Jail in preparation for possible grant applications.
Overall recidivism in Lake County is 50.5%. Among inmates with a mental health diagnosis, the rate is about 70%. For those with a dual diagnosis for mental health and substance abuse, the recidivism rate is 84%.
Lake County did away with its padded cells because the Department of Justice, which is overseeing the jail's compliance under the settlement agreement, "was not a fan" of them, Mescall said.
In Porter County, where there is no specialized unit for the mentally ill, jail staff is under constant pressure to monitor inmates in padded cells 24/7, officials said.
Corrections staff check on inmates in padded cells every 15 minutes, and they're constantly monitored by camera.
The need for constant monitoring takes a toll, said Jay Birky, the jail's program manager and chaplain.
"It's taxing your resources," he said. "It's taxing your staff because they have to zero in and spend so much time with one person, to make sure that person is OK."
Suicide is a byproduct of all of this, Reynolds said.
"If you look at the numbers, we don't have a suicide problem," he said. "We have a mental health problem."
Intervention is key
Porter County contracts with a private company to provide mental health treatment to inmates. Reynolds and Birky credited Kim Hearon, the jail's mental health provider, for her tireless efforts to help mentally ill inmates.
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Officers send her verbal or written referrals when incoming inmates might need to be evaluated, and she sees them immediately if she's on duty. When she's not on duty, medical staff help care for the person until she can complete an assessment.
"My first intervention is making sure they have whatever medications we can provide for them as far as history," she said.
She attempts to reach family members, doctors and pharmacies to gather information about any prescriptions inmates might have had before incarceration, she said.
The Associated Press and the University of Maryland'sCapital News Service conducted a joint investigation and found that about a third of inmates named in the 500 lawsuits they reviewed attempted suicide or took their lives after staff allegedly failed to provide prescription medications used to manage mental illness.
In Lake County, inmates likely receive necessary medications faster than Porter County Jail inmates because of the jail's specialized staffing.
Supervision in the Y Pod also is significantly different than the traditional linear model in use in Porter County.
Corrections staff in the Y Pod operate under a direct supervision model. They wear blue and sit among the inmates, engaging in conversation.
"It's more about getting to know the person holistically," Mescall said. "And getting to know them so if they're having a bad day, they're willing to talk with you before fighting or hurting themselves."
Nowhere else to go
Even instances where Porter County's Hearon and outside doctors see a clear need for an inmate to be placed in a protective mental health facility, beds in such facilities are scarce, Reynolds said.
"If they have no insurance, they won't take them," he said. "That's a fact."
Corrections staff in Lake and Porter counties work to sign inmates up for Medicaid, but people often lose that health coverage because they fail to follow up at government officers after their release.
"As the addiction issue has been on the rise, so has the mental health issue," Birky said. "They go hand in hand."
At times, inmates being held on relatively mundane charges show clear signs of mental illness, such as throwing feces, Reynolds said. Such inmates need to bond out, but they often have nowhere to go.
"His family doesn't want him, but jail isn't really the right place for him to be," Reynolds said. "We can't keep a guy in the padded cell for weeks on end. And we can't put him in general population."
Reynolds said he's spoken with the offices of the governor and attorney general and legislators about his concerns.
It would not be feasible to renovate a part of the Porter County Jail for mentally ill inmates, he said. If a jail satellite facility were built to house mentally ill inmates, it would come with the cost of hiring a specialized staff, he said.
The concept of pooling county resources to build a regional jail equipped to house mentally ill inmates has been floated, he said.
The Porter County Jail's medical and mental health care provider recently suggested a cost-sharing arrangement with other counties to hire a psychiatrist who could work in multiple facilities.
"There's a lot of people trying to figure this out," Reynolds said.
'People need help'
One possible solution is mental health courts, established about a year ago by Lake Criminal Court Judge Salvador Vasquez and Magistrate Natalie Bokota and in January by Porter Superior Court Judge David Chidester.
Applicants to the problem-solving courts are screened and typically enter the program under a plea agreement in a pending criminal case.
Defendants accused of violent crimes, such as murder and child sex abuse, are not eligible. Participants must have a diagnosed mental illness.
If defendants successfully complete treatment and other requirements as part of a multiphase program, they receive a substantial benefit with regard to their criminal prosecution. If they fail, they return to the original sentencing court.
The goal is to reduce recidivism and improve public safety, Chidester said.
The need for a mental health court in Lake County had been present for many years, said Vasquez, who also has been working for nine years with the county's re-entry court.
All courts see people who, if not for a mental illness, would not have committed theft, used crack cocaine, escaped from a work-release program, or ripped off their own family members through forgery or fraud, Vasquez said.
"People need help more than prosecution," he said.
Vasquez said Bokota has been instrumental in Lake County's mental health court and has sat there more this year than him.
Another problem "no one wants to talk about" is homelessness, Reynolds said.
"We have a homeless problem. Maybe not as bad as in some other counties," Reynolds said. "There are people who don't have a place to live. A lot of these people have mental health problems. It becomes more apparent in the winter."
Porter County's mental health court is unable to help this population because no facility exists to house them, Chidester said. Defendants in the court live at halfway homes or private residences, he said.
'People really appreciate it'
Lake County's mental health court does serve homeless defendants because of assistance from Lake County Community Corrections. The organization had enough space at its work-release facility in Crown Point to create a separate space for defendants participating in the mental health court, Vasquez said.
About 15 defendants are currently participating in Lake County's mental health court, Vasquez said. They start off going before Vasquez or Bokota every two weeks.
In Porter County, 10 individuals are enrolled. Those in the first phase of the program see Chidester once a week.
"No one has been terminated or discharged yet," Chidester said. "We max out at 20."
Vasquez said the Lake County mental health court current accepts defendants with Level 4, 5 and 6 felony charges. There have been cases, particularly burglaries, where individuals with a Level 3 felony charge could have been considered, he said.
It's possible the court will begin accepting such defendants in the future. For now, the court's staff wanted to start off slow, he said.
"It's almost amazing how much we've benefited people," he said. "We see it every two weeks. People really appreciate that we're trying to help them out."
It just takes "a little bit of a push," a lot of contact and court supervision, he said.
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