Alternatives sought for treating mentally ill, drug addicts

June 27--Second in a series on how mental health issues impact the local criminal justice system.

ALBANY -- When a person with a mental illness or substance abuse problem deteriorates to the point they cause a disturbance, they often end up in jail. But many working in the trenches of the judicial system say such individuals could be served better by getting care in a facility where there is awareness of the warning signs that call for special help.

Lt. Col. Dennis Parker, the administrator for the Lee County Jail, admits he is frustrated by the tendency to criminalize mental illnesses that should not be treated any differently than any other illness.

A large percentage of individuals booked into jails should really be somewhere else, Parker said, adding that mental health is one of the most crucial issues jail officials have to deal with these days, and that those who suffer from such illnesses are given the least attention and get very little help.

"There are more mental issues than medical issues (in the jail system)," he said. "The focus is on medical rather than mental. To me, mental health is more important."

Parker said jails often have the task of protecting society from the mentally ill and that most treatment options given to those individuals are not often long-term in nature.

"It's frustrating because there are so few resources and the problem is so big," he said. "It is like fighting a gorilla in the closet in the dark. (Society is) just turning its back on mental health."

Drug dependency is another problem Parker said significantly impacts the Lee jail, with about half of the jail population on most days consisting of drug abusers who are likely stealing to survive.

"We've spent more money putting people in jails," he said. "We should be spending less on jails and more on mental health. A lot of these folks do need treatment. They should be in a clinical setting getting help."

Handling the problem this way, Parker said, doesn't even act as a bandage, much less a solution.

Dana Glass, chief clinical officer at Aspire Behavioral Health and Developmental Disability Services, said efforts have been ongoing in the counties it serves to provide crisis intervention training to law enforcement. That training, she said, is meant to teach law enforcement about various mental illnesses and how to work in the field with someone who appears to be impacted by such illnesses.

"The police department here is very committed to that," Glass said.

The crisis center, located on West 11th Avenue in Albany, provides walk-in stabilization services around-the-clock to anyone who comes in the door.

"We make sure law enforcement knows that service is available," she said. "There is no legal mandate. We can do an evaluation."

Glass said Aspire has a memorandum of understanding to provide basic services at some jails in the area. The agency seeks to provide a continuum of care, and multiple professionals are often brought in to help get individuals the treatment they need.

Among the resources is a Mental Health and Substance Abuse Court headed by Dougherty Superior Court Judge Stephen Goss, which can work as a diversion to jail, she said.

The ultimate goal is to address the problem so that those impacted by mental illness as well as substance abuse can become productive members of society. Glass said some who have utilized Aspire's services go on to work for the organization.

"They understand what it has been like to walk through that journey," she said.

In Lee County, Aspire is adding group services for addictive disease. Elimination of services elsewhere has resulted in an increase in the need for outpatient care in places like Calhoun County. Glass said Aspire is working to expand its reach, particularly in rural counties.

The crisis center is a 30-bed facility, including six beds for outpatient care. There is also a 14-bed long-term facility for men known as Touchstone located nearby for substance abuse recovery. A mental health group meets daily, and peer support and psychological support are provided for the severely persistent mentally ill.

Crisis respite lasts for 30 days, during which time a person can get treatment and housing.

"Our focus in all our programs is trying to treat the whole person," Glass said.

Glass said those who typically need the services that Aspire provides are often brought to the attention to law enforcement when they get aggressive and a situation escalates to the point that neighbors are inclined to call the police.

Aspire, Glass said, is constantly looking for ways to expand services they provide. Volume is high, and funding for additional staff to solidify its roots would be helpful. The organization gets its funding from the state, Medicaid, grants and also functions through the support of other agencies.

"We have a commitment to serve, and we are the safety net for these communities," she said. "About 90-95 percent of those (individuals) might not have other places to go."

She added that there is a push to catch troubled members of the younger population early, before they get into the system as adults.

"If they feel they can't get out of bed, talk to them," Glass said. "Don't wait until they are suicidal. They can start seeing a therapist today."

Dr. Angela Dawson, a psychiatrist at Phoebe Behavioral Health, has worked with the population at the Dougherty County Jail for three years after working with the youth detention center in Rome and the Augusta Correctional Institute.

"I would say there is a mental health crisis in this country, and those with mental health issues end up (in jail)," she said.

Dawson has found that substance abuse problems tend to be rampant, and with either a mental health or substance abuse problem -- many times occurring in the same individual -- treatment can only be issued voluntarily.

"The problem in jails that interferes with receiving medication and treatment is not that it is unavailable," she said. "The problem is that the patient has to want to seek treatment."

Even in the case of a person dealing with schizophrenia, that person still has the right to refuse treatment. That is true not just in county jails or Georgia's prison system, but the population at large, Dawson said.

"As a country, we value personal freedom, (including) the right to say we don't want treatment or even to change our mind," she said. "(Patients can) come off a medication or use drugs that alter their thinking and act in ways that break laws. As a result, we do have a lot (of individuals) in jail with mental health problems.

"When they sober up, they sometimes realize they need (treatment)."

During a treatment course, Dawson said, patients must participate all the way through the course for it to be effective, which they often don't do. They may have a hard time keeping up with appointments or their support system may be diminished, Dawson said.

The growing problem is worsened in part by multiple generations being impacted, she said.

"In the '70s, drug use was mostly in the young, and (the product) was not as potent as it is now," the psychiatrist said. "The attitude in the '80s was that certain (drugs were used) based on socioeconomic background. Now, that doesn't matter.

"There are grandparents who are substance abusers, making their own meth. In the past, if parents had problems they could go to the grandparents because the grandparents were stable. That is not the case anymore. There are more people in the prison system now who are older."

That population can include people without a drug history or who are stealing prescription drugs. The way to address the problem of mental health patients and substance abusers in the jail system may not be prevention as much as education, the psychiatrist said.

"More needs to be done by the community at large to try and educate (and find ways to intervene)," Dawson said. "We shouldn't have to wait until they break the law or hurt someone before they get care. Probate Court can give 72 hours of hospital time to evaluate, but in a country so focused on personal rights, (we are) not giving help to those who need it."

For a mental health or addiction issue, a patient may choose not to disclose everything about their condition, which can further compound the problem of keeping them out of the system. The job of the person providing treatment is to talk to the person, evaluate, explain the medications and answer any questions he or she may have.

"A lot of barriers come up," Dawson said. "That doesn't mean we are not able to help."

In the case of a mental health problem, a bridge must often be crossed with personal problems on one side and treatment on the other. The goal, Dawson said, is to make sure the bridge remains intact.

"We need to know," she said. "With substance abuse, they don't usually tell. If they acknowledge it, they usually minimize it and are usually not forthcoming until they hit a bad point."

Dawson said substance abuse is the top problem she sees, an issue that impacts children as early as age 9. The sore spot is finding a solution to the problem before those younger abusers end up behind bars.

"I wish there was a way to enforce the need for treatment, even for those with poor insight," she said. "The problem would not occur if (they were in) treatment. We (behavioral health specialists) need to be more vocal in telling people what the problems are and not relying on Hollywood to tell us."

She said some perceive the solution -- for a mental health or drug crisis -- to be more cumbersome than the problem. A crisis center, such as the one on 11th Avenue, can help. But it may be limited in what it can handle when someone is aggressive.

"There needs to be some type of containment, until the worst of their agitation has subsided," Dawson said.

Even with containment available, Dawson said, the Catch-22 still comes into play.

"We can't enforce (treatment) if they don't want it, and most don't," she said. "What's their incentive to get into treatment, and why does it have to come to that?"

PART 3 TUESDAY: Mental health court.

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