Experts: Money alone can’t solve mental health access issues in rural jails
Seven years after voters approved a greater investment in mental health and substance abuse services for Oklahoma counties, the money finally is on the way.
But advocates for criminal justice reform warn that wide swaths of the state are at a disadvantage, unable to provide proper mental health and substance abuse treatment.
For instance, jail officials in Woods County, Custer County, and Noble County said they have no partnerships with nonprofit organizations and do not provide any formal mental health treatments.
“You have a problem that is systematic, and that’s kind of decades in the making,” said Damion Shade, a public policy analyst and executive director of Oklahomans for Criminal Justice Reform. “Your access to justice shouldn’t depend on what ZIP code you live in.”
In May, the state Legislature approved the transfer of $12.7 million into the County Community Investment Fund, set up by the passage of State Question 781 to help cover the costs of treatment in all 77 counties.
Even with the additional money, jails are ill-equipped to provide treatment, said Judge Ken Stoner, who presides over Oklahoma County drug court cases.
Tulsa County Sheriff Vic Regalado recently ended his jail’s agreement with the state health department to provide treatment for those in custody with severe mental illness, insisting they belong in a hospital.
Such cases typically are treated at the state’s 216-bed Oklahoma Forensic Center in Vinita, which has been burdened for years by a waiting list. And a dozen rural hospitals, including their psychological treatment services, have closed since 2007, according to state data.
Nearly 70% of female offenders and 48% of male offenders in Oklahoma jails were diagnosed with a mental illness, according to 2015 state report. To help resolve the issue, voters approved State Question 781 to increase mental health and drug addiction treatments in jails in 2016. The law requires savings from State Question 780, which reduced the number of people in jails by lowering certain drug and property crimes to misdemeanors, to go into a mental health fund available to every county.
Local justice systems can use the money to add staff or provide employment training and assistance. They can bolster existing mental health and addiction diversion programs, such as Smart on Crime.
“We know that when we invest in mental health or substance use or job training, that it decreases crime,” said David Gateley, a criminal justice analyst at Oklahoma Policy Institute.
Felony filings decreased by 30% the first year after State Question 780 took effect, according to an Oklahoma Policy Institute analysis of court records. Gateley pointed to estimates provided by a group that includes the state’s Legislative Office for Fiscal Transparency, which show savings could reach $20 million by next year.
Although rural counties will find ways to use the extra money, they may never be able to catch up to urban areas, which have better proximity to nonprofits, Gateley said.
Large jails and prisons can rely on outside organizations such as Diversion Hub and The Education and Employment Ministry to provide treatment and transportation services to incarcerated individuals, but many of those nonprofits only operate in the metro area.
In Cleveland County, commissioners increased the jail’s budget this year to pay for a licensed counselor to work at the detention center five days per week.
But in many cases, the only mental health resource for rural jails is through a partnership with Oklahoma City-based Red Rock Behavioral Health Services, which has 13 state offices. Yet, limited staff and beds can present barriers to access. Ariel Joseph, a spokesperson at Red Rock Behavioral Health Services, said the providers find ways to cater to rural areas and limit their barriers, such as meeting virtually with clients.
But nonprofits can go the extra mile by developing individualized health and career plans for their metro-area clients, Joseph said.
Michigan’s modelThe same year Oklahoma voters approved State Question 781, Michigan funded pilot programs in eight counties aimed at applying psychotherapy, and expanded to 10 counties in 2017.
Analysts at the Center for Behavioral Health and Justice at the Wayne State University School of Social Work then compared the treatment-based pilot programs to traditional jails. The center documented how alternative services, such as treating detainees with therapy and medication, affected individual outcomes, said Lynn Sutfin, a Michigan Department of Health and Human Services spokesperson.
People who received those jail-based diversion services were 64% more likely to engage in treatment after release compared to those who did not receive jail-based diversion services.
“The consensus is the more you can connect people to community services, even while they’re incarcerated, the more likely they are to follow up,” Sutfin said.
After five years of data-collecting and research, the center determined the best practices for counties, which included expanding services for police training and substance abuse treatments.
Rahni Cason, jail diversion manager at the Center for Behavioral Health and Justice, said the biggest obstacle is establishing uniformity in Michigan’s justice system. Similar to Oklahoma, rural counties do not always have access to medication or other resources.
Cason said the organization partners rural counties with high-performing counties and provides extra funding when available to reduce the disparities. The center and council garner funds from the state and other third-party organizations.
Cason and Sutfin said statewide efforts are underway, and said the extensive research has aided their progress. For states considering jail diversion approaches, Sutfins recommended identifying the problems first.
“I would do a landscape analysis of what’s going on in the state and not dive in with solutions before you understand what is actually already happening,” Sutfins said.
Once the money is transferred to the fund, counties will have to request funding through the Department of Corrections, similar to a grant system. However, counties have a maximum amount they can request based on population (see table).
In Logan County, where they will receive approximately $161,491 for mental health and substance abuse initiatives, Sheriff Damon Devereaux said he would like to partner with the county’s healthcare provider, Turn Key Health Clinic, and invest in a mental health module. The program would either provide more mental health providers to jails or set up more beds for outpatient care.
Either way, Logan County inmates need a consistent mental health regimen, Devereaux said.
Devereaux said the county already spends about $250,000 on rehabilitation services, and the mental health module costs about $1,500 per month for four more hours of care a week.
Devereaux said he was excited about the passage of State Question 781 but remains uncertain about its effect because of the seven-year delay.
“We now need to hold our legislators accountable for what people voted for, and put the money where the mouth is,” Devereaux said.
Kay Thompson, chief of communications at the Oklahoma Department of Correction, said the department has not discussed plans or recommendations for spending 781 money, but said there is a need for more staff.
Policy analyst Shade said all the programs can be built.
“There’s a hopeful story here that I hope remains at the center of this,” Shade said. “It’s going to be a transformative, transformational change for Oklahoma.”