Prisons see more inmates requiring mental health care

LAWRENCEVILLE - A few years ago Carol Cousins was living in a nightmare of her mind's own creation - one in which a CIA agent was stalking her.

The 35-year-old, who now resides in Duluth, had spiraled into a world of paranoid delusions and anxiety. Diagnosed with bipolar disorder and depression, Cousins believed a male CIA agent had released poisonous gas inside her South Carolina home and was trying to communicate with her through songs on the radio.

She drove to Washington, D.C., in 2003, seeking help from the FBI, but wound up being arrested several times by local police. The first arrest occurred because a couple thought Cousins was following their vehicle on the highway. It turned out to be a misunderstanding.

Cousins mistakenly thought she was following a different couple who had helped her earlier that day. However, when Cousins told police about her CIA agent delusions, they detained her for two days in jail before a judge ordered them to free her.

Two weeks later, Cousins was pulled over again by police for driving the wrong way on a street she was unfamiliar with. A check of her driver's license revealed her father had reported her missing and flagged her as a mentally ill person. She was arrested and held until her father could pick her up.

Cousins now leads a stable life because of medication and treatment. She even runs a support group in Lawrenceville for bipolar disorder and has a master's degree in psychology.

Research shows that, like Cousins, about 80 percent of people suffering from mental illness can be successfully treated and function normally in society. But finding the right medication or therapy is often a long, tortuous journey for them and their loved ones.

Antipsychotic and antidepressant drugs often make people feel bad, so they quit taking them. Or prescription drugs may be too expensive or unavailable, causing a large number of mentally ill people to self-medicate with alcohol and illegal narcotics. Often it takes years for someone to admit they need long-term medical intervention to stabilize their emotional and mental state.

But Cousins was actually one of the lucky ones - a person with mental illness who has learned to cope and stay out of prison.

Many other people with mental illness become locked in a never-ending cycle of incarceration, national statistics show. The prison system in the United States has taken the place of government-funded asylums ever since the deinstitutionalization movement of the 1960s, according to the nonprofit Treatment Advocacy Center.

Prisons providing

mental health care

In 1965, Congress ceased funding state psychiatric hospitals through Medicaid. Federal officials intended to implement a system of community mental health centers to replace the state psychiatric hospital systems. However, as a result of that decision, most patients were discharged onto the streets. Hundreds of thousands of patients became homeless with no access to medication or treatment and were incarcerated.

In the past four decades, America has lost effectively 93 percent of its state psychiatric hospital beds, resulting in increased rates of homelessness, incarceration, suicide, victimization and violence, according to the Treatment Advocacy Center. The largest mental health facility in the country is now the Los Angeles County jail.

"There is no system for people in crisis, so police are the ones that end up responding to these people," said Ron Honberg, legal director for the National Alliance on Mental Illness (NAMI). "Most of these people are not doing anything terrible, maybe something unusual or unlawful, but often not violent. We basically stand around and let people reach the point where they are engaging in criminal behavior before we do anything."

The federal Bureau of Justice Statistics estimates there are 283,800 mentally ill offenders in jails and prisons in the United States. An additional 547,800 are on probation. About 16 percent of those in state and local jails are mentally ill.

Georgia prisons are on par with national statistics. Roughly 7,700 of 46,600 state inmates were receiving mental health services in June 2006, or about 16 percent, according to an independent audit of the Georgia Department of Corrections. The budget for the Georgia prison system's mental health care in 2005 was more than $29 million.

Caring for just one mentally ill state inmate costs a whopping $4,025 per year.

Alarmingly, while the number of inmates being treated for mental illness has increased 73.4 percent between 1999 and 2006, the number of psychiatry hours decreased by 31.8 percent and psychology hours decreased by 24.6 percent, according to the independent audit. Picking up the slack are full-time counselors, whose staffing levels increased by 43.2 percent.

The independent auditor for the Georgia Department of Corrections, Jeffrey Metzner, said in his findings the increase in counselor positions was "encouraging," but said the majority were unlicensed counselors. This increase in unlicensed counselors and decrease in psychologists and psychiatrists was causing "a significant supervision problem," Metzner said.

The public information office of the Georgia Department of Corrections initially granted a request by the Gwinnett Daily Post to tour facilities for the mentally ill at Phillips State Prison in Buford. However, several days before the tour was to take place, it was canceled without explanation.

Yolanda Thompson, spokeswoman for the Georgia Department of Corrections, said other unnamed officials had reviewed the request and would not be able to schedule a tour "at this time." She declined to reschedule the tour.

Dr. Dana Tatum supervises the mental health care for 268 chronically mentally ill inmates in the Gwinnett County Detention Center. About 200 of them are on antidepressant or antipsychotic medication. He said when the Georgia Mental Health Institute on Briarcliff Road in Atlanta closed in the late 1990s, the jail's population of inmates with mental illness increased dramatically.

"The schizophrenic and chronically ill mental population just exploded and we found ourselves being the hospital," Tatum said.

That prompted jail officials to open "H Pod" at the Gwinnett jail in 1998, a housing unit specifically designed for patients suffering from severe mental illness. As of Monday, there were 29 inmates in H Pod. The detention center employs six full-time counselors and one part-time counselor. Last month alone, those counselors had more than 1,650 patient contacts, Tatum said.

"We are not a treatment facility, yet if you have a mentally ill spouse or loved one, this a good place to be," Tatum said. "We have individual counseling, emergent care, psychiatry on call 24/7 and group therapy. We are taking care of these people because it's the right thing to do and also because we are the hospital now."

Changing directions

Government officials and mental health advocates seem to agree that more nonviolent inmates from jails and prisons should be diverted into treatment programs.

Advocates for the mentally ill said government should fund mental health care in jails, but more money needs to be provided for outpatient treatment, job placement, housing assistance and access to medication. An up-front investment to help people with mental illness function in society would prevent taxpayers from the shouldering the end costs of


"NAMI believes the majority of people with mental illness, if they receive appropriate services, can live in the community," Honberg said.

A statewide effort is under way to teach police officers how to recognize symptoms of mental illness and de-escalate crisis situations. Since the first Crisis Intervention Training program was taught in December 2004, 75 law enforcement agencies across the state have participated, including Lawrenceville Police, Gwinnett County Police and the Gwinnett County Sheriff's Department.

Crisis Intervention Training brings together police, mental health providers and consumers to determine what alternatives to incarceration are available in the community. The program was funded by a $450,000 grant from the Georgia Department of Human Resources.

Janet Oliva of the Georgia Bureau of Investigation helped get the curriculum off the ground. Oliva said the state's goal is to train 20 percent of each law enforcement agency by 2007.

Officers receive 30 hours of classroom instruction on mental health topics and 10 hours of crisis de-escalation skills.

"We don't want the officer to get hurt, or the consumer or any bystander or family member," Oliva said. "This helps weed out persons that don't need to be in jail. Also it's a huge liability decrease, because if you respond safely and effectively to a crisis, no one gets hurt unnecessarily."

Mental health advocates strongly advocate CIT.

"Since police are the ones getting there first, we feel very strongly that they need to be properly trained to know how to respond to people in a way that calms the person down and de-escalates the crisis," Honberg said.

Lawrenceville Police Capt. Greg Vaughn said he has tried the tactics taught in CIT several times and found them effective.

"I believe in it," Vaughn said. "We're not asking officers to drop their guard. But when you've got a mental person in a crisis, sometimes you have to listen to them, try to convince them that you want to help them and not arrest them."

Another state-funded program working to rescue people suffering from mental illness from the cycle of imprisonment is called Transitional Aftercare for Probationers and Parolees (TAP).

The program's focus is to have a case manager begin assisting mentally ill and mentally retarded inmates prior to being released on probation with resources they need to reintegrate into society, said Bill Kissell, director of the office of quality and evaluation for the mental health division of Georgia Department of Human Resources.

A case manager meets with prison mental health staff to determine the needs of the inmate prior to their discharge from prison. The case manager helps the inmate find a residential program if they haven't already found somewhere to live, and assists with vocational planning or employment placement.

Courts take initiative

Another option to divert nonviolent offenders with mental illness out of jail is mental health court. Much like the drug and DUI courts already operating in Gwinnett County, a mental health court involves closer monitoring and intensive treatment for offenders instead of jail time.

Hall County Superior Court has operated a mental health court, called Health, Empowerment, Linkage and Possibilities (HELP), for the past two years with some success. There have been 32 participants, and only four were terminated from the program for failing to comply with


An independent evaluation of the Hall County mental health court by Georgia State University published in June 2006 found clients in the program had greater psychological and emotional stability. However, more resources were needed for residential placement, job opportunities and staffing of case managers, the evaluation stated.

"We wanted to develop a program we could grow from," Kissell said. "We think there are some serious successes with HELP."

The Hall County program was funded through fiscal year 2006 by the Governor's Criminal Justice Coordinating Council, but because of federal cuts, the funds may no longer be available. The court is seeking alternate funding through state grants to continue its operation, said HELP case manager Melin Foscue.