Law and Disorder

Most people who land in Marathon County
jail have a mental illness, but rarely get the treatment they need

While doing rounds at the Marathon County Jail recently, a corrections officer passed the cell of someone she’d been keeping an eye on. He’d been listed as suicidal, so was checking to make sure he was OK.

Her instincts were right. The corrections officer found the man hanging by his neck underneath his bed, using the frame to hold his weight. Luckily, the man had fallen in such a way that his arms supported him, and the corrections officer was able to save his life.

This incident was far from rare in the Marathon County jail. Another inmate had slit his wrists, and he, too, was found in time to save.

It took at least two months to get one fellow, who believed he was an FBI agent sent to eradicate Nazis, sent instead to a state mental health institution.

A female inmate who had been actively cutting herself and was considered suicidal was denied mental health treatment.

A man who thought he was an angel and should be freed from jail by President Obama punched another inmate so violently the victim was sent to the hospital. The obviously delusional inmate was denied mental health treatment because he was capable of clear thoughts, a North Central Health Care crisis team member told jail staff.

Those incidents are part of 11 such scenarios that occurred at the Marathon County Jail in which Chief Deputy Chad Billeb says services the county contracts for mental health failed to help people with a mental illness. In all these instances inmates were denied treatment or that treatment was too long in coming.

And all the above-listed scenarios occurred recently, between Nov. 24 and March. That’s a sign that there’s a problem, Billeb says.

Those problems are continuing. One man who talked to City Pages Wednesday says he had recently been taken to North Central Health Care by police who recognized a mental illness issue, but was told to leave the facility after officers left.

Those scenarios Billeb highlighted, especially the two suicide attempts, prompted Sheriff Scott Parks to launch a panel to look at how inmates with mental illnesses are treated and how Marathon County can better assess their needs. Parks, Billeb and Jail Administrator Sandra La Du-Ives are hoping this panel review can improve the way mental illness is addressed in Marathon County in the same way the independent jail panel was able to improve safety.

Because right now, the system is broken.

Billeb is the first to say that. Like other jails and prison across the country, the Marathon County Jail is a revolving door of mentally ill inmates. These places have become de facto mental health institutions, a designation for which nearly all of them, and certainly the Marathon County Jail, are ill-equipped. Those inmates aren’t getting help in the jail system, and they’re not getting the help from North Central Health Care (NCHC), which the county contracts for mental health services.

Marathon County Board supervisors have become aware of the situation, and their concerns are rippling over to Mount View Care Center, the county-owned nursing home run by NCHC. Plans to renovate the facility—a long-studied, $13.5 million project—were put on hold Tuesday by the board, mainly due to so many county supervisors losing trust in NCHC.

Though the panel Sheriff Parks convened will look at long-term solutions to address mental health issues in the jail, NCHC CEO Gary Bezucha revealed on Tuesday a series of changes that could be implemented as early as July to put more mental health professionals in the criminal justice system.

“When we talk about regaining trust, results are a way to regain trust,” Bezucha said at an earlier meeting. “Should we have done something a year ago? Yes. But I can’t go back in time.”

Those changes are just one step of several the county must take, Billeb says, but they’re a positive step in the right direction.

The revolving door

As it stands now, the typical scenario works like this, according to Billeb: A mentally ill person commits a crime, they are arrested and taken to jail. If it’s known the offender has a mental illness, officers might already be in contact with NCHC’s crisis line or take the person to the health care center directly.

But those people are getting little if any treatment at NCHC.

Another problem is that it’s not always clear that a person committing a crime has a mental illness.

At the jail, offenders are asked a series of medical questions, which include whether they are on medications or whether they have a mental illness, La Du-Ives says. That can be an indication, but it’s completely voluntary, and no one has to report any condition. They also can’t be compelled to comply with any treatment recommendations already made, La Du-Ives says.

The underlying problem, Billeb explains, is that jail is considered by some as a safe place. Once they’re in custody, they’re no longer a threat to themselves and others, right? The above examples would indicate otherwise, Billeb says. “The jail is not a safe place,” Billeb says. “There are many different ways [inmates] can harm themselves.”

The average jail stay is 29 days, but that includes offenders who have sat in jail for many months. Taking those out of the equation, the average jail stay is closer to three or four days.

Once an inmate is released, there’s nothing jail staff or any other county department can do for those whose troubles are largely caused by mental illness. “We don’t have the staff with professional skills to help these people,” Billeb says. “Oftentimes they leave in the same predicament they were in when they got here. That’s a real challenge and one that needs to be addressed.”

Here’s what would happen ideally: When a person enters the jail, he or she would go through a screening for mental health and substance abuse. Once that assessment is complete, jail staff would arrange services for that person while incarcerated.

When the inmate leaves jail, he or she would be assigned to a social worker, who would ask, Do you have a place to stay? Where is your next meal coming from? Do you have family to rely on? Do you have employment? If the answer is no to any of those questions, the social worker would connect the person with resources in the community.

Solution in the works

That ideal solution might be closer than anyone thought. Bezucha didn’t ignore those concerns when they were brought up to him. He came to Tuesday’s mental health panel with a solution.

By July, staff at NCHC hope to have in place three key changes that will help address mental health needs in the jail system:

A full-time forensic mental health therapist on staff to assess inmates and recommend treatment options.
A psychiatrist made available via tele-conferencing who could prescribe medication (which a therapist can’t do).
An assigned social worker for the jail to make sure released inmates have those things Billeb says are necessary: a place to go, food to eat and a support network. The social worker also would help inmates not return to bad influences, namely social circles that contribute to landing them into trouble.

These changes won’t cost the county anything extra, at least not in 2015. The money will come from a fund set aside by NCHC for innovative programs, and the agency believes people already on staff can handle those positions. It’s a matter of re-arranging some responsibilities, Bezucha says.

Might this whole issue be a lack of systemized structure, a matter of two very different agencies getting their wires crossed? Bezucha does say now that the county has given NCHC a clear direction on its handling of mentally ill inmates, he’s working things out.

And there are plenty of details to work out, such as where a full-time forensic therapist would go in the already-crowded jail, but La Du-Ives says she and her staff will do what they need to in order to make it work.

Mental health stigma

John Hartman, a well-known Central Wisconsin photographer and member of National Alliance for Mental Illness Wisconsin, knows the troubles firsthand. One of his relatives suffers from bipolar disorder and substance addiction. Those two conditions have led that person to be in and out of jail several times, Hartman says.

Mental illnesses are different than physical illnesses, Hartman says. If you have a heart attack, you’ll have chest pain. Diabetes can also have symptoms that can send a person to the doctor.

The symptoms of mental illness are erratic behavior, such as fighting or damaging property—behaviors that usually send a person to jail.

Mental illness and substance abuse often go hand in hand, Hartman says, because many of those suffering from the former self-medicate, consciously or not, with alcohol or drugs.

It’s frustrating, because there’s little people like Hartman can do besides watch their loved ones go in and out of jail, he says. Laws passed in the 1960s make it very difficult to institutionalize someone, and no parent can force their adult child to take their medication. Jail often is the only corrective measure, a wake-up call.

“We need to take care of these people better than locking them up like common criminals,” Hartman says. “There’s a lot of stigma around people [with mental illnesses],” Hartman says. “There are some people who want to just push it away, who think you can just snap out of it. It doesn’t work that way.”

Not even for those fully aware of their illness and who want help. Mike Prue, 41, was arrested in April after an issue involving drinking. Prue says he was having an episode related to his bi-polar disorder.

According to Prue, he was taken to NCHC by officers who recognized his mental health condition. After those officers left, staff at the health care center told Prue he could leave; he wouldn’t be helped by their staff, Prue says. It was frustrating not getting any help at a critical time, he says, because he knows his disorder will likely lead him to trouble again.

Kenny Lecher, 44, of Wausau expressed similar sentiments. While Lecher says he had private treatment for a mental health condition, he saw several people during his time in jail who weren’t able to get the treatment they appeared to need. “They’re so backed up, right now they’re not helping anyone,” Lecher says.

The ripple effect

Sheriff Parks’ panel on mental illness and the jail met for the first time publicly last month, and aired their concerns. County board members listened. The issues surrounding mental health and what some are calling a failure on the part of North Central Health Care to help mentally ill inmates in times of crises, are contributing to a distrust of the agency by many on the county board.

Marathon County will pay $7.8 million this year to NCHC for services such as its disability programs, alcohol and drug treatment, the nursing home, crisis program, adult protective services and others.

County leaders decided that the organization needed more oversight, and on Tuesday created a committee to supervise all of the health care center’s operations. Various other committees that oversee parts of NCHC will report to this one over-arching committee.

Marathon County is far from the only county dealing with mental health as it relates to its jail. Leaders in Portage County acknowledge this as an issue they need to address, too.

Portage County Jail Administrator Cory Nelson said at least 75% of the jail population there has a mental health and/or addiction issue—an estimation echoed by the public defenders office in that county.

In Marathon County, that number might be even higher, says La Du-Ives. As many as 65% of inmates have a mental illness, and coupled with alcohol and drug issues, that covers nearly everybody. Both jail administrators agree their facilities aren’t equipped for treatment.

But Portage County is one place Marathon County is looking to as an example, Billeb says. Portage County Jail has a person from their health care center dedicated to doing assessments, making sure inmates get their meds, and identifying services for those inmates who need them.

Their scenario is hardly perfect, Nelson admits. Portage County regularly ships inmates to Waupaca County. But just having a mental health specialist at the jail regularly would be a start, Billeb says about Marathon County.

Green Lake County provides something closer to a model. Its program is serving as a pilot for the Department of Corrections, which could recommend the method to counties statewide.

Green Lake County’s program, called a community therapeutic approach, provides outpatient psychotherapy and AODA counseling, along with an addiction specialist. It includes job training programs and follow ups with inmates once they leave the facility. Group sessions with former inmates help give participants hope of a future, says Philip Robinson, Green Lake County’s Health and Human Services deputy director.

“It’s the inmates taking responsibility for their own recovery,” Robinson says. “It’s a climate of accountability and ownership.”

So far it’s working. Robinson says in the six months since being implemented, only 2% of offenders in the program have reoffended. And that’s not just low-risk offenders. Everyone is eligible. Robinson says about two-thirds of inmates participate.

Billeb and others would like to see something like that in Marathon County. For the time being, any change that slows the jail’s revolving door of mental illnesses is a step in the right direction.

“If there isn’t a component that addresses people before they get to jail, if we wait until our officers are coming into contact with someone who’s causing a scene and arrest them, then it doesn’t do any good,” Billeb says.