Incarcerating the mentally ill doesn't help them, and it's expensive

Incarcerating the mentally ill doesn’t help them, and it’s expensive

steve.maynard@thenewstribune.comJune 16, 2013 

Repeat jail inmate Phillip Essary said he was winning the battle to stay sober and cope with his mental illness.

Three days a week, two hours each day, he attended outpatient group sessions and counseling for alcoholism and drug addiction. As many as five times a week, he met with his case manager.

A nurse monitored his medications for depression and pain. He lived in a room in a “clean and sober” house in Tacoma.

“It’s hard to stay sober,” Essary, 43, told The News Tribune early this spring. “But if you want it and strive for it, you can do it.”

Essary qualified for the intensive help because he’s on a Pierce County list called the Top 55. OptumHealth, the company that provides mental health services for the county, is targeting the 55 top repeat jail inmates who’ve had some sort of contact with the mental health system.

Most have had misdemeanor charges, but some were accused of felonies. Some, like Essary, have both.

The effort is called the Community Re-Entry Program, and the purpose is more than turning around broken lives. It’s about trying to fix a broken county jail budget.

Each of the 55 has been incarcerated at least five times during a 12-month period, driving up costs at the Pierce County Jail. The re-entry program has data on 54 of the 55 repeat offenders. In 2012, they totaled 270 arrests and 5,499 days lodged in the county jail in downtown Tacoma.

By keeping Essary and other repeat inmates out of jail, the county hopes to cut expenses at a time of intense budget strain. Facing a shortfall of $4.2 million, Pierce County Sheriff Paul Pastor recently announced that the jail is eliminating 30 jobs and closing two units that can house more than 160 inmates.

In Essary’s case, the re-entry program hasn’t been successful – at least not yet. Last month, several weeks after The News Tribune last spoke to him, he was evicted from his house for violating rules that require him to return home at night or call ahead, said DeDe Hazzard, his chemical dependency professional.

Essary wound up homeless, returned to drinking and was arrested May 31 in Tacoma for second-degree criminal trespassing. He’s in jail in Des Moines.

His setback shows the challenges of keeping oft-arrested offenders in treatment and out of jail. Most of the Top 55 have mental illness; a few don’t carry a diagnosis but have received some kind of service, said Deanna Carron, manager of the program. And many struggle with the self-medicating spiral of addiction.

Essary made the Top 55 by being arrested 10 times in the 12 months prior to September, when the list was developed. He has been diagnosed with depression and post-traumatic stress disorder.

He told a reporter he’s been in and out of the county jail dating to 1988 and homeless for the last eight years. Records show he was jailed 23 times from January 2010 to December 2012.

Essary is one of 24 people currently enrolled in the Community Re-Entry Program, all of whom have been diagnosed with mental illness, Carron said.

Ten of the 24 have stayed out of jail since the program started in December, Carron said. Ten have been rearrested. Four enrolled while in jail and have yet to be released.

The rest of the Top 55 have refused help, haven’t decided, can’t be found or are in prison.

REDUCING COSTS

Pierce County Executive Pat McCarthy said early results show the program is getting mentally ill offenders into treatment.

Numbers show the re-entry program comes at a significant cost in state and federal dollars: an average of $29,177 per participant per year, based on the current number of enrolled clients.

But from the county’s standpoint, McCarthy likes what she sees.

“I think that serves them, and it serves the taxpayers because it’s reducing our expensive medical costs in the jail,” she said.

Judy Snow, manager of mental health services for the jail, said the program is reaching some of “the most treatment-resistant individuals” who have been in and out of jail.

But she said it’s too soon to tell if those getting treatment will stay out of lockup and whether the program is saving the jail money. Officials say they need at least six more months to determine that.

Snow said what’s needed long-term is more hospitalization and treatment plus housing in the community to prevent others from entering the jail.

Greater Lakes Mental Healthcare of Lakewood is under contract with Minnesota-based Optum to run the Community Re-Entry Program. It is one of several steps undertaken to reduce the number of mentally ill people in the jail.

Last year, McCarthy gathered mental health leaders and others to address problems at the jail, cuts in beds for Pierce County at Western State Hospital in Lakewood, and long delays in competency evaluations. All contribute to keeping mentally ill inmates in jail.

In September, Pastor decided to stop booking nonviolent misdemeanants with mental illness requiring “high intensity” management. Instead, the Sheriff’s Department wants these minor offenders with mental illness diverted to a crisis stabilization unit in Fife that contracts with Optum.

Police officers now often bypass the jail and take many nonviolent, mentally ill misdemeanants to the crisis unit directly, Snow said.

Consequently, the jail doesn’t know how many seriously mentally ill people have been diverted since September, she said.

Pastor has said the increasing number of inmates with serious mental health issues was a major reason for soaring corrections overtime costs last year. High-intensity inmates require close monitoring and are so impaired they can’t interact with other inmates.

“Too many people in our jail have mental problems,” Pastor said in an email this month.

“Many of them commit minor crimes or are a danger to themselves rather than others,” he said. “We need to divert these people because they increase jail costs and because the jail is not equipped to provide them the treatment they need.”

Before the county started diverting high-intensity inmates, the jail had run out of room to house them, Snow said. Their numbers increased from 56 in January 2012 to 76 five months later.

Only about 50 beds are set aside for high-intensity inmates out of a total 1,200 beds at the jail, Snow said. They are separated from the main jail population.

The jail provides medication, assessment and help from mental health professionals for inmates, especially in severe cases, Snow said.

FINANCIAL COSTS

It’s unclear exactly how much of a financial burden mentally ill inmates are putting on the jail.

The Sheriff’s Department charges from $89.50 to $92 a day to house an inmate. Most inmates with mental illness cost more than the general inmate population, Snow said, though the Corrections Bureau, which operates the jail, doesn’t know exactly how much more.

Gary Robinson, the county’s budget and finance director, said the cost of housing a seriously mentally ill inmate at the jail is estimated at $170 per day in chronic cases and $209 per day in acute cases.

Those estimates were calculated before the city of Tacoma pulled out of the county jail this year and started taking its arrestees to the Fife City Jail. Snow said the county won’t know if those figures are accurate until a study of jail rates is completed.

The county is paying a consultant $58,769 to study jail costs and where rates should be set to recoup those costs. The study, due to be completed in August, includes examining the cost of inmates who require mental health services, said Bill Vetter, performance audit analyst.

The county jail is housing fewer mentally ill inmates overall now that Tacoma is contracting with Fife, which led to the cuts Pastor announced last month. Since January, those with mental illness arrested in Tacoma are sent to the Fife jail and then to the SCORE jail in Des Moines, where they receive mental health but not chemical dependency treatment.

Today, seriously mentally ill inmates accused of the most serious crimes are the biggest burden for the county.

“We are still near capacity for the seriously mentally ill,” Snow said.

At least 80 percent of the jail’s population is made up of people charged with felonies who by law the jail must house, she said. Because of state cuts in mental health services, an increasing number of seriously mentally ill people aren’t getting adequate treatment, if any at all. As a result, more accused felons have untreated mental illness, she said.

Closing two more units at the jail will make it more critical to reduce the number of mentally ill inmates, Snow said. Budget dollars for the general inmate population help offset the higher costs of mentally ill inmates, she said.

“We’re getting in a hole,” she said. “Right now, the jail is running at a loss.”

Officials hope to get a payoff from the Community Re-Entry Program in the form of fewer repeat inmates.

Optum, a for-profit company that contracts with the state, is spending $416,500 for the program from its start Dec. 10, 2012, through the end of this month. Of that amount, $122,000 is from the state contract, $285,800 is from federal Medicaid funding, and $8,700 is from dollars through Optum’s cost-saving.

Cheri Dolezal, Optum’s director for the Pierce Regional Support Network, said the program will be continued for another year at a cost of $700,236.

Dolezal said the program has a team available 24 hours a day, seven days a week. The eight-member team includes chemical dependency and mental health professionals, peer case managers and a nurse practitioner to prescribe medications.

The hope, Dolezal said, is to get to the point where nobody with mental illness is locked up in a jail. “It’s not the right place for them,” she said.

“We want people to have an opportunity to live in the community independently with the supports they need to stay out of jail, out of the hospital, out of these acute services, and get what they need,” she said.

Carron said the Community Re-Entry Program recommends inpatient psychiatric treatment in some cases. She said four of the 24 repeat offenders in the program have gone to inpatient units.

In addition, four have gone into inpatient treatment for chemical dependency.

WHAT’S NEXT

Inpatient care is likely the next step for Essary once he’s free again, according to Hazzard, his caseworker.

Greater Lakes Mental Healthcare picked him up from the jail back in January, the last time he was released, and gave him the full menu of outpatient services.

The Rescue Mission provided his housing. Optum paid the $230 cleaning deposit and $200 security deposit. The state paid for his chemical dependency treatment program in Lakewood. And he met with Hazzard several times a week.

In an interview about two months before his latest arrest, Essary said he had refused help six times from Greater Lakes’ workers while he was in jail 90 days for criminal trespassing.

“The seventh time they came, I said I might as well take the bait and try to get out of this cycle,” Essary said. “I just want to be sober again.”

He said he’d been arrested 14 times in the past two years for criminal trespassing – usually for panhandling on private property where he’d already been banned for causing problems. He said he’s been convicted of felonies as well.

Essary, who is not married, dreams of being reunited with his teenage child who lives in the Northwest. He has a work history in commercial fishing, landscaping and construction, and moving and storage.

While disappointed by her client’s latest setback, Hazzard said she will continue to work with Essary to break the cycle of relapse.

“I’m still hopeful,” she said.

Steve Maynard: 253-597-8647
steve.maynard@thenewstribune.com
blog.thenewstribune.com/street
@TNTstevemaynard

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