Warehousing the mentally ill: Texas sheriff, county attorney see need for action in jails
On Aug. 2, Hunt County Jail held 299 inmates - 156 of whom (52%) had been flagged with some form of mental illness
By Hank Murphy
The Herald Banner, Greenville, Texas
GREENVILLE, Texas — On a recent day at the Hunt County Jail, more than half the beds were filled with mentally ill people.
On Aug. 2 the jail held 299 inmates, 156 of whom (52%) had been flagged with some form of mental illness, according to sheriff's Lt. Chad Starnes, head of jail operations.
The sheer number of mentally ill inmates in the county lockup demonstrates the onus placed on the local criminal justice system by mental illness — from patrol officers to jail staff to nurses to court officials. In essence, the county jail has become a revolving door warehouse for many of the county's mentally ill.
In May, a Hunt County Behavioral Health Leadership Team was established, and County Attorney G. Galvin Grogan has taken a lead role in identifying best practices for dealing with mental health issues. Among Grogan's chief observations about Hunt County's approach is a lack of treatment options.
"Lack of facilities, beds to provide the type of care that these people need," he replied when asked to cite the biggest mental health challenges confronting the county.
Another challenge: "We don't seem to have any out-patient options. A lot of these people don't need inpatient. If they just got a 30-day prescription for medication they'd stabilize, and if you had a continuity of care plan ... I think some of the problems could be addressed."
Thirdly, he points to a lack of coordination and transparency among those involved with the world of mental illness in Hunt County.
"I don't think there's enough transparency between what we're trying to do. So if we're all doing things in the mental health world because of different reasons, and if we're unaware of what each stakeholder is doing it for, it's hard to say 'I need your help on this issue' if you don't know what they're driving interest is," he explained.
Like Grogan, Starnes and Hunt County Sheriff Terry Jones also point to a lack of dedicated space for people with mental illness. As it stands now, mentally ill inmates are mixed in with the general jail population.
"We don't have room to segregate them in this facility," explained Jones. "We would love to have a wing for that, but as of right now we don't have that."
The jail does employ a psychiatrist who visits twice a week and prescribes medication, according to Starnes. The jail also has access to resources at the North Texas Behavioral Health Authority, including counseling for people in crises, noted Starnes.
Still, the great preponderance of mentally ill people in the jail poses tough challenges for jail staff, according to Jones and Starnes.
"If you've got a person who's suicidal, you've always got to keep an eye out," said Jones. The behavior of mentally ill inmates is often hard to predict.
"They'll twist off at the blink of an eye," said Jones, who cited an incident in which a mentally ill inmate attacked a nursing working at the jail as she prepared to dispense medication.
"And when I say attacked, he beat her down," said Jones. Her injuries were extensive, and a year after the episode the nurse has yet to return to work, according to the sheriff.
Although the jail does what it can for mentally ill inmates, most do not get the treatment they need.
"We're not equipped. You put people in here, they're not seeing daylight, they're not walking .... the help's not here," Jones said.
Grogan advocates for a facility similar to what Rockwall County has in its jail, which is a separate medical side that includes beds for the mentally ill.
"I think it's doable. They need to have free space. They (the jail) need to have rubber rooms, they need to have facilities that are specially designed to isolate (mentally ill inmates) incase they deteriorate. We don't have a single bed that qualifies for that," said Grogan.
As far as a free-standing mental health facility, neither Jones nor Grogan are under any illusion that such a thing will be constructed here any time soon.
"When you put this kind of issue before the community, there will be some who don't want this kind of facility in their back yard. Especially if you're going to share those beds for cost-purposes with neighboring counties. That would be something I think we'd have to do. For us alone, I don't think we have the demand to justify a 100-bed facility," said Grogan.
Still, the current system for dealing with Hunt County's mentally ill population — many of whom also are also homeless or substance abusers — isn't getting at the root of the problem, argues Grogan.
"Until you can find a place to treat them — and sometimes they only need to be treated for a week — but if you don't have the bed space, the only solution is to take them to the ER, get them cleared there and either drop a charge on them and put them in jail or put them back on the street, and then you're dealing with them in 48 hours again.
"I think adding a few beds at the jail is not a permanent solution. We need a capital project. I would prefer that before a homeless shelter because I think it goes right to the root of the problem — you could actually treat the mental health issue," said Grogan.
Although a grand solution may be a long way down the road, Grogan sees several initiatives that are doable in the short term.
"Crisis intervention teams are something that a lot of the more progressive counties have been doing to address the mental health problems in their counties. I think that is an easy baby step. It just needs coordination," he said.
Secondly, Grogan is considering the possibility of establishing a specialty court for people with mental health issues. He also would like to see a fulltime mental health coordinator for Hunt County.
"There's a lot of grant money either through the state or the federal agencies. We're thinking about applying for it next year," he said.
Instead of removing vagrants and trespassers and warehousing them at the county jail, Grogan said he's expressed another approach to law enforcement officers in Hunt County.
"I've told them I want to do something different as county attorney. I am not going to prosecute your criminal trespassing cases if these are mentally ill people. I don't think these people have the criminal intent. They're mentally ill. And to me as a prosecutor, I'm not going to prosecute someone if the criminal intent is missing."
Jones said he considers himself a pro-active person not a reactive one.
"I hate trying to fix something from the back end. We need to start finding out what's happening in the front end," he said.
Often, what lies at the front end of a person's failing mental health is a dysfunctional home or substance abuse or lack of a support system. He sees the need for a larger, more sustained effort to deal with mental health countywide.
"We're failing," he said. "If we don't get a hold on it, it's just going to get worse."