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.

Nuitari (Grand Master Editor) December 24, 2012 at 02:58 PM
Try privatizing the jails then we can see some reform.
Lyle Ruble December 24, 2012 at 03:25 PM
@Nuitari....Privatization is not going to solve the problem, in fact it will only make the problem worse. This is clearly a case of too few dollars chasing too great a need. Not only are healthcare services, especially mental health, lacking in the jail and prison systems, but also in general. Milwaukee County doesn't even have a accredited mental health center and is so short of qualified staff, creating a serious threat to those who are in need of services but the general public as well. The problem with privatization is that even more control is given up and less oversight is the result. Where current services like this are privatized, what you get is less effective services at the same or greater costs. The other problem is there isn't enough trained mental health professionals from either the private or public sector.
FreeThought Troy December 24, 2012 at 04:07 PM
http://truth-out.org/article/item/76:troops-or-private-contractors-who-does-better-in-supplying-our-troops-during-war Privatizing is not the magic bullet we all think it is. There are occasions it costs tax payers more. Also, ask our Gov. Walker how much it saved Milwaukee Countty when he privatized security. It actually cost Milwaukee County more more less benefit.
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vocal local 1 January 11, 2013 at 12:00 PM
"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." 6% number is in error. Even if you clicked on the link provided the authors use the lower number which is wrong. Real number of general population diagnosed as mental health is one in five which per my math is 20% of our population is dx mental health on medications and does not include persons no longer being seen on meds or diagnosed. The numbers are way too high to be naturally occurring/accurate. My belief and I can prove it, is the mental health drugs used on children are the causative factor making children mentally ill adults per the chemical effect on sensitive brain tissue and fluid by increasing the acidity making CNS, CSF caustic. Christie in NY wants to increase access to mental health drugs. He wants to create more mental health victims is my best answer.
Lyle Ruble January 11, 2013 at 01:18 PM
@vocal local 1....And, childhood immunizations causes increases in Autism? Your claims are just a mythological as the claims of the cause of Autism. Your misguided misinformation is not only wrong, but dangerous. There is a big difference between true mental illness (6%) and people who are in need of mood enhancers for treatment of mild depression or mild anxiety. It sounds as if you have personal experience with something that may have gone awry, but your experience is limited to you and you alone.
Nuitari (Grand Master Editor) January 11, 2013 at 01:59 PM
Remember, Lyle is a doctor with much research in this matter. I agree in general that the whole scare of immunizations doing harm is BS.
vocal local 1 January 11, 2013 at 02:33 PM
No, I do not think Autism is caused by immunizations, I do not think it is genetic but to get a research grant in the US of A you better be able to link your proposal to genetics or your not getting funded. Govt. Research funding a causative factor of our lag behind other nations in advancement in medicine. I'll take you out where the buses don't run on my suspicion on cause of Autism: Epidurals. I suspect the Epidural interferes with contraction force on the over riding cranium by increasing time of contraction and relaxation. NO RESEARCH to back up theory. Note incidence of Autism rising proportionally to use of Epidurals. Remember all the CP babies? Naturally healthy babies in gestation who at birth were horribly damaged. Lyle, could you please expand on your claim that there is a big difference between your coin of "true mental illness" and people in need of mood enhancers, I'm assuming your including benzodiazapines, mild anxiety (SAD) and depression. I remind of the debilitating pattern of mental health. In short, those you desire to exclude do not get better, do they? I am, not misguided, and/or misinformed. It is you and people who have been taught to think like you that are truly responsible for our crisis situation in mental health. YOU need to research the effects of the drugs you desire to administer. In my studied opinion shared by many in the mental health arena pharmaceutical drugs are the major contributing factor to our rising mental health crisis.
Lyle Ruble January 11, 2013 at 03:25 PM
@vocal local 1....Let's assume for a moment that what you are claiming, is in fact, the case. What do you propose as an alternative?
vocal local 1 January 11, 2013 at 09:57 PM
I’d immediately ban all mental health medication use on children that do not evidence organic brain damage. This could be problematic as some have been on the drugs so long that there is irreversible brain damage but at least we’d save some and future generations from a life of drug dependency and abnormal behaviors. I’d ban non-psychiatric doctors from prescribing mental health drugs and I'd control psychiatrist from over prescribing by mandating team approval.. I’d mandate individuals experiencing mental health issues and families work with teams of mental health professionals in environments the individual functions in not just sterile self report clinical office visits. I fully agree mental health drugs are at times when individuals are manic necessary but only in a clinical setting. Compulsory educational attendance based on age should be abolished.We need attendance and placement based on developmental age and achievement. You ask hard questions as there are so many variables, so many collateral problems such as parenting, insurance, social attitudes and the role and power the educational system which has been legally mandated to provide costly, non academic services. I steadfastly maintain our mental health crisis is magnified by drugs, the power of pharmaceutical company lobby, health care professionals drive to make money, and the unquestioning compliance of workers within the mental health arena based on what they were taught as correct in college.
ns January 12, 2013 at 08:53 AM
Systematic activities to prevent or cure health problems and promote good health in humans are undertaken by health care providers. Applications with regard to animal health are covered by the veterinary sciences. Thanks. http://www.weightlosspunch.com/garcinia-cambogia-extract-dr-oz-calls-weight-loss-holy-grail/
vocal local 1 January 13, 2013 at 10:31 AM
ns, I'm not so sure you've got it right. Health Care Providers work for health care networks. They follow the networks SOAPS which are designed to make money for the network. The health care professional/doctor that makes money ordering tests that yield profits is categorized as the Good and Honored regardless of the condition of the patient. Your vet actually in most cases has greater automony and decision making powers in diagnostic care, treating disease and curing health problems is my take.
Lyle Ruble January 13, 2013 at 02:44 PM
@vocal local 1....One of the problems that is reoccurring, is that mental health has always taken a back seat to other medicine. The foundation of mental health has always been steeped in abstraction and a lack of effective tools. If you look at the investment made in health research, research in mental health is only a small fraction of the total. Third party payment has always been restricted to only a fraction of that made to other treatment therapy, resulting in limiting options to effective treatment of chronic mental health conditions. The philosophy of the medical model supports chemotherapy for most conditions, such as in the case of a bacterial disease and treatment with antibiotics. Since there isn't any chemotherapy in mental health that treats the cause of the malady or dysfunction, medicine has taken the position of controlling the symptoms through the use of psychoactive drugs. I'm not sure that this nation would ever fully support a change in the mental health model that would allow full research into causality and effective therapies other than chemotherapy. The other issue is more political and philosophical than medical; there is a belief system that mental health is closely tied to moral will. In many ways, mental health and mental illness is not much more advanced beyond the belief in people suffering from demonic possession. People refuse to fully support that mental illness is actually disease but only a moral failing.
Lyle Ruble January 13, 2013 at 03:15 PM
@vocal local 1....Earlier in the discussion, I quoted 6% as a figure of those suffering from serious mental dysfunction and base this on probable organistic causality. These conditions usually require heavy lifetime chemotherapy to return the patient to some form of functionality by controlling the expression of the dysfunction. However, less serious dysfunction can and is usually responsive to different forms of intervention, including psychotherapies. We are faced with a conflict between nature verses nurture. Research is now focused on nature; thus the search for genetic causes. This is cyclical and we can only hope that the research will pay off.
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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