Mental health lockups spiked by 1,365 percent in two years at Summit County jail (360 video)
Bed shortage leaves mental health patients in lurch
Funding for state-run psychiatric hospitals has slowed to trickle over the past several decades, contributing to an increasingly acute shortage of available beds. Currently, the state operates 543 beds in two hospitals in Pueblo and Fort Logan.
When private hospitals are included, the total number of beds is estimated at around 1,300, and some experts say as many as double that is needed. Minds Springs Health, a non-profit that provides care on the Western Slope, operates 43 of those at its West Springs Hospital in Grand Junction. A planned expansion will increase the number of beds to 59 with an option for an additional 16 in the future.
A new law that includes $7 million to expand emergency mental health care will also include a 6-bed crisis stabilization unit somewhere on the Western Slope. Frisco is being considered as a location, however no decision has been made yet.
When John told a crisis hotline counselor that he was suicidal last September, he didn’t expect the police to get involved. But roughly two hours later, he says, sheriff’s deputies arrived at his home in Summit Cove.
John, who asked his real name be withheld, had been drinking heavily and fallen asleep after making the call. A roommate woke him up, and he went outside to meet the deputies, who later reported that John refused to go to detox.
So instead, he was taken to jail. There, staff asked him to strip off his clothes and don a “suicide smock” — a garment made of tear-resistant material that can’t be used as a noose — and placed him in a small padded cell.
There was no toilet, just a rectangular hole in the floor covered by a metal grate. Every 15 minutes, a jail deputy checked to make sure he was still alive.
“It was pretty miserable, I was just walking around in the cell kind of losing my mind,” he recalled. Twelve to 14 hours later, he said, a staffer for mental health care provider Mind Springs Health cleared him to be released from the beige and scuff-marked enclosure.
John’s experience was not unique. Across the state, people deemed a risk to themselves or others due to a mental health crisis are often placed on 72-hour protective holds. When they are highly uncooperative or a psychiatric bed isn’t available, they can wind up in padded jail cells — even if they haven’t been charged with a crime.
In Summit County, the average number of hours people spend in jail holds has skyrocketed from 44 hours in 2014 to 651 last year, a 1,365 percent increase that mirrors similar spikes in counties across the state. This year, the number is on pace to reach 1,177.
It’s unclear how many of the people locked up were charged with a crime. And according to three experts and law enforcement officials, police sometimes charge dangerous patients with minor offenses to get them in a cell rather than wait for space in a medical facility to open up.
Whether or not patients are charged, the practice effectively criminalizes mental illness, and there is a consensus among the county sheriff, lawmakers and care providers that it is inhumane, ineffective and expensive.
This year, the Legislature passed a law that will end mental health lockups for non-criminal patients by May 1, 2018. It also allocated $7 million in marijuana tax revenues to expand crisis care services, including a six-bed crisis stabilization unit somewhere on the Western Slope.
The move is hailed as a major step forward that removes Colorado from the list of seven states that jail patients. And while the law provides money to expand crisis care, supporters acknowledge there is still much work to be done to repair the state’s strained and inefficient mental health care system.
“Ending the use of jails as warehouses for people experiencing mental health emergencies is a step in the right direction, but it would be an enormous mistake to declare victory and go home,” said Andrew Romanoff, president of advocacy group Mental Health Colorado.
Experts point to a range of factors in the surge of crisis patients, from high cost of care and lack of providers to increasing drug use and, anecdotally, the legalization of marijuana in 2014.
Whatever the cause, an acute shortage of psychiatric beds in the state means that jailers have been forced to act as a crude final backstop against tragedy. It’s a duty they are eager to relieve themselves of.
“Folks suffering from mental health problems shouldn’t be in a jail environment,” Summit County jail commander Erik Bourgerie said. “It’s not therapeutic, it’s not healthy for them and it has a negative impact on staff.”
In Summit County, uncooperative but non-criminal crisis patients used to be immediately taken to jail, Bourgerie said. In recent months, more have instead been diverted to emergency room beds.
Sometimes, however, patients pose too much of a risk for hospital staff and must be taken to the jail.
“On the one hand, I think the sheriffs in the state are pretty happy to get rid of the mental health stopgap measure they were providing,” Bourgerie said. “But on the other hand, there is going to be an impact on the community itself and we’re just going to have to just see what that (new) stopgap is.”
The money allocated by the new law is intended to ensure an adequate care network is in place once that last-resort option goes away. But given the challenges the system already faces, Summit County Sheriff Jaime FitzSimons said that will require a lot of work to accomplish.
“The bill does a great job of saying here’s what we want you to do and you work a way to do it, but it doesn’t tell you how to do it,” he said. “But our numbers continue to skyrocket, which is why I am passionate about finding a way — through our combined efforts — a way to fix this.”
The state will spend the $7 million on mobile clinicians, tele-health providers and a statewide patient transport network — but not the hundreds of psychiatric beds experts agree are needed.
“I think the 7 million dollars will do a lot of good,” Romanoff said. “But it doesn’t close the gap, and I don’t think the new law purports to do that.”
Some of the added burden is likely to fall on hospital emergency rooms, which can physically restrain or sedate dangerous patients.
Marshall Denkinger, chief medical officer for St. Anthony Summit Medical Center in Frisco, said he doesn’t expect a major influx of patients but acknowledged that the hospital might need to increase its security staff.
“We’ll have to see how things progress and respond appropriately,” he said. “These are things that we have been working on and monitoring for years, so we will have to adjust those processes accordingly.”
Mind Springs Health regional director Tom Gangel offered qualified optimism that the state system will be ready when the law takes effect.
“There a lot of good things about this law,” he said. “It’s going to move some of the problem to new locations because not all of it’s been fixed yet but we’re heading down the right track.”
In the meantime, the Sheriff’s Office said it will continue to try and minimize the number of non-criminal patients in jail. Given their unknown share of the mental health hold population, it’s unclear how much the soaring numbers will decline — if at all.
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