Original Article Detaining mentally ill in jail a problem County seeking solution to woes Christina Leonard The Arizona Republic Mar. 17, 2005 12:00 AM Maricopa County officials say their jails house more seriously mentally ill people than any other facility in the state. No hospital, no halfway house, no clinic houses more of them. Nearly everybody agrees it's a bad deal. And now, after putting up with the situation for decades, county officials are ready for action. Members of a new countywide task force plan to meet next Thursday to evaluate the system, streamline procedures within the county and hash out possible solutions. The stakes are high for the county, taxpayers and mental patients. The patients, many accused of minor crimes, often don't get the care they need. They're thrown into overcrowded jails where they can fall prey to other inmates. Many are taken off their treatment plans. And most end up right back in jail once released. For the county and its taxpayers, the process is extremely time-consuming and expensive. County officials not only must pick up the costs for feeding, housing and medicating the inmates, they also pay the salaries for everyone from detention officers and psychiatrists to public defenders and judges. It often costs two to three times the amount to send a mentally ill person through the criminal-justice system compared with treating the person outside it. And the community as a whole loses out. Although the issue went nowhere within a legislative ad hoc committee earlier this year, county officials say they're devoted to improvements and plan on hitting the Legislature hard until they make progress. "What we're doing is the most costly approach to solving the problem, and it's not solving the problem," said county Supervisor Don Stapley, who is spearheading efforts within the county. "We're simply warehousing the mentally ill in lieu of seeking medical treatment and solutions. "I'm passionate about this because it's wrong. It's morally wrong to do what we've been doing." The patients Paul Padilla, 35, of Chandler, said he has been in and out of jails and mental institutions since he was 13. He has spent time within Maricopa County jails for crimes ranging from disorderly conduct and criminal damage to assault. And he doesn't want to go back. "They really don't care about the mentally ill in jail," Padilla said. "I get so scared. I have paranoia about the violence. . . . I've seen people get beat up. I've seen the guards talk bad about people." Padilla, who said he has paranoid schizophrenia and bipolar disorder, calls jail a "scary place." He is going through a special mental-health court now to avoid jail time but knows he could end up back behind bars. He's not alone. Officials say it's common for the mentally ill to repeatedly go in and out of jail. In one case, a woman was arrested 29 times in six years for prostitution to theft to drugs. Another man was arrested more than 50 times in four years for everything from criminal trespass to shoplifting. A Maricopa County Superior Court commissioner summed up the problem with housing the mentally ill in jail this way: "Severe overcrowding, unsanitary conditions ... and bullying by professional criminals, including assaults, extortion and stealing medications, are typical of the conditions under which the mentally ill live." The department Correctional Health Services, the county department that provides medical treatment in the jails, has come under fire and undergone major leadership changes during the past few years. Administrators admit the department is stretched thin. They struggle to keep up with staffing demands for psychiatrists and deal with a chronic shortage of nurses and have a limited number of available psychiatric beds. Inmates often complain about poor care. And some inmates can go without their medications for several days, depending on when they're booked and what drugs they're taking. "The worst thing you can do is put them in jail and take them off their medication, their treatment plan and sever their continuing ability to access their pharmacy needs," Stapley said. Last year, the county signed a $500,000 contract with Phase 2 Consulting of Salt Lake City to conduct a "top to bottom" assessment of Correctional Health, said Lindy Funkhouser, contract administrator. They've already made improvements and will continue efforts as two new taxpayer-funded jails open. The lawsuits Over the years, the county has faced a slew of lawsuits against Correctional Health Services and the Sheriff's Office, and the county has paid out thousands of dollars to families of inmates who have committed suicide in jail. One example: In 2003, taxpayers footed a $175,000 settlement for the family of David Hyslop, 33, who committed suicide after being left alone in a cell after repeatedly being sent to the psychiatric unit. County officials estimate 20 percent of the jail's population is seriously mentally ill. In 2004, jail officials identified more than 2,000 inmates who are clients of ValueOptions, a private company the state contracts with to provide mental-health services. But county health officials believe there are hundreds, possibly thousands, more who are not clients. It's difficult to determine exactly how many mentally ill inmates are in jail because the system relies on self-reporting and inmates don't always admit they're mentally ill. Many of them have committed minor crimes such as public urination, shoplifting or disorderly conduct. They generally stay in jail longer than other inmates, and most are repeat customers. "For some of them, they don't mind this," said Clarke Romans,executive director of National Alliance for the Mentally Ill in Arizona. "Compared to sleeping in a park in Mesa or on a bench somewhere, they're safe in jail and they get fed." The county Maricopa County picks up the cost for any person who goes through the criminal-justice process. "Every arraignment, every initial hearing, every judge, every county prosecutor, every public defender gets paid by the taxpayers," Stapley said. "It's an enormously expensive process." Correctional Health Services alone has asked for additional contingency funds for at least the past three years, facing increased costs in pharmaceuticals, temporary nurses and outside hospital services. A study in King County, Wash., showed that it cost $1.1 million to serve 20 seriously mentally ill patients who were repeatedly jailed, hospitalized or admitted to crisis centers over a one-year period. That's about $55,000 per person. Compare that with $20,000, the annual cost to care for a mentally ill individual in the community, according to the Criminal Justice/Mental Health Consensus Project. On top of that, Stapley said taxpayers end up paying double because ValueOptions receives a fixed amount for every client whether they're in jail or not. Under Arizona law, the state has responsibility for making sure more than 70,000 mentally ill people receive services that include counseling, medication and housing. The state contracts with ValueOptions to provide services. "Every person who's booked into jail who is an SMI (seriously mentally ill) client of theirs, ValueOptions, they get paid, but it doesn't cost them anything," he said. "Because it's costing the taxpayers. We're paying double." The solutions Maricopa County's new task force, the County Commission on Justice System Intervention for the Serious Mentally Ill, will meet for the first time next week. There is some minor relief already on its way. Once the county's two new jails, which were originally scheduled to open last June, do become available, they will be able to provide more than twice as many beds for mentally ill inmates. And county officials are building a $23 million homeless campus in central Phoenix that will bring together at least eight agencies. The homeless will receive everything from food and shelter to medical care at the location. Another highlight is mental-health courts. The Superior Court began its mental-health court more than two years ago. It's a "problem-solving" court where stakeholders work closely to provide alternatives to jail. That may mean putting the defendants in rehab programs and ordering them to stay clean and get jobs. "Our goal is to have the judges, the public defenders, the county attorneys, the staff, trained to deal with seriously mentally ill so as to have some more sensitivities to what's happening there, and ideally they wouldn't fall through the cracks and spend less time in jail," said Judge Carey Snyder Hyatt, who heads the court. Tempe Municipal Court has a similar program for its misdemeanor cases, which also has received recognition for its work. But many experts say the trick is to divert the seriously mentally ill before they are booked into jail and enter the criminal-justice system. Because once they're in the system, they stay in. "We need to begin to divert as many of these folks out as we can and to not incarcerate them when that's the more costly option and much less effective," Stapley said. More than 300 Phoenix police officers have been trained to recognize mental illness. Lt. Steve Haynes, who used to coordinate the training, said the classes allow officers to empathize with the mentally ill and educates them about alternatives to jail. The training program has spread to several other police departments. The Sheriff's Office also is considering training deputies in mental-health issues. Sheriff Joe Arpaio said they're talking with Correctional Health Services about sending mental-health professionals to crime scenes. "I do have to give in a little and say the jails shouldn't be used as a baby-sitter for the mentally ill," he said. ValueOptions has a nationally recognized 12-week program that diverts some mentally ill clients accused of misdemeanor crimes before they hit the courts. But the stakeholders still face significant challenges. Experts say government agencies need more staff. The community needs more resources. And there still are some legal issues that need to be ironed out. Stapley said he believes the biggest issue by far is housing. He said state statute prohibits anyone with a criminal record from utilizing public housing. "Once they get out of jail, they have nowhere to go so they go back to the streets," he said. Most experts agree that it will take time to work out all the problems. But Stapley believes it will happen: "It will take every partner in the process working together from the state down to the smallest community-based non-profit involved with this population and this problem."