Nearly a third of county inmates require drugs for mental illness

The three largest mental-health facilities in the United States are jails in New York, Chicago and Los Angeles.

Cape Girardeau County Jail is not immune to this phenomenon. About 75 inmates at the jail of a total of about 220 are on some type of medication, Cape Girardeau County Sheriff's Jail Capt. JP Mulcahy said. Thirty inmates are on psychotropic drugs.

Corrections officers are at a disadvantage in trying to treat inmates with mental-health disorders, Mulcahy said. By the time they reach jail, mentally ill inmates often have taken themselves off their medications or are taking the wrong kind. Before the jail can give medication, it requires a doctor's order, which can take time.

The jail is working toward adding 10 hours a week of mental-health counseling, where a contracted, qualified mental-health professional will talk to inmates. Mulcahy said he hopes this will speed the process to get inmates their prescribed medication.

Still, the jail cannot administer a controlled substance (Xanax for instance), because of the high likelihood those drugs will be smuggled around the jail, Mulcahy said.

"It's tough for us, because we don't know all the history," Mulcahy said of mental-health inmates. "We don't have the ability to give him a sedative."

Inmates with mental-health disorders can become targets of bullying from other inmates, Mulcahy said.

Law-enforcement and court-system officials in Cape Girardeau County said they do not want mental-health patients to wind up in jail. Cape Girardeau Police Sgt. Adam Glueck said putting patients in jail does not help the patient, who can receive better treatment outside with the help of the Community Counseling Center, Department of Health and Senior Services, Department of Mental Health and other organizations.

"Our goal is to help people," Glueck said.

Cops' options

Law-enforcement officers have a bevy of options when they respond to a mental-health crisis that involves a crime.

Cape Girardeau Lt. Rodney Barker said common procedure on a misdemeanor -- Mulcahy said theft and property damage are common for inmates -- is to issue a summons and release the person. In a more serious case, when a person needs help, police can opt for voluntary and involuntary commitments.

From 2011 through Feb. 11 Cape Girardeau police transported 191 people with "perceived mental illness" to Southeast Hospital. All perspective patients must be transported there because that is the only local hospital with a mental-health ward.

That ward soon will be moved out of Cape Girardeau and added to the SoutheastHEALTH hospital in Dexter, Missouri.

Police departments around Southeast Missouri went through a weeklong crisis intervention training seminar in February. The goal was to teach police to properly identify someone in a mental-health crisis and use calming language to de-escalate the situation. Part of the training is finding ways to ask patients whether they want to go to the hospital.

St. Louis County Sgt. Jeremy Romo, a crisis intervention training instructor, said one of the techniques he uses is to give patients options, and those options might be a hospital or jail.

"When you slow things down and invest the time, everyone benefits," Romo said.

Romo said he has presented this to those he has suspected of mental illness: "What if you were here for me? Would you feel comfortable leaving me alone?"

When a voluntary commitment is not an option, officers can fill an affidavit and request a judge to sign for a 96-hour or 21-day hold. In Cape Girardeau, all these cases start at Southeast Hospital, although long-term commitments need to be transported to an inpatient facility, the closest being in Poplar Bluff or Farmington.

Mulcahy said sheriff's deputies also have consulted with crime victims in these cases and ask whether they want to press charges. Unlike what is portrayed in the movies, this is not an automatic step for law enforcement. Mulcahy said many times the victims know the patients and will drop charges.

On felony cases, however, law enforcement still needs to treat mental health patients as if they were any other person.

"If somebody commits a violent crime ... that's not something they can get out of," Glueck said.

Prosecution options

There are options for the prosecutor. One is to request from the judge a mental-health examination by a professional from the Department of Mental Health, Cape Girardeau County Prosecuting Attorney Chris Limbaugh said. Depending on the results of that evaluation, the prosecutor can recommend dismissing the case, although the person may not be fit for release, Limbaugh said.

"There is always extra careful consideration of releasing them to the public," Limbaugh said. "It all depends on the case."

Defendants may plead guilty and go on probation. Limbaugh said mental-health treatment often is a requirement of probation conditions.

Drug court

If the offender is known to have a substance-abuse problem, he or she can be evaluated for treatment court. Mulcahy said he prefers when drug court is an option for inmates with mental-health disorders, because treatment will be a part of a strict program.

Adult drug treatment court is intense. At the beginning of the four-phase program that usually takes a year and a half, participants are subject to several drug tests a week. Administrator Sheila Sauer goes to great lengths to make the tests unpredictable. Participants must call a lab phone number every day at 6 a.m. to find out whether they test. If so, they have until 10 a.m. to make it to the lab in Cape Girardeau.

Participants must attend group therapy sessions, usually Narcotics Anonymous or Alcoholics Anonymous meetings. They must meet with a counselor and probation officer at least weekly. Participants must obtain employment.

"People who truly want to be clean and sober, they're willing to do all that," Sauer said. "We want them to be productive citizens again."

In specific cases for participants with verified mental-health disorders (about 40 percent of participants), Sauer will make them bring in their prescription medications and count each pill. Participants often will admit to not taking the right amount of medication, or they stop taking it.

Severe mental illness can disqualify a person from being in drug court, however, when a person's mental health needs outweigh treatment needs for substance abuse.

Counselors

Drug court counselors are not mental-health counselors. The only mental-health counselor in the system is Community Counseling Center's Warren Skinner, who also serves as mental-health liaison for all law enforcement in Cape Girardeau County. Skinner can offer assistance and treatment options to officers and the courts.

"Honestly, people going through drug court, about half have mental-health issues," Skinner said. "There are people with mental-health issues that are too serious to take into drug court. ... We would love to get a mental-health court."

A mental-health treatment court would bridge that gap and provide more counseling options through existing organizations such as Community Counseling Center. Mental-health courts exist in St. Louis County and Kansas City, Missouri. Sauer is applying for funding to establish a mental-health court for the 32nd Circuit. She said it may take as little as $30,000 in state funding to get it started.

Mental-health court, however, would apply only to participants also initially struggling with substance abuse, Sauer said. People arrested after a mental-health crisis situation would be subject to the normal court process.

Still, Sauer and Limbaugh said mental-health court would be a benefit to the community.

"My experience with more specific programs, such as drug court, is that we have a much higher success rates and lower recidivism," Limbaugh said.

Judge Scott Lipke is the judge for drug court and would be the judge for mental-health court. He said the success of the drug court program is partly because of how much the team members -- Sauer, counselors, probation officers and himself -- care what happens to the participant.

"You see them so often ... it's kind of like a parent," Lipke said. "You know when something is bothering them."

George McFall was in a treatment court program for 2 1/2 years. He works for a janitorial service.

"Judge Lipke, he's just wonderful," McFall said. "Drug court with Sheila and Mike, I think it's their calling. ... They truly care."

bkleine@semissourian.com

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