Two weeks ago the Pima County jail received word that all the mental health beds in Tucson were full. If someone had a mental illness crisis over the weekend, and law enforcement was called as it often is, chances were the person would end up not in a hospital but in jail.
"We expected a busy weekend," said Corrections Capt. Greg Gearhart. And they got it. "We're the largest mental health unit in Southern Arizona. We don't turn anyone away."
This scenario - where jail is the default mental illness care provider, even temporarily - speaks to the need for mental health services in our community. Between 40 and 50 percent of all jail inmates have some form of mental illness, he said, and between 6 and 15 percent of those have been diagnosed as having "serious mental illness." This level of illness includes, generally speaking, bipolar disorder, schizophrenia and major depression - severe, persistent conditions that, if untreated, can significantly impair the ability to function.
People coming into the Pima County jail are seen by an EMT and then by others. At each stage the person is supposed to be asked about his mental health situation, and anyone who shows or reports symptoms of mental illness is flagged to be evaluated.
The jail runs two locked areas for people showing signs of mental illness. The acute unit has 44 beds, and is divided into a block of cells for men and a block for women. When there's an overflow and male inmates are housed on the women's side, portable visual screens are set up.
The cells are spartan and their front walls are clear, so the occupants can be observed at all times. The people in the acute unit are usually in the midst of a mental illness crisis and are kept separate until, if possible, they are stabilized.
Once stabilized, some inmates will move to the chronic unit; others remain in the acute cells. The chronic unit has room for 70 people in 35 rooms, but Corrections Lt. John C. Meister said they avoid bunking inmates together because some people can't be with other specific inmates, or don't get along with anyone, period. This balancing act affects when and for how long the inmates in this area are out of their cells within the locked unit, he said.
This isn't cheap. The jail spends $62,000 a month on psychotropic drugs, Gearhart said. The acute unit is staffed by eight people in three shifts over 24 hours, and the chronic unit has five people. Elsewhere in the jail, the unit ratio is three officers over 24 hours, he said.
Gearhart and Meister said jail personnel work closely with mental health service providers, like the Community Partnership of Southern Arizona, which is the umbrella organization for mental health in Pima County. The two share data twice a day, so CPSA can tell agencies if any of their clients are at the jail, and likewise alert the jail that a specific person needs particular medication.
The situation has deteriorated for people who aren't poor enough to qualify for Arizona's Medicaid system, the Arizona Health Care Cost Containment System, or AHCCCS. As of July the state stopped paying for this group to have case managers, so they're on their own if they don't have family or friends to look out for them. By the time someone reaches jail, family relationships are frequently strained, Gearhart said, and the person is alone. Without proper follow-up and supervision, it all happens again.
Figuring out what bad behavior is prompted by mental illness, and what bad behavior is simple criminality by someone who has a mental illness is a constant balancing game, Gearhart and Meister said. But there are people in jail who, "but for their mental illness, they wouldn't have gotten in trouble," Gearhart said. These people are arrested on minor offenses, such as urinating in public or being disruptive. They come into the jail, get back on their meds, get stabilized and then, depending on why they were arrested in the first place, released with court dates set.
But if the support systems aren't in place, or if they're not adequate, as so often happens, the cycle repeats. And repeats.
Pima County has an interwoven system of mental health care that, if you are poor enough, offers a good array of services. Using those services can be another thing, but at least the infrastructure is in place. For people who aren't on AHCCCS, the situation is more dire - and many are finding themselves in the cycle of getting inadequate care, being unsupervised until an emergency happens and then ending up in a hospital or jail.
These issues are complex and interwoven. Over the coming months the Star will continue to examine facets of the system and how we, as a community, deal with mental illness - while searching for ways to do it better.
Arizona Daily Star
Join the discussion
The free and public forum, "A Delicate Balance: Creating a better, post-Jan. 8 system to protect the public and help the seriously mentally ill," will be held April 27 at Centennial Hall on the University of Arizona campus. The Star is partnering with the Schorr Family Award organization on the event in the shared belief that mental illness is a paramount issue in our community. Go to www.cpsa-rbha.org/ and click on the "Schorr Award" link for more information.