Official: Fewer Mental Health Beds Affects Mentally Ill

By Cynthia T. Pegram, The News & Advance, Lynchburg, Va.

Jan. 7–The reduction in the number of state mental health beds has led to jails being used as “de facto psychiatric hospitals,” says the state’s director of forensic operations for the Department of Mental Health, Mental Retardation and Substance Abuse Services.

Virginia has seen the reduction of about 500 mental health beds over the past 10 to 15 years, said Jim Morris.

The people who would have used those beds and obtained treatment “have not been able to secure that treatment,” he said, and because of the lack of treatment their behavior brought them into the criminal justice system.

“These are people who would be a low risk if diverted out of the jail and into community for treatment,” Morris said in a telephone interview.

The Lynchburg area is seeing an increasing interest in the needs of the mentally ill who’ve ended up in jail, convicted of minor non-violent crimes such as trespassing, petty theft or disturbing the peace.

In December, DMHMRSAS awarded a $30,000 grant to Central Virginia Community Services to address re-entry of the mentally ill to the community from jail. In addition the “Community Jail Diversion Alliance,” a group of agencies and organizations, received a $50,000 federal grant to study the diverting of the mentally ill from incarceration if they have committed misdemeanor crimes.

Morris said that researchers have looked at ways to achieve the diversions.

One method is through crisis intervention teams, which step in before a person is arrested, but after the police call.

It’s an expensive process in that it requires specialized training of law enforcement, dispatchers and rescue squads. It also requires setting up a no-refusal drop-off center where the person could be brought by a police officer, who can then leave “and not squander patrol hours providing security at a mental health agency or assessment center,” Morris said.

Some Community Services boards have developed partnerships with hospitals and have “crisis intervention suites” at hospitals, which can be used as a drop-off center.

One of the problems is that an officer responding to a call does not know until he arrives on the scene, said Morris, if he is working with a law enforcement call or a mental health call — and it can become a matter of clinical judgment for the officer.

Post-booking alternatives can involve the creation of a mental health court, where at some stage of the adjudication — from posting bail, appointment of counsel, or even trial — the case involving a mentally ill person is reviewed, and a determination made about the charges.

Morris noted that most misdemeanor offenses, jail time is a matter of a few days, yet the mentally ill person arrested can spend months in jail waiting a competency hearing and evaluation.

Yet there’s no doubt that the jails are playing a role in treatment of the mentally ill.

A statewide study of the jail population on Sept. 13, 2005, found that 4,000 people in jail had a mental disorder, said Morris. That’s about 16 percent of the roughly 25,000 people in jail on that day. And of that group, 8 percent had a serious mental illness.

The data from that study, available online, included the 990 inmates in the Blue Ridge Regional Jail in Lynchburg. Of those, 138 inmates had a mental illness that ranged from mild depression to delusional to mentally ill but with no formal diagnosis. Of the mentally ill, 59 had both mental illness and substance abuse disorders.

A substantial number were also on antipsychotic medications — 37 inmates; 23 were on mood stabilizers or anticonvulsants; 90 were on antidepressants, and 12 were on anti-anxiety medications.

The study also asked the jails to estimate the cost of all psychotropic medications for fiscal 2005. And at Blue Ridge Regional Jail the estimate was $173,400. Estimates of mental health care costs, but not medications, were at about $71,920.

Because there aren’t enough psychiatric beds for disruptive or violent people “some of the criminalization of the mentally ill is directly attributable to lack of resources for treatment,” said Morris.

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