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Professor offers guidelines for jails to manage mental health populations

Monday, March 11, 2013

LAWRENCE — Mental illness continues to make headlines in the wake of high-profile violent criminal incidents, but the intersection of mental illness and criminal justice, especially in jails, is nothing new. A University of Kansas professor has published an article and spent a career researching and advising jails across the country how they can better deal with individuals with mental illnesses.

Margaret Severson, professor of social welfare at KU, has worked with jails and as a mental health expert for more than 30 years, and since the 1990s she has provided training and consultation to jails on how to improve management of indivicuals with mental illness. Severson recently published an article in the National Jail Exchange outlining how the challenges associated with the detention of individuals with mental illness, many of whom would be better and more appropriately served by the mental health system, can be improved by taking steps such as setting limits on who jails will accept and changing the language used to articulate the principle mission of the jail.

“Jails have been inundated with people with mental illness,” Severson said. “What I’m saying is it’s time to put some limits on who is admitted into the jail. What makes this really relevant is the discussion on what we do about violent offenders. If we end up with new mandatory sentencing legislation as some people are calling for, you’ll have lots of people with mental illness and lots of people who are violent incarcerated. But a person who has mental illness is not always violent, and a violent person does not necessarily have a mental illness. Mixing up notions of mental illness with our fears of violence spells trouble for jails. There will never be enough jail beds to house people detained for serious criminal behaviors, and people detained because their behaviors, not the products of a criminal thought process, make us uncomfortable.”

Research has shown that about 14 to 17 percent of individuals in jail populations have some sort of mental illness and that number reportedly can reach as high as 31 percent when focusing solely on women. When substance abuse and dependence issues are included, that number can climb as high as 68 percent.

One way to help avoid unnecessary incarcerations is to perform assessments “at the door.” Many states have statutes that allow jail personnel to provide an assessment when an individuals are brought to the jail to screen for mental health or substance abuse issues. If individuals meet established criteria, they may be refused for admission and instead referred to an emergency room, mental health treatment center or other appropriate facility. Once adequately screened in the right place and at the right time, they should be referred to the appropriate place. That place may be the jail, but it may also be the psychiatric hospital or to an outpatient or sub-acute residential unit of the local community health center. As to those initial jail assessments, there are readily available screening/assessment tools jails across the country can access.

“It’s important that jails use those when a person is first brought in, because they assume full responsibility for a person’s health and mental care after they are admitted,” Severson said.

She likens the situation to someone brought into a jail that then suffers a heart attack. That individual would be taken to a hospital, not incarcerated. The same should hold true for individuals suffering from serious mental health challenges, she said, noting that both are health crises which demand responses more appropriate than incarceration.

While jails are not designed to deal with individuals with mental illness, they have done an admirable job doing so in many cases, Severson said. They often help start or restart a person on medication, and provide structure and help that can prove beneficial. However, that is not a jail’s principle mission; rather its mission is to maintain custody of people legally detained to assure their appearance in court. All too often there is a perception of jails as being mental health facilities. For example there is a persistent myth that the Los Angeles County Jail is the nation’s largest mental health facility. But the jail is not a mental institution, Severson said, nor should it be mistaken for one. Jails can help fight that assumption by clarifying their language and making clear that treating mental health problems is not what they are designed to do.

“When I hear jails boast about how well they are doing handling mental illness, I have mixed reactions. In many cases I know they’re doing well and, in fact, if the public really knew the challenges that their local jail manages on a daily basis they would be amazed and surprised, too," she said. "But no matter how successful the jail is at saving lives and stabilizing people, the jail is simply not the right place to send people with mental illnesses, not morally, not legally and not for many other reasons. Too often, the jail is just the most convenient place to take the person no one else wants or has the capacity to manage.”

Jails can also clarify their mandate to address mental health problems when they are identified among the inmate population. By exercising control of personnel who are hired and placed in critical positions, such as those who will deal with mental health symptoms of those incarcerated, and not attempting to duplicate the responsibilities of community mental health and state psychiatric hospital systems, jails can make their mission of providing custody clear.

The problem of diminishing community mental health services exists in many areas of the country. Still, it does not make sense to shift the responsibility for mental health care from an underfunded mental health system to an underfunded criminal justice system, Severson said. She advocates partnerships with community leaders, resource providers and others to come up with solutions, identify plans and offer assistance to those who need it. In Douglas County, for example, Severson, Sheriff Ken McGovern and others have teamed with Bert Nash Community Mental Health Center and other agencies to clarify the language and mission of the jail.

“Nationally jails have unintentionally become mental health providers in many communities,” McGovern said. “It is a task that few correctional facilities were prepared to undertake. Over the past decade we have worked hard to address the problem and have made great progress in working with mental health issues in our jail. We are now able to address inmate mental health issues more effectively and provide a safer and more stable environment for our staff and inmates. Working with community partners is essential.”

Severson, who has also done research in ways to reduce recidivism after individuals are released from incarceration, also encourages people to advocate for legislation and policy that provide adequate funding for mental illness and allow jails and personnel to address the issue without being forced to accept individuals who could be better served by psychiatric treatment.

“Policy is being changed by people who are standing up and saying, ‘You’re putting everyone in the facility at risk if you keep bringing people with mental illness to jail because the jail is the only service provider in town that doesn’t have a waiting list,’” Severson said. “We are all responsible for the health, welfare and care of the people in our communities.”


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