Mental health adds burden at state jails

Jan. 15--Malcolm Lynn Andrews had mental health issues even before he arrived at the Caldwell County Jail.

He spent several months at Broughton Hospital, a state-run mental hospital in Morganton, after exchanging gunfire with Caldwell County deputies in a standoff at his uncle's house in Globe in May 2015. His uncle, James B. Andrews, said at the time that Andrew hadn't taken medication he needs and became increasingly agitated.

"Next thing I know, he went plumb wild," Andrews said.

Treatment at Broughton stabilized him, but Malcolm Andrews' time back in the Caldwell jail illustrates the more severe end of the issues jail staff have to deal with, said Capt. Mark Shook, detention division supervisor for the Caldwell County Sheriff's Office. When inmates are booked into the jail, they must fill out a form that asks, among other things, whether they have a mental disorder.

"One-hundred twenty-three out of 154 answered that they have either some kind of mental disorder or something like that on their intake form," Shook said in December. "We've got some folks in here that are truly mentally ill, and commit simple crimes, and don't know what they're doing. ... There's a definite need for mental health reform in this state."

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JAILS

In Andrews' case, he arrived at the jail late last summer with prescription medication and his behavor under control. But after arriving at the jail he stopped taking some of his medications again, and his behavior changed, Shook said. Unlike employees at mental hospitals and Central Prison, county jail staff cannot force inmates to take prescribed medication.

By early December, Andrews' behavior was beginning to deteriorate, and staff familiar with Andrews were becoming concerned.

"At that time he was standing in front of his mirror just kind of rambling incoherently ...," Shook said. "When officers would stop, check on him, ... they could see him becoming more aggressive."

At that time Andrews was transferred to Central Prison in Raleigh, which has a psychiatric ward and a 24-hour medical staff, court documents show.

Shook said that for the eight guards typically on duty at the jail, dealing with a constant stream of mental health care problems can be taxing.

"It'll burn you out quick. It makes for a long day when you have someone just constantly screaming or banging the doors," he said. "You try to talk with them to get them calmed down, and then they won't. Some are very out of control, yelling, screaming, beating on the walls. Just being in that environment for 12 hours, sometimes it gets a little wearing on your nerves."

With inmates who have severe mental health care problems, jail staff "have to be more on guard. They have to expect, really, for someone like that to become violent any minute. Some of these folks, you can talk with them, and they're fine, and then the next thing you know, they're at your throat. You've just gotta be on your toes. You can't be complacent."

When guards encounter inmates who are increasingly disruptive, they will at first try to verbally de-escalate the situation. If that tactic is ineffective and an inmate is becoming physically violent, guards can put them in a "restraint chair," Shook said.

"You strap their arms down. You strap their legs down. You pull one strap across their chest to keep them seated. Basically, it's just, they have to sit still," he said. "Someone as large as some of these guys are, we have to use several staff members if we have to put them in a restraint chair. It might take three or four officers to get them in the chair. That takes some time."

If the inmate continues to behave in an aggressive and disruptive way, guards can ask a magistrate for an involuntary commitment order, which sends the inmate to a mental health facility. If an inmate is displaying extremely erratic behavior, staff can, as in Andrews' case, ask a judge to approve an order to transfer that person to Broughton Hospital, Central Regional Hospital in Butner, or Central Prison.

Typically, if guards are exhausted by an inmate, they communicate with Shook and change rotations to spend time in a different part of the jail. While new staff members have expressed surprise at the challenges of the job, Shook does not believe employee retention rates have been affected, and while guards take regular vacations, they do not ask for extra time off.

"They know it's a part of the job and they know that they have to expect it. Some people can do it, some people just can't. We rotate responsibilities throughout the day to keep them from being with them constantly," he said.

When inmates arrive at the jail, they fill out an intake questionnaire that is intended to help identify people with mental illnesses. The questions can get specific, such as "Do you currently believe that someone can control your mind by putting thoughts into your head or taking thoughts of of your head?" It also asks more general questions, such as, "Have you ever been in a hospital for emotional or mental health problems?" and "Are you currently taking medication prescribed for you by a physician for any emotional or mental health problems?" The questionaire is intended to encompass substance abuse, which is considered a mental illness, Shook said.

When an inmate begins to exhibit abnormal behavior, guards initiate special watches and take steps to connect that patient to care.

The jail has a contract with Dr. Deron Coy, a Raleigh-based psychiatrist who owns Correctional Behavioral Health, an organization that provides mental health services to inmates in small and medium sized jails, including in Caldwell County.

Correctional Behavioral Health connects inmates to care via video calls, providing initial mental health assessments as well as follow-up appointments to determine what kind of treatment is needed.

Coy said the number of people with mental illness who wind up behind bars may be particularly high because after the mental health care system was privatized in the early 2000s, meaning mental health services became funded by private entities, the state closed Dorothea Dix Hospital, a mental hospital in Raleigh, and many people who might have at one time filled beds there ended up filling beds in jails and prisons across the state, Coy said.

"Right now in North Carolina, we have less than 10 psychiatric beds per 100,000 people. At a minimum we need 50, and we used to have close to 100 25 years ago, before the mental health care system was privatized," he said.

He said that being away from family, friends, and their support system is particularly challenging for inmates who have a mental illness.

Coy believes that a possible solution would lie in widespread changes to the mental health care system in North Carolina, particularly the need for more mental hospitals, which would reduce the number of people in jails who need treatment.

Shook agreed: "That's one thing that the state really needs to look at is getting these beds back."

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