As Alabama cuts mental health care, sheriffs say jails overwhelmed
Limestone County Sheriff Mike Blakely in his office in Athens, Ala. (Bob Gathany/bgathany@AL.com)
By Lee Roop | firstname.lastname@example.org
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on August 08, 2016 at 7:24 AM, updated August 08, 2016 at 2:31 PM
Email the author | Follow on Twitter
on August 08, 2016 at 7:24 AM, updated August 08, 2016 at 2:31 PM
Front Line on Mental Health
By Lee Roop & Challen Stephens
People who set fires in cells. Take their clothes off in lobbies. Walk or run toward deputies carrying guns and knives. Try to break into sheriffs' homes at night.
Alabama sheriffs say they face a growing number of mentally ill residents and a shrinking state mental health system.
"Did I really comprehend the magnitude of it?" asks Sheriff Rick Singleton in Lauderdale County. "Probably not until I actually got into office and started dealing with it."
"The biggest problem is there are no beds, no place to put them when you get an involuntary commitment," Limestone County Sheriff Mike Blakely said. "We've had that at least three times this year."
The state has closed three psychiatric hospitals since 2012 for financial reasons, cutting the number of beds for patients from 740 to 268 -- a drop of 64 percent.
"Currently, those in need of mental health services only have three options we're aware of – inpatient care, outpatient care or care during incarceration," said Chief Deputy Randy Christian in Jefferson County.
Without available beds, sheriffs talk of searching for charges to find a way to house potentially dangerous individuals.
In Alabama, if you (want to) protect someone from themselves, you charge them with harassment and put them in jail.
"We have to charge them with something on so many occasions," Blakely said. "We know we might be working a killing or something else if we don't go ahead and put 'em in jail. So, if we've got a misdemeanor we can charge them with ...."
"In Alabama, if you (want to) protect someone from themselves, you charge them with harassment and put them in jail," agreed Baldwin County Sheriff Huey "Hoss" Mack.
But jails are not hospitals, deputies aren't nurses and this temporary solution often creates new problems for all involved.
Ask any sheriff
In February, Marion County Sheriff Kevin Williams became the latest sheriff to go public with a rant about the lack of mental health care in Alabama.
Williams said his deputies took a man named Jimmy Cooper to a confinement facility in 2015 for being "a danger to himself or others."
That's the legal standard that allows an Alabama probate judge to order someone confined after a hearing, usually sought by relatives. Taking the person into custody is the job of the sheriffs' offices in Alabama's 67 counties.
Seven months after being committed to a mental hospital as a danger to himself or others, Cooper allegedly used a handgun to kill two people in downtown Hamilton. He was back in the community, where there wasn't mental health care for him, the sheriff said, and there were five other people in his jail at the same time that should have been hospitalized.
"Any sheriff in Alabama" could tell similar stories, said Williams during a press conference.
Two thirds lack services
A team of four reporters called every county in Alabama earlier this year to gauge the scope of the problem.
The first question was: "Do you have any inmates in jail right now who need mental health treatment?"
Sheriffs or chief deputies in 40 of 67 counties responded. And 70 percent answered that at that moment they were holding someone in need of mental health services.
"We have a young girl in (jail), who is 17 years old, for trying to burn her house down with her mom and daddy in it," Escambia County Sheriff Grover Smith said. "The county jail is not the best place for her, we'd all agree. We have no other options, and no one is seeing her or counseling her. We have a psychologist who comes in once a month and talks to her. But he's not here for treatment, but for prevention and making sure no one hurts themselves."
The second question was: "Have you had trouble finding services for at least one inmate with mental problems in the last year?"
This time, 65 percent said yes.
The last question was: "Is your department equipped to deal with people in mental health crisis?"
Answers varied, with larger departments more likely to report some training or some access to medical or psychiatric services. Still, more than half of the sheriff's departments said they were not equipped to deal with the with mentally ill individuals, despite the influx in county jails.
In the end, 55 percent said they were not equipped, 32.5 percent were prepared and 12.5 percent said it was a mix, meaning they could handle some situations and not others.
Houston County Sheriff Donald Valenza said his department has a doctor and a medical assistant who can serve the county jail. But he said that's not typical. "I've heard some of the other sheriffs talk about how they really need help."
In the jails
Most shared stories.
"He was mentally ill and he wouldn't comply with anything," Franklin County Sheriff Shannon Oliver said of a recent case. "As the (cell) door came open, he assaulted a corrections officer. He wouldn't eat and wouldn't sleep. He was dealing with some paranoia – a very dangerous person. He had no family in the area. Eventually, he got some help and he's doing somewhat better now. It sticks out to me because his paranoia was just constant."
Franklin County Sheriff Shannon Oliver, left, and Phil Campbell Mayor Jerry Mays days after a tornado hit Hackleburg and Phil Campbell in 2011. (Mike Oliveremail@example.com)
Often the deputies know the person is mentally ill and seek help. The FBI last summer was investigating the case of a man seriously injured by deputies in Madison County jail, a man who was restrained after tearing down the sprinkler system.
"We had an inmate who did over $1,000 to the jail," Sheriff Blake Dorning told the Madison County Commission in October of 2015. "When they tear these sprinkler systems off the jail, it costs us well over $1,000 to repair them. We have to have the sprinklers in the jail to meet fire codes for their safety. When the officers go to remove them, he has defecated in a carton that he was given milk in that morning and he throws it at them – throws it at them, throws it at them."
"The young men and women who work in the Madison County Jail face the most difficult circumstances that our society could only imagine because they don't know the facts of what goes on inside that facility."
Madison County and the man's attorney both agreed that he should be moved to a mental health facility. Attorney Bruce Gardner said his client was schizophrenic. Instead, due to the lack of beds, the county held him in solitary into 2016.
"I recall one individual we saw numerous times," Lee County Sheriff Jay Jones said. "We were doing what we could to help this person, and we did get this person assistance, and he would get back on his meds. But then he would constantly get off his meds and back into trouble. There was nowhere else for this person to go. This individual, for lack of a better place to be, ended up in the jail a lot. He was found deceased out in the county simply because of the lack of resources, because there was nowhere for him to go."
Sheriff Smith in Escambia had this example.
Madison County Sheriff Blake Dorning tells his county commission about the problems mentally ill prisoners are causing in the county jail. (File)
"One lady has been in the jail 25 times and will go into the office and sit down in the lobby and take up residence," he said. "Sometimes she keeps her clothes on, and sometimes she takes them off. She obviously needs inpatient care. There is none available."
But a bed itself is not the solution. Psychiatric hospitals in Alabama once warehoused thousands of patients, until a federal lawsuit forced the state to improve treatment and transition to community-based care.
Hospitals downsized, and then closed. But sheriffs say the promised community-based care is inadequate. And what's more, due to long waiting lists, patients can cycle through treatment facilities quickly.
"A guy came in (and) he had not had his shot in 90 days," recalled Elmore County Sheriff Bill Franklin. "He thinks I'm a dragon sent from Satan himself. He goes to a medical ward in North Alabama. I ask the facility for an alert when he gets out.
"About two months later," Franklin said, "I wake up to somebody trying to tear down my door at 3 a.m. I went in the kitchen and saw him running away across a field. I told my wife, 'I have no doubt who that guy is.' I called the facility. He got out two days (earlier)."
"When he's on his meds," Franklin said in a common comment, "you couldn't tell which one of us was mentally ill."
The only facility in North Alabama has since closed.
Some times, sheriffs say, they use patience.
"About once a month, we have to deal with mental health issues," Marengo County Sheriff Ben Bates said. He tells a story of a mentally ill juvenile who threatened to kill himself.
"We couldn't lock him up. All I could do was take him to the emergency room and then back to jail where I had him lay down on the hallway next to my office. He wasn't charged with anything. More or less, I babysat him all night. The next day, we were able to find a place for him."
But often, sheriffs say, encounters become violent.
Calhoun County Sheriff Larry Amerson's department has "had to use deadly force six times" and "four were severely mentally ill. One tried to set himself on fire, and he ultimately killed his girlfriend and her two small children. We ultimately shot and killed him. He shot one deputy in the leg."
"We've had several encounters where I've had officers shot and where I've had to use deadly force," said Blakely in Limestone County.
Not getting better
Sheriffs are frustrated at jails being used as the imperfect solution to a growing problem.
Calhoun County Sheriff Larry Amerson, shown here making a speech to law enforcement academy graduates, says his department has had to use deadly force four times against mentally ill persons. (File)
"We live in an age where there seems to be an increase of mental illness or better medical technology for diagnosing mental illness," Walker County jail administrator Trent McClusky said. "Yet we receive less funding to treat that which we diagnose. So what's the point of diagnosing what we are not going to treat?"
"You have officers who are outnumbered, and yet they are dealing with every classification, from those who didn't pay fines and fees, to those who have committed horrendous violent crimes, to those who are mentally ill," McCluskey said. "You see the court system having to deal with this and, at the same time, the community is also facing an increase in transitional housing because of the closing of institutions."
He said: "And when you see that more lenient custodial level of living in transitional homes, you're going to see more violations of society's rules that are committed by those who are mentally ill."
"It's not going to get any better," predicted Singleton in Lauderdale County. "The state doesn't have any money. It's not just the mentally ill. Local detention centers are going to be faced with more and more challenges from having people incarcerated in our local jails."
Staff writers Amy Yurkanin, John Sharp and Paul Gattis contributed to this report.