‘All of our jails are psychiatric facilities’

At 17 years old, Michael was diagnosed with bipolar disorder. He also was battling an addiction to heroin. Through his father’s private insurance, he received treatment and medication for both.

In 2010, when his father lost his job and he was forced to apply for Medicaid, Michael’s access to care declined. Although he continued to take medication for his bipolar disorder, his addiction to heroin worsened over the following years. Then a 2016 conviction for menacing and providing alcohol to a minor sent him to the Douglas County jail for six months.

“I was struggling really bad,” said Michael, 34, who requested that his last name be withheld for privacy reasons. “I couldn’t get clean on the outside — it was impossible.”

But jail, he says, proved to be a blessing.

There, he received medication for his mental illness, met with a counselor for an hour each week and participated in group therapy. He acquired a sense of accountability and respect for authority. These days, Michael lives in Highlands Ranch with family and has a steady job.

He never expected the help he needed would come from behind bars. But jails and prisons across the country are increasingly becoming a repository for men and women with mental illnesses and substance-abuse disorders, which experts say often go hand in hand. The increasing numbers are challenging detention system philosophies and straining resources in efforts to develop programs to address the needs.

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The Douglas County jail is no exception.

Fifty percent of the approximately 320 inmates in the Douglas County jail have a diagnosed mental health condition. And even though the jail is doing what it can to be a leader in mental health practices, many inmates are not being adequately treated because of a dearth of funding and resources, said Kevin Duffy, captain of detention for the Douglas County Sheriff’s Office, who has overseen the Douglas County jail since 2014.

In fact, the population of inmates with mental illnesses at the jail has increased so much — in 2014 about 40 percent of inmates had a diagnosed mental illness — the jail in 2015 had to expand its mental health unit.

“When people look at county jails, they think we are housing bad guys,” Duffy said. “All of our jails are psychiatric facilities. We are criminalizing mental illness.”

‘They can’t get the help elsewhere’

The Douglas County jail sprawls through the basement floor of the Douglas County Justice Center, an expansive brick building next to Interstate 25 in Castle Rock. A chamber of fluorescent-lit hallways, just off the elevator, monitored by cameras and ID scanners, leads to the cells.

Inmates dressed in colored jumpsuits are spread among nine pods or housing units. The jail’s capacity is 518 inmates, though authorities prefer to stay under 400. The average length of stay is 17 days. The maximum is two years.

Through the thick sliding door of the K-Pod — the mental health and medical unit also referred to as King Pod because it is the largest of the nine — is a small room with surveillance cameras, computer screens and panoramic glass windows. On the other side of the glass are two levels of holding cells and two common spaces, where on a January day, one inmate was seen sweeping the floor. Several others sat behind closed doors.

“Not a lot of deputies have the patience to deal with this,” said Douglas County Deputy Tiffany Yacuta, who spends 10 hours a day, four days a week in the pod, where there are a range of behaviors and personalities. She oversees the unit and checks on the inmates’ wellbeing. “I feel like I can advocate for them.”

The pod is a special management unit for people with mental health and medical problems, though mental health needs — most commonly bipolar, personality and post-traumatic stress disorders — consume the majority. The goal is to get the inmates stable enough to transition into the jail’s general population, Yacuta said.

Completed in 1999 for about $41 million, the Douglas County Justice Center underwent a $24 million expansion in 2014 that included construction of the K-Pod. When it first opened in 2015, 10 beds served inmates with medical needs, such as wheelchairs, walkers or canes. Twenty-one beds were for inmates with mental health issues.

Eighteen months later, the jail restructured the pod. Beds for inmates with mental health needs rose to 27. Beds for inmates with medical issues decreased to four.

Males occupy 19 of those beds. Eight are for females.

“With the increasing problems with the inmates who had severe mental health issues, primarily males, we had to make some adjustments to the unit,” Duffy said. He and other clinicians who work in the jail noted that in recent years, the mentally ill female population also is increasing.

The mental health crisis stretches beyond prisons and jails. In the U.S., one in five adults — or about 43.8 million people — are living with mental illness. Because of lack of resources, costs and stigma associated with such illnesses, many won’t receive the help they need.

More than 2.3 million people across the country are in state and federal prisons or local jails. About 20 percent of those in jails and 15 percent of inmates in state prisons have a serious mental illness, according to the Treatment Advocacy Center, a national mental health policy organization.

That means, for example, in 2014, based on the total national inmate population, some 383,000 individuals with severe psychiatric disease were locked up — nearly 10 times the number of patients in the nation’s state psychiatric hospitals, the center found.

The Douglas County jail faces a similar challenge as jails across the Denver metro area. Every captain and sheriff in the region is swamped with cases that involve mental health, said Neil Gowensmith, assistant clinical professor at the University of Denver’s Graduate School of Professional Psychology.

But in his view, the Douglas County jail system stands out because of the amount of awareness it shows for those experiencing mental illness.

“I can say that they do have a captain that seems to understand the importance of addressing mental illness and the population that he is dealing with,” said Gowensmith, who has worked in forensics in various jails and hospitals. “They have dedicated resources and staff to addressing mental health needs in their population.”

Duffy and about 12 mental health professionals, social workers and deputies meet once a week around a large table in a jail conference room to review the cases of inmates’ they are concerned about, one by one, on a large projector. They discuss the progress or regression of each person and decide into which pod, if any, he or she should be transferred. Often, mental health is part of the conversation.

The jail’s two mental health care clinicians, and two clinicians from AllHealth Network who are there thanks to a state grant, oversee and counsel more than 300 inmates. About three times a month, the jail’s sole nurse practitioner prescribes medication for the 50 percent of inmates with a diagnosed mental illness. Deputies and nurses can only force a medication if it is court-ordered or necessary for calming an inmate, Duffy said.  

Every day, health services administrator Jennifer Glenn and mental health care clinician Shauna Shipps said they see the effects of lack of community treatment options for people with mental illness.

“There are just no resources,” Glenn said. “You have mentally ill people on the streets, not taking their medication, and then they commit a crime.”

Some inmates, booked in jail for petty crimes or misdemeanor charges, sit and wait while their mental state languishes.

Said Shipps: “It’s more sad that they end up here because they can’t get the help elsewhere.”

But housing mentally ill inmates takes professionals, space and programs that jails frequently do not have the money for, mental health experts and law enforcement officials in Colorado say.

The result, they say, is overcrowded jails in many regions, a maxed-out state mental health institute and an overwhelming number of inmates who are not getting the treatment they need.

Colorado’s only mental health institute for court-ordered individuals or individuals found not guilty by reason of insanity is in Pueblo. Since 2000, the institute has seen a 931 percent increase in judge-ordered competency restorations for individuals to stand trial, according to the Colorado Department of Human Services. Last year, the mental health institute performed 2,000 competency evaluations, nearly double the amount performed five years ago.

A bed to restore competency costs $696 a day, according to Patrick Fox, chief medical officer at the Colorado Department of Human Services. The cost to house an inmate in jail, depending on several factors, including the kind of mental health treatment, generally costs $35 to $90 a day.

“A jail is predominantly run by deputies with a small cadre of health professionals,” Fox said. “Hospitals, like forensic hospitals, are run by a huge phalanx of health professionals with a small cadre of security forces. They are almost like the inverse of each other.”

Inmates with mental illness in Douglas County jail may spend weeks waiting for an evaluation to determine if they can get a bed at the state’s mental health institute.

“Their bonds are minuscule but families can’t take care of them. It can be a huge drain financially and emotionally on a family,” Duffy said, of caring for a person with a mental illness. “In a jail, at least families know the person is safe, fed, cared for and their mental health needs are met.”

Collaboration is key

A directed and joint community effort is needed to generate more funding, increase the numbers of mental health professionals and create a societal shift in attitude toward people with mental illness, mental health experts and law enforcement say.

Laura Usher, program manager for the National Alliance on Mental Illness, believes that if funding were adequate, community mental health centers and programs — such as supportive housing — could treat the majority of people with mental illness. And, she added, mental health care must be integrated into primary health care.

“Often, our system will treat one and not the other and we have bad outcomes when we do that,” said Usher. “We need to improve the services that are available in communities long before a crisis occurs, so that people can get help for serious conditions.”

Collaboration among available resources is key, mental health experts say.

Duffy has made that a mission since taking over supervision of the jail in 2014.

Clinicians and re-entry caseworkers from AllHealth Network help connect inmates who are about to be released to local resources, such as Arapahoe/Douglas Works! Workforce Center — which provides job training and employment opportunities —shelter, transportation, food assistance, health insurance and treatment centers for substance use disorders.

A letter of recommendation from an AllHealth Network clinician helped Michael land his job at Goodwill, where he works in donations.

His story, he says, is a testament to the effectiveness of the jail’s programs.

During his six-month sentence, he received a new medication that stabilized his bipolar disorder and went through the state-funded Jail Based Behavioral Health Services (JBBS) Program, which provides counseling for inmates with substance use and mental health disorders.

“The one-on-one (counseling sessions) helped the most because I hadn’t had a one-on-one with a counselor who cared about me in a long time,” Michael said.

For Duffy, stories like Michael’s show that with the right resources, an inmate can be successful at life after jail.

It’s all about giving inmates a hand up, Duffy likes to say, not a handout.

“Our job is not to judge or punish these people. Our job is to safely and humanely house these people and treat them with dignity and respect,” Duffy said. “We are dealing with human beings down here and we are going to treat them like that.”