Saturday, April 18, 2015

DNR Article Calls For Improved Mental Health Services At Our Local Jail

The following excellent front-page piece by Elaina Sauber in today's Daily News-Record makes a strong case for improved and expanded mental health services at our local jail, and highlights some changes a number of us have strongly advocated for years. 

For those of you who don't have access to the paper, this condensed version contains the first and last parts of the article, posted here with the kind permission of Peter Yates, DNR's managing editor:
Mental Health In Focus At Local Jail  - Elaina Sauber
George Nipe, half time jail counselor (photo by DNR's Daniel Lin)
HARRISONBURG — On the day after Christmas, Shannon Smith was desperate. The Dayton resident was on probation for the unlawful wounding of a police officer in 2012, and struggled with bipolar disorder, anxiety and depression. She attempted to end her life with a gunshot to the abdomen.
“I don’t know that I necessarily wanted to die,” she said. “I really felt like I didn’t know where to get help.”
An inmate at Rockingham County Jail, Smith’s attempted suicide sent her to the University of Virginia Medical Center in Charlottesville over New Year’s, and then back to jail for possession of a firearm as a convicted felon and a probation violation.
But Smith, 38, is getting the counseling she needs that goes beyond medication. Since landing in jail in January, she has met with licensed professional counselor George Nipe a half-dozen times.
Nipe now provides 20 hours of weekly therapeutic support for inmates with mental illness at the local jail as part of an 18-month pilot program.
Started in January by the Harrisonburg-Rockingham Community Services Board, the pilot program widens the jail’s resources for distressed inmates through one-on-one counseling led by Nipe, who teaches coping skills to handle their emotions in jail and other high-stress environments.
The Community Services Board spent $30,000 in one-time funds on the pilot program, and in December, Harrisonburg City Council and the Rockingham County Board of Supervisors each approved $15,000 to match the amount, according to Ellen Harrison, CSB director of acute services.
 That spending was approved amid heated debates between residents and city officials on the construction of a $63 million annex to help alleviate overcrowding in the jail, with opponents vying for incarceration alternatives.
Nipe joined nurse practitioner Michelle Wood, who works in the jail three hours a week providing medication assessments and services, and community liaison Joanne Benner, who counsels inmates with serious mental issues for 10 hours a week, and helps them prepare for release. All are employed through CSB.
While many observers familiar with the pilot program see it as a step forward in the jail’s mental health care, some ask whether 33 hours of care a week is sufficient when, according to the State Inspector General’s Office 2014 jails review, such facilities have become “an essential part of the commonwealth’s mental health system.”
(the middle section of the article, not included here, highlights the prevalence of bipolar disorder and substance abuse issues in jail populations)

‘Not Enough Time’
While the jail administration’s efforts to treat inmates with mental illness have improved with the pilot program, one practice at the jail still disturbs observers such as Harvey Yoder, a licensed professional counselor.
When inmates express suicidal thoughts or become a potential harm to others, jail staff often confines them to a restraint chair or its segregated padded cell. Yoder thinks such devices are counterproductive to an already troubled inmate’s mental state. 
“It’s exactly the opposite of what a mentally ill person needs: supportive, nurturing connections with human beings who care about them, who can explore their fears [and] give them assurance,” said Yoder, who has been vocal advocate for seeking alternatives to jail as a means of easing crowding.
In the first half of 2014, unstable inmates were confined to a restraint chair, which restricts the legs, arms and torso, 22 times. The padded cell, which is empty except a grate in the floor for inmates to relieve themselves, was used 14 times during the same period, according to records Yoder obtained from jail administrator Capt. Steve Shortell.
Records tracking the use of those devices during the second half of 2014 and since January were not readily available. Benner, however, believes the amount of inmates’ restraint time has decreased since Nipe started working at the jail. “It used to be everyone who made suicidal comments [was put] on suicide watch in the padded cell or restraint chair,” she said, “but now, they can have a professional assessment before getting to that point.” 
Hutcheson notes that the restraint chair and padded cell are used for an inmate’s own safety, adding that the jail also has a regular segregated cell with a bed and toilet for at-risk inmates. Jail staff is required to conduct 15-minute checks on such inmates, he said.
“In most cases, it’s someone coming in off the street because of alcohol, drugs or a combination, in an agitated state and having violent behavior,” Hutcheson said.
Yoder said he thinks the pilot is a “step in the right direction,” but it may not be sufficient for the jail’s nearly 325 inmates.
“One half-time person for that population ... with a larger percentage of mental-health issues than the average population — it’s just not enough time for any one person to meet the needs,” he said.
‘Hopeless And Helpless’
As for inmate Smith, who was permitted a five-minute conversation with a Daily News-Record reporter to detail her experience, she presents Nipe with the spectrum of mental-health issues with which he must deal: addiction, depression, anxiety and bipolar disorder, the latter requiring medication and counseling.
“I really felt like I didn’t know where to get help,” she says of her suicide attempt. “I felt really hopeless and helpless — and found my father’s gun.”
Now things are looking up and Smith wants to turn her life around. Nipe, she says, “is very encouraging, and is interested in seeing if I could be transferred to Western State Hospital [in Staunton], where I could get some help for my mental problems.”
But the help Smith gets is far from perfect, she said. When she had trouble adapting to the new medications Wood prescribed her, Smith said she had to wait a month before she could meet with Wood again.
“At no point could I relax. I just cried and cried,” Smith said.
Wood confirmed that inmates sometimes wait several weeks to see her, but said that the three hours a week she works is simply not enough to meet their needs any sooner.
Said Wood, “I think if I could see every inmate when they wanted to be seen, I’d work at the jail 40 hours a week.”
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