Sunday, August 22, 2004

Jail guards against suicide

Network monitors inmates' mental health

By Jim Hannah
Enquirer staff writer

Eleven days ago police locked up a suicidal man in the Grant County jail. He had tried to kill himself before and been hospitalized for a mental illness within the last 60 days.

Yet local mental health hospitals refused to accept him for treatment because he was charged with a felony - even though all he did was refuse to pay back child support.

That's when jail deputies looked to a new program that assesses a prisoner's mental health and then seeks to get treatment.

The 300-bed Grant County jail, about 40 miles south of Cincinnati, was one of five jails across Kentucky that began testing the program last year. The test was so successful it was one of the few new programs funded by the Kentucky General Assembly in the last session. Now, Kenton County's jail has become one of the first two jails in the state to sign onto the newly funded initiative.

The one-of-a-kind program, called the Kentucky Jail Mental Health Crisis Network, is being closely monitored by at least five mental health advocacy groups or jail associations that think it could be adopted nationally.

"We are all for it," said Harry Mills, Kentucky executive director of the National Alliance of the Mentally Ill. "It provides a way for people to be assessed real quickly instead of having them sit and wait for who knows how long. This will provide for better care and treatment for people with mental illnesses."

Grant County Jailer Steve Kellam said his jail signed up for the pilot program after he saw an increase in the number of prisoners who need mental health treatment.

The program uses a standard set of questions to screen people for suicidal tendencies while booking them, said Connie Milligan, regional director of intake and emergency services for the Lexington-based Bluegrass Regional Mental Health-Mental Retardation Board.

Jail officials question the prisoner and arresting officer. If answers indicate a problem, jail employees can call a 24-hour crisis line run by the Bluegrass mental health board.

The hotline workers categorize the prisoner's risk category from low to critical, and the psychologist or social worker arranges for follow-up care. The jail follows protocols developed by retired Lexington jailer Ray Sabbatine.

Since implementing the program 11/2 years ago, there has not been a suicide attempt at the Grant County jail. Kellam said the jail averaged one attempt every three months before the program. There hasn't been a suicide at the jail since Kellam took over in August 2001.

Those results helped jailers get the legislature to approve the plan for statewide expansion. An additional $5 fee tacked onto court costs is paying for it, and the fees are expected to provide $2.7 million each year.

Sabbatine said lawmakers responded after at least 17 inmates in Kentucky's county jails killed themselves in a 30-month period. He said other than personnel issues, mental illness and suicide are the most pressing problems in jails nationwide.

There are 200,000 to 300,000 prisoners with mental illness in U.S. prisons, three times as many as in mental health hospitals, according to a report published in October 2003 by Human Rights Watch. The rate of mental illness in the prison population is three times higher than in the general population.

"What the jail needs is a helping hand at 2 a.m. when you have a guard, often making not much more than minimum wage, who is making a decision that can result in life or death for the inmate," said Sabbatine.

He said the idea behind the program is to give Kentucky's rural jails, such as Grant County, access to the same master-level clinicians the big-city jails have.

"We will never say it will totally prevent suicides, but it gives jails a reasonable level of care to prevent negative outcomes," Sabbatine said. "The county jail will be defensible when faced with a liability claim after a suicide."

Kellam said sometimes the mentally ill end up in the Grant County jail after being arrested while driving home to Northern Kentucky after being discharged from Central State psychiatric hospital in Lexington.

Kenton County Jailer Terry Carl said the mentally ill often get arrested because they draw attention to themselves by behaving in socially unacceptable ways and not because they have committed a serious or violent crime.

Many of these mentally ill people "act out" because the medication is so expensive they don't take it, Carl said. They then end up back in jail where county taxpayers foot the bill for their medication. But once released, the former inmate quits taking his medication and the situation repeats itself.

"I just run a revolving door here," Carl said.



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