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Last Resort: Mental Healthcare Behind Bars

Andrea Smardon

For those in Utah who are addicted to drugs or mentally ill, jail may be one of the only places where treatment is free and accessible. In part one of a two-part series, KUER looks at how Salt Lake County cares for its incarcerated population.

Talking to people outside the Road Home shelter in Salt Lake City, you hear about job losses and the deaths of family members and friends, life events that can derail those who don’t have much of a support system, but you also hear another prevailing strain.

“Most people that are homeless do have mental health issues,” says one homeless man.

“They say I’m bipolar, and now I have a personality disorder they say,” says a woman outside the shelter. “Then you have some of us that use drugs to cover up the mental illnesses that we do have.”

On the other side of the Road Home building, at the entrance to the women’s shelter, three police cars, an ambulance, and a fire truck arrive. A police officer says someone from the shelter reported an overdose in the bathroom. A team of emergency responders enter the shelter with a stretcher, but they come out escorting a woman. An officer holds a used syringe which the police believe contains heroin. The woman slumps on the curb, holding her head, tears running down her face. She says she’s been to jail before.

“I don’t want to go to jail,” she says. “I’m so tired of jail. It just never seems to take care of my problems.”

"I'm so tired of jail. It just never seems to take care of my problems."

Her name is Sandy. She says she’s from Utah County, she’s 45 years old. Sandy says her son died last year – a drug related death, and she came to the Road Home to try to get her life together. But Sandy won’t be able to come back to the shelter for 6 months because she broke the rules and was caught using drugs on Road Home property. A police officer tries to give her some advice. 

“Best option you have right now is try to get help,” the officer says. “It sounds like the only place that’s going to get you help is the justice system. You ask what’s better jail or here, and I’ll you this…

“Not jail,” Sandy says.

“It is,” the officer replies. “The one and only thing that jail does for you that this place doesn’t - it keeps you clean.”

Inmates at the Salt Lake County Jail can get a mental health evaluation, detox treatment, medications, and recovery counseling if they stay long enough. Sheriff Jim Winder says many of the inmates have not seen a physician in years, and it’s often the only way low income people get mental health and drug treatment.

“I don’t know that the general population understands that the jails of today have become a very large player in the indigent healthcare approach in our country,” Winder says.

He estimates that 75 percent of the population in the jail has a mental health or substance use disorder. He says a portion of them are constantly cycling in and out of jail; some have as many as 140 bookings in a year. Winder says taxpayers are footing the bill. For these inmates, he says the county pays not only the basic rate of 84 dollars a day, but as much as 120 dollars a day for medical care. That doesn’t include the police department’s costs for arrest or booking.

“Here’s the bottom line, we are paying, you know 3,4,5,10 times more than we should be because the cyclical nature of this particular treatment approach to this population,” Winder says. “It’s insane.”

He says he’s seen many people make great recoveries in the jail, but they don’t have access to the same services when they leave.

“The sad part is, now they are preparing to be returned to the streets of our community, and when they go back, there is simply nothing there for them,” he says.

"Now they are preparing to be returned to the streets of our community, and when they go back, there is simply nothing there for them."

Many of these inmates do not have access to health insurance when they’re released. They only qualify for Medicaid if they’re pregnant, if they’re parents below 50 percent of the poverty level, or if the federal government has determined that they are severely mentally ill. So, many of the single men and women coming out of jail would not qualify for Medicaid in Utah, even with no income at all.

Ron Gordon, Executive Director of the state Commission on Criminal & Juvenile Justice says there is growing evidence that providing people with healthcare can reduce the likelihood they will return to jail.

“There’s no question that the needs in the criminal justice population for mental health treatment and substance use disorder treatment are very high,” Gordon says. “So our ability to reduce recidivism relies on our ability to treat those very specific problems. The more resources we can put to those issues, the more likely we are to be successful.” 

Gordon says he believes Governor Gary Herbert’s plan to expand Medicaid would help. The Affordable Care Act was originally designed to provide this type of coverage to those under the poverty line, but Utah’s lawmakers have resisted implementing the federal government’s plan for how to expand Medicaid. Now state legislators are poised to consider the governor’s plan, but a decision is still pending.

In the meantime, those Utahns who do not qualify for Medicaid will rely on the charity care that is available, or put their names on the waiting list for a county-funded spot at a recovery center. But the director of Salt Lake County’s Behavioral Health Services Pat Fleming says there are not enough funds in the budget to treat all the people who need it.

“We have more and more uninsured individuals on our waiting list to get into care right now because we just don’t have the capacity,” Fleming says. “We’re really concerned that if we don’t get this right, that the default is going to be the county jail.”

"We're really concerned that if we don’t get this right, the default is going to be the county jail."

“One could say that has been the default position,” says Sheriff Jim Winder. “I guess the next question is - is that the moral approach? You know, I don’t think so.”

As for Sandy who was allegedly caught with heroin at the homeless shelter, she’s scheduled to appear in court on Wednesday. Sandy is charged with possession of drug paraphernalia and public intoxication. According to the city prosecutor’s office, the maximum penalty is a fine of up to 4600 dollars and a year in jail.

Andrea Smardon is new at KUER, but she has worked in public broadcasting for more than a decade. Most recently, she worked as a reporter and news announcer for WGBH radio. While in Boston, she produced stories for Morning Edition, Marketplace Money, and The World. Her print work was published in The Boston Globe and Prior to that, she worked at Seattleââ
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