1. Mental Illness in Jail JJ Larson, MS, NCC, NCAC-II
Manager, Psychological Services Division
Greenville County Detention Center
Department of Public Safety, Greenville County
Presented by Kelly Troyer, Executive Director, NAMI Greenville

2. Bureau of Justice Statistics Sept 2006
At midyear 2005 more than half of all prison and jail inmates had a mental health problem, including 479,900 in local jails.
This estimate represented 64% of jail inmates.
The above findings in this BOJS report were based on data from personal interviews with State and Federal prisoners in 2004 and local jail inmates in 2002.

3. SO ? Persons with SPMI often slip through the “judicial” cracks
Largest Psychiatric Facilities in the country
Without planning & community support – can enter the revolving door

4. Bureau of Justice Statistics Sept 2006
MENTAL ILLNESS
Jail inmates had the highest rate of symptoms of a mental health disorder (60%) (compared to federal or state prisoners)
Approximately, 24% of jail inmates reported at least one symptom of a psychotic disorder.
SUBSTANCE ABUSE
Among inmates who had a mental health problem, local jail inmates had the highest rate of dependence or abuse of alcohol or drugs (76%),
Among inmates without a mental health problem, 53% in local jails were dependent on or abused alcohol or drugs.

5. Bureau of Justice Statistics Sept 2006
Nearly a quarter of jail inmates who had a mental health problem, compared to a fifth of those without, had served 3 or more prior incarcerations.
Female inmates had higher rates of mental health problems than male inmates.
Local jails: 75% of females, 63% of males
Over 1 in 6 jail inmates who had a mental health problem had received treatment since admission

6. Mental Illness and Substance Abuse are prevalent problems amongst today’s criminal offender population.

7. Who is housed out the GCDC ?
Persons who are sentenced to less than 90 days
Persons who are waiting for trial
Persons who are sentenced through family court for child support
Persons with charges ranging from: disorderly conduct to assault and battery to burglary to murder and everything in between
Average daily census = 1400
Book in & Release 100 persons per day (on average)
Annual Booking for 2006 =
22,000 - with 4,000 being repeat offenders in same year

8. Who is housed out the GCDC ?
Average inmate – white male mid to late 20’s, charged with A&B or Burglary 2nd degree
Average mental health inmate – could be any charge from disorderly conduct to assault & battery with intent to kill
Most often male, most often off medication
Of the 1400 inmates – 33% are on prescribed medication
Of those inmates % are on psychotropic medications
Most Common Diagnosis appear to be– SCHIZOPHRENIA, BIPOLAR, MOOD DISORDERS
TOP 4 Meds in OCT 07:
DEPAKOTE, LEXAPRO, SEROQUEL, & RISPERDAL

9. What GCDC Has undertaken
Improving & Enhancing Psychological Services provided to incarcerated persons
Seeking to enhance community partnerships for improved pre-release and “discharge” planning
Partnering with NAMI with Inmate & Family Support program

10. Staffing vs. Inmate Population
2000 with average of 855 Inmates –
1 mental health clinicians
1 psychiatrist, part-time
2007 with average of 1400 Inmates –
1 mental health administrator
3 mental health clinicians
1 administrative clerk

11. Psychological Services
Mental Health Emergencies
Inmates who have been identified with suicide distress or other crisis level mental illness symptoms – most often psychosis.
Seen by clinician – may be referred to psychiatrist.
Mental Illness - Crisis Stabilization
Clinician Evaluation/ Assessment of inmates who have active mental health symptoms needing resolve prior to housing
Recommend and implement plan to bring about stabilization
General Mental Health
Inmates who have requested medical services through M360 system.
Seen in their Housing Units; at times seen in Mental Health Office
Substance Abuse Treatment
Groups services offered to male and female inmates of detention center. Must apply and be screened as eligible – by disorders, charges, keep separates, anticipated length of stay
Psychiatric Services
Inmates screened by mental health staff and assessed as requiring psychiatric or pharmacological interventions or adjustments

12. ZONES for Mental Health
On-Call Staff
Weekly rotation – responds to all after hours emergent issues
Conducts Intake Mental Health Triage Care
Inmate Requests
Responds to requests for services in Zone
First responder for Mental Health Crisis in Zone
Emergent/ Phone-In Concerns
Respond to requests by officers/ concerned others
May refer inmate to use of Inmate Request system (M360 form)
Case Management
Troubleshoot medication verification
Assist with discharge planning on inmate request
Coordinate pre-release planning based on needs assessment
Mental Health & Suicide Observation
Monitor inmates on these protocols, monitor stabilization, recommend appropriate possessions and housing as needed
Maintain mindfulness of safety –of self, of staff, of inmates

13. Staff Challenges Medication- verification & compliance Housing Issues
Dual Diagnosis & AOD
Discharge/ Pre-release planning
Inpatient Commitment/ Placement
Specialty Field –
“correctional mental health”
Security Issues / Behavior
Malingering

14. Commitment to Quality Care
Estelle v. Gambel defined “Adequate Healthcare” for Correctional Facilities at a National Level.
In 1976, the Supreme Court of the United States found in the Eighth Amendment to the Constitution that inmates had a constitutional right to medical care. The Court noted that an individual in custody is unable to seek medical care and is totally dependent on the employees of the institution for their health care. Therefore, failure to provide that care would be considered “cruel and unusual punishment.”

15. Commitment to Ongoing Quality Care
Jails & Detention Facilities have become the largest psychiatric hospitals in the nation
Inmate acuity (aka – amount of time it takes to manage an inmate’s psychiatric needs) will continue to increase as the population grows/ages
More Psychiatric Needs = More Staffing Needs
Provision of recidivism reducing treatment

16. Inmates Seen 2006 – 5319 inmates seen by mental health 2007 –
3945 inmates seen for 1:1
530 inmates seen in group sessions
4475
84% of 2006 total – in just 1st six months of this year

17. Other Challenges Lack of Jail Diversion: Pre-Booking
Occurs at at the point of contact with law enforcement officers and relies heavily on effective interactions between police band mental health/ substance abuse agencies.
Most entail: specialized training by police and a no-refusal crisis drop-off center
Our county lacks crisis drop-off center
Post-Booking
Mental Health court referrals which entail collaborations with judicial and mental health or dual diagnosis treatment
-- Can’t meet all demands –
Transition Planning prior to release from Jail is evolving. Not yet a complete “Post-Booking” program; needs to be part of a community collaboration and recidivist reduction effort

18. Contact for more information:
Ms. Jennifer “JJ” Larson
Main office number:
Kelly Troyer
NAMI Greenville