Mental health on lockdown
The KHI News Service and Topeka Capital-Journal recently published a series of reports on how the state’s legal system deals with people with mental illness:
- Mental health issues drive some Kansans to repeated jail stays
- Handling Kansans with mental illness a matter of training for law enforcement
- Advocates of Kansas mental health courts say lives improved, taxpayer dollars saved
- Minnesota mental health court a model
- Kansas’ treatment of those with mental illness was a ‘study in neglect’ decades ago
The “special management” unit on the third floor of the Douglas County Jail is where county officials place inmates with medical needs, including mental illness.
It’s next to the jail’s maximum security unit, separated by a single wall. Both units have the same metal doors, the same small windows and are watched by the same guards.
They’re identical — and that concerns jail employees.
“This over here is probably not really the ideal climate for people with mental health issues,” said Eric Spurling, a captain in the Douglas County Sheriff’s Office. “It’s loud. Every noise echoes.”
The jail, like many other corrections facilities, was not designed with mental health management in mind. Spurling and others who work there say overcrowding has exacerbated design flaws and created an environment where inmates with mental health issues are less likely to manage their conditions and reintegrate into society successfully.
County leaders are considering a $30 million jail expansion and renovation that would include modern design concepts to maximize behavioral health services. Those changes are coupled with plans to establish a mental health crisis center and behavioral health court, although the cost for those plans has not been determined.
But a local group called Justice Matters, headed by religious leaders, is pressing the county to put the jail expansion on hold and enact only mental health diversion programs to try to reduce the need for the expansion.
Jail officials said they agree with the goal of treating mental illness before it leads to jail time but don’t believe diversion programs alone will be enough to stave off the need for additional space and a more progressive jail design.
“I’m a social worker,” said Mike Brouwer, director of the jail’s nationally recognized mental health and substance abuse treatment and anti-recidivism programs. “Philosophically, I’m opposed to mass incarceration on a national level. … But I also think you need to look at where you are and what you need in your community.”
When the Douglas County Jail was designed in 1995, the county had about 90,000 residents, the jail averaged only a handful of female inmates and few corrections programs were doing much to distinguish between inmates with a history of mental illness and those without.
The county now has about 120,000 residents, an average of 40 female inmates and an awareness of the benefits of identifying inmates with mental health needs and treating them during incarceration.
“Mentally ill people have always been here, we just didn’t do a good job of identifying them before,” Brouwer said.
He said “there’s nothing therapeutic” about the current special management unit.
The jail expansion proposal calls for a new special management unit on the ground floor, with a design that prioritizes natural light and access to an outdoor courtyard.
Instead of being next to the maximum security section, inmates with mental health issues would be across from the work release area where inmates with the lowest security threats stay.
The expansion also would mean major changes for the female inmates, who are currently housed in a 14-cell unit, regardless of what threat they pose to security. With two beds in each cell, the jail theoretically has room for 28 women, but Spurling said the county occasionally has female inmates who can’t be placed with a roommate for safety reasons.
Having all security classifications in the same unit limits the time women can spend outside their cells.
“The more different (security) groups you have in here, the less free time everybody gets because you have to keep them separated,” said Gary Bunting, the county undersheriff for corrections.
The renovation plan calls for female inmates to have separate units based on security classification, the same as their male counterparts.
Jail officials say they can’t make the changes without the proposed expansion, which would add 120 beds.
The facility currently has 186 total beds throughout the work release, medium security, maximum security, special management and female inmate units. About 15 percent of them have to be left open in each unit to provide room for inmates to be moved up or down based on their behavior.
The county had 251 inmates in its most recent count, with 157 at the jail, 84 in other counties and 10 in specialized treatment facilities.
Treatment in jail
Brouwer said inmates sent to other counties may not have access to the same resources that Douglas County provides to help them succeed when they get out of jail.
“It keeps me up at night,” he said.
The Douglas County Jail has a medical unit open 24 hours that is staffed by one registered nurse and seven licensed practical nurses. Through a partnership with Bert Nash Community Mental Health Center, the jail also has behavioral health specialists on-site 40 hours a week, which is rare in Kansas.
“Philosophically, I’m opposed to mass incarceration on a national level. … But I also think you need to look at where you are and what you need in your community.”- Mike Brouwer, director of mental health and substance abuse treatment and anti-recidivism programs at the Douglas County Jail
Brouwer and Bunting said they believe a mental health crisis intervention center is necessary for their county but will not prevent enough incarcerations to substitute for the jail expansion.
“Not everybody who has a mental health problem is going to be eligible for that type of center,” Bunting said.
He said only people who commit low-level crimes and volunteer to enter the center would be eligible.
A crisis intervention center in Kansas City called Rainbow Services Inc. is considered a model for the rest of the state but has the capacity to prevent only a few incarcerations a month, Bunting said.
That facility’s CEO, Randy Callstrom, told a legislative committee this month that Rainbow Services is successful within its current scope but would need more funding and the legal authority to take involuntary patients in order to expand its impact.Rainbow Services is almost entirely funded through a state grant.
Bunting said funding for projects like that is one way the state can help take pressure off jails. Another would be to pass a law that allows for suspending, rather than terminating, Medicaid benefits while people are incarcerated. A few states have done that to make it easier for people to regain their coverage quickly after leaving jail so they can receive mental health treatment.
Brouwer said the Douglas County Sheriff’s Office budget currently provides some money to purchase prescription medications for people leaving the jail.