County Jails Struggle To Treat Mentally Ill Inmates

Enlarge this image toggle caption Christine Herman/Illinois Public Media Christine Herman/Illinois Public Media

DeVonte Jones began to show signs of schizophrenia as a teenager. His first public episode was nine years ago at a ballgame at Wavering Park, in Quincy, Ill.

"He snapped out and just went around and started kicking people," says Jones' mother, Linda Colon, who now lives in a Chicago suburb.

The police were called. Jones was arrested, charged with aggravated battery and placed in Adams County Jail. Colon says Jones had no recollection of what happened.

Her son got out on probation and went to therapy. He started on medications, but Colon says they didn't help. When he got caught self-medicating with marijuana, he ended up back in jail.

Jones has been in and out of the criminal justice system ever since. He's among the estimated half-million people incarcerated in the U.S. who have a serious mental illness.

According to federal data from 2011 to 2012, more than 40 percent of jail inmates reported having been told by a mental health professional that they had a mental health disorder. And while about 1 in 4 jail inmates met the threshold for having serious psychological distress at the time of the survey, only about a third of those were receiving treatment for it.

In recent years, county jails across the nation have taken steps to try to keep inmates with mental illness, like Jones, from coming back. One approach involves stepping up mental health screening, coupled with efforts to get inmates plugged into community-based treatment after they are released.

Such efforts require often-unprecedented collaboration between those on the front lines of mental health and criminal justice. But research shows such collaboration is key to addressing the problems many jails face when they become their communities' largest psychiatric facilities.

Colon believes the jail conditions her son faced caused his condition to worsen. He lost access to his medications there, she says, and would experience episodes related to his schizophrenia that landed him alone in a cell.

The mental illness leads to them committing these crimes and there's really no place else for them to go, so they come here. This is not a hospital. This is a jail. You do the best you can.

"But if you're a mental illness patient, there's no way to calm yourself down without any kind of medication or therapy," says Colon, who has been in jail herself and is currently out on probation.

Adams County Sheriff Brian Vonderhaar says he can't comment on Jones' situation because he didn't work in the jail back then. But, he says, all the Adams County inmates are screened for mental illness, and medical providers there administer medications as needed. Inmates who are suicidal may indeed be placed alone in a cell, he acknowledges, with nothing but a mat and a garment they wouldn't be able to use to harm themselves.

Real change needed

Efforts to reduce the number of inmates with mental illness need to involve the jail system, says Richard Cho of the Council for State Governments Justice Center, because it is "the front end of the criminal justice system."

In 2015, the CSG Justice Center, together with the National Association of Counties and the American Psychiatric Association Foundation, launched the Stepping Up Initiative to help jails reduce the number of inmates with mental illness.

More than 400 counties have passed resolutions to join the program, which promotes the use of evidence-based screening tools to identify inmates who have a serious mental illness. Inmates who screen positive are referred to a clinician for a follow-up assessment.

The CSG Justice Center provides counties with technical assistance to collect data to understand the scope of their problem and determine whether efforts to reduce the number of inmates with mental illness are working.

Enlarge this image toggle caption Christine Herman/Illinois Public Media Christine Herman/Illinois Public Media

The Champaign County Jail signed onto the Stepping Up Initiative after Deputy Chief Allen Jones realized the majority of the jail's "frequent flyers" — people who landed in jail five or more times a year — had mental health or substance use issues.

Connecting inmates to care

Since then, the deputy chief has implemented a mental health screening tool as part of the intake process.

The jail partners with Rosecrance, a community-based mental health treatment provider, which receives funding from the county to send caseworkers to the jail to help inmates get plugged into treatment after they're released.

And the group Champaign County Health Care Consumers, led by Claudia Lennhoff, sends people to the jail to help inmates sign up for health insurance, to ensure the care they seek in the community will be covered.

"It's very hard for a lot of communities to do this kind of work, because you [often] don't have partners like the sheriff's office willing to cooperate," Lennhoff says. "A lot of what we're doing is building trust, so that people know that help is available."

Many inmates get connected to care for the first time through the jail, Lennhoff says.

Pam Rodriguez is the CEO of TASC-Illinois, another organization that helps inmates successfully make the transition back into the community. She agrees with Lennhoff that jail can be a turning point for people with untreated mental illness. But it's a shame those people didn't find help sooner, she says.

"These are people who were noticed in school, I'm almost certain," but who didn't receive help, Rodriguez says. "These are people whose families have probably tried to get them into care."

Ideally, Rodriguez says, people with mental illness who get arrested would be diverted to treatment instead of to jail where their condition can worsen.

On the one hand, Rodriguez says, being housed alone in a cell can help prevent a mentally ill inmate from being victimized. Federal data finds inmates who show signs of serious mental illness are at higher risk of sexual victimization by another inmate.

"But isolation tends to exacerbate mental illness," Rodriguez says. "Then the jail, which is not prepared to deal with serious mental illness, has to figure out what to do. And that's a huge challenge."

Societal roadblocks to mental health

To keep people with mental illness out of jail entirely, Cho says, the U.S. needs a mental health system that destigmatizes mental illness "and is able to identify people at the very first onset of symptoms."

"We're so far from that in this country," he adds.

Across the U.S., community resources for mental health continue to be stretched thin.

In Illinois alone, for example, mental health services took a hit over the past several years. Lawmakers went months without paying providers who were promised state funding. That led to behavioral health agencies reducing services; some permanently closed their doors.

Lt. Ryan Snyder, who works at the Champaign County jail, says the reduction in mental health services has created a challenging situation for law enforcement.

"The mental illness leads to them committing these crimes and there's really no place else for them to go, so they come here," he says. "This is not a hospital. This is a jail. You do the best you can."

But it's not easy, Snyder says, for any jail to provide the kind of one-on-one mental health treatment that many inmates need.

In the omnibus bill approved by Congress in March, appropriations for the Department of Justice's Mentally Ill Offender Treatment and Crime Reduction Act was increased $30 million — more than double the previous year's allocation. The act was initially authorized by Congress in 2004 to facilitate collaboration among those working on the front lines of criminal justice, juvenile justice, mental health services and substance use treatment.

Looking ahead

Deputy Chief Jones is applying for federal funding to hire more caseworkers who can help police officers handle calls for mental health crises in Champaign County. He's working with academic researchers to find out how efforts to reduce the number of inmates with mental illness in the jail are doing.

"I don't know how to fix societal issues," the deputy chief says. "But I'm trying to find ways to get the best outcome that we can get."

In Adams County, Sheriff Vonderhaar says the jail is developing a mental health court that would divert people with mental illness into treatment instead of jail. The county is also building a new jail facility with a layout that would allow for new programs for inmates such as support groups for drug addiction, mental health counseling and GED classes.

Meanwhile, Linda Colon's son, DeVonte Jones, is now 24 and back in jail — this time in Livingston County, Ill. He's charged with production and possession of child pornography and is awaiting sentencing.

Colon says he takes medications but is still not well.

"He's attempted suicide a few times," she says. "So for me, out here as a parent, I'm wondering if I'm ever going to get that phone call one day saying that they went to my son's cell and found him not alive."

Colon says she can't help but wonder whether the right interventions earlier would have kept her son out of the system.

For now, she does what she can to help him stay positive. Colon calls her son almost every day and reminds him that she loves and accepts him unconditionally.

"I just really hope that he doesn't get so low that he gives up," Colon says.

This story was produced by Side Effects Public Media, a news collaborative covering public health.