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Mental Blocks, Part 1: Needing a Psychiatric Bed, Ending up in Jail
12/23/2013   Reported By: Patty B. Wight

Maine spends more per capita on mental health services than almost every other state. Still, there are big gaps in the system. According to the National Alliance on Mental Illness, only about a third of Maine adults with serious illness are getting the help they need. We'll explore the consequences of those barriers over the next two weeks in a multi-part series, "Mental Blocks." Our first story takes us to the Penobscot County Jail, a common destination for people with persistent and severe mental illness. Patty Wight has more.

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MH - Glenn Ross Penobscot County Sheriff

It's mid-morning on a summer weekday, and Sheriff Glenn Ross (right) has a problem on his hands. A new inmate has just arrived, straight from a local emergency room. She'd been waiting at the hospital for three days for a psychiatric bed to open up. But before she could be appropriately placed, she assaulted hospital staff.

Now, she's facing a felony charge. And, according to the woman's mother, it's not the first time. "All of my daughter's felonies have been in psychiatric hospitals or emergency rooms she was when in acute psychosis, waiting for a psychiatric bed - or in a psychiatric unit," she says. "She's not a criminal. She's acutely ill. She needs treatment."

The mother explains that her daughter has schizoaffective disorder, which means she has symptoms of both schizophrenia and bipolar disorder. She's received treatment on multiple occasions, but after being released, has stopped taking her medication, and spiraled back into into psychosis.

"She's delusional," her mother says. "She thinks people are trying to kill her. She thinks people are trying to poison her. She thinks people are trying to harm her. She is fighting for her life."

Sheriff Glenn Ross assures the inmate's distraught mother that he believes this is a mental health problem, not a criminal one - and that her daughter doesn't belong in jail.

"I will do whatever I can to try to make sure that we get the services that's needed," Ross says, "but I do not see any good solution facing us."

The problem, Ross explains, is that none of the approximately 145 state psychiatric beds are available. The local ER doesn't want to hold the woman, and the jail is ill-equipped to treat her. The work-around, says Sheriff Ross, is to send jail staff to the hospital.

It's an expensive prospect, but the risk of the woman harming herself or someone else in jail is just too great. Plus, Ross says, she has a better chance of getting a psychiatric bed if she's in the ER.

"The voice of the sheriff is a very small voice calling for a bed," Ross says. "The voice of the hospital is a multiplier of that. And so, it's a system that we're in together. It's not a good use of either the jails or the hospitals - we feel badly about that - but I alone can't provide this service."

MH - Penobscot county jailRoss says his title may be "Sheriff," but he often feels like the CEO of the largest mental health facility in Penobscot county. "I'm just dealing with this over and over again," he says. "The system doesn't change, the numbers of mentally ill still appear at our doorstep. It's very disturbing, and it's one that should concern the whole state of Maine."

It may be of concern to state prison officials, but it's no surprise.

"Probably 45 percent of our population is on psychiatric medication, so it tells you the level of mental illness that's in the prison system already," says Dr. Joe Fitzpatrick, associate commissioner for the Maine Department of Corrections.

"That's not a shocking statistic," he says, "because when you look nationally, the level and acuity of mental illness that's in the prison systems and the jail systems, it's like an epidemic."

Mental health advocates say the primary reason for the situation is deinstitutionalization. That was a movement starting in the 1950s that sought to get patients out of psychiatric hospitals, and provide better resources at the community level. Hundreds of patients were released from institutions, but advocates say Maine failed to establish an adequate continuum of community services that address the varied needs of the mentally ill.

Jenna Mehnert, director of the National Alliance on Mental Illness in Maine, says frustrated families of adults with mental illness have turned to the only system they can find - the jails.

"And I've talked to families who have said to me, 'I don't know what else to do - my adult child needs resources. Everybody I talk to says, Well get them arrested, and they'll have to get services,'" Mehnert says, "instead of having other ways in to quality mental health services."

And Penobscot County Sheriff Glenn Ross says with fewer psychiatric beds and not enough community resources, the burden has been handed over to the jail system.

"It's like squeezing a balloon," he says. "When you don't provide it in certain areas, it pops out in other areas, and sometimes in a very expensive and difficult way."

Ross says the jail does what it can to help. He has one social worker, although he says he could really use four or five.

And Ross himself doesn't hesitate to get involved. After a call to the governor's office explaining the situation of the young woman who's in crisis, he transfers her back to the ER, along with two correctional officers. She waits another day there - and finally gets a spot at a psychiatric hospital.

Jail, Ross says, was not the medicine she needed.

Tomorrow, in part two of our series, Mental Blocks, Patty Wight visits an emergency department specially designed to meet the needs of mentally ill patients.

Photos:  Patty  Wight


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