We Can Afford Humane Mental Health Treatment For Local Inmates

Should suicidally depressed persons be put in restraint chairs?

I've just submitted the following to the DNR as an edited version of an earlier blog. Please read the last paragraph.

Here's question for local legislators: Why should the Rockingham-Harrisonburg Regional Jail have the lowest budget for mental health services of any facility in the area?

According to information obtained from the RHRJ, suicidally depressed inmates were confined to restraint chairs a total of 22 times during the first six months of this year. The minimum amount of time spent in such restraint, with belts and cuffs immobilizing the inmate's legs, arms, and torso, was two hours, with 28 hours being the longest.

During the same period, the jail’s segregated padded cell was used 14 times for inmates at risk for suicide. RHRJ's "rubber room", the only one of its kind used by any area jail I know of, has no bed or other furnishings, and no mattress, blanket, reading material or eating utensils. A grate in the floor serves as a commode, and the inmate has only a suicide-proof smock for warmth. He or she has no human contact except for regular suicide checks, and is offered no counseling whatever.

During this period 12 inmates were assigned to a regular segregated cell while on suicide watch. Here an inmate is allowed a blanket and a few personal items, similar to the procedure followed by most jails for suicidal inmates.

Incarceration itself, especially in crowded cells with some inmates sleeping on the floor, is extremely stressful, and it’s hard to imagine the trauma the above forms of confinement create for clinically depressed, paranoid and/or suicidal inmates. Hence the efforts of some of us to work with Sheriff Bryan Hutcheson at our local jail, along  with Mr. Lacy Whitmore of the Community Services Board, to seek ways of improving mental health services for local inmates.

This effort includes appealing to members of the City Council and Board of Supervisors for more funds for mental health services as well as offering volunteer local mental health professionals and supervised interns to help as needed. These carefully vetted individuals could work with the CSB and jail personnel to provide therapeutic support for inmates in a time of crisis.

I know it must be challenging for the sheriff and his overworked staff to provide for the needs of some 400 inmates. They have to deal with situations the best way they can with their limited budgets and resources.

But why should our relatively well-to-do community, blessed with a near surplus of mental health professionals, be limited to an annual budget of under $18,000 to provide psychological treatment and care for local inmates? This expenditure, through a contract RHRJ has with our local CSB, is by far the most meager per inmate of any facility in the region, and covers only about an hour of mental health screening and three hours of medication management per week, the latter provided by a trained nurse practitioner.

By comparison, the new Rappahannock-Warren-Shenandoah Regional Jail, with a capacity of 375 when filled, employs a full time mental health worker, and the Winchester Regional Jail, with 600 inmates, has two full time counselors.

The Arlington County Jail, currently housing just over 500, employs five full time professional counselors and a full time psychologist, partly funded with grant money. By last report, Arlington County, with this comprehensive approach, is actually seeing its jail population decline.

Our area boasts of having the lowest tax rate of any in Virginia except for tourist rich Williamsburg, but we are far, far from being the poorest locality in the Commonwealth.

Not only can we afford to offer more decent mental health services here, but given the wealth of human and other resources in our community, we could develop an enviable criminal justice system that could become a model for Virginia and the nation. We could invest more in education, prevention, treatment, diversion and restorative justice programs that help keep people out of the correctional system and less in building ever more expensive jail facilities.

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.”

Here's a link to numerous other blog posts on this topic.

Guest Post On Jail Expansion Alternatives

photo by Andrew Jenner, an excellent blogger on this topic

The following letter by local mental health and criminal justice advocate Sam Nickels was sent to members of the Harrisonburg City Council and the Rockingham Board of Supervisors earlier this week. Nickels is director of the Center for Health and Human Development, a nonprofit that operates community mental health programs in Central America.

Dear County and City Representatives (Mr. Byrd, Mr. Cuevas, Mr. Chandler, Mr. Eberly, Mr. Degner, Mr. Shearer, Mr. Kyger, Mr. Breeden, Mr. Baugh, Mr. Chenault),

I write regarding the possible jail expansion. I appreciate the first meeting held last week by Moseley Architects to reach out to us in the community regarding jail expansion alternatives.

I am greatly concerned about this issue for two reasons. First, the cost is large to the taxpayer. Second, the number of people we have in jail is far too high. Our U.S. rate of incarceration is higher than any other country in the world *, including China, and we must begin to do something about this as a society, starting here, today.

Having seen the research on this issue over the last number of years, it is clear there are alternatives we have not tried that should be considered to reduce prison populations. For example, mental health courts can mandate alternatives to incarceration for those with mental health problems and who have encountered trouble with the law, a group which takes up 25% of jail bed space.

See the one-paragraph abstract of this 2012 study published by the American Psychological Association: http://psycnet.apa.org/journals/lhb/30/6/659/

And please watch two minutes of this very powerful video on mental health courts: http://powerofadvocacy.wordpress.com/

Then read the first two paragraphs of this article about Virginia and mental health courts: http://powerofadvocacy.wordpress.com/2013/03/25/virginia-is-not-for-lovers-of-mental-health-courts/          

It also appears to me that it is a clear conflict of interest to having a jail architectural firm which can benefit from the construction of a building also carry out a search for alternatives from which they will not benefit financially. I know you have already signed a contract, but I would suggest in the future, these issues be separated.

For the present, you might consider hiring JMU/EMU or other researchers to do some work for you on alternatives that are based on pilot and full alternative programs in other places, as a complement to the work being carried out now by Moseley. Moseley also indicated in the meeting that their ability to carry out a full look at alternatives was quite limited in the short timeline they have (December), so having others also helping with this task seems appropriate.
       
Why pay more attention to alternatives? Because the long-term savings are potentially very significant for the citizens of the county and city, and because humane treatment of people with mental health challenges and their families, as well as other non-violent offenders, is important to how well our society functions and how these people are able to recover from their illnesses and other challenges. Also, the need for non-violent offender wage earners to be present in the home for their families is key to the functioning of our social system.

I am aware that we are spending $1 million a year to send some of our prisoners to the nearby Middle River Jail due to our overcrowding here, but if we take five years to really look at and implement alternatives, as the city of Richmond has begun to do, and if we then could save $20 million in the long run from jail expansion costs, then you have done us citizens a great benefit.

* See this link for information on global incarceration rates:  http://www.prisonstudies.org/sites/prisonstudies.org/files/resources/downloads/wppl_10.pdf

We Can Afford Decent Mental Health Services For Local Inmates

Is this the best we can offer a suicidal prisoner?

According to information obtained from the Harrisonburg-Rockingham Regional Jail, suicidally depressed inmates were kept in restraint chairs a total of 22 times during the first six months of this year. Two hours was the least amount of time spent in such restraint, with belts and cuffs immobilizing the inmate's legs, arms, and torso, and 28 hours the longest. 

During this same period, the jail’s segregated padded cell was used 14 times for "medical reasons" (for someone considered at risk for suicide). HRRJ's "rubber room", the only one still in use by any area jail I know of, has no bed or furnishings of any kind, no mattress, blanket, reading material or eating utensils. A grate in the floor serves as a commode, and the inmate is given a heavy suicide smock for warmth. He or she is cut off from all human contact except for regular suicide checks, and no counseling is available at this or any other time.

Also during this time period 12 inmates were assigned to a regular segregated cell while on suicide watch. Here an inmate wears a "suicide smock" (paper gown), and is given a blanket and a few approved personal items. This is the procedure followed by most jails and state prisons for suicidal inmates.

Incarceration itself, especially in double-bunked, crowded cells with some inmates sleeping on the floor, is psychologically stressful for anyone, and it is even harder to imagine the trauma the above forms of confinement might create for depressed, paranoid and/or suicidal inmates. Hence the efforts of some of us to continue to work with Sheriff Bryan Hutcheson at our local jail, along  with Mr. Lacy Whitmore of the Community Services Board, to seek ways of improving mental health services for local inmates.

This includes appealing to members of the Harrisonburg City Council and the County Board of Supervisors for more adequate funds for mental health services as well as offering the services of local mental health professional volunteers and supervised interns to help as needed. These carefully vetted individuals could be on call to work with the CSB and jail personnel to provide a therapeutic presence for troubled inmates in a time of crisis.

I fully understand the present plight of the sheriff and his overworked and underpaid staff having to provide for the needs of some 400 inmates. They have to deal with their inmates the best way they can with the limited budget and resources they have.

But why should our relatively well-to-do community, blessed with a near surplus of available mental health professionals, be limited to a budget of under $18,000 a year to provide psychological treatment and care for its local inmates? This expenditure, through a contract HRRJ has with our local Community Services Board, is by far the most meager per inmate of any facility in the region, and covers only about an hour of mental health screening and three hours of medication management per week, the latter provided by a trained nurse practitioner.

By comparison, the new Rappahannock-Warren-Shenandoah Regional Jail, with a capacity of 375, employs a full time mental health worker. The Winchester Regional Jail, with 600 inmates, has two full time counselors, and the Arlington County Jail, with just over 500, employs five full time professional counselors and a full time psychologist, partly funded with grant money. By last report, Arlington County, with this enviable program, is actually seeing its jail population decline.

Rockingham County boasts of having the lowest tax rate in Virginia except for tourist rich Williamsburg, but we are far, far from being the poorest County in the Commonwealth.

We can not only do better than we have, but given the wealth of human and other resources in our community, we could develop a criminal justice program that could become a model for Virginia.

Special thanks to Sheriff Bryan Hutcheson and Captain Steven Shortell for graciously providing information for this blog.
 Click here for more posts on this subject.

A Respectful Appeal To Local Supervisors

photo from Old South High blog

I welcome your feedback on the following draft of a three-minute speech I hope to present at our local Board of Supervisors' meeting this Wednesday at 3 pm:

Thank you, Chairman Ceuvas and other members of the Board, for this opportunity to address my concerns about how our community can better serve the increasing numbers of mentally ill men and women in our local jail.

I know you are in the early stages of determining how to respond to the final version of the Moseley Architects' proposal due this month, and I understand it may include a space for people needing mental health treatment. As a therapist, I find that heartening, but I also have some serious concerns.

As you see from the copy of Thursday's op ed piece on this issue you have in front of you, we currently have the most meager budget for mental health services of any regional jail in our area, one that pays for only 10% of the personnel time as does the new RWS Regional Jail, for example, with a total of 375 beds, and  only 5% of the mental health personnel time as the Winchester Regional Jail, with 600 inmates.

So when someone is considered at risk for suicide at our Rockingham/Harrisonburg Regional Jail, for example, the staff there often feel they have no choice but to put such inmates in restraint chairs or to strip them and place them in the isolated padded cell, sometimes for hours on end. There are simply no counselors of any kind available.

I applaud any improvement in this area we could provide in a new facility. But just creating physical space doesn't provide clinicians for a viable mental health program. To staff such a program would require an additional budget of at least $100,000 a year, even for only two mental health clinicians. Compare that to the clearly inadequate $18,000 ($9000 from the County) the Jail pays the Community Services Board for the services of one very part time nurse practitioner to meet the psychotropic med needs of a population of 400 plus people at a mere three hours a week.

With the additional financial burden of funding a new multimillion dollar facility, to say nothing of the additional cost of staffing and maintaining it, how can we expect to have even more money to invest in an adequate mental health staff, given the fact that we currently feel we can afford only $9000 a year for such services?

A lot of people I talk with in our community wonder whether it wouldn't be wiser to continue to rent available jail space at Middle River for the time being, at what may be a bargain compared to new construction and personnel costs we're looking at now, regardless of what we decide to build. And then to invest more dollars in our CSB, for example, to enable it to provide more adequate mental health and drug treatment programs that could help keep as many people as possible from having to become incarcerated in the first place.

Gemeinschaft Home, an already existing local treatment and reentry program, could be a model for the kind of structured environment many drug offenders could be assigned to as an alternative to incarceration--before they get into the criminal justice system rather than after they have served a sentence. The Fairfield Center is also prepared to handle cases through their Restorative Justice program that could divert many offenders from our courts and our jails (see the article on the McDonnells in front of you).

All of these kinds of programs have been proven to be more cost-effective, and just far more effective, period, than incarceration in many cases. We will still always need to have a facility such as the one on Liberty Street to house violent offenders and for those who may represent a flight risk, as well as for those fail to take advantage of the kinds of alternative work-based programs our community could provide for low risk offenders. But if we were able to get by with 70 jail beds prior to 1995, we shouldn't need over six times that number in just two decades, when our population has increased a mere 25% during that period, if my numbers are right.

I close with a recent statement by Ken Cuchinelli, our former Virginia Attorney General:
  
“For far too long, the only answer to decreasing crime was to put more people in prison. We built prisons at rates we didn’t need and couldn’t afford, especially for non-violent offenders.  Now, we know there are alternatives that cost less and work better.  I am proud to sign on with the Right on Crime initiative to help fix this problem by making cost effective, data driven public safety decisions that reduce recidivism rates.”  

******************************************************

NOTE: Here's an online petition to the local Community Corrections Board, which is to have a meeting that's open to the public to consider the Moseley Architects proposal on December 8, and to members of the Harrisonburg City Council and to Rockingham County Board of Supervisors, who are to approve it by December 31. Even f you have already signed a hard copy of the petition, please circulate and share this link as widely as possible.

Progress Report: Improved Mental Health Services At HRRJ

Harrisonburg/Rockingham Regional Jail

Thursday I had the privilege of meeting with two representatives of the Community Services Board, Executive Director Lacy Whitmore and Acute Services Director Ellen Harrison, and with Sheriff Bryan Hutcheson and Jail Director Captain Steven Shortell to discuss ways of improving mental health services for inmates at our local jail.

Here are four areas of concern we covered:

1. As state funds become available for more community-based mental health services in Virginia, what might be the best possible ways of using such funds to expand and improve mental health treatment at the jail?

Captain Shortell's ultimate dream would be to have a separate fully staffed mental health unit added to the facility. This would decrease the number of inmates needing to be transferred to the forensic unit at Western State Hospital and could greatly improve the quality of services at HRRJ. Such a unit may only be a pipe dream, of course, under present budget constraints, but it would represent a far cry from currently having only one CSB Nurse Practitioner available for one three-hour block of time per week (plus other CSB case workers as called on for emergency needs). Meanwhile any increase in the number of trained counselors could help improve mental health treatment.

2. Could inmates already under a doctor or psychiatrist's care when they are incarcerated continue that care while at HRRJ, with the patient or patient's family billed for any prescriptions and/or phone consults involved and with nursing staff continuing to dispense medications as provided?

We were told that if an inmate brings prescriptions from home that these may be continued at the discretion of medical personnel if it is clear that they are have been taken on a consistent basis prior to their coming. However if, for example, full bottles of meds are brought without evidence that the inmate has been taking them as prescribed they may not be given. More time and staff available to do more coordination with outside providers would clearly be a plus in making required medication management more efficient and effective.

3. Could a community-based advisory board be created for the purpose of hearing the Jail's challenges in providing mental services and brainstorm potential solutions? 

It was encouraging to have Sheriff Hutcheson assure us that if the Community Services Board were to get such a group together that the Sheriff and staff would be willing to give their recommendations every reasonable consideration. This is potentially a great step in collaborating with concerned community members to help provide for better mental health services within current budget restraints--as well as perhaps working at ways of increasing necessary funding to provide at least the level of care available at state prisons.

4. Subject to the recommendations of such a group, could a select team of volunteer professionals be granted access to inmates in need of counseling similar to what volunteer chaplains now have?

Sheriff Hutcheson is open to having outside clinicians help provide services if clear credentialing guidelines can be established by the CSB for those allowed access to inmates, perhaps on the same basis as attorneys are presently. The proposed advisory board could be useful in establishing such guidelines.

Meanwhile, here's some really good news: I was encouraged to hear that all sheriff's deputies and corrections officers are set to receive a mandated 40-hour Crisis Intervention Team training initiated by the CSB and funded by a special grant. CIT is a program designed to improve the way law enforcement and the community respond to people experiencing mental health crises. The first persons enrolled in the program just completed their training last week, and three other classes are planned for this year. More details will be posted on the HRRJ website by the end of this week.

Please feel free to offer your comments or suggestions for working collaboratively with the Sheriff and the CSB to do an ever better job of rehabilitating offenders.

Could We Make This Dream Come True?

At noon today local pastor Cindy Carr, EMU counseling professor Cheree Hammond, pastor and jail chaplain Ben Risser, Rockingham Cooperative General Manager Norman Wenger and I met with Community Services Board Director Lacy Whitmore to discuss ways of improving mental health services at the local jail.

Currently the CSB has a contract to provide only 2 1/2 hours of psychiatric services each week for a very crowded inmate population of approximately 340. Due to a lack of staff and other resources suicidally depressed persons may still spend hours confined to either a restraint chair or the padded isolation cell, the latter with the inmate having only a paper gown to wear and with their only amenity being a hole in the floor for a commode.

By way of contrast, Cindy Carr talked about the recent experience of having their adult daughter successfully complete a well staffed five-week drug rehabilitation program, one which has completely revolutionized her life. The cost was considerable of course, but still less than the $26,000 tax payer cost of a year of incarceration that provides for virtually no rehabilitation.

We realize a jail can never be like a rehab center, but the dream that emerged today was whether we could generate the support needed (perhaps in collaboration with the CSB) to hire a full or part time therapist for the jail, one who could also coordinate a program of volunteer professionals to help meet some of the mental health and reentry needs of inmates. Safety and liability issues were raised, but state regulations do allow for outside personnel to visit inmates at the discretion of the sheriff or other jail administrator, as follows:

Code section 53:1-127 "... the sheriff, jail administrator or other person in charge of the facility shall prescribe the time and conditions under which attorneys and other persons may enter the local correctional facility for which he is responsible."

Here are some of the questions I had prepared for Mr. Whitmore prior to our meeting:

Is the current contract with the jail (to provide 2 1/2 hours a week of psychiatric care) adequate for the needs of over 300 inmates?

Answer: No official CSB position on whether this is adequate or inadequate.

What benefits, if any, would there be in some kind of partnership with other concerned professionals in expanding or improving mental health services at the local jail? What form of partnership might be most helpful?

Answer: May be desirable, but difficult to implement.

Does the CSB have any position or recommendation regarding the current use of the restraint chair and/or the isolated padded cell for suicidally depressed inmates? Or the segregated cell, where inmates may be held for weeks at a time with no reading material (except the Bible)?

Lacked sufficient time to discuss this.

Would the CSB welcome having other health care professional, including volunteers and counselor interns, be available for close monitoring of suicidal inmates and/or other counseling services if permission could be granted by the Sheriff?

Answer: Not sure. It’s hard to picture that happening in the current situation.

Does the CSB share the jail administration's fears about liability and safety if there were greater access granted for additional professional mental health services to inmates?

Lacked sufficient time to discuss this.

If you could have your own wishes granted, what would be your dream program for mental health services for inmates at our regional jail?

Spent some time brainstorming time this.

Overall, this was a good session, for which we sincerely thank Mr. Whitmore, and I hope we can keep this conversation going. Maybe the dream of having the jail become more of a place for growth and rehabilitation can still come true. Stay posted.

You may also want to read this recent post.

Better Mental Health Services For Local Inmates?

restraint chair

Daniel Robayo, rector of Emmanuel Episcopal Church, and I had a productive meeting with Rockingham County Sheriff Bryan Hutcheson and Lieutenant Steven Shortell on Monday to discuss the following:

1) How can our community support an increase in the number of hours and personnel available to provide much needed mental health services to jail inmates, including enlisting professional mental health volunteers if necessary?

2) How could an expanded staff help provide alternatives to the use of the restraint chair and the isolated padded cell when dealing with mentally ill and suicidally depressed persons?

3) How could the jail and/or the Community Services Board better respond to numerous concerns expressed by inmates who reporting problems accessing medications as prescribed?

Uses of Restraint Chair and Isolated Padded Cell (January 1 through June 30, 2012)





Unlike the above photo, our local jail does not strip inmates who are confined to their restraint chair, but when suicidally depressed or incorrigible inmates are placed in the isolated padded cell for similar safety or medical (suicidal) reasons they are stripped of their clothing and given only a paper gown to wear. While there they have no access to reading material, mattress, pillow, blanket, or eating utensils. A hole in the floor serves as a commode.



We can understand the occasional need for such restraint or confinement for incorrigible inmates, but the primary purpose of Monday’s meeting was to discuss more humane ways to treat mentally ill and suicidal detainees.



We had recently asked for, and kindly received, documentation from Sheriff Hutcheson’s office about all uses of the jail’s restraint chair and padded isolation cell from January 1 to June 30, 2012.
 Their report showed there were 19 cases of mentally ill persons (usually suicidal) being confined to the restraint chair during that time, an average of three per month. In restraint, belts and cuffs have the prisoner's legs, arms, and torso immobilized.



In an additional 8 cases inmates were in restraint for things like “were intoxicated,” “wouldn’t listen,” “were bouncing off the walls,” or who were otherwise seen as possibly harming themselves. The average time spent in the chair for these 27 persons (for medical and these other reasons) was four hours, with the shortest time being two hours and the longest ten hours.      



In addition, there were 22 other reported cases of the chair being used for inmates demonstrating violent behavior and who were considered potentially harmful to others. Some of that number may also have been suicidal, but this was difficult to determine because many were under the influence of alcohol or other drugs. The average time spent in the chair in these cases was six hours, with two hours being the shortest time and 24 hours being the longest.
     


As to the isolated padded cell (the “rubber room”), there were 7 cases of it being used for medical reasons (inmates deemed suicidal) during this six-month period. In an additional 13 instances an ordinary segregated cell was used and a guard assigned to regularly check to make sure the prisoner did no harm to him or herself. Here the inmate does have access to a Bible, mattress, blanket and a commode.



Segregation cells are used routinely for disciplinary purposes in jails and prisons, and sometimes for the protection of an inmate who is in danger of being harmed by his or her cell mates. Such sentences to the “hole,” for either the prisoner’s protection or for in-jail violations, may be for weeks at a time.
     


In all fairness, extreme overcrowding at our local jail, along with challenges of limited budget and personnel have Sheriff Hutcheson and his staff stretched to their limit. Our jail, built for 208, is double bunked and typically houses from 325-375 inmates, some having to sleep on the floor. As a result, jail staff feels they have few choices at times but to resort to the use of the restraint chair, segregated cells, and even to the dreaded isolated padded cell. They do report, however, a definite trend toward fewer uses of such measures.



Current Medical and Mental Health Resources

Our local jail has a contract with Southern Health to provide one or more nurses on site around the clock to meet the medical needs of inmates. In addition, a retired MD from Staunton is available on a very part-time basis.

For mental health needs, the jail contracts with our local Community Services Board to provide a Psychiatric Nurse Practitioner for 2 1/2 hours once a week and two professional mental health counselors for a part of two days per week and to be on call for emergencies.

Two very part time volunteer chaplains are also available for male inmates and one for female detainees.

Ongoing Challenges

Over the past year a number of concerned citizens in our community have been meeting to explore alternative sentencing options and other ways of reducing jail overcrowding, as well as brainstorming better ways of dealing with mentally ill and suicidally depressed inmates. 

One idea is to assign such persons to regular segregated cells with trained volunteer mental health providers or interns taking turns being next to the cell and relating to that person until he or she is able to be returned to general population. Such volunteers, coordinated by the CSB, could also be useful in the booking area, where persons may be kept for as long as 24 hours (occasionally longer) until they are sober and can be appropriately assigned to regular population.



In this holding area, inmates are normally not allowed a mattress, pillow or blanket for fear they may attempt to harm themselves, and are typically denied their medications during that time, especially if they are intoxicated.



I believe a community like ours can work together to provide more effective and humane treatment of our incarcerated citizens. Monday’s meeting gave us new hope that together we might be able to make that happen, with Sheriff Hutcheson suggesting in his last email that “the CSB is a primary factor in this matter of discussion”. 



Check out the following links for more background information: 



http://harvyoder.blogspot.com/search?q=can+we+make+this+dream+come+true


http://harvyoder.blogspot.com/2012/03/some-reflections-on-tuesdays-forum.html

http://www.nmha.org/go/position-statements/24

P. S. SAVE THIS DATE: A community forum is being planned for the Massanutten Regional Library from 12-1:30 pm Monday, November 19, to discuss the expanded use of GPS bracelet monitoring technology for pre-trial and post-trial non-violent offenders. The program features a panel of speakers that includes the founder of Nexus Programs (a non-profit agency that provides such monitoring), a representative from the bail bond industry that offers similar technology, and a Clerk of Court and national expert on these issues from North Carolina. Their input will be followed by a Q & A time with participants. The event is free and open to the public.

A Visit To The Arlington County Jail

I recently had the pleasure of accompanying Lacy Whitmore, Executive Director of the Harrisonburg/Rockingham Community Services Board for a visit to the Arlington County Detention Facility. Our local CSB has a $13,000 annual contract to provide mental health services at the Harrisonburg/Rockingham Regional Jail, and Mr. Whitmore and I share an interest in improved services for that population of up to 400 (45 of these are currently housed in Augusta County's Middle River Jail due to overcrowding--the jail was built to house 208).

When we met Suzanne Somerville, director of ACDF's mental health unit, operated through a contract with Arlington County's CSB, one of the first things we learned was that this 11-year old state-of-the-art facility has been experiencing a gradual drop in numbers. Built for 600 inmates, its present census is just over 500.

Sheriff Beth Arthur

It would seem that Arlington County, with a urban population of over 212,000, would have more offenders than Rockingham,with a population of some 128.000. HRRJ is a regional facility, but well over 90% of our detainees are from our rural and small town area, and we are certainly not experiencing a decrease in our jail population.

As we toured the facility and were in conversation with Somerville and one of her colleagues, psychologist Grace Guerro, I kept asking myself whether there are other factors that might have a bearing on reducing their prison population, starting with their having a new Drug Court in their judicial system. Drug Courts are known to assign more drug offenders (involving an increasingly large percentage of court cases) to treatment programs and other alternative sentences.

Then there is an intake process at ACDF that involves a mental health person and one of the facility's 13 inmate counselors. This team is sometimes able to arrange for alternatives to detention.

Also, an increased number of the staff at ACDF, like ours at HRRJ, are taking, or have taken, "Crisis Intervention Team" training promoted by their respective CSB's. Numerous ACDF deputies proudly wore their CIT pins and spoke highly of the training. Thus jail staff and mental health providers are able to experience a greater sense of collaboration and mutual support in their work. This kind of atmosphere helps reduce the stress experienced by mentally ill persons in a prison environment and can sometimes lead to treatment options rather than incarceration.

Likewise, one wonders how effective the ACDF's intensive treatment focus might be in reducing its recidivism rate and contributing to reduced numbers of re-incarcerations. In the common area in each unit of individual cells we saw numerous therapy groups being held during our visit.

The ACDF also promotes an optimal number of work options for inmates. Many are involved in kitchen and cleaning duties, in the distribution of library books throughout the facility, and in serving as tutors for individuals in literacy and GED classes. Four work crews of five each are involved in work in the area in such roles as trash and snow removal and in the care and maintenance of other Arlington County facilities. Neither they nor HRRJ offer any work release programs, however, such as are available at the Middle River Jail in Augusta County.

The people with whom we spoke clearly believe what they and other staff are doing at ACDF is helping. They admit it may be too early to tell for sure, but they currently estimate that their "graduates" have a return rate of around 50% instead of the typical 80% number of re-offenders nationwide, and that those who do relapse are symptom free longer before returning to jail or to some treatment facility.

The jury is still out on many of the details, but any or all of these factors may be reducing ACDF's jail population. There is increased evidence that investment in prevention and treatment of mentally ill and substance dependent persons results in fewer long term costs for tax payers.

Sheriff Beth Arthur, currently president of the Virginia Sheriff's Association, has been in the forefront of reforms in Arlington's program. While we may not be able to replicate her program here, I believe we may be able to make significant improvements in how we rehabilitate, rather than simply incarcerate, our offenders.

Under Sheriff Hutcheson's administration we have already seen the following changes:

1. Inmates again have three meals a day on weekends, rather than only two as has been the case for many years. This helps boost morale in a crowded and stressful jail environment.

2. A safety blanket and smock (instead of only a paper gown) is now provided for persons confined to the isolated padded cell.

3. Ongoing Crisis Intervention Team training is being provided for jail personnel and deputies.

4. A reentry class led is being led by a team of local volunteers.

I hope we can have an ongoing conversation on how to reduce our jail population and provide better mental health services to those who need it.

Improved Mental Health Services At Our Local Jail

Many of the 350-400 housed here suffer from mental illness

You may have read numerous posts here about the level of mental health care our Community Services Board has been able to provide through its contract with our local jail. Until January of this year this covered the services of only three hours a week by a nurse practitioner to take care of the psychotropic medication needs of a population of 350-400 inmates, plus a social worker or other staff person for another hour or two weekly for intake, assessment or other needs (The jail has a contract with Southern Health for other medical care).

Thankfully, the CSB, under the leadership of Lacy Whitmore, was recently able to access some regional reserve funds to provide a half-time counselor on site at the Rockingham/Harrisonburg Regional Jail for the first time, beginning this January. This fund has been matched by some $14,000 each allocated by the Rockingham Board of Supervisors and the Harrisonburg City Council, which means the CSB's present level of services can continue through June of 2016.

This is a most welcome development.  CSB clinician George Nipe finds himself extremely busy during the twenty or so hours he spends at the facility, and while it is impossible for him to respond to nearly all of the requests he receives for his time, this is a good start.

My sincere hope is that this can be a step toward our CSB significantly expanding its services at the jail in the near future. The Winchester Regional Jail, for example, with just over a hundred more inmates that ours, employs two full time counselors, and the Arlington County Jail has five counselors and a full time psychologist for an inmate population of 525.

One inmate at the RHRJ recently wrote me the following:

"I have been able to meet with the new counselor from the CSB twice now since I came here two months ago. He is very encouraging, and he is interested in seeing if I could be transferred to Western State Hospital where I could get some help for my mental problems.”

To further illustrate the need for the RHRJ to provide additional (and improved) medical and mental health services, however, here some excerpts from other recent letters I’ve received recently:

"I've been trying to get into things like an AA group, a mental health class and a class for substance abuse. They keep telling me the groups are full or that I have to wait till next month.."

"I have not gotten my proper meds since I have been here, and medical won't even ask the UVA Hospital to fax them my medical records. And I also know of two inmates who have asked the medical department repeatedly to see the CSB counselor and nurse practitioner and have gotten no response."

"One of my cell mates had a seizure and fell on the floor and it was 15 minutes before a member of the medical staff came. When they did, the inmate was taken to a cell to lie down instead of being taken to medical for treatment."

"When I was really distressed and asking for help, they threatened to put in the padded isolation room instead of giving me the help I needed."

"When I was having a hard time adjusting to the new meds the nurse practitioner prescribed for me it took over three weeks before I got to see her again to tell her how they were affecting me."

Of course there may be another side to every individual story, but these are typical of concerns I and others have been hearing for years from inmates and family members. I also realize the jail staff and budget may be stretched to the limit when it comes to providing for the needs of the physically and mentally ill in its crowded facility, but shouldn't we treat those we incarcerate with some of the same kind of dignity and care we would expect for ourselves or our loved ones?

I hope and trust we are beginning to move in a positive direction.

"Remember those in prison as if you were their fellow prisoners, and those who are ill treated as though you yourselves were suffering." Hebrews 13:3 (paraphrased)

Some Reflections on Tuesday’s Forum (updated and revised)

WHO: Some fifty concerned citizens, including attorneys, social workers and mental health professionals and three panelists: Rockingham County Sheriff Bryan Hutcheson, Sarah Albrecht, licensed professional counselor at the Community Services Board and David Rawls, psychologist at Western State's 45-bed forensic unit (serving persons convicted of some crime).

WHAT: A forum on the treatment of mentally ill and suicidally depressed inmates at our local jail.

WHEN: Tuesday, March 6, from 12-1:30 pm.

WHERE: Massanutten Regional Library meeting room.

WHY: To consider humane alternatives to the use of the restraint chair or the padded isolation cell for suicidally depressed inmates (see blog on this topic), including the use of volunteer mental health professionals to be available to be with such persons on a rotating, round the clock basis if necessary.

Sheriff Bryan Hutcheson agreed that the restraint chair should be used only in cases where an inmate is out of control and in danger of harming him or herself or others, and that being confined to the padded cell (where suicidally depressed inmates are stripped of their clothing and given only a paper gown to wear, and are without any reading material, bed, mattress or blanket, and with a hole in the floor for a toilet) should only be an option of last resort. However, he stressed that jail security and the protection of inmates is his first priority, along with the need to follow strict Commonwealth of Virginia guidelines and to avoid the risk of liability if any volunteers assisting such individuals were injured.

Sarah Albrecht, LPC, reported that the CSB is able to provide the equivalent of about 1.5 mental health counselors or psychiatric nurses (a full time equivalent number that was only her estimate, so it could be higher) for an overcrowded facility which houses 345 inmates who have little or no outside human contact or access to any other mental health resources. This is no fault of the CSB, of course, which also offers several educational groups led by the five part time CSB persons who make up that 1.5 or more number (including the psychiatric nurse practitioner who oversees the use of meds) but little counseling is offered.

Psychologist David Rawls reported that at Western State padded cells are no longer used for the patients from other jails and prisons housed there, but suicidal inmates are given one-on-one oversight, and the restraint chair is used only when there is an incorrigible patient. He also reported the use of trained peer support persons assigned to suicidal inmates in some prisons, but offered no details.

In summary, given the perceived risks, I left the meeting with little hope for any significant change in the near future in how our local jail deals with mentally ill inmates. However, Sheriff Hutcheson did say he is always open to at least meeting with any concerned citizens to hear their concerns, and stated that more training of jail personnel is a priority, with one deputy already being specifically assigned and trained to work at coordinating services to inmates with mental health needs.

I remain interested in generating a list of people who would be willing to further investigate workable and humane options that would not strain already stretched personnel and resources at the jail. My goal would be to both offer support to our new sheriff and promote better services to those citizens to our community who are behind bars.

Meanwhile, it would be interesting to know how many of our local inmates are actually being confined because they are guilty of violent crimes, and what percentage are in fact being detained for no crimes at all, but for technical parole violations, failure to pay child support, etc. I would also like actual statistics on the number of unarmed persons holding Sunday services or offering classes at the jail who have ever been threatened or harmed.

Your ideas are welcome, and please let me know if you are interested in being a part of further conversations with the Sheriff on this and other jail related concerns.

The Survey Says--86 Members Of Inmate Families Weigh In On Local Jail Policies

Special thanks to Dr. Robert Robinson and student interns at Mary Baldwin University for analyzing the results of a survey distributed at the Rockingham County jail in early August to assess visitors’ attitudes towards 17 different policies and services at the jail.  

• There were 86 respondents to the survey. 
• They were able to indicate their relationship to the inmate they were visiting and make comments of their own on the form. 
• Note: Some people responded with N/A for some questions and therefore no rating was given for that question, making the number of respondents vary for each question. 

In the survey, respondents were asked to assign items a level of importance from “0” to “3,” with “0” representing “not important, or I don’t know”, “1” representing “somewhat important”, “2” representing “very important”, and “3” representing “extremely important” to these seventeen different statements.  The statements below are arranged in order of priority based on responses from participants.  

1. “Commissary items being more affordable for inmates”
2. “Phone calls being more affordable (and longer) for inmates”
3. “Inmates having better access to a mental health counselor”
4. “Inmates having more opportunities to attend substance abuse recovery groups (AA, etc.) and other programs while in jail.”
5. “Inmates being able to attend job training and skills classes while in jail”
6. “Inmates having better access to affordable medical care/prescriptions”
7. “The $1 a day fee ($3 a day at MRRJ) reduced or eliminated”
8. “Having more frequent opportunities for family members to visit inmates”
9. “Non-violent inmates being allowed to visit family members without being in handcuffs”. 
10. “Inmates having more opportunities for physical exercise”
11. “Inmates having access to education-focused e-tablets, books and other study materials”. 
12. “A number to call for information about how to help an inmate”
13. “Complaint (grievance) procedure in place for family members’ concerns”.
14. “Inmates having fewer hours in lockdown (where applicable)”
15. “Non-violent inmates being allowed to wear street clothes and not being handcuffed when appearing in court”
16. “A manual with information for family members about local jail rules”
17. “Support groups for family members to meet with on a regular basis”

• There was only one variable where “extremely important” was not the mode (e.g., the most often chosen) #17, "support groups for families to meet with on a regular basis"
• There were several variables where “extremely important” was assigned by more than 70% of respondents
• Examples: reducing the daily fee charged by the jail, having more frequent visitation of inmates, having more affordable commissary items, having phone calls be more affordable (and longer),  inmates having better access to medical health care/prescriptions, inmates having better access to mental health counselor, inmates having more opportunities for job and skills training while in jail, and inmates having more opportunities to attend substance abuse recovery groups (AA, etc.) and other programs while in jail.

Here are some of the written comments by family members:

- Daughter had a baby two months ago, has been allowed no physical contact.

- My brother was under the care of a psychiatric doctor at the time of his arrest, and was on two NECESSARY medications (Gabapentin)(Abilify), and as of today my little brother STILL hasn’t even seen a doctor, or been given any meds! This is cruel and unusual punishment, and I have spoken to and retained a lawyer for this and another legal matter. But I would love to avoid the messiness of a lawsuit, I just want my brother’s mental health needs met and stabilized ASAP.

- Machine and debit card costs extra money for use ($5 to deposit $20). We both (mother and grandmother) live over 25 miles one way drive. We would like to do more, but can’t do it. Too expensive! We’re both on social security income.

- Not fair that families have to pay so much for everything while inmates are in jail.

- Amounts of money having to be paid weekly is ridiculous.

- Inmates go outside ONCE monthly if that.

- Daughter has cyst on ovaries which ruptured, needs hysterectomy, pre-cancerous cells.

- Mental health & physical health need better resources

- Expenses for family ridiculous!

Re: Support groups for family members:

- We have it through church and friends, others might not. W/inmate

Re: Substance abuse programs:

- So few exist!

- The prison system fails to remember addiction is a sickness. They are quick to lock up but have way too little resources or extended waits for what resources they do have. Therefore the addict gets caught up in the revolving door. They definitely need better drug/substance abuse programs that continue once the offender is released, as well as job skills so the offender is not just continually thrown out of jail the same or worse than they were when they went in, with no money and no job.

Re: Medical care:

- Prescriptions are needed as well as visits with the doctor. Visits cost $10 each and some medications are refused to inmates.

- Make sure they get their medicine when family delivers it the day she came in and it been 5 days without her medicine. And I called and talked to a nurse at the jail. 

Re: Phone calls:

- The local calls are 21 cents a minute. That’s $3+ for a 15 minute call. Could be much cheaper and more affordable. (I have 4 children that want to speak with Daddy and he has to call more than once to speak with them)

- Calls are ridiculously expensive. Life continues for us out here. So we have to discuss lawyer, legal stuff, with our loved ones, which cannot always be done in 15 minutes. So then we end up paying $3.17+ for each 15 minute call till business is taken care of.

Re: Commissary:

- Commissary is expensive and needed by inmates. Family members provide the money to the accounts.

- Salt/pepper/mayo/mustard/ketchup not provided except as commissary items.

Re: More frequent visits:

- The definition of family is very limiting for some inmates.

- 30 minute visits are once per week and short especially with multiple visitors (4 children).

- Mothers to be able to bring strollers for their infants when visiting.

- We should have at least two visitations a week.

Re: The daily fee:

- The fees for inmates per day should be eliminated—another burden for family. ex: To provide money for commissary the fee per day must be added because it will be deducted before the inmate can receive commissary (along with medical fees) so to give $30 for commissary $60 or more must be deposited and that doesn’t include the fee for depositing.

Local Citizens: Support Reform At The Next Meeting Of The Community Criminal Justice Board

source

Mr. William Kyger, District 4 member of the Rockingham Board of Supervisors, will be serving as the new chair of the CCJB beginning with its next meeting at 4 pm Monday, August 29, at the Fire and Rescue Room in the southwest corner of the County Administration Building. 

Your respectful presence will show support for the CCJB as it considers such agenda items as the following (this one from from the local Reentry Council): 

The Harrisonburg/Rockingham/Page Reentry Council wishes to collaborate with the CCJB in further evaluating and implementing more of the Moseley Group's recommendations they adopted in December, 2104, to help reduce incarceration:

1. Adult Drug Court 

“…the scientific evidence is overwhelming that adult drug courts reduce crime, reduce substance abuse, improve family relationships, and increase earning potential. …Drug Courts in Virginia saved taxpayers $19,234 per person as compared to traditional case processing, and reduced recidivism rates for the persons completing a program.”

2. Day Reporting Centers

“…to offer enhanced treatment and supervision to probationers or sentenced offenders not on probation; to monitor early released inmates from jail; to monitor arrested persons prior to trial; as a halfway-out step for inmates who have shown progress in community corrections or work-

release centers; and as a halfway-in step for offenders who are in violation of probation. Sometimes referred to as a “one-stop” shop, a Day Reporting Center offers many of programs and services that best practices suggests reduces the likelihood of reoffending; reduces recidivism, and eventually reduce jail bed space requirements, including: individual and group counseling, substance abuse education, anger management, domestic violence prevention, cognitive and life skills training, parenting and family reintegration, community service, education/GED preparation, and reentry services.”  

3. Implement New Programs

“…initiate a long range planning strategy to investigate, develop and implement a continuum of jail-based ...programs and services for persons with mental health and substance abuse issues, and programs and services which target the probation violator population which appears to be utilizing a substantial portion of jail beds.” 

4. Reduce Number of Inmates In Three Categories 

1. un-sentenced detainees awaiting trial (approximately 40% of the inmate population);
2. probation violators (by a number of measures a disproportionally large offender group),
3. offenders with substantial substance/mental health issues that are associated with repeated criminal behavior and contribute to the jail’s “revolving door.” 

5. Increase System Coordination, Goal Setting, Oversight and Planning

“The community has a formal Community Criminal Justice Board (CCJB) with the statutory responsibility to: (1) advise on the development and operation of local pretrial services and community-based probation programs and services for use by the courts in diverting offenders from local correctional facilities; (2) assist community agencies in establishing and modifying programs and services for offenders; (3) evaluate and monitor community programs, services and facilities; and (4) develop and amend criminal justice plans. This group should oversee an ongoing planning effort that focuses the issues associated continuing crowding at all levels.”

6. Have CCJB Form Working Sub-committees

“…reviewing, analyzing and identifying processes and programs within the system that can be enhanced to create a more effective and efficient criminal justice system. These sub-committees should include a broad spectrum of representatives from the criminal justice, public health, higher education communities, as well as concerned citizens.” 

7. Investigate Ways to Reduce Intake

“Programs and administrative practices aimed at reducing intake should be evaluated and implemented. Early and effective pretrial programming should be enhanced with the goal of reducing future intake pressure.”

8. Investigate Pretrial Confinement Policies, Procedures and Administrative Practices

“… determine risk levels of persons incarcerated, bond statuses and reasons for confinement. There are, for example, a large number of detainees who are confined without bond for reasons that are not apparent. In addition, available data suggests that over 90% of ordered secure bonds are for amounts of $5,000 or less – amounts that poor people may not be able or willing to pay. In the face of research that suggests that requirements of small secured bond amounts is not related to public safety or appearances in court, further investigation is recommended.”

9. Increase Pretrial and Probation Staff Levels

“…consider funding new positions rather than waiting for the State funding process…A total of 6.5 pretrial and local probation officers combined to provide services to a community with over 125,000 residents with an annual operating budget of just over $635,000 is not adequate to provide services and programs for the offender population…”

10. Expand Home Electronic and GPS Monitoring For Pre- and Post-trial Supervision

“…provides a viable and effective mechanism for controlling jail crowding.” 

11. Implement and Strengthen New Jail-based Programs

“...including: work release, education release, public work force, electronic home monitoring, weekend sentencing (non-consecutive sentencing).”

12. Expand and strengthen reentry services for incarcerated offenders

“…the provision of reentry and transition services is an important service delivery component of many jail-based programs.”

13. Provide Expanded Mental Health and Substance Abuse Services Within the Jail 

“Increasingly, offenders with chronic mental health issues are residing in local and regional jails, and greatly contributing to the ‘revolving jail door’ that is apparent in Rockingham-Harrisonburg.”