Rural Jails Struggle to Cope with Rise in Mentally Troubled Inmates

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Individuals with mental health and behavioral issues are a rising population in rural jails. Photo by Chloe Cap for Mental Health Awareness Week., via Flickr

When someone is booked into Polk County jail in rural Wisconsin, the first step is a screening process to determine the individual’s medical and mental health care needs. The information from that screen is reviewed by the jail nurse and jail sergeant, who determine if the jail nurse needs to follow up.

Once in the general jail population, the inmate can submit a nurse call slip for non-emergency mental health concerns, and the nurse or jail staff member will follow up as needed. An urgent mental health need is handled through a request by call slip to a nurse or staff on regular rounds.

Many big-city jails, which are now the main source of medical help and counseling for the mentally ill, have used similar strategies to deal with a growing roster of inmates who need special medical help.  But the approach has now spread to smaller rural jails in states like Wisconsin.

“Our jail staff is excellent in recognizing symptoms of mental health and of untreated mental health issues, notifying me, and addressing those issues,” said Donna Johnson, the Polk County public health nurse, who has worked in the county jail for 20 years.

Rural jails often bear the brunt of what has become a growing national problem. A 2016 survey of 230 jail staff members across 39 states found that 96 percent reported having inmates with serious mental illnesses during the previous year.

Three-quarters of the jails reported seeing more or far more seriously mentally ill inmates compared to five to 10 years ago.

More than 80 percent of people incarcerated in the Polk County Jail have mental health needs, according to Johnson.

“For the people we’re seeing with serious and pervasive mental health issues in the jail setting, methamphetamine (addiction) is by far the greatest issue that we’re dealing with,” she said.

According to the federal Substance Abuse and Mental Health Services Administration (SAMHSA),  the toxic effects of substances can mimic mental illness in ways that can be difficult to distinguish from mental illnesses.

Substance-induced mental health disorders involve psychiatric symptoms that are caused by using a substance. People can also have co-occurring mental disorders, where they have a mental illness and a substance use disorder.


The 160-bed Polk County Jail in rural Wisconsin has seen a rise in inmates suffering from mental health and substance abuse issues. Photo courtesy Leader-Register.

Rob Drew, captain of the Polk County Jail, estimates that around 70 percent of the county jail’s inmate population would benefit from some type of mental health care, be it from a counseling session or meeting with a psychologist.

“We have a fairly low number of people that rise to the level of being suicidal, but the number of people that could benefit from general mental health services is very high,” said Drew, who oversees the county’s 160-bed jail.

Drew said it is difficult to calculate the specific amount of people in jail with mental health needs due to the variation in inmate mental health needs, which aren’t tracked with jail records.

Polk County’s Johnson says that the mental health of those in the county jail has always been a concern, but it has dramatically changed over the years.

“It used to be a rare occasion when we had someone who displayed [suicidal tendencies] … (and was in need of) psychiatric services,” said Johnson.  “Now it is really the norm,”

Looking back to the first methamphetamine epidemic that occurred about 20 years ago, Johnson says that they had people in the jail displaying acutely psychotic behavior where they experienced both auditory and visual hallucinations.

“We see that on a chronic basis now,” said Johnson, who believes the mental health issues the county is experiencing right now are largely due to methamphetamine and alcohol use.

“Alcohol remains our Number One issue,” said Johnson. “It (alcohol) doesn’t get as much attention because it’s legal.”

The American Psychiatric Association reports that chronic heavy methamphetamine use can cause temporary paranoid delusional states that may last for weeks, months and even years. Symptoms can also include dementia, psychotic episodes, and evidence of “bipolar” disorder.

Heavy long-term alcohol use can cause brain damage that causes symptoms of dementia that are not entirely reversible even with sobriety.

However, most substance-induced symptoms begin to improve within hours or days after substance use has stopped.

In 2017 the Leader-Register reported that Polk County leads the state of Wisconsin in per capita criminal prosecutions of methamphetamine. That year there were 184 individuals arrested for methamphetamine alone with 393 drug charges against them.

The Polk County behavioral health unit pychiatrist, Dr. James Rugowski, visits the jail once a month for about five hours to handle medication assessment, management and to assess individuals’ mental health needs.

Crisis workers connect incarcerated individuals with behavioral health services before they are released from jail, so there is a continuation of care. Before their release individuals who are identified in need get help processing their (medical assistance) BadgerCare application from a county health department staff member.

“When they walk out of the jail doors, they can have their BadgerCare application already processed so they have insurance to cover their mental health services, medications and medical needs,” said Johnson.

Stark and Johnson also provide suicide and mental health training to jail staff.

“From administration all the way down to the line staff, we all strongly believe that it’s equally as important to care for [inmates’] mental health as it is to care for their physical health,” said Johnson.

The county offers a crisis call line through Northwest Connections, a third-party organization contracted by the county’s mental health unit to handle the county’s crisis call work. This allows the county 24/7, 365-day coverage for crisis calls and is used in the jail.

“The officer can bring the inmate to the phone and give the call taker a synopsis of what’s going on and the inmate will speak to the crisis call person and they determine the appropriate care for them,” said Drew.

Challenges they still face include serving non-county residents, and a lack of resources for proactive care and the continuation of care outside of jail.

“I do think we are doing a really good job of managing what we have with the resources that we have available,” said Drew.

“More resources would be nice, but you can only play with the cards you’re dealt.”

Johnson has found connecting individuals from outside of Polk County to services once they leave jail a challenge, because not all counties have the same services or resources.

“I can’t always have an appointment scheduled for them when they walk out the door, whereas I can if they are a Polk County resident,” she said.

Barriers for individuals continuing their mental health care outside of jail include finding housing and transportation to appointments. Those that are enrolled in BadgerCare can access the state’s nonemergency medical transportation services.

However, in Johnson’s experience, that extra step of organizing transportation can become a barrier for some people.

Polk County has one transitional housing facility for those returning to society after incarceration called the Serenity Home, but its future at its current location, in the old county jail, is uncertain.

“It has been a godsend to have them where they are, but unfortunately the county board opted not to renew their lease when it is up,” said Johnson.

The Serenity Home, operated by the Salvation Army, is located across the street from the Polk County Jail and neighbors the county’s behavioral health unit.

Looking to the future, Johnson and Drew are hopeful about the potential to better serve individuals incarcerated in the county jail who have mental health needs.

Recently, the county’s community services unit proposed two positions to expand behavioral health services. The positions are an additional half-time jail nurse, specializing in mental health services, and a full-time nurse practitioner for the behavioral health unit.

Drew supports both positions.

“If that comes to fruition, which I am hoping it does, I think it will be a really good model for other counties to provide more preventative care,” said Drew.

Danielle Danford, a staff writer for the Leader-Register, is a 2018 John Jay Rural Justice Reporting Fellow. This is a condensed and slightly edited version of a story written as part of her Fellowship project. The full story is available here.

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