Courts and state made Peoria County Jail a top mental health center
Journal StarApr 23, 2018
Do you take any medications?
Do you feel like hurting yourself or someone else?
Have you ever been diagnosed with a mental illness?
Staff at the
Mental health histories, as well as intentions for self-harm, form part of an intake survey that provides correctional officers with a rudimentary picture of an inmate's overall well being. The tabulation also constitutes the first step in a protocol that aims to treat mental illness behind bars and beyond the barbed-wire fence once inmates are released.
The process may seem simple, but the implementation of those questions and even the primary duties of the employees who ask them took decades to reach the current state. Along the way, they were shaped by forces that affected every jail in the nation, as well as state policies that inadvertently pushed more mentally-ill people toward incarceration.
"This jail has become the largest mental health institution in the area," said
Constitutional right
The local approach to inmates' mental health treatment can be traced to three milestones dating as far back as 1976, when a landmark
In Estelle vs. Gamble, the justices actually ruled against a
The court's opinion, however, did equate indifference to a prisoner's medical needs with an unnecessary and wanton infliction of pain -- in essence qualifying healthcare, and thus mental healthcare, as a constitutional right for all inmates.
The effect on the correctional system was immediate.
"It's one of the most expensive things we do," Asbell said, noting that inmate health care costs today account for 9 to 14 percent of the
Zeller closure
The next milestone forming the
Around the turn of the century, changing treatment preferences gained enough acceptance among the upper echelon of
A limited number of former residents from the facility ended up in different living situations that resulted in more contact with law enforcement and the criminal justice system, Asbell said.
More significantly, police and emergency responders lost the most effective and efficient resource to deal with mentally ill citizens encountered while responding to calls for help. Emergency rooms and hospital psychiatric units remained viable options, but those outlets could not handle the breadth or volume of individuals detained by authorities.
"Throughout the state, all the sheriffs and jails ran into the same problem," Asbell said. "Jails became de facto mental health centers because there were no other options."
According to current figures compiled by the
Those figures correspond with national numbers and illustrate how jails and prisons have become "the new asylums," according to the Treatment Advocacy Center. The group issued a report in
Compared to the incidence of mental illness in the overall population, the prevalence among
In 2015 and 2016, only 15.73 percent of
The increased prevalence of inmates with mental illness after Zeller's closure contributed to circumstances where courts once again marked a milestone for change at the
Accreditation
The third and most recent marker did not result from a single court decision. The jail's medical and mental healthcare lacked consistency, Asbell said, and was the source of the most litigation involving the facility. The lawsuits highlighted the need for an inmate healthcare system that adhered to independently established and professionally accepted standards.
In 2010, the
They achieved accreditation in 2012 with a protocol that begins at booking and is intended to continue after inmates are released. The continuity of care is meant to reduce crime by treating the mental illnesses that are often at the root of illegal behavior.
"It's pretty simple at this juncture: it's a person eight hours a day who simply provides assessments and brief interventions," said
The position represents the first mental health professional working full-time inside the facility. Jailers still conduct some initial screenings at the time of booking, but every person staying overnight or longer receives a more in-depth interview from medical or mental health professionals.
"We were depending on security staff to make these clinical decisions on what was going on with a person related to mental illness, and they weren't qualified to do this," Asbell said. "We also found people were very hesitant to provide their medical history to security, so we switched it up."
In addition to the daily presence of a mental health professional, a psychiatrist visits the jail at least four hours per week to manage inmate medications. If needed, detainees are provided a seven-day supply of meds when they are released.
The medication plan has resulted in a 30 to 40 percent increase in pharmaceutical costs per inmate, though the jail has paid less for drugs overall because of a decline in the jail's population, according to figures compiled by the county.
The
"If we can begin to manage those feelings, then we can begin to manage behavior and how we react," Gilmer said. "That's what is critical, but all that takes time -- and the volume is such that the assessment and brief interventions are what takes most of our time."
The greatest challenge of the enhanced focus on mental illness also is the top goal: to continue care after incarceration concludes.
An obvious logistical hurdle to the plan is the uncertain timeline of an inmate's stay. Appointments can't be scheduled if someone doesn't know an exact release date.
Coverage for treatment outside the jail also proves problematic. But because a significant percentage of the inmate population qualifies for Medicaid, the
"A theme for us is continuity of care," Asbell said. "When someone is discharged from the facility, we want them to continue treatment. ... All this goes hand in hand with trying to make these individuals more productive citizens, and hopefully, they don't get back in that cycle and return to the jail."
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