Stepping up: Jail programs tackle mental illness and substance abuse disorder




  • In US
  • 2022-02-13 19:21:00Z
  • By The Record-Eagle, Traverse City, Mich.

Feb. 13-TRAVERSE CITY - Last week a man at the Grand Traverse County jail wrapped a phone cord around his neck in an attempted suicide.

Jail deputies saw the man's actions and stepped in before he could harm himself, but his desperate effort puts him in a category alongside more than one-third of inmates with mental illness.

Lt. Chris Barsheff, jail administrator, said he hopes a Stepping Up program that assesses people booked into the jail early on for mental illness and substance use disorder will have them getting the help they need and getting it quicker than they are now.

"The goal of the Wayne State initiative is to keep people out of jail," Barsheff said, calling the program proactive rather than reactive. "Why don't we put our efforts not so much in the jail but outside of the jail?"

Jail populations nearly tripled during the past half-century, becoming warehouses for people with mental illness and addiction, which often overlap.

Stepping Up has the goal of diverting those people away from jails and getting them the help they need. The national initiative started in 2015 and in Michigan is run by the Wayne State University School of Social Work Center for Behavioral Health and Justice.

The Grand Traverse County board approved a resolution to put the Stepping Up initiative in place in early 2020, but Barsheff said the program was waylaid by the pandemic.

For those 27 Michigan counties that passed the resolution, the program is funded by the Michigan Department of Health and Human Services.

Diversion from jail

Statistics showing that jail populations in Michigan nearly tripled since the mid-1970s even as crime rates fell were the impetus for a landmark package of jail reform bills signed into law in January 2021.

The Michigan Joint Task Force on Jail and Pretrial Incarceration looked at years of data, consulted with experts and listened to public testimony to come up with 18 recommendations, many of which were codified into laws that eliminate suspending a person's driver's license for infractions not related to dangerous driving, improving probation practices, and doing away with jail time for many nonviolent offenses.

One recommendation calls for people with behavioral health needs to be diverted from the justice system, both pre- and post-arrest. The recommendation did not make it into the jail reform package, but several bills introduced in this year's legislative session focus on investing in community-based treatment aimed at diversion.

Laine Putans, jail diversion manager with the Wayne State CBHJ, said diversion can mean a lot of different things to different entities. Diverting people to a crisis center where they can be assessed for mental illness or SUD and kept out of jail is the "gold standard" in a lot of communities, but is also expensive, she said.

"But we can also look at diversion as a much smaller entity," Putans said.

Law enforcement officers in a handful of counties are assessing people at the scene of an incident and, if needed, referring them for behavioral health treatment rather than arresting them. The process is quick and inexpensive, Putans said.

Diversion can also mean getting a person out of jail early and into treatment, and it encompasses measures that focus on keeping people from coming back to jail.

Many community leaders are advocating for a crisis stabilization center in Traverse City that would be open 24/7 and provide crisis beds, short-term residential beds and follow-up care for children and adults in the region. A 15,000-square-foot office building is being looked at, but it comes with a price tag of about $4.5 million, including renovations.

Many are hoping the county will help fund the center with part of the $18.2 million in American Rescue Plan Act money. The state also has more than $5 billion in unspent ARPA funds.

A crisis or diversion center needs buy-in from law enforcement, prosecutors, the court system, mental health providers and the community, Barsheff said.

"It's a community decision and all these partners are part of that decision," Barsheff said.

The first step in implementing Stepping Up was gathering baseline data on those incarcerated in Grand Traverse County over a 110-day period from October 2020 to February 2021. A new screening tool was used that asks those being booked into jail about 20 questions, including whether they feel hopeless, depressed or worthless, as well as questions about their use of alcohol, drugs and opioids.

A positive score on the test is not a diagnosis, but indicates symptoms of mental illness, psychological distress or misuse of substances are present.

During that data collection period 206 screens showed that 38 percent of inmates tested positive on the mental health portion and 30 percent were at risk for an opioid use disorder. In addition, 20 percent of those screened said opioids were their drug of choice, and 15 percent were concerned about withdrawal from a drug while in jail.

The jail previously used a screening tool in which inmates answered questions, but whether a person was referred for services was based on the observations of corrections officers. Under that subjective screening several inmates were missed, with only 18 percent being referred for services, Barsheff said. The new tool uses a point system to score answers.

"It makes it very simple for staff because it's objective," Barsheff said.

The study also showed that the average time for a mental health referral in the jail is 11 days, with an average of another six days time for an inmate to be seen by Northern Lakes Community Mental Health once a referral is made. While a contract with CMH that put two full-time employees in the jail expired more than a year ago, the agency continues to provide limited services for inmates via telehealth.

Vickie Patson's grandson, who was on anti-depressants and a medication used to treat opioid use disorder, was in jail from June through August. During that time he saw a psychiatrist once and saw a counselor once for about 15 minutes, Patson said. His medications were also changed, she said.

"My grandson is only one of many people in that system who are hurting, who need assistance," Patson said.

The American Civil Liberties Union in October sued the county, Sheriff Tom Bensley, Undersheriff Mike Shea and Barsheff in federal court on behalf of Cyrus Patson for withholding the suboxone that is prescribed by his doctor.

Patson said she hopes the Stepping Up program offers inmates the help they need.

"I hope that they have conscientious, good people that are going to work in this program," Patson said. "I hope they're staffed well and that they follow through. I have nothing good to say about the justice system in Grand Traverse County."

The jail is in the process of hiring one provider that can offer medical, mental health and psychiatry services. Four companies submitted proposals and a recommendation will be on the Feb. 16 agenda for the county board to approve. The new provider will be in place March 1, Barsheff said.

Putans said services offered by the CBHJ in the Stepping Up program include integrating data from the jail and community behavioral health providers to measure progress. Data can be used to apply for grants or to garner more state and federal funding, she said.

The data will prove what the county already knows - that the need for better funding exists, Barsheff said.

A right path

Greg Hall, who has been openly critical of the jail's policy of withholding medications from people being treated for mental health disorders, is skeptical when it comes to programs like Stepping Up. Hall had two family members who had medications for depression, anxiety and post-traumatic stress disorder discontinued when they were arrested and placed in jail.

"All these programs are wonderful and well-intentioned, but if you don't have people there to manage them well it's pointless," Hall said.

Hall, who ran against Bensley in 2020, said the jail has gotten away from restorative programs that would help inmates once they are released.

"If I go to jail today there's zero attempt to get me on the right path," Hall said.

Barsheff was appointed jail administrator in 2019, just before the pandemic and just after the resignation of former Capt. Todd Ritter, who did time on convictions of embezzlement by a public officer, misconduct in office and willful neglect of duty. The jail had also had 51 attempted and two completed suicides over a 7-year span, as well as severe staff shortages.

Barsheff said Stepping Up is just one initiative to make improvements at the jail. He plans to restructure life skills programming that was suspended during the pandemic. Classes for those who need them are offered by Catholic Human Services, which provides SUD services at the jail, Keys to Freedom Ministries, which does discharge planning, and Before During & After Incarceration, a group that advocates for alternatives to jail.

Barsheff also plans to bring back Alcoholics Anonymous and Narcotics Anonymous meetings, as well as church services.

Patson said the stigma of having been incarcerated and being an addict makes it difficult to get a job.

"The jail should add job coaching classes to the mix to help them become employable," Patson said.

Hall said that for things to change the whole system - law enforcement, prosecutors, judges and jail staff - all need to view things a little bit differently.

Putans says how society views mental illness and addiction is changing.

"Communities are starting to see people who are in jail as community members who will at some point return to the community," Putans said. "It is to everyone's benefit to see them as people who need mental health treatment or substance abuse treatment.

"Our work would not be practical or feasible if people had not come around to seeing the value of those people."

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