Ignored and Underfunded, Mental Health Care Thin at County Jails

Key GOP lawmaker wants to look into issues in county correctional system.

For more than a decade, Milwaukee County’s jail system has been under the scrutiny of a court-appointed medical monitor for its failure to provide adequate health care, including for inmates with mental illness.

In August, the monitor found mental health care in Milwaukee County’s two jails was still in shambles. Among the problems: Vacancies in top medical positions left jailers to make medical decisions, such as when an inmate should be removed from suicide watch. A man who had threatened to kill himself stopped eating and drinking for four days and was never taken to a hospital. He died in his cell.

Mental health advocates and correctional officials agree that Wisconsin’s 72 county-run jails are strapped for resources and not prepared to deal with the large numbers of inmates with mental illness they house. The state Department of Corrections (DOC) is charged with oversight of jails, but the agency’s inspectors are not physicians and, the agency said, not responsible for assessing the quality of health care.

The DOC inspection checklist includes whether the facilities keep adequate records, have the correct staff and keep medications secure. In Milwaukee County, for example, the two jails’ most recent DOC inspections last December give no hint of the problems identified by Dr. Ronald Shansky, the court-appointed physician.

Again and again, inspector Gregory Bucholtz marked an X for “meets approval” for each health-care standard, concluding that at Milwaukee County Correctional Facility-South, “Health care services at the facility continue to be good … Mental health services also remain good.”

Shansky’s take, in an inspection days before that DOC visit, was radically different. He found systemic problems in several areas, including record keeping, delayed access to medical services and medications, and “severely mentally ill patients being inappropriately placed in disciplinary cells.”

Just five counties’ jails — Waukesha, Washington, Walworth, Fond du Lac and Dane — are accredited by the National Commission on Correctional Health Care, which uses health-care professionals to assess the quality of care at facilities.

More information needed

Rep. Garey Bies, R-Sister Bay, who chairs the Assembly Committee on Criminal Justice and Corrections, said he plans to ask the DOC to present information to his committee on how well jails are caring for their inmates.

As a former chief deputy sheriff, Bies used to oversee the Door County Jail. He said he is particularly interested in ensuring inmates are screened for mental health problems, which he said is crucial to providing proper care, helping them transition back into the community and avoiding crises that could arise while they’re incarcerated.

“Do that (screening) up front, and it really cuts down on issues in the long run,” Bies said.

In a 2009 DOC survey, less than half of the county jails that responded had a registered nurse or mental health professional doing the initial health screening of inmates; correctional officers did it in most jails.

The DOC makes preannounced inspections of county jails annually, and investigates after suicides and other incidents.

“We mitigate risk by providing technical assistance and training, based on best correctional practice,” said Kristi Dietz, director of the DOC’s Office of Detention Facilities. The agency provides verbal or written feedback after inspections, but it doesn’t punish jails with sanctions.

Lawsuits are frequently cited as an incentive for jails to improve.

But “you can’t count on lawsuits to expose these types of problems,” according to Larry Dupuis, legal director of the American Civil Liberties Union of Wisconsin, which sued Milwaukee County over its lack of jail health care services.

Ron Honberg, policy and legal director for the nonprofit National Alliance on Mental Illness (NAMI), said county jails nationwide have a “long, long way to go” in providing adequate mental health care.

Honberg ticked off the problems: “Lack of oversight, lack of treatment resources, lack of expertise, lack of qualified staff, overcrowded conditions.”

More need, less attention

Dietz said communities are falling short at helping people with mental illnesses, “and as a result the jails and prisons, unfortunately, have been taking on more and more of that population.”

A national study estimated the one in three female inmates and nearly one in six males suffers from mental illness — far higher than the general population estimate of 6 percent. Even after a substantial drop from 1990 to 2010, the national jail suicide rate is still three times greater than in the general population.

Jail officials and advocates statewide have been seeing more inmates with mental illness in recent years, although no specific estimates are available.

The problems in jails are often overshadowed by those in prisons. But mental health needs may actually be greater at these facilities, where inmates face uncertain fates, more stress and fewer services.

And jails aren’t only for short-term detention — some inmates end up spending years there if they have consecutive sentences or their trials are delayed. Walworth County Jail Superintendent Howard Sawyers said his county almost always has inmates who have passed the one-year mark, some staying two or three years.

Since 2003, 52 Wisconsin county jail inmates have taken their own lives. According to a Wisconsin Center for Investigative Journalism calculation, Wisconsin’s jail suicide rate in recent years was 40 per 100,000 inmates, slightly higher than the 2007 national rate of 36.

According to Dean Meyer, executive director of the Badger State Sheriff’s Association, state-run prisons are “much better equipped” to provide health care.

“A prison has their own dentist, their own doctors and their own nurses. And for the majority of county jails, they contract that service out, and the providers only come when needed,” Meyer said.

Lawmakers may examine jails

Jails are required by a state law dating back to 1987 to provide the DOC with annual reports on mental health care services. Since 1989, the law has required the DOC to summarize and relay those findings to the Legislature. But the DOC acknowledges it has not been regularly asking jails for the reports, and has not prepared summaries for the Legislature, the Center found.

It’s been five years since the Baraboo News Republic newspaper pointed out that the reports weren’t being done. In 2007, DOC officials said they would address the shortcoming. This month, Dietz said her office “is going to take another look at that statute.”

Bies and a fellow lawmaker, Sen. Kathleen Vinehout, D-Alma, said they are concerned about mental health care in jails, but lack the information to tackle the issue.

Vinehout, a member of the Senate Committee on Education and Corrections, said she couldn’t get information she wanted from the DOC about the types of inmates and the care they need. She believes the agency should strengthen its oversight of local jails to help inmates — and the general public.

“We want to be able to understand what’s happening and do what we can to lower the cost and make Wisconsin a safer place,” Vinehout said.

This project was produced in collaboration with the Investigative Journalism Education Consortium, ijec.org. The nonprofit Wisconsin Center for Investigative Journalism (www.WisconsinWatch.org) also collaborates with Wisconsin Public Radio, Wisconsin Public Television, other news media and the University of Wisconsin-Madison School of Journalism and Mass Communication.

All works created, published, posted or disseminated by the Center do not necessarily reflect the views or opinions of UW-Madison or any of its affiliates.

vocal local 1 January 13, 2013 at 06:16 PM
Yes Lyle, I fully agree with you and I add “control of symptoms through the use of psychoactive drugs that hasten mentation by their very chemical action. We spend lots of money on collateral effects of mental health. Unfortunately, the pharmaceutical companies spend more to push unsafe products strictly for profit. My hopes are persons in the medical field, persons on the street, parents will rise up and pressure their elect to ban the psycho drugs thereby not allowing the brains of their loved ones destroyed forever. Jack moral failing up a notch to the persons prescribing and administrating the meds, government elect that take drug company political funds and were surely a national moral failure. That would include you. You still have not dug out your chemistry books and looked at the caustic chemical action of popular prescribed drugs on sensitive brain tissue. When we burn out chemical receptor sites will they rejuvenate upon cessation of the meds by the individual often taken under force be it physical or court ordered. How many parents are not listening to their children when they say the meds cause pain in their tummies, takes away their appetites, makes them unable to sleep or puts them in a daze. I am a behaviorist. I firmly believe behaviors, the good the bad and the ugly are learned. We are a nation that practices despotism not equality and opportunity. If we don’t demand corrective action we become the problem.
Lyle Ruble January 13, 2013 at 07:25 PM
@vocal local 1....I don't share your reliance on behaviorism. I find human behavior to be much more complicated and I firmly believe that we are born with propensities that can be either manifested or not manifested by experience or other environmental variables. In my own practice I found that sometimes behavioral therapies worked and sometimes not. My approach was eclectic and I used a combination of therapeutic interventions including chemo, behavioral and psychotherapy.
vocal local 1 January 14, 2013 at 01:50 PM
Did you ever statistically compare those of your patients in which psycho therapy without meds worked against psycho therapy with psycho drugs and the timeline of each therapeutic intervention? How do you factually account for the disproportionate rising numbers of mental health in developed nations with health care delivery systems and drug treatment -v- the lower numbers of mentally ill in undeveloped nations with poor mental health delivery without the use of pharmaceuticals? (I will not accept: lack of identification per lack of health care delivery professionals) Per emergence of the bell curve, isn’t it truth that the majority of man born in either society is only capable of training and acquisition of general knowledge principles with lower numbers of persons we call gifted and compromised on either end? The problem here in the good ole US of A is we unfairly promote opportunity of practice of skills of the average man per our proclamation of equality which skews practice, discovery, and advancement as the masses though trainable are not competent to participate/practice? To date we cannot predict who when and where superior thinking individuals will be born. Two genius can produce a low level intelligence individual. In contrast two mentally challenged can produce genius. Cont. below
vocal local 1 January 14, 2013 at 01:52 PM
Cont. This failure to predict protects the masses to a degree. It does not protect their children that are often dx by our public educational system and mental health “experts” as handicapped. They can’t sit still, they don’t appear to be able to focus, their minds and bodies wonder so we drug them into group compliance and destroy their potential for greatness and advancement of our society as a whole. No Lyle, careful examination of numbers and intervention will force one to address and correct the institutionalized trained concepts of thought and practice. THINK OUT OF THE BOX OF COMMONLY ACCEPTED IDEOLOGY try not to defend, try to examine the truths I try to get you to recognize and address not defend. What is the conclusion of the “experts” when they debate the same issue we are discussing? Don’t those debates conclude: cost prohibition of therapy –v- less expensive behavioral control by drugs regardless of the effects on ones individual physiology and the collateral effects on the society?
gg March 07, 2013 at 03:32 PM
People in Wisconsin, DO NOT understand mental-illness! This is "physical". There are meds to correct this. No need to put these poor people in JAIL! This is despicable to say the LEAST, evil and DUMB. Try telling this to the crackpot DAs that put these people in there. SHAME on them. Get educated, you are not paid to punish them, HELLOOOOO.


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