Op-Ed

Mental illness, substance abuse plague Whatcom County jail inmates

An intoxicated inmate naps on the floor of a temporary holding cell shortly after being booked in but before being moved to more permanent housing in July, 2015, at Whatcom County Jail in Bellingham. Cells designated for inmates with drug or behavior issues often fill quickly on nights and weekends giving jail staff few options on where to house them. (The date of this image was corrected April 6, 2016.)
An intoxicated inmate naps on the floor of a temporary holding cell shortly after being booked in but before being moved to more permanent housing in July, 2015, at Whatcom County Jail in Bellingham. Cells designated for inmates with drug or behavior issues often fill quickly on nights and weekends giving jail staff few options on where to house them. (The date of this image was corrected April 6, 2016.) eabell@bhamherald.com

First of a series adapted from presentations given March 19 at the League of Women Voters of Bellingham & Whatcom County’s “Mental Health & the Whatcom County Jail: Where are We Going?” program.

Beginning in the mid-1950s our country began a huge social experiment in the treatment of people with mental illness and substance abuse disorders. It involved closing down large, publicly funded psychiatric hospitals and moving residents who had been hospitalized, in some cases for years, to local communities. This movement started as information was made public about some horrific abuses that were occurring in those facilities, and new medications were coming on the market that helped control symptoms associated with these disorders.

70%Whatcom County jail inmates who admit to having a substance abuse disorder

24%Whatcom County jail inmates who are identified as having a serious mental illness

44%Whatcom County jail inmates who can be diagnosed with a combination of mental illness and substance abuse

The plan was to place residents back into communities, provide them with medication and intensive outpatient support from professionals. It was theorized that these supports would allow the residents to remain stable in their new environment. This change, labeled “deinstitutionalization,” was hailed as a huge step forward in the treatment of seriously mentally ill and addicted individuals. It would end the abuses of this vulnerable group, respect their civil rights and save money that was being spent on hospitalization.

As a result of this movement, almost a million individuals who had been receiving care were discharged to the community. Another result has been that since 1955, the number of psychiatric beds available in the United States has dropped 95 percent, and continues to drop to this day.

Interestingly, during the same time period, the number of jail and prison offenders identified as having a behavioral health issue started to rise. The rate of that increase has accelerated over the past 30 years, growing to the point that in most communities, the local jail is the largest facility holding the mentally illand chemically dependent. That is true here in Whatcom County.

In response to the reality of growing numbers of special needs offenders, and with the assistance of our local Health Department, the Corrections Bureau has been increasing services offered at the jail over the past 8-10 years.

Last year the Sheriff’s Office Corrections Bureau booked 7,371 people into jail on criminal charges as diverse as failing to show up for court on a shoplifting charge to murder. Roughly 70 percent of our offenders admit to having a substance abuse disorder and approximately 24 percent are identified as having a serious mental illness. According to a recent study from the Department of Social and Health Services, 44 percent of our local jail population can be diagnosed with a co-occurring disorder (a combination of mental illness and substance abuse).

In response to the reality of growing numbers of special needs offenders, and with the assistance of our local Health Department, the Corrections Bureau has been increasing services offered at the jail over the past 8-10 years.

Triage for needs

Our response starts at the beginning of the booking process. Corrections deputies use a series of screening questions to help identify individuals who may need referral to in-house behavioral health resources. Deputies ask questions about drug and alcohol use or symptoms associated with mental illness, check our records for a history of such issues, and look for signs that may indicate behavioral health problems. If it is determined that the offender may be vulnerable or is at a risk of harming themselves or others, they are placed in special housing.

Screening questionnaires are reviewed by nursing staff within approximately 8 hours; sooner if there is a more immediate need. Offenders are referred to mental health services as a result of the screening or by referral from a number of different sources including corrections deputies, nursing staff, family or friends who may call and report their concern, other offenders, or by request of the offender. Eighty-four percent of the referrals are triaged and acted on within 24 hours.

Currently the jail has two full time mental health professionals, one full time re-entry specialist, a part-time psychiatrist and part-time advanced registered nurse practitioner with special training in psychiatry. These individuals, along with the medical providers and nurses, work together as a team to provide further screening and assessment, treatment planning, medications, some limited counseling, coordination of civil commitments or competency evaluations and restoration, connections to community providers, housing resources and enrollment in available health plans. The link with our medical providers is critical, given the long-term health effects many of these offenders face. Issues such as liver failure, Hepatitis C, malnourishment and infections are very common and need to be treated.

Inmates may have gone without treatment for years prior to being arrested on a criminal offense, and many have little or no insight to the fact they have a mental illness or substance abuse issue.

To assist with the re-entry process, the Corrections Bureau releases offenders with a 7- to 10-day supply of critical medications to take with them, along with a prescription for an additional 30-day supply. Since there is currently a long wait for appointments with community providers, the medications and prescriptions help bridge the gap and assist the offenders in remaining stable in the community. We also facilitate getting offenders signed up for available health insurance plans that will take effect when they are released from custody. State regulations prevent us from accessing Medicaid or most insurance plans to pay for offender health care.

Facility issues

Providing these services in the jail is not without its challenges. The current downtown facility was not designed for the number of offenders it holds. There is a lack of treatment space and very few housing options. Some of the most seriously ill offenders have to be housed in isolation cells due to the behaviors associated with their illnesses. Inmates may have gone without treatment for years prior to being arrested on a criminal offense, and many have little or no insight to the fact they have a mental illness or substance abuse issue. This makes them resistant to the help being provided, and often means they will not follow up with treatment in the community. As a result, they frequently commit new crimes and wind up back in jail. In addition, the complexity of the offender’s underlying behavioral health issues makes it more difficult to find providers willing or able to accept them as patients.

We as a community and as a nation will continue to wrestle with the complex realities of behaviorally disordered inmates. In the interim, the Sheriff’s Office Corrections Bureau will continue to work collaboratively with the community to provide needed support for these special offenders.

Wendy R. Jones is chief of the Whatcom County Sheriff’s Office Corrections Bureau.

MEETING

Whatcom County’s Incarceration Prevention Reduction Task Force meets 9-11 a.m. Monday, April 4, at the Whatcom County Courthouse, 311 Grand Ave.

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