Keeping the mentally ill out of jail
By Clinton Burton, firstname.lastname@example.org
The man, we’ll call him David, ambled down the avenue. With no family locally, no job and not so much as a permanent address the street was the only home he’d known for some time. A veteran, his time in the service had wounded his body leaving him with slurred speech and irregular gait. Time and genetics gave him delusions and a propensity for rambling soliloquies.
Living on a fixed income of Social Security benefits and his meager pension, he could never afford the help he so desperately needed.
David would often frighten residents along the streets he walked. Thinking him to be inebriated or worse the police would be summoned and, having limited choices, David would find himself spending another night in jail. If he acted out, he might spend a few nights.
The time in jail would cause him to lose his Social Security and veteran’s benefits and, after his release, he would have to start the application process anew, a scenario that could leave him without an income for weeks or months.
With no money and no support system, David would eventually be back on the streets and the cycle would repeat.
As recently as the late 1990s, studies estimated that the number of mentally ill inmates in Florida jails and prisons outnumbered those in state mental hospitals by almost a five-to-one ratio. Few studies have been done since, however findings from research conducted from 2002 to 2006 determined that nearly 15 percent of male and 31 percent of female inmates in county jails have some degree of serious mental illness.
Once even minor offenders are behind bars, mental illness can be exacerbated by the added stress, putting themselves, other inmates and corrections officers at risk.
Despite their best efforts, a lack of understanding and education and budgetary concerns have often correction officials at the county and state level ill-equipped to deal with these individuals.
The solution, at least in Lee County, isn’t to try to treat them once they’re locked up, but to keep them from getting locked up in the first place.
In 2008, a joint effort between Lee Mental Health Center, the Lee County Board of County Commissioners, the Salvation Army, Lee Memorial Health Systems, Southwest Florida Addiction Services and United Way led to the opening of the Lee County Triage Center and Low Demand Shelter. Funded in part through a federal grant and local funds, the center now serves as a model for similar programs throughout the country, according to Ann Arnall, deputy director with Lee County Human Services.
The program was conceived as a voluntary alternative to incarceration and and the unnecessary use of emergency rooms and is primarily for individuals having a behavioral health problem, she said, but also is available to anyone who is picked up for lesser offenses such as trespassing, having an open container or disturbing the peace.
Since its inception, the center has taken in 304 people who might have otherwise been taken to jail, been hospitalized or received no intervention at all leading to a greater risk of escalating behavior, human services figures show.
If that escalation leads to a situation where the person is determined to be a danger to himself or others, officials have the person involuntarily committed to a mental health facility via the rules set forth by the Baker Act.
The Florida Mental Health Act of 1971, or the Baker Act, as it is more commonly known, allows judges, law enforcement officials, physicians or mental health professionals to have any person involuntarily committed to a psychiatric facility for observation if the person the person is a danger to himself or others and if certain criteria are met. One of the criteria is refusing voluntary examination, such as would be provided at the Triage Center.
If the Baker Act is invoked, the involuntary committal can last up to 72 hours in Vista, the county’s designated Baker Act receiving facility in Fort Myers. After evaluation at Vista, a patient may be subjected to court-ordered treatment either out-patient or in a mental health facility.
The Cape Coral Police Department has used the Baker Act to involuntarily commit 418 people since the city began using the current electronic tracking procedures near the end of 2003, according to Deputy Chief Jay Murphy.
Murphy said a Cape police officer spends an average of 2.2 hours on a call resulting in a Baker Act committal.
Based on the city’s pay scale, taking into account hourly wage and benefits, Murphy said, the average call costs the city roughly $35 per hour. At 2.2 hours, the city will spend $77 on every Baker act committal.
The number of hours officers spent took a tremendous spike in 2008 at 102 up from just over 60 in 2007 and this year promises to exceed the 2008 numbers with 75 hours already spent only halfway through 2009.
Between 2008 and 2009, thus far, Baker Act calls have costs taxpayers just over $6,000. That number is miniscule, Murphy said, compared to the number of man hours the city spends chasing down false alarms.
Since the center’s opening, Cape police have logged 16 pickups that were transported to the Triage Center.
Murphy said his department has been working with the Lee County division of the National Alliance on the Mental Ill to increase awareness of what services are available.
“Our primary job is to enforce the laws and keep the city safe,” he said. “But we don’t want to take someone to jail who would benefit from getting help instead.”
Other law enforcement agencies in Lee County may have adopted the same philosophy.
Although the bulk of the center’s intake comes from the Fort Myers Police Department, 203 so far, another 70 have come from the Lee County Sheriff’s Office.
All of those numbers should increase as knowledge of the center and the options it provides becomes more commonplace, Arnall said.
Although the majority of clients, 63 percent, entering the Triage Center and Low Demand Shelter arrive in a police car, some arrivals come from other sources.
“We don’t turn anyone away,” she said.
In fact, more than 33 percent come from Lee Memorial Health Systems which provides an intake nurse for eight hours every day to triage incoming patrons.
If the person is deemed not to be a danger to himself or others he or she can them enter the shelter component of the center which is operated by the Salvation Army.
Otherwise they may be taken to a hospital or, in rare cases, on to jail.
The majority of the center’s client suffer from some form of mental illness or substance abuse problem or both.
The Triage Center, Arnall said, helps keep those that need help from being introduced into the criminal justice system where they are at a statistically greater risk of hurting a fellow prisoner or corrections office or of becoming a victim of violence themselves.
Some of these risks can be mitigated through proper training. Capt. Thomas Eberhardt, Services Division commander with the Lee County Sheriff’s Office, said all certified corrections officers are trained on dealing with the mentally ill during their initial academy as mandated by FDLE.
“Additionally,” he said, “they receive training as part of their field training and an annual refresher on suicide intervention. During the booking process, each inmate is given an initial medical and mental health evaluation by medical staff.”
Eberhardt also said jail facilities have several areas dedicated for those with differing degrees of mental illness so that they can be monitored and supervised more closely.
Although mental health care is not an additional fixed cost to the county but is covered under the county’s medical contract with Prison Health Services, which also includes clinical and dental services, Eberhardt said, statistically those persons with chronic or extreme mental illness can stay in the legal system longer than others, thus accruing additional jail days.
Those extra jail days, which Eberhardt said costs about $75 per day, can add up over time. The Triage Center’s alternative to incarceration has had a significant impact on the local criminal justice system.
According to Arnall, even habitual offenders have shown a lesser risk of re-entering the system if they go to the Triage Center first.
Lee County Human Services records indicate that clients who passed through the center had spent a collective 9,274 days in jail in the year prior to the center’s 2008 opening.
Since the center has been open, clients who passed through have spent only 6,280 total days in jail.
“That’s a 32 percent reduction in jail time. That’s good for clients and good for the local jail,” Arnall said.
Clients who stay and complete a treatment program have seen an even greater reduction in jail time. Statistically speaking, clients passing through the Triage Center spent 48 percent fewer days in jail in the year before and the year after the center’s opening.
The reduction in jail time also saves money. According to figures released by human services, the cost to the county treating clients at the Triage Center and Low Demand Shelter as opposed to incarceration in the county jail has been in excess of $189,000.
“It’s hard to put an exact figure on what it cost to treat every individual because every case is different and everyone who comes through needs a different level of service,” Arnall said.
That could mean anything from the initial assessment and a few days of observation to a complete psychological evaluation and treatment from a psychiatrist, she said.
“Obviously, the more services they require, the more cost is involved,” Arnall said. “But any way you look at it, it’s better for the client and everyone else if we treat people instead of putting them in jail were they are not likely to get any better.”