People experiencing mental health crises are spending months in county jails, often after arrests for minor crimes, because the Wyoming State Hospital, which is charged with evaluating or taking in such cases, doesn’t have the capacity to deal with them.
The problem is a long running one for the state, and an official with the Wyoming Department of Health says changes are in the works. A letter written last month by Albany County Sheriff Dave O’Malley, however, paints a stark picture of the strain such arrangements bring to both deputies and inmates.
In his Sept. 8 letter, O’Malley wrote that the Albany County Detention Center was still holding an inmate incarcerated on July 17 and another who had been there since March 10. Previously, the jail held an inmate for 227 days.
All three men were in the midst of mental health crises, O’Malley wrote, as he described wrenching scenes behind the walls of the Albany County Detention Center in downtown Laramie.
“The inmate removes his jail coveralls and remains naked most of the time,” O’Malley wrote of the man incarcerated on July 17. “He is continuously combative and disruptive. He frequently defecates on his food tray and rubs the fecal matter onto the walls and windows within his cell. He frequently throws fecal matter at/on detention deputies and urinates through the food port on the cell door onto the floor in the booking area.”
The jail stays are damaging for all involved, the retiring sheriff wrote.
“As someone who has witnessed the strain in the eyes and on the faces of our deputies who must deal with these inmates 24/7, I assure you it is extremely taxing on them,” O’Malley wrote.
As for the inmates, “sometimes the inmate’s behavior deteriorates over time while incarcerated, and sometimes those who are prescribed medication, and take it, improve,” O’Malley wrote in an email response to questions from WyoFile. “Oftentimes we have inmates with compounded problems of mental health issues and substance abuse/addictions.”
Albany County contracts with a private company for inmate healthcare, and there is a psychiatric nurse practitioner who visits the jail “frequently,” O’Malley wrote to WyoFile. However, some inmates in the most severe mental health crises refuse to meet with that nurse, “and some are too violent and combative to do so,” he wrote. “We simply can’t just medicate people to make them more manageable. When the proper medications are subscribed, some do improve.”
Every Wyoming sheriff he’s spoken with has similar stories, O’Malley said. Sheriff Jeff Hodge of rural Crook County echoed the sentiment.
“Jails are not supposed to house mentally ill people, yet we will sit here with them for 4-6 months when they should be in the state hospital,” Hodge said.
O’Malley’s letter is the latest signal that even before this year’s deep and ongoing budget cuts, state government was struggling to meet mental health demands for the most severe cases.
“As you have heard me say in the past,” O’Malley wrote, “our Legislature seems to find funding to build more beds for incarceration, while beds for people dealing with severe mental health crises remain the same.”
Officials say a recently completed construction project at the Wyoming State Hospital and one at the Wyoming Life Resource Center in Lander will soon mean fresh capacity. DOH will be able to move some long-term patients with mental illness from the state hospital to the Lander facility for care, freeing up yet more beds, said Stefan Johansson, the Deputy Director of the Wyoming Department of Health.
The problem often unfolds as follows: Someone is arrested amid a mental-health crisis, often for minor crimes — one of the Albany County inmates was incarcerated on charges of a breach of the peace and being a pedestrian on a state highway.
A judge orders the individual to be evaluated for mental competency to stand trial. Such evaluations have to be done either at the state hospital, which the Wyoming Constitution mandated be in Evanston in the far southwest corner of the state, or by an employee of the state hospital who travels to the county jail.
The current delays are lengthy. In September, the average wait for admittance to the hospital for Title 7 patients — a reference to the statute that judges use to order the evaluations — was 87 days, Johansson said. In August it was 76 days.
The delays have increased during the pandemic, because of public health procedures that further slowed the process, Johansson said. Still, in December 2019, which he called “a relatively good month,” the wait — and corresponding jail stay — was 47 days.
The construction projects should increase capacity at the state hospital by 15-25 beds, Johansson said. “We really need to operate those facilities at full capacity and really turn up the operations of those facilities,” he said.
The new facilities are coming online this month. DOH officials are hopeful that once COVID-19 impacts diminish the state should see shorter delays, and thus shorter stays for county jail inmates experiencing mental health crises, Johansson said.
The problem extends beyond adults. County juvenile detention center staff also struggle to deal with young people who run astray of the law in the midst of mental health crises. Treatment placements for those youths are slim, and so they stay in detention centers for long periods. Workers in juvenile justice describe scenes similar to those O’Malley wrote about.
“We have kids smearing feces in their cells and we have kids smearing blood in their cells and on themselves and detention staff are just having to make do,” Craig Fisgus, a project director for the nonprofit Volunteers of America, told Wyoming’s State Council For Juvenile Justice at a September meeting.
Wyoming has four juvenile detention centers — in Sweetwater, Natrona, Campbell and Laramie counties. There are two psychiatric residential treatment centers for juveniles in mental health crises — one in Torrington and one in Casper.
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Using data from the four juvenile centers, Fisgus determined that in 2019, 17 “high need” youth were detained. He defined those youth as those who had engaged in suicidal thoughts, self-harm or assaultive behavior. Their average stay in detention centers before reaching a residential treatment bed was 115 days.
“These juveniles spent a significant amount of time in secure detention while the system struggled to identify options, and these extended placements were not beneficial for detention staff or, of greatest importance, for the juvenile,” Fisgus wrote in a letter to Department of Family Services Director Korin Schmidt that he provided reporters.
In September, Schmidt convened stakeholders in juvenile justice to begin confronting the problem. Meanwhile, a legislative committee this year has been examining the state’s spectrum of mental health services, both private and public, to determine how to best channel limited taxpayer dollars.
As Gov. Mark Gordon continues to make deep cuts to state agency budgets, his administration seeks to avoid cutting into mental health and substance abuse treatment programs. Officials have worked to insulate such programs from budget cuts because they know those reductions drive up costs elsewhere — like in prisons or in court-ordered hospital stays at private facilities.
Budget cuts, however, could deepen without solutions to the state’s declining revenues.
Officials also acknowledge that even budget cuts that aren’t made directly to mental health and substance abuse programs can unravel the state’s already fragile social safety net.
“We know there’s those indirect-effect potentials that are out there,” Johansson said. “They’re hard to define but there.”
The Legislature’s Joint Subcommittee on Mental Health & Substance Use has focused on the state’s capacity to treat mental health patients who either commit crimes or reach a level of crisis that a judge can order them into the state hospital for their own protection and the protection of others. Lawmakers will likely bring legislation that directs community mental-healthcare providers that receive state dollars to prioritize the state’s highest-need mental health patients, Rep. Lloyd Larsen, a co-chair of the committee, told WyoFile.
“I think what you’ll see as a result of the discussion is that our justice-involved populations are the ones that really are kind of a top priority,” Larsen said. “Those that have the highest needs are generally impacted by systems of the state … the judicial system in many cases.” Youth in mental health crises are also a committee focus, he said.
Committee members hope focusing the state’s mental healthcare resources on those with the highest needs might divert some people from county jails or the state hospital, Larsen said.
Larsen, who is also a longtime member of the Joint Appropriation Committee, said the work on mental health care could be a reprioritization of existing funds, not an infusion of hard-to-come-by new tax dollars.
The strategy of prioritizing high-need cases he outlined, however, is not a new one. Then-DOH director Tom Forslund told WyoFile he wanted to pursue a similar strategy in January 2017, when the costs of involuntary hospitalizations at WSH had ballooned and were eating into his agency’s budget.
Community mental health providers at the time said they opposed the strategy unless it came with new funding. Larsen acknowledged that the issues are ones lawmakers have grappled with for years. “We’ve had multiple bills that have come forth and for a variety of reasons met challenges,” he said.
He is hopeful that this time lawmakers are charting a course that will succeed, though he described his committee’s work as just the beginning. “I don’t think the effort on this will be complete in this particular [bill] draft,” he said.
Tennessee Watson contributed reporting on juvenile justice issues.