County Seeks Options to Help Mentally Ill Inmates

When he first began working in the Harford County, Md., sheriff’s office in 1972, the county’s detention center was a place to hold criminals, said Sheriff L. Jesse Bane.

“Now the detention center is a mental health facility, an addiction treatment center, and a homeless shelter,” Bane, who has been sheriff since 2006, said at a January conference in the northeast Maryland county. “Many should not be in there because we are not large enough and not equipped to manage their needs.”

True, the inmates are all accused of crimes, but had they been in treatment for their mental illness or were not homeless, many would not be in the detention center, he maintained.

The center now logs about 5,000 admissions a year, and that includes repeat offenders, reflecting a 60 percent recidivism rate, said Elizabeth Hendrix, director of the Harford County Department of Community Services. The county is a once-rural, rapidly suburbanizing jurisdiction located along Interstate 95 north of Baltimore.

The January meeting was the first to bring the sheriff’s office and Hendrix’s department together, along with community activists, church groups, and mental health agencies.

Without a robust system to return inmates to the community, the people released from the detention center are likely to slide right back into unemployment, drugs, and crime.

“They go from a crisis situation to a crisis situation,” said Hendrix.

A comprehensive reentry program would help.

“Getting any mental health services cuts the recidivism rate by half,” said keynote speaker Erik Roskes, M.D., an assistant professor of psychiatry and surgery at the University of Maryland School of Medicine and director of forensic services at Springfield Hospital Center in Sykesville, Md.

A study reported in the February Psychiatric Services found, for example, that patients who received outpatient care or case management shortly after release from incarceration were less likely to be jailed again or require emergency services within 90 days.

But connecting released prisoners with follow-up care is often hampered by several systems problems, Roskes noted. It might take a month to get an appointment with a mental health clinician, thus allowing time for backsliding. If jails set up appointments before prisoners left those facilities and gave them a 30-day supply of medication, some of those problems might be overcome.

“But often we don’t know when a prisoner will be released,” he said, because that depends on court rulings about bail or other legal issues.

Roskes suggested several approaches that might keep prisoners from returning to jail: peer support, faith-based services, trauma-informed care, job training, drop-in centers, education, and better access to general medical care.

Coordinating those services is complex and may involve more than the released inmates alone.

For instance, nationally, half of all prisoners are parents, so the effects of incarceration are felt by their children too, said Roskes. Perhaps 10 million American children today have had a parent in jail or prison.

Thus, when prisoners return home and are trying to keep up with treatment, find a job, and stay off drugs, children may be a “competing need,” and many prisoners may require comprehensive services and supports addressing both their needs and those of their families.

Mental health services at the Harford County Detention Center are managed by Conmed Healthcare Management Inc., of Hanover, Md. The center provides a full-time Ph.D.-level counselor and other professionals who run substance-abuse and mood-disorder groups. A psychiatrist serves the center one day a week and is on call around the clock for emergencies.

Some volunteer nonprofit groups now go into the jail to counsel inmates, said Kevin Bianca, a correctional officer who was recently appointed community services coordinator for the county. His job is to forge links between service providers in the county and inmates on the verge of release.

Bianca would like to see that kind of reentry process better organized to cover more inmates and stabilize their transition into the community.

“We want to offer our local service providers greater access to our jail population so that they can get the services they need,” said Bane.

The January meeting was a step in that direction, bringing together public and private entities from around the county. The organizers scheduled follow-up work-group meetings in the subsequent months.