'The biggest mental health facility in the state is the county jail'
This 10-part series, a collaborative effort of the newspapers of Rust Publishing, NWIA, examines the myriad issues surrounding the mental health care crisis in Iowa. Reporters and editors from the Spencer Daily Reporter, Storm Lake Pilot-Tribune and Dickinson County News have contributed to the report.
Many times, when persons dealing with mental health diagnosis commit crimes, and they don't meet criteria for emergency evaluation by the nature of their behavior, the individual finds themselves transported to the county jail where charges are filed.
"The state of Iowa has closed all the facilities where they had trained mental health nurses, doctors and staff ... the places where these people were able to go," Dickinson County Sheriff Greg Baloun said. "If you talk to any sheriff in the state, the biggest mental health facility in the state is the county jail."
Baloun estimated at most times 75% of people in the jails probably have some kind of mental health issue. When substance abuse is added, there is a dual diagnosis, and jail staff are being forced to deal with the situation.
Clay County Attorney Kristi Busse said almost everything which comes to her office is connected to mental health and many of those cases also involve drug use which she said often links back to mental health needs not being properly treated.
"I think a lot of people will say they use drugs because it helps them cope," she explained. "It helps them operate on a daily basis where, if they were getting prescribed medication that they could take regularly, it would probably help with some of that."
Spencer Police Chief Mark Warburton said he has seen cases where people have been taken to jail with a mental illness who have committed crimes but donít necessarily meet the threshold for an emergency evaluation.
Kim Wilson, CEO of Northwest Iowa Care Connections Mental Health & Disability Services and Clay County services director, said 72 adult individuals accessed mental health services from NWIACC region's contract with the Clay County Jail from July 1, 2018, to April 30. Thirty-nine individuals in Dickinson County Jail received similar care provided through Hope Haven during the same time period.
Nicole Huckfelt, who has been a correction officer in Clay County for the past 10 years, currently serves as the jail administrator.
"If they have mental problems, they canít be out in the streets, but the jail is not the place for them either," Huckfelt said.
Recently the jail has housed individuals dealing with hallucinations and those coping with autism. She said when inmates can't function in a cell block with other inmates, the jail staff has to find a safe secure environment for them during incarceration. Sometimes it requires them to be placed by themselves until proper medical care can be received. It can be a challenge to isolate a prisoner when the jail begins nearing capacity.
"We're not psychologists or mental health professionals, weíre just trying to keep them safe," Huckfelt said. "You have to have some patience and be on your toes at all times. They can be unpredictable."
Buena Vista County Attorney Paul Allen echoed Huckfelt, noting despite the training they receive, correctional officers are not psychologists.
"Theyíre trained to make sure people stay safe inside and outside," he said. "That's what their job is. They get training about how to handle it, but they get trained to handle it from the perspective of a jailer. They have a purpose to serve and it's not providing mental health services."
There have been cases, according to Huckfelt, when the jail staff has had to seek medical committals through the court for an inmate they feel is a risk to themselves or others.
"I know our jail staff does a tremendous job trying to identify those people and get them to professionals, but that takes time," Warburton said. "They may be in jail a day or two before that happens."
Huckfelt said services for inmates needing care while serving a sentence had been provided through Compass Pointe and Hope Haven. With Compass Pointe's recent closure, and Hope Haven's announcement it will discontinue mental health services at the end of June, the Clay County jail administrator said going forward inmates will be working with Season's Center on a limited basis, but will rely on Sioux City-based Jackson Recovery heavily. She's not exactly sure how that model is going to look, but said the process for the transition is in motion.
"It's almost tragic," Busse said. "We have such a lack of resources here anyway and to have two main components of that shut down. ... It's just tragic we can't as a state figure out how to provide these services to people who so desperately need them."
A secondary challenge for the jail is medicating the clients while they are being incarcerated. The jail pays the pharmacy bill for its occupants while they are being housed in Clay County. When an inmate is released, it is up to them to repay the pharmaceutical costs which, depending on the medication necessary can be exorbitant. If the money is not repaid, the jail absorbs the expense.
"It's difficult for our jails to incarcerate someone, keep them in if they have a mental heath problem," Allen said. "Medicine for things like schizophrenia are ungodly costly."
A great deal of the recidivism in the county jails can also be tied to the lack of services available for people struggling with mental health challenges and substance abuse.
"I can safely say with a majority of our long-term inmates and recidivism Ö mental health is a problem," Buena Vista County Sheriff Kory Elston said. "We work very well with our mental health region, Rolling Hills, to provide them the choice of getting mental health help. But it's voluntary, the inmate has to want it. If they say, 'no,' we can't force them unless we get a court order."
The Buena Vista County sheriff noted even if they receive help while they are incarcerated, once they are released and return home to their friends and the environment they originally came from, they may not follow through.
Warburton said even people who want to comply with court ordered care or treatment programs are finding it harder to do, especially in cases when they can't travel because of a revoked license or other mobility matters. The services or care they are ordered to obtain is often not locally available. When they fail to meet their guidelines for release, they are found in contempt, arrested and placed back into custody. Warburton called it a "perpetual loop."
"If someone has been previously committed and are not following through with their recommendations, they can have a warrant put out for them," Busse said.
"It makes absolutely no sense," Baloun said. "That's how the jails got to be such a holding facility for this problem."
An area of particular concern to Storm Lake Police Chief and Public Safety Director Mark Prosser, through his dealings with school systems and education professionals, is increasing numbers of children, juveniles and adolescents being medicated for behavioral issues. The police chief said he has been involved in several meetings with school professionals who all raised their hands when asked how many have students medicated for behavior-related issues. The hands rise again when he asks if they have students they would consider critical in terms of mental health care needs. He doesnít see the unfunded Child Mental Health Care plan handed down from the state as a viable solution.
"We have the adult issue and we have the rising mental health issue of adolescents and children," Prosser said. "That's even more scary. There's not enough money being pumped in there. These are young people who are going to carry that illness for the rest of their adult life if not properly treated."
Looking forward, Baloun said his office now contracts with Sanford Behavioral Health in Sioux Falls for beds, but all of the agencies agreed, Iowa needs to step up to the plate to address the mental health crisis in the Hawkeye State. It starts with funding for beds and care professionals.
Allen said ideally he likes the regional care center approach, meaning one as close as a neighboring county, which would offer service providers as well as in-patient programs. He noted they should be corrections-based to house those who could be "violent or potentially explosive." Allen stressed the regional approach would allow the cost to be shared throughout the area. It would also afford those receiving care the opportunity to be closer to home and access to family.
Others proposed simply reopening facilities which had previously been closed.
Warburton feels in Clay County strides are being made with Wilson working to coordinate local teams to help address immediate needs for people in times of mental crisis. By engaging the collective services and getting the different entities involved, including law enforcement, medical professionals, care facilities, crisis management personnel and community to all work together, the Spencer police chief thinks they are improving things in the short-term.
"I think we're on the right track by bringing partners together and having meetings to try and streamline," Warburton said. "I think streamlining is one of the best things we can do."
The long-term solution is going to involve investment on everyone's part according to the administrators, starting with state financial support for facilities and beds to meet the needs of the state's under-served mental health population.
Prosser said, "If services are not replaced by something, understanding a lot of these folks donít have the ability to pay ... and if they can't find access to mental health care in existing entities that are up and running, it will translate to a more crowded emergency room, more people committing crimes because of mental health issues as opposed to criminal intent, and the potential for more people harming themselves or others."
- Responding to the mental health crisis in NW Iowa: Beating the stigma (05/29/19)
- At the forefront of mental health (06/04/19)
- New programs, static funding strain Iowa's mental health system (06/04/19)
- The people who care (06/04/19)
- Mental health caseload takes a toll on hospital ERs (06/11/19)
- MHI Cherokee: a portal between the past and future of mental health care (06/11/19)
- Law enforcement challenged with limited resources (06/18/19)
- The two Jeffs -- Part I: Criminal cases reveal hidden hurt (06/25/19)
- The two Jeffs -- Part II: Guilty plea leads to tragic end (06/25/19)