Caring for Virginia's mentally ill inmates: An expensive problem complicated by a bitter partisan debate

Dec. 28--PORTSMOUTH

When U.S. Justice Department officials announced this month that they will investigate the Hampton Roads Regional Jail, they made clear that one focus will be a practice commonly used by many jails around the state: isolating mentally ill inmates in cells by themselves.

It's the culmination of an issue jail officials and advocates have been talking about for years -- that a lack of services for the mentally ill leads to greater numbers winding up in jails not equipped to care for them.

Any steps to address that problem, local jail officials and advocates agree, are likely to be expensive.

So where would the money come from? In the past, that question quickly has led to bitterly partisan debate.

Gov. Terry McAuliffe pushed hard for Virginia to join the list of states that accept Medicaid expansion under the Affordable Care Act. The Democrat, who did not make such a bid this year, argued for years that the commonwealth was leaving billions of dollars on the table by rejecting the federal aid.

Some sheriffs, who oversee Virginia's jails, have said such a windfall could bring in as much as $200 million a year to improve the care and treatment of the mentally ill and those with substance-abuse disorders.

But the Republican leadership in the state's legislature has strongly opposed Medicaid expansion. And the Virginia Sheriff's Association has taken no position on the issue.

Two sources familiar with the matter -- a law enforcement source and a lobbyist -- say the Republican leadership has threatened cuts in funding for jail programs if they come out in support of Medicaid expansion.

"The question was asked, well why don't we do expansion, can't we begin to come together and lobby and request that expansion be done? And the word came back that if sheriffs and the Sheriff's Association were to do that, they would see funding cuts," said the law enforcement source, who asked not to be named for fear of retribution from House Republicans.

Medicaid expansion would help facilities such as the Hampton Roads Regional Jail tremendously, the source said. It would provide money for mental health services in the jails as well as expanded services in communities, which ultimately helps free up bed space in the state's mental hospitals.

Jamycheal Mitchell died in the Hampton Roads Regional Jail in August 2015 after being accused of stealing $5 worth of snacks from a convenience store. He was ordered by a judge to spend time in a state mental hospital, but the paperwork was tucked in a drawer until after his death.

If the system would have provided more services and helped Mitchell more before he was arrested, he may not have gone to jail to begin with, the law enforcement source said. The Medicaid money would have provided those types of services, the source said.

"The expansion would have helped tremendously," the source said. "Look at the Hampton Roads Regional Jail. It could have helped expand access to services and helped to keep him out of there to begin with."

The threats of cuts in funding were attributed by the law enforcement source to Del. Chris Jones, whose district includes parts of Chesapeake and Suffolk and who chairs the appropriations committee, and by the lobbyist source to Del. William Howell, speaker of the House of Delegates.

Jones called the claim ludicrous and said he has worked to bring more services to the mentally ill.

"Anyone that knows me knows I don't operate that way," he said. "The insinuation is offensive to me. That's not the way I operate, that's not the way the Appropriations Committee operates. ... We are looking to do what we can to try and alleviate the burden on jails and try and get treatment to the individuals in need."

John Jones, executive director of the Virginia Sheriff's Association, said no one threatened cuts if the association supported Medicaid expansion.

"As far as a threat, I don't interpret anything like that," he said. "Basically, we had members who supported it and members who didn't. Why weigh in one way or another if we had members on both sides of the issue?"

John Jones, who recalls the conversations on Medicaid as happening about three years ago, said he had to work with both McAuliffe, who backed expansion, and many in the legislature who did not. Sheriffs need the support of both, he said.

"We play the budget game," he said. "No one ever told me our funding would be cut if we supported it."

Christopher West, spokesman for Howell, said no one in leadership ever threatened the Sheriff's Association with funding cuts over Medicaid and that the allegations are a "political football" being tossed around over a dead issue.

"The governor didn't put it in his budget," he said. "There are lots of groups that we are friendly with that have supported Medicaid whose budgets have not been affected."

Expanding Medicaid would ultimately cost the state more money, West said, arguing a position long held by Republicans in the legislature. He said states that have accepted the funding are seeing their budgets expand.

"John Jones is a great friend to us and a very well-respected leader," West said. "I think if they were to adopt a pro-Medicaid expansion piece, we would take that into consideration. But at the end of the day, our message is that we just can't afford it."

To argue that accepting the funding might have led to help for Mitchell is "Monday morning quarterbacking," he said.

"How many instances has something happened and then someone has said, 'I wish we would have done more the first time around.' That's all that is," he said.

The law enforcement source said the association was told that advocating for Medicaid expansion could lead to cuts that would include about $12 million in money needed to support jails.

"At the end of the day, we need to take care of Virginians," the source said. "And to make Virginians suffer because of political expediency makes no sense to me."

It's unclear whether the way the regional jail isolates inmates like Jamycheal Mitchell violates the law. But jail officials and advocates say it's a practice used at jails all over the state.

If the Justice Department finds a problem in the regional jail, it will likely find similar problems in jails throughout the state, said Mira Signer, executive director for the National Alliance on Mental Illness of Virginia.

"We tried to make a case to the Justice Department that they should look not just at Hampton Roads Regional Jail, but at all of the jails because while there are specific incidents and really horrible incidents there, it's not a problem specific to that jail at all," she said.

The Hampton Roads Regional Jail spends more on inmate health care than any other jail in the state, according to figures provided by the State Compensation Board. In 2015, it spent $26.16 per inmate per day on health care -- more than triple the average of the approximately 60 other jails in the state.

The mentally ill often end up in jail over low-level offenses simply because there is no where else for them to go, said Norfolk Sheriff Bob McCabe, who recently stepped down as interim superintendent of the regional jail. And putting them in with the general population can be dangerous for them and other inmates, he said.

"What we do is try to manage it the best way we can," he said. "It's really a challenge every day for jails. You don't want to house people in ... isolation, but when you have someone that's a danger to themselves or others, sometimes you have to put them in a segregated area."

Jails are limited by the space and money they have, McCabe said. Treatment of the mentally ill has evolved over the past 15 years, he said, as more and more mentally ill have been arrested and jailed. Often when they get out, there's no place for them to go and they wind up getting arrested again.

"There's no safety net," McCabe said. "I think most of the sheriffs are aware of it."

McAuliffe announced a budget proposal earlier this month that provides $31.7 million in new funds for mental health and substance abuse services in the state. That does not include Medicaid expansion under Obamacare.

Among the funding is $4.2 million for positions to support mental health screenings and assessment in jails, and an additional $4 million for grants.

West said the Republican House leadership is still examining McAuliffe's proposal.

The Hampton Roads Regional Jail recently received a state grant of nearly $1 million -- more than any other jail in the state -- for a pilot program to provide services to the mentally ill.

Virginia Beach Sheriff Ken Stolle said that very few inmates in his jail are ever in isolation, but that he believes he has more resources than most sheriffs.

"We try to discourage isolation because they don't react very well to it," he said. "If you're not crazy when you went in, you're certainly crazy by the time you left. ... I'm not criticizing anyone for doing that because there are very few options. I think we have more options than most."

Stolle said his jail uses a classification system to determine which inmates can be allowed into the general population and which need some form of isolation or seclusion. Even inmates that must stay in their cells by themselves most of the time can look out and interact with inmates with more freedom, he said.

"There is no funding for the mentally ill, and we are the largest mental health facilities by default," Stolle said. "It's really a shame."

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