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The Mentally Ill in Jail
By Lt Bob Bramblet
Published: 05/23/2016

Power of family

All over the U.S. jail populations have swelled with more and more mentally ill inmates than ever before. The reason for this has several root causes, including the closing down of overcrowded state run psychiatric hospitals in favor of community based treatment centers that never opened, and the tougher criminal penalties introduced throughout the 80s and 90s. The result is more mentally ill inmates being held for longer periods of time without effective mental health care.

In the early 1900s, state run psychiatric hospitals and insane asylums were becoming overcrowded. These institutions became notorious for patient abuse and poor living conditions. The increased scrutiny of these asylums helped expose the deplorable conditions and treatment, eventually causing a movement toward deinstitutionalization and community based treatment. In the years that followed, state and federal funding for these community based alternatives never fully materialized, leaving former patients to fend for themselves. Many became homeless and eventually caught up in the legal system, arrested for trespassing or panhandling, causing the jail system to absorb their population.

Now we find ourselves in troubled times. Current estimates are that at least 20% of all incarcerated people have a severe mental illness, while up to 65% are diagnosed with some sort of mental or personality disorder. Our county jails have become the de-facto mental health facilities in the absence of any real, meaningful funding. Correctional facilities find themselves ill-equipped and understaffed to handle the problem effectively and the public seems to not notice there even is a problem. Sadly, that leaves many people suffering from mental illness lost in the shuffle, most likely causing more harm than good and often resulting in violent behavior and a rise in incident reports. However, there are ways to help mitigate the problems associated with housing and classifying inmates identified as the most at risk of having a mental illness in jail.

Making an investment in Officer training is an important step to dealing with this problem. There are many courses available from local and national resources such as the American Correctional Association’s multitude of onsite and online classes and seminars. The ACA has also been working on a landmark Correctional Behavioral Health Certification for Corrections Officers. The National Alliance on Mental Illness offers “Crisis Intervention Techniques” through a partnership with local law enforcement agencies and is specifically geared toward teaching de-escalation techniques during confrontations with mentally ill subjects in the field, or inmates in a correctional setting. It’s very important for Classifications Officers to receive specific training on the classification of inmates with mental disorders as well.

Having a dedicated housing area for mentally ill inmates to be classified to is also very important. A direct observation unit to house the more severe mentally ill can help to insure their safety while facilitating easier access to treatment. A unit such as this shouldn’t be a depository for inmates with behavioral problems but for those inmates who are recognized by medical staff as having a mental illness and possibly being a danger to themselves or other inmates. Care should also be given to the staff assigned to direct observation units and the assignment should be limited to Officers certified in crisis intervention techniques.

Building external stakeholder support and partnerships is critical in caring for the incarcerated mentally ill. In some cases, agencies have a contracted medical division that provides for mental health professionals to be on staff. That’s not always the case as budget cuts can preclude any such arrangement. Outside partnerships with other agencies or civilian treatment centers can result in an enhanced mental health program for affected inmates. Even if the partnership results in a mental health professional visiting the facility a couple of times a week, it can be the beginning of a more robust relationship later on down the road. Often times it just takes a phone call to begin the process.

The Lee County Sheriff’s Office in Fort Myers, Florida runs several facilities including the 457 bed Main Jail and the 1600 bed Core Facility. Many years ago, the Command Staff realized the need to prepare for inmates with mental illnesses and took steps to replace their makeshift 8 cell direct observation unit. During construction of their Core Facility, a new dedicated 4 pod, 32 cell direct observation unit was built using the latest in correctional engineering technology. Every glass front cell faces a central desk area. Every inmate entering the Lee County Jail is screened by qualified Medical staff and, if deemed to be at risk, or possibly having a mental illness, is transported to the direct observation unit. Within 24 hours, those inmates are seen and interviewed by a Mental Health Professional.

Furthering their commitment, the Lee County Sheriff’s Office has mandated that all of their Corrections Officers become CIT certified and has amended policy to ensure that all non-emergency incidents require a CIT certified Deputy is present to attempt to keep a behavioral incident from turning into a use of force. LCSO also has long standing relationships with outside mental health treatment centers to provide out of facility treatment for inmates who express suicidal thoughts or tendencies. Mental Health Professionals are on scene to see inmates classified as mentally ill every day and they meet twice a week with outside providers to discuss individual cases. They also meet quarterly with the Mental Health Court and with the VA to discuss the ever growing populations of our nation’s veterans suffering from PTSD.

The use of jails as depositories for the mentally ill was certainly an unintended consequence of well meaning legislatures. Regardless of our thoughts on the matter, we are fast becoming the leading mental health care providers in the country. It is what we do now that will shape the future of corrections. We must live up to our responsibilities and hold our law makers to theirs. More meaningful funding specifically targeting at providing for correctional mental health professionals, providing safe housing for mentally ill inmates and providing Correctional Officers with the tools to understand when they are dealing with a mentally ill inmate are important steps on our road to dealing with the issue. It’s not just a problem any more, it’s our responsibility.

Lt Bob Bramblet is a 15 year veteran of the Lee County Sheriffs Office in Florida. He is a Certified Jail Manager (AJA) and a Certified Corrections Supervisor (ACA). Bob is currently assigned as the Intake Division Lieutenant, PREA Compliance Manager and Corrections FTO Manager for LCSO.


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