The largest mental-health facilities in the United States are not hospitals -- they are jails: in L.A. County, in Chicago's Cook County, and on New York's Rikers Island. Locally on any given day, the Hennepin County Medical Center Psychiatric Inpatient facility holds fewer mentally ill individuals than we hold in the Hennepin County jail, and quite frankly, many of these folks do not belong in our jail.
Over 35,000 inmates each year are booked into the Hennepin County jail. The Sheriff's Office manages and operates the jail, and is responsible for the safe and secure custody of approximately 750 inmates each day as they await the resolution of their criminal charges by the court. We provide food and required medical care. We securely transport inmates to court appearances and to other facilities as determined by the courts. We estimate that as many as 25 percent to 30 percent of inmates suffer from mental illness.
The jail has medical and nursing staff who regularly check on inmates and provide prescribed medications and mental-health screenings. The Sheriff's Office created a mental-health unit to allow for appropriate identification and placement of inmates with mental illness. Sheriff's Office personnel receive extensive training on custody and safety issues for mentally ill inmates. The program has won a national award for its innovative and humane approach.
Even so, we know that a jail is not the right place to house the mentally ill for extended periods of time. In particular, I am concerned about criminal defendants with persistent and severe mental illness who have been determined by the court to be incompetent to stand trial, and those who have been civilly committed for up to six months at a time (because they are mentally ill and a danger to themselves or others). These inmates have been evaluated by licensed psychologists and have been ordered to the care and custody of the Minnesota State Department of Human Services (DHS). Yet, the Sheriff's Office often is unable to make transfers, because there is a shortage of space at a suitable treatment facility. As a result, many of the mentally ill inmates stay in our jail for weeks and even months awaiting transfer and placement.
As an example, "T," a 28-year-old male, was arrested by Richfield police and charged with felony possession of a firearm; he was booked into the jail in July. He suffers from grossly disturbed behavior and faulty perceptions, and he poses a substantial likelihood of causing physical harm. He was evaluated by a court-appointed forensic psychologist and was determined by the court in mid-August to be incompetent to stand trial. After further evaluation, the criminal charges against T were stayed in late October, and he was committed by order of the court to the custody of the Commissioner of Human Services for inpatient hospitalization for six months.
Sheriff's Office personnel transported him to the jail to await placement in a treatment facility, and contacted DHS over and over again for two weeks before he could be taken to the hospital in St. Peter.
From the early 1900s through the 1960s, we permanently institutionalized the mentally ill. Following national studies like "The Shame of the States," exposing neglect, abuse and mismanagement in mental hospitals across the country, and the advancement of medication and treatment alternatives, states adopted policies to "deinstitutionalize" the mentally ill in favor of community living and progressive treatment.
While the concept of "deinstitutionalization" overall has been an important advancement in providing improved care to the mentally ill, the dramatic reduction in the number of psychiatric beds has had dramatic side effects: increased homelessness, increased numbers of mentally ill in emergency rooms waiting for psychiatric beds, increased demands on sworn officers (who become the frontline mental-health workers), an increase in the number of mentally ill individuals in our jails and prisons, and an increase in acts of violence committed by mentally ill individuals who are not being treated. (The recent mass shootings in Arizona and Colorado, as well as at the Accent Signage Company in Minneapolis, all come to mind.)
The Treatment Advocacy Center and the National Sheriffs Association studied violent-crime statistics and trends, comparing them with the number of psychiatric beds available, and found a correlation: "When individuals with severe mental illness receive appropriate and effective treatment, their risk of committing violent acts is no greater than that of the general population. When they do not receive treatment, multiple studies have found their risk of violent behavior, including homicides, to be significantly elevated."
Ironically, Minnesota is a health care leader across the country, but we have the lowest number of psychiatric beds per capita in the nation: 3.9 per 100,000. (Others range from 4.1 in Arizona to 29.2 in South Dakota and 39 in Mississippi.) The Anoka Metro Regional Treatment Hospital has just 116 beds to serve all of Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, Sherburne and Ramsey counties. When we call to transfer an inmate, we often are told there is no space available.
The jail cannot serve as an adequate substitute for the care and treatment provided in a hospital. The conditions in any jail would have harmful effects on the mentally ill. High-intensity interactions, lack of privacy and noise levels add to the stress and agitation of these folks, and they get worse instead of better: They despair, refuse to come out of cells, refuse medications, exhibit psychotic symptoms, harm themselves and/or violently act out. By virtue of a court's order we know they are a danger to themselves or others, and the risks they pose to themselves, to other inmates and to our staff only compounds with each successive day without proper medical care and treatment.
It is unacceptable that DHS regularly and routinely violates the orders of the Hennepin County District Court. As a nation, we decided long ago, and I agree, that our society shouldn't criminalize mental illness. So why are these mentally ill individuals housed in our jails? It is certainly no more civilized or humane than a hospital. It is long past time that we address the epidemic of untreated mental illness and invest in additional intensive psychiatric beds and community placements to best serve those clearly in need of our help.
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Rich Stanek is the Hennepin County sheriff.