A four-part series
Editor’s note: Reporters from the Topeka Capital-Journal and KHI News Service collaborated for a six-month exploration of how the state’s legal system deals with people with mental illness. This is one of the stories in a four-day series.
For more than 20 years, the Douglas County Jail was almost a second home for Kenneth Brouhard.
The Lawrence man was in and out of the facility nearly 30 times between 1990 and his last conviction for aggravated sexual battery about three years ago.
He might still be trapped in that cycle if not for an intensive mental health treatment program that helped him break it.
“I’ve been in and out of the Douglas County Jail since it’s almost been opened (in 1999),” he said. “I didn’t want to be looked at just as a criminal. I just wanted to be done with all my troubles.”
Brouhard was fortunate that his encounter with the criminal justice system was in a county that offered such a program for inmates. For many others with mental illness, a county jail was the last place they could expect to find the help they needed.
“Joe,” a Johnson County man who asked not to be identified, was arrested in 2003 after hitting his wife on the back when she tried to pull him out of bed in the morning. At the time, he was being treated for depression.
“My wife had reason to believe when she called 911, she was going to get help getting me to the hospital,” he said.
Instead, he spent 10 days on suicide watch in the county jail. He didn’t start improving until he was discharged for treatment at Shawnee Mission Medical Center.
“The real thing that I look back on is that people who are in mentally perilous positions, especially if they don’t have a lot of resources, they get medication and not much else” in jail, he said.
Treatment and training
County jails have become the default mental health provider in many communities since the 1990s, when Kansas and many other states closed state hospital beds with the idea that people with mental illnesses could be better treated in their communities.
The new system worked well for many Kansans with mental illness, although others struggled to get the help they needed and instead found themselves ensnared by the criminal justice system.
Some Kansas counties are responding to the problem. Douglas County has a standing contract with the Bert Nash Community Mental Health Center in Lawrence to provide mental health care to those in the county jail who need it.
Sgt. Kristen Dymacek, public information officer for the Douglas County Sheriff’s Office, said everyone processed into the jail gets a mental health assessment. Any who exhibit symptoms are then seen by a Bert Nash clinician.
The county also provides special mental health training to its jail staff and sheriff’s officers. The officers are trained to spot symptoms of mental illness so that they can divert people in crisis to treatment rather than charging them with a crime and hauling them to jail, Dymacek said.
Even so, she said, the number of people with mental illness serving time in jail continues to increase.
Brouhard, the Lawrence man who had been in and out of the Douglas County Jail since 1990, said the treatment he received while incarcerated was helpful. But it was a more intensive, outpatient program operated by Bert Nash that really made a difference.
After Brouhard was released from jail, staff at the mental health center helped him find housing and buy work boots. They also checked in from time to time, which helped him avoid turning to alcohol again when his symptoms worsened earlier this year, he said.
“If I didn’t have that kind of help, I wouldn’t be here right now,” he said.
Like Douglas County, corrections officials in Johnson County have more resources to work with as they strive to improve mental health care and avoid a repeat of what happened to “Joe.”
Robert Sullivan, criminal justice coordinator in the county manager’s office, said the Johnson County Mental Health Center, district attorney’s office and sheriff are examining six years of arrest data. They hope to use the research to keep people with mental illnesses out of jail or at least shorten the time they spend there, he said.
“We find that they stay in jail about twice as long as the general population,” he said. “We’re trying to figure out what those issues are and what levers we can pull.”
The jail pays for a two-week supply of psychotropic medications, which released inmates can pick up at a local pharmacy. Staff also work to set inmates up with an appointment at Johnson County Mental Health Center and to find housing if they need it.
Some police departments and courts have started programs to avoid arresting people with mental illnesses or to help them avoid incarceration if they comply with treatment orders and other conditions. Those programs are limited to some of Kansas’ largest counties, however, and smaller communities have few alternatives to jail.
Fifty miles from the suburbs of Johnson County, Travis Wright oversees the jail for the Atchison County Sheriff’s Office. He said some people with mental illnesses have been through the county jail so many times that they greet him when their paths cross at the store.
Wright would prefer if the faces weren’t so familiar. Atchison County inmates had an average of 4.6 jail stays in 2014, with some inmates being booked in only once and some returning almost as soon as they were released. Like Brouhard in Douglas County, many of the “repeat customers” have mental health issues that drive them back to the jail over and over again, he said.
“I was shocked at it,” he said. “I couldn’t believe (the average) was that high.”
Unfortunately, Wright said, police and sheriff’s deputies don’t have the resources to reach people before their conditions deteriorate. Mental health care is available in Atchison County, but people who experienced a crisis in the evening or on a weekend have nowhere to turn, he said.
When Wright started overseeing the Atchison County Jail 10 years ago, police could take people in crisis to St. Luke’s Cushing Hospital in Leavenworth for inpatient care, Wright said. When that hospital stopped treating involuntary patients, they went to Rainbow Mental Health Facility in Kansas City, Kansas, which now has only eight beds. Right now, the only option is Osawatomie State Hospital, where demand for space is high, he said.
“Getting them to take anybody is like pulling teeth,” he said.
The problem of finding inpatient mental health treatment has been more severe in eastern Kansas than in the western counties, said Sandy Horton, executive director of the Kansas Sheriffs’ Association. Osawatomie State Hospital is only admitting involuntary patients, and some who have court orders for involuntary treatment have waited days in jails or emergency rooms.
Often, law enforcement officials would rather send someone to the state hospital for treatment than charge them with a minor crime, Horton said, but they can’t do so if there isn’t space available.
“I’m hearing a lot of the sheriffs express concern,” he said. “Nobody wants to hold somebody in jail because they have a mental health issue.”
The problem isn’t confined to eastern Kansas, however. Gove County Sheriff Allan Weber said his department contracts with Trego County because it doesn’t have a jail, but was responsible for a man with apparent mental health issues who was arrested for lewd behavior in March. The county attorney had to get a court order to have the inmate committed to Larned State Hospital after he went on a hunger strike, Weber said.
A staff member at Larned State Hospital said the facility couldn’t admit the inmate without an evaluation from a community mental health center, which wasn’t possible because he refused to talk to the mental health staff, Weber said.
Deputies then drove him to a mental health center in Pratt, about 55 miles away, where a different mental health agency determined the inmate was a danger to himself, he said.
“I asked the (Larned) employee to assist us in getting something set up. I was not happy when he stated that it was not his job. I am sorry, but I think that is the wrong answer,” he said. “Trying to help someone with mental health issues, especially if they are incarcerated, is a joke.”
The man only stayed at Larned State Hospital for about a week and returned to finish his sentence, Weber said. After his release, the inmate said he intended to hitchhike to California, and family members have no idea where he has gone or what condition he is in, he said.
“It’s a screwed-up mess,” Weber said.
Varied approach to screenings
No one knows exactly how many inmates in Kansas jails have a mental illness or whether they receive treatment because the state doesn’t track the results of inmate screenings and counties vary in how they approach the issue. The 20 jails that responded to a survey KHI News Service sent to all county jails estimated anywhere from 3 percent to 50 percent of their inmates had a mental illness.
Some facilities, such as the Shawnee County Jail, have a standard form asking inmates about signs of serious mental illness, such as feeling hopeless, believing someone is conspiring against them or going long periods without sleep.
Others, however, rely on the inmate to disclose a mental health problem or take action only if inmates appear likely to hurt themselves or others.
Kingman County Sheriff Randy Hill said jail employees monitor inmates for signs but can’t offer treatment because most inmates stay less than 48 hours. Programs are limited to groups like Alcoholics Anonymous and religious services, he said.
Small counties aren’t the only ones that can’t offer all services that inmates may need. All Riley County Jail employees have received mental health first aid training, but any mental health treatment that inmates receive there is “minimal,” said Capt. Kurt Moldrup, jail division commander. Inmates with current mental health prescriptions continue to get their medications and some are prescribed new ones, he said, but they don’t have access to other treatments.
“They receive some help through staff, as well as our contracted medical provider who can and does prescribed appropriate psychotropic drugs as needed,” he said.
Kyle Kessler, executive director of the Association of Community Mental Health Centers of Kansas, said most community mental health centers work closely with jails in the areas they serve. A few haven’t been able to offer services because state funding doesn’t cover mental health centers’ work with inmates and not all counties have enough of a tax base to support a partnership, he said.
The state doesn’t fund mental health treatment at the local level, though county jails can bill Medicaid under certain circumstances, such as if an inmate has a severe disability or is pregnant. Most inmates have short sentences, however, giving jail employees little time to arrange reimbursement.
Doug Bonney, legal director of the American Civil Liberties Union of Kansas, said the group has received some complaints about jail inmates not receiving treatment. Sheriffs have said they sometimes didn’t know they needed to provide medication and subsequently agree to get it for the inmate, he said.
“I haven’t run into any sheriffs that say, ‘I don’t care,’” he said. “I have run into some that say, ‘We don’t have any money.’”
‘A new emphasis for us’
Not all counties struggle to fund basic mental health services for inmates, however. Capt. Jared Schechter, commander of the support division in Sedgwick County, said the jail created a mental health management unit about three years ago. The unit has a clinician, registered nurses, social workers and case workers, as well as security staff who are trained in mental health, he said.
In addition to managing medications, the unit’s services include discharge planning and teaching social skills, coping skills, symptom management and basic self-care, if needed. Inmates in the unit have at least three group therapy sessions per week.
“This was a large undertaking and something which was done to create a better environment for our inmates with severe and persistent mental health issues,” Schechter said.
Other counties also have been able to expand their treatment offerings in recent years. Paula Hopkins, who works for Horizons Mental Health Center, provides mental health services at the jail in Reno County. A few years ago, the jail only contracted for mental health care a few hours a week, but that changed to having a full-time clinician when the new jail opened in August 2015, she said.
“I haven’t run into any sheriffs that say, ‘I don’t care.’ I have run into some that say, ‘We don’t have any money.’”- Doug Bonney, legal director of the American Civil Liberties Union of Kansas
The partnership allows inmates who already were Horizons clients to continue receiving therapy and medication if they are admitted to the jail, Hopkins said. The mental health center and jail share information so a person who dropped out of receiving mental health services before being arrested can restart them, she said.
They also have made it a standard practice to schedule Horizons clients for a follow-up appointment after they get out of jail, and to give other inmates information about how to make an appointment and get their prescriptions filled, Hopkins said.
“This is a new emphasis for us,” she said.
Some less-populated counties also are trying to keep inmates from coming back. Harvey County Sheriff Townsend “T.” Walton said the jail offers programs such as anger management classes and assistance with resumes and is working on case management for those with more extensive needs.
“This has been an ongoing challenge for lack of funding and available resources,” he said.
Other jails aren’t able to offer so much support. Shannon T. Moore, jail administrator for Coffey County, said employees talk with inmates about the importance of continuing their treatment after release, but the inmates often choose not to do so.
“Staff and counselor try to impress on them how important it is for them to continue counseling and to take their medication,” she said. “However, we have found that they walk out of the facility and quit both and we then get them back into the facility.”
‘Not an answer’
Some question whether efforts to improve care through the jails are missing the point, however. Marion County Sheriff Robert Craft said he is concerned that jails are being pushed to house more inmates with mental illnesses because of budget cuts to mental health treatment and fewer beds in treatment facilities.
Most corrections workers have only limited mental health training, and it isn’t realistic to expect them to become mental health workers, he said.
“Locking those persons in a jail facility only designed, built and staffed to house and control inmates, with no ability to help or to treat the illness is not an answer,” he said. “That path only shifts the burden of care and places an undue liability and expectations on those not qualified or trained to handle the illnesses, in a facility that in most, if not all, cases is not designed or built to provide that care.”
Susan Crain Lewis, president and CEO of Mental Health America of the Heartland, said many people with mental illnesses who are arrested are picked up for relatively minor offenses, such as trespassing or public urination. Some law enforcement agencies are able to divert people to mental health treatment, she said, but jail may be the safest place for the person if treatment isn’t available nearby.
“That is profoundly problematic, that somebody has to be charged to be safe,” she said.
Craft said the state could ease the burden on jails by opening small-scale regional mental health treatment facilities scattered across the state.
It also needs to invest more money in the community mental health centers and supportive services, like housing, Horton said.
“People don’t understand it’s not just medication. That’s just part of it,” he said. “The problem with everything we’re talking about is it all takes money.”