Police, medical officials and even state law agree that jail isn’t the right environment for people in mental health crisis
EAGLE — Colorado has a well-documented lack of mental health support service — too few psychiatric beds, too few community programs, not enough funding.
The one thing the state does have in abundance is need. Combine the two factors together and the law of unintended consequences arises.
“Jails are the de facto mental hospitals, and it’s not just in Colorado. It’s across the country,” said Capt. Gregory Van Wyk, jail administrator for the Eagle County Sheriff’s Office. “We see many people who really need to be in a medical facility.”
But with the enactment of Senate Bill 17-207 last year, Colorado has drawn a clear distinction between mental illness and criminal behavior. Committing a crime, as always, will land someone in jail. Having a mental illness episode won’t.
Mental health holds
Since the late 1980s, Eagle County Sheriff James van Beek has argued against bringing people into the jail solely for mental health holds.
“The jail is not the right place for these people,” van Beek said. “It’s not a law enforcement problem, it’s a community health problem.”
The new law in Colorado reflects that distinction.
“People can no longer be brought into the jail for non-criminal reasons,” van Beek said.
So, for example, if someone is threatening suicide but has not been arrested on any criminal charges, he or she can no longer be taken to the jail. But Colorado incarceration institutions continue to deal with mental health issues.
Like the communities they serve, jail populations include people who suffer from depression or bipolar disorder or other mental health conditions. Being in jail can exacerbate those conditions, leading inmates to threaten or attempt self harm. By necessity, jails have to be prepared to respond to these situations.
It isn’t easy to do.
Drain on resources
Van Wyk stressed the goal in the jail is to find the safest, least restrictive environment for inmates.
“We call the classification of inmates an art, as opposed to a science,” Van Wyk said.
There are many factors to consider when the jail brings in a new inmate — sex, physical condition, language and severity of the offense, for example. Mental health needs are part of that puzzle. During the booking process, deputies try to sort through those needs as they make the decision about where to place a new inmate.
“We talk to people. Everything starts with an interview,” Van Wyk said.
“We ask ‘How are you really doing?’ And its OK to have that conversation with people,” van Beek said. “The beauty of the situation is we have time.”
Van Wyk pointed to a booking interview from earlier this fall when a woman was charged with driving under the influence.
“She was terrified of us, yet we were trying to help her,” he recalled. Ultimately, the woman’s blood alcohol count came back at zero and the booking deputies realized she was likely experiencing a mental health crisis. They were finally able to communicate with the woman and then contact her family, who then came to take custody of her.
“We saw her at the end of a downward spiral,” Van Wyk said. “We deal with things like that on a regular basis.”
When all other avenues fail, an inmate is placed in a restrictive mental health hold — dressed in a “suicide smock” and housed in the soft cell. Items such as eyeglasses are taken away for the inmate’s own safety and the cell doesn’t even have toilet fixture, just a floor drain, so there are no hard surfaces inside. In short there shouldn’t be anything in the cell that an inmate could use to harm him or herself. But van Beek and Van Wyk stressed putting an inmate in the soft cell isn’t the easy way out for deputies. Making that determination means more work for the jail staff, not less.
“One person (in the soft cell) can consume the better part of 13 people’s day,” van Beek said. “It’s a ripple effect and it also takes away resources from the rest of the jail population.”
When an inmate is in the soft cell, they are housed directly in front of the detention deputies’ command area. If they are experiencing a crisis and yelling or making other noise, it disrupts the entire area. Deputies are required to check in on the inmate every 15 minutes and special precautions are part of meals and other interactions. The entire focus is to keep the inmate from hurting him or herself.
The jail will also call in mental health resources to evaluate the inmate and give a recommendation about jail placement. The deputies use that evaluation, along with their own observations, to make a judgment about the inmate’s placement.
“Sometimes the holding cell is the least impact, least restrictive environment possible,” Van Wyk said. “But not everyone with a mental illness is in crisis.”
The jail also must provide for inmates who have mental health needs, but who aren’t in immediate danger.
Longer term need
The jail’s medical team includes one full-time registered nurse, a number of emergency medical technicians, a physician’s assistant and other contracted services. There simply isn’t enough manpower to keep inmates who have mental health needs under constant supervision, so Van Wyk and his crew have developed some creative solutions.
For example, one recent inmate received a four-month sentence at the jail and he was at high risk for suicide the entire 120 days.
“They saved his life at least nine times in this facility,” van Beek said. “It drained everyone in the jail but we kept him alive until he got out of our facility.”
As they were dealing with the man’s issues, jail staff realized that he was most at risk when left alone.
“We could maintain his safety in a cell and we couldn’t employ a deputy to be with him full-time,” Van Wyk said. “We wound up engaging other inmates to talk with him, watch television together and play board games. But he would wear people out.”
Taking it seriously
When a member of the jail population vocalizes suicidal intentions, the deputies take it seriously. Van Wyk said a suicide threat will often land inmates in the soft cell, and chances are that’s not where he or she wants to be. But that response is not punitive, Van Wyk stressed.
“We have to take the steps to protect people from themselves,” he said.
After an inmate has been on a mental illness hold for 72 hours the process can start to place him or her in a hospital, if there’s a space available. There aren’t even enough voluntary mental health beds in Colorado and the need is even greater for non-voluntary facilities. The reality is often that after the 72-hour period ends, the jail staff will still be responsible for housing the inmate.
“Our job is to stabilize people. We have to be good at that from an operational standpoint,” Van Wyk said.
Just last week, some of the jail staff members received a special award for their speedy and successful effort to thwart a suicide attempt. While Van Wyk is proud of his staff’s actions in that case and in numerous others, he noted that ideally inmates who need more intensive mental health service should be placed in a different environment.
“We are proud of our facility and what we have done to protect people,” Van Wyk said. “But jail is a punitive environment. It is designed for safety and securing. Jails aren’t designed for mental illness circumstances.”