The Largest Psych Hospital in America, Psst. It’s A Jail…

A couple of years ago I wrote a post in another blog about the incongruity that the Harris Co. Jail in Houston TX was the country’s largest inpatient public psychiatric hospital in disguise. This week an article in the local Houston press reminded me of Houston’s Harris Co. Jail ‘claim to fame:’Houston’s biggest jail wants to shed its reputation as a mental health treatment center
Ever the trickster brother even in my elder years, at that time, I actually brought this to the attention of my non-mental-health-issues-aware sister who lives there. I would tease her and ask her to arrange a tour for me there when I had an upcoming visit. I laid the teasing on thick, adding a hint, dear to her heart, that I might consider moving there since Harris County Jail was advertising for psychiatrists to work there, and a large number, FIFTEEN back then.

 

Everyone seems to have heard about Rikers Island prison in New York City and its horrors, overcrowding, deaths etc. I suppose it does not help Rikers’ public image much since it has been mentioned in every episode of Law and Order for over 20 years on television. And I further suppose Harris County Jail has been happy to fly well under Rikers’ blip on the national consciousness radar.

Another acquaintance of mine in the Houston who is in government tells me the officials in the area governments are very sensitive to stories like this about their county jail and do not want it lumped together with other infamous jails such as Cook County (Chicago), Los Angeles, Phoenix, etc. And who can blame them? A quote from the article brought to me by my trusty Google Search New Bots hinted at this sensitivity: ” The Harris County sheriff’s office doesn’t want its jail to be the largest mental health facility in Texas anymore.”I must preface my coming complimentary remarks about Texas’ efforts in the state’s jail systems by stating that in my estimation, Texas is one of the several states in the country that is making huge and creditworthy reform efforts on many fronts in their entire state’s mental health care delivery system.  The legislature formed a task force on mental health in 2014-5, and it actually DID something. It issued a very comprehensive report in a year’s time. It is a piece of landmark analysis and goals. And, to top it off, the state legislature in Texas started drafting and passing concrete reform legislation. They started talking about spending up to $500M initially in a few years to get the massive, multifaceted statewide effort underway. It was all the more amazing since the Texas state legislature was the same body that had a number of its legislators hide in motels across state lines in another state to avoid a politically contentious vote several years ago. It was the laughing stock of the country for a week or so as all kinds of media and Internet games and memes started about where the missing lawmakers were. Pseudo rewards were offered. Petitions were started by wags and satirists to rename the missing officials “Waldo.” Kinky Friedman the inimitable  Texas satirist and sometime candidate for the Governorship had a field day. Molly Ivins, the late great political satirist of Texas, was said to have been sighted in the Legislature and her newspaper’s offices. It was great theater.

The Harris Co. Jail has a triaging setup that is situated RIGHT AT the front intake booking desk. A trained officer with a communicating wireless tablet can consult with a nearby consulting psychiatrist to start the referral process form evaluation and treatment within the jail complex. Harris Co. Jail has decided that it will not pursue a mental health “diversion” program like many other judicial systems have started. In point of fact, Texas has started dozens of pilot diversion programs in counties elsewhere in the state. This model is felt to fit better in smaller counties with much smaller local jail populations.

So rather than having the ‘diversion-referral process start in the courtroom, this process is situated at the receiving desk of the jail. The model is structured so that the staff, from the trained deputies to the consulting mental health providers (from counselors to psychiatric social workers and psychologists to the close-by psychiatrist) on down, have a more vertically integrated and functional system that makes sense. It can be activated for any arriving inmate right at the first contact within the jail. It is certainly a novel approach and should be studied and likely tried elsewhere.

The jail has its own inpatient unit, the Harris County Psychiatric Center, which has nearly 300 beds. This is filled all the time and has a waiting list from the rest of the jail’s population. The jail as a whole, has long known that 1 in 4 or its total population have mental illness and need medication based psychiatric treatment and management. Nationally, over 400,00 inmates have psychiatric illnesses needing ongoing treatment, a staggering number.

Texas’s and Harris County’s efforts are to be applauded, followed closely and studied. Hopefully, it is a sign of things to come.

 

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Colorado To Cease Using Jails for Mental Health ‘Holds’

Colorado has had the practice of holding patients needing psychiatric evaluation in jail for many years. There are a number of states who utilize the local, county or municipal jails for such purposes around the country. Some observers of the long term history mental health services’ delivery, have chalked up this practice to the lack of hospitals and therefore emergency rooms, in large areas of states that have no psychiatric services. This practice has largely been dropped by most states. It seems to persist especially in western states where communities are far from such facilities and have to rely on the local jails to ‘hold’ prospective mental health patients who need emergency evaluations and there are no suitable mental health resources available locally.

The term mental health ‘hold’ is essentially another term for an “involuntary civil detention” of a person who has not committed a crime but is a danger to themselves or others. Usually, these kinds of orders in Colorado and other states such as Kansas, to permit holding persons against their will for up to 72 hours. Kansas, for the curious reader, is struggling at present with the issue of how to structure their involuntary holding process altogether.

Colorado now is moving legislatively to force the abandonment of this practice for once and all. In an article entitled, “Colorado would outlaw using jails for mental health holds, increase services under $9,5 million proposal,” written by reporter Jennifer Brown and published in the newspaper, the Denver Post yesterday, this attempt at modernizing and providing mental health intervention and referral services before persons in need have to parked in jails is detailed.

The main thrust and corrective action of this bill would be to establish “two-person teams” that would perform evaluations locally and refer persons felt to be having more mental health problems than legal ones, on to suitable treatment resources before they would be placed in a local jail. This bill would ban the use of jails as holding areas for such persons based on an initial judgment of their being a danger to themselves or others, such as persons who made suicidal threats and about whom an emergency phone call has been issued by families or spouses to the first responders who usually are the police.

The bill would further increase the availability of the on call assessment teams, increase local crisis response centers and transportation from rural areas to treatment centers. A “behavior health specialist” would work directly with police on such emergent service requests and in effect intervene to deflect the crisis-bound person in need to treatment rather than to a local jail.

Interestingly enough, the funding for this expansion of statewide largely rural emergency mental health services is envisioned to be funded by monies from the medical marijuana retail industry now legal and growing in Colorado.

Presently, Colorado law permits holding such a person deemed in mental health crisis in jails for up to 24 hours and then mandating disposition such as transportation to a distant behavioral health services center, such as a clinic or a large urban hospital ER, or the state hospital many miles away also. In practice, it appears that such persons in crisis were held for longer than the prescribed 24 hours and that counties found the volume of such patients to be higher than they were equipped to deal with. The article notes one example county had over one hundred persons in its jails in little over a year’s period of time. The article makes mention of the issues seen all over the country, that law enforcement agencies face day in, day out, namely the lack of resources to provide transportation for patients. It notes that counties would face the issue of removing a law enforcement officer from patrol service to the county when a patient would be driven to a far distant mental health service center. The article notes that this is a much bigger problem in the wide open spaces, sparsely populated of Colorado’s western counties. I lived in western Colorado for a few years as a young child in mountainous mining towns and my trips back later in life showed things and population densities had not changed. So I read the dilemmas that the agencies providing mental health or first responder services in the vast reaches of a western state and immediately sensed why.

The article notes that Colorado has the sixth highest suicide rate in the USA, yet is in the bottom half of the states in this country as far as providing adequate mental health/substance abuse services.

Observers of the mental health reform scene in this country may watch Colorado’s admirable restructuring of mental health service delivery efforts through the vehicle of this commendable legislation.