Mental health, addiction and jail time

Sometimes options limited for those in crisis

A few weeks ago, officers from the Anderson County Sheriff’s Office responded to a call from an Oliver Springs woman who said that her grandchildren, ages 5 and 3, were missing.

As it turned out, the five-year-old was at school and the three-year-old was with its mother.

They were fine, but the grandmother was experiencing a mental health crisis, according to ACSO spokesperson Tyler Mayes.

People in a mental health crisis are more likely to encounter police than get medical help, according to the National Alliance on Mental Illness. It’s a burden on the judicial system, yes, but it’s a devastating reality for people with mental illness.

“Police and the criminal justice system are not designed to deal with the mentally ill,” said Assistant District Attorney David Pollard. “I think by underfunding mental health at the state level, we have effectively charged law enforcement with an unfunded mandate to deal with the mentally ill.”

As mentioned in part 1 of this series, the deinstitutionalization of state-run mental health facilities left a huge gap in treatment for people with mental health disorders. For many, untreated mental disorders has led to self medicating in the form of illicit drug use.

It can be hard to tell which came first — addiction or mental illness.

Jan Cagle has been the criminal justice program manager for Ridgeview Behavioral Health in Anderson County for 14 years. She works closely with Anderson County Sheriff Russell Barker.

“There’s definitely been a spike in the jail population since I started,” she said. “The criminal justice system is now the defacto mental health treatment system.”

There is a high correlation between mental health problems and substance abuse disorders, according to Cagle, and that has created part of the prison overpopulation problem. Fourteen years ago, when Cagle first got started, the Anderson County jail population was really small. There were around 180 inmates, as opposed to the current 440.

“Lakeshore was still functioning,” she said, referring to the Knoxville mental health institute known locally as the Lakeshore Asylum. It was originally called the East Tennessee Hospital for the Insane. It was shut down in 2011, and at one point held a “small village” worth of people, according to Cagle.

There are four long-term mental health facilities in the state now, and the closest one to Anderson County is Moccasin Bend Mental Health Institute in Chattanooga.

“The length of stay was longer back then and there were more wraparound services,” Cagle continued. “There were more case management services. And since those have been winnowed away, we’ve seen a huge jump in the jail population.”

When Lakeshore closed, there was an immediate spike in homelessness and the jail population in Knox County and surrounding areas.

There weren’t many people in the Anderson County jail with severe mental illness 14 years ago, according to Cagle. Now there are.

According to the U.S. Department of Justice, four out of 10 inmates at local jails have mental disorders. So based on those statistics, if we do the math, that’s 176 inmates in the Anderson County jail that are in jail who need mental health services.

According to the American Psychological Association, two-thirds of inmates in local jails have a substance abuse problem, and rates of serious mental disorders are up to six times higher than in the general population. Co-occurring mental disorders and substance abuse problems are more the norm than the exception.

“And it’s harder to engage in treatment because of the substance use,” Cagle said. “When you partner those two things together, there just aren’t the community resources available to treat those complex needs.”

The Anderson County detention center is, according to Cagle, really great.

“I can’t say that for some of the other jails,” she said. “Anderson County tries very hard.”

They have a medical company that is supportive of providing mental health treatment, and also a quiet unit for people who need more mental health services, according to Cagle. They also refer inmates to Ridgeview Behavioral Health.

The majority of the inmates in Anderson County have a substance abuse problem.

“Sometimes it’s meth, sometimes it’s pills,” said Cagle. “It depends on what’s more accessible at the time.”

But not all who need mental health are willing to receive it.

“It is harder for people who are in jail to get access to the state hospitals,” Cagle said. “The perception is that the jail can keep them safe... So that leaves a huge gap in services for folks that need care. The jail isn’t and shouldn’t be tasked to provide that.”

But what keeps people from getting help before things get bad? What are local resources for people struggling with mental health? What are the costs involved and does insurance cover it? These are questions we will tackle in next week’s installment.