Austin Colbert/The Aspen Times
More than half of the average daily population in Pitkin County’s jail has a serious mental health issue, according to a 2022 report by Justice Planners.
The high incidence of mental health issues among incarcerated populations is no coincidence; the lack of support for people struggling with mental health often results in entanglement with the criminal justice system.
The criminal legal system and mental health are deeply intertwined and can be tied to the rise and fall in the use of mental asylums, according to Mental Health Colorado President and CEO Vincent Atchity.
“We went through a phase as a nation where we recognized that warehousing people in giant asylums was not productive of good health outcomes,” Atchity said, noting mental health treatment facilities did not replace the asylums. “Our jail and prison populations have grown as a consequence, as has our homeless population, but there are people who are ill and can’t survive in our economy without supportive housing.”
The nebulous path to finding appropriate resources and the high cost of care can make it difficult to get the support one needs, especially before their mental health reaches a breaking point met with institutionalization or incarceration.
“We have a group of parents that come to us with their stories and their advocacy. And they are famously being told in many instances by people (to) wait until (their loved ones) do something egregious enough that the police will come and take them away and arrest them so that you’re not worried about where they are or their safety and they may get some access to care,” Atchity said.
In some cases, jail is the only way to access mental health services due to the prohibitive cost of accessing mental health care, according to Atchity.
“Jails and prisons are the number one largest psychiatric facilities in every state in the country,” he said.
The lack of an accessible pathway to care can result in people ending up in crisis — they might lose their homes, turn to hard substances, or act compulsively in a way that ends up with law enforcement becoming involved, Atchity said.
During the pre-trial period, people who are charged with a crime are held in jails, establishing a connection to the jail regardless of conviction status.
According to Interim Detentions Divisions Chief Dan Fellin, Pitkin County law enforcement aims to divert people from jails by connecting people with alternative resources when responding to calls.
“We haven’t ever really had that hard-line, hard-nosed approach,” he said. “Everybody around here, all the agencies … we all see the need to help people versus taking everybody to jail.”
For calls involving substance use or mental health, law enforcement partners with the Pitkin Area Co-Responder Team (PACT). The program pairs mental health professionals with law enforcement officers with the objective of decriminalizing mental illness and improving access to resources for people struggling with mental health or substance use.
“Our goal is to, when possible, keep people out of jail and out of the hospital and keep them within the least restrictive disposition,” Pitkin County Public Health Planning and Programs Manager Jenny Lyons said. “Whenever possible, the team is going to do their utmost to resolve things on scene. A huge area of focus is just helping people stay safe and connecting them to resources without unnecessary transportation elsewhere.”
Of the 173 active calls where a PACT clinician responded on-scene in 2022, only six individuals were transported to jail, according to PACT’s annual report. Of those incidents, 113 were resolved on scene; in other cases, individuals were transported to emergency departments or put in touch with other community resources.
For people with serious mental health or substance use issues, being isolated from their community and cut off from systems of support can exacerbate those issues.
PACT aims to connect people with resources so they can remain in their communities while receiving support, rather than introducing additional stressors associated with being transported somewhere else, according to Lyons.
Acknowledging that being in jail is a punishment in itself, Fellin said the county jail offers mental health services to inmates with the goal of reducing recidivism and providing inmates with the support they need.
“People with mental health issues can deteriorate in jail, which is why I think it’s a big deal for us to be offering all the services that we can and as much help as we can provide to people when they’re inside and then continuing that care once they’re outside,” Fellin said.
The jail contracts with Turn Key Health Clinics to provide mental health services to inmates.
For inmates who have already received diagnoses prior to their incarceration, Turn Key facilitates continuity of care, including access to medication and follow-up appointments with medical providers, according to Turn Key Director of Psychiatry and Mental Health Services Dr. Jawaun Lewis.
During the intake process, inmates complete a medical screening, as well as a mental health screening. If the patient is determined through the intake process to need mental health support, Turn Key will provide support for starting or continuing relevant medications. Turn Key itself does not diagnose patients; they only treat symptoms, Lewis said.
If people come into jail without a diagnosis, Turn Key will refer patients to an outpatient provider for a diagnosis. In those cases, an assigned case manager or therapist works with the individual to set up an outpatient appointment for a diagnosis.
After release from jail, case managers continue to work with individuals for a set period of time. Funding for case management, mental-health treatment, and other mental health services is provided by Colorado’s jail-based behavioral services program.
According to Atchity, incarcerated individuals are the only people in the United States with a constitutional right to healthcare.
“You should not need to get arrested in order to access care for your mental health or your substance use condition,” Atchity said. “That care ought to be accessible to you in your state of liberty in the community.”
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