**This content is embargoed until 12:01 Central time Saturday, Dec. 22, 2012**
CONDENSED VERSION - 1,900 words
WITH SIDEBAR - 700 words
Key findings:
• Wisconsin’s county-run jails are overloaded with people with mental illness — but services are largely inadequate.
• The state Department of Corrections is charged with oversight but does not evaluate the quality of jails’ mental health care.
• For nearly a quarter-century, the Legislature has required the DOC to collect and summarize annual reports on jails’ mental health care, but most jails have not provided the information, and the DOC acknowledges it has not been asking for them.
• One-third of Wisconsin’s jails have been cited for inadequate suicide prevention efforts.
Ignored and underfunded,
mental health care thin at county jails
Key Republican lawmaker wants to examine issue
By Rory Linnane, Tegan Wendland and Kate Golden
Wisconsin Center for Investigative Journalism
For more than a decade, Milwaukee County’s jail system has been under the scrutiny of a court-appointed medical monitor for its failure to provide adequate health care, including for inmates with mental illness.
In August, the monitor found mental health care in Milwaukee County’s two jails was still in shambles. Among the problems: Vacancies in top medical positions left jailers to make medical decisions, such as when an inmate should be removed from suicide watch. A man who had threatened to kill himself stopped eating and drinking for four days and was never taken to a hospital. He died in his cell.
Mental health advocates and correctional officials agree that Wisconsin’s 72 county-run jails are strapped for resources and not prepared to deal with the large numbers of inmates with mental illness they house. The state Department of Corrections (DOC) is charged with oversight of jails, but the agency’s inspectors are not physicians and, the agency said, not responsible for assessing the quality of health care.
The DOC inspection checklist includes whether the facilities keep adequate records, have the correct staff and keep medications secure. In Milwaukee County, for example, the two jails’ most recent DOC inspections last December give no hint of the problems identified by Dr. Ronald Shansky, the court-appointed physician.
Again and again, inspector Gregory Bucholtz marked an X for “meets approval” for each health-care standard, concluding that at Milwaukee County Correctional Facility-South, “Health care services at the facility continue to be good … Mental health services also remain good.”
Shansky’s take, in an inspection days before that DOC visit, was radically different. He found systemic problems in several areas, including record keeping, delayed access to medical services and medications, and “severely mentally ill patients being inappropriately placed in disciplinary cells.”
Just five counties’ jails —Waukesha, Washington, Walworth, Fond du Lac and Dane —are accredited by the National Commission on Correctional Health Care, which uses health-care professionals to assess the quality of care at facilities.
More information needed
Rep. Garey Bies, R-Sister Bay, who chairs the Assembly Committee on Criminal Justice and Corrections, said he plans to ask the DOC to present information to his committee on how well jails are caring for their inmates.
As a former chief deputy sheriff, Bies used to oversee the Door County Jail. He said he is particularly interested in ensuring inmates are screened for mental health problems, which he said is crucial to providing proper care, helping them transition back into the community and avoiding crises that could arise while they’re incarcerated.
“Do that (screening) up front, and it really cuts down on issues in the long run,” Bies said.
In a 2009 DOC survey, less than half of the county jails that responded had a registered nurse or mental health professional doing the initial health screening of inmates; correctional officers did it in most jails.
The DOC makes preannounced inspections of county jails annually, and investigates after suicides and other incidents.
“We mitigate risk by providing technical assistance and training, based on best correctional practice,” said Kristi Dietz, director of the DOC’s Office of Detention Facilities. The agency provides verbal or written feedback after inspections, but it doesn’t punish jails with sanctions.
Lawsuits are frequently cited as an incentive for jails to improve.
But “you can’t count on lawsuits to expose these types of problems,” according to Larry Dupuis, legal director of the American Civil Liberties Union of Wisconsin, which sued Milwaukee County over its lack of jail health care services.
Ron Honberg, policy and legal director for the nonprofit National Alliance on Mental Illness (NAMI), said county jails nationwide have a “long, long way to go” in providing adequate mental health care.
Honberg ticked off the problems: “Lack of oversight, lack of treatment resources, lack of expertise, lack of qualified staff, overcrowded conditions.”
More need, less attention
Dietz said communities are falling short at helping people with mental illnesses, “and as a result the jails and prisons, unfortunately, have been taking on more and more of that population.”
A national study estimated the one in three female inmates and nearly one in six males suffers from mental illness —far higher than the general population estimate of 6 percent. Even after a substantial drop from 1990 to 2010, the national jail suicide rate is still three times greater than in the general population.
Jail officials and advocates statewide have been seeing more inmates with mental illness in recent years, although no specific estimates are available.
The problems in jails are often overshadowed by those in prisons. But mental health needs may actually be greater at these facilities, where inmates face uncertain fates, more stress and fewer services.
And jails aren’t only for short-term detention — some inmates end up spending years there if they have consecutive sentences or their trials are delayed. Walworth County Jail Superintendent Howard Sawyers said his county almost always has inmates who have passed the one-year mark, some staying two or three years.
Since 2003, 52 Wisconsin county jail inmates have taken their own lives. According to a Wisconsin Center for Investigative Journalism calculation, Wisconsin’s jail suicide rate in recent years was 40 per 100,000 inmates, slightly higher than the 2007 national rate of 36.
According to Dean Meyer, executive director of the Badger State Sheriff’s Association, state-run prisons are “much better equipped” to provide health care.
“A prison has their own dentist, their own doctors and their own nurses. And for the majority of county jails, they contract that service out, and the providers only come when needed,” Meyer said.
Services few for mentally ill
Mental health care varies greatly from county to county, and it can be thin at many county jails.
For example, while inmates in Sheboygan County’s 286-person jail shared 40 hours a week of mental health services, those in comparably sized Marathon County received mental health services for “crisis situations.” According to a December 2011 inspection report, the jail planned to begin offering mental health services 20 hours a week.
Lawmakers may examine jails
Jails are required by a state law dating back to 1987 to provide the DOC with annual reports on mental health care services. Since 1989, the law has required the DOC to summarize and relay those findings to the Legislature. But the DOC acknowledges it has not been regularly asking jails for the reports, and has not prepared summaries for the Legislature, the Center found.
It’s been five years since the Baraboo News Republic newspaper pointed out that the reports weren’t being done. In 2007, DOC officials said they would address the shortcoming. This month, Dietz said her office “is going to take another look at that statute.”
Bies and a fellow lawmaker, Sen. Kathleen Vinehout, D-Alma, said they are concerned about mental health care in jails, but lack the information to tackle the issue.
Vinehout, a member of the Senate Committee on Education and Corrections, said she couldn’t get information she wanted from the DOC about the types of inmates and the care they need. She believes the agency should strengthen its oversight of local jails to help inmates —and the general public.
“We want to be able to understand what’s happening and do what we can to lower the cost and make Wisconsin a safer place,” Vinehout said.
This project was produced in collaboration with the Investigative Journalism Education Consortium, ijec.org. The nonprofit Wisconsin Center for Investigative Journalism () also collaborates with Wisconsin Public Radio, Wisconsin Public Television, other news media and the UW-Madison School of Journalism and Mass Communication.
All works created, published, posted or disseminated by the Center do not necessarily reflect the views or opinions of UW-Madison or any of its affiliates.
SIDEBAR
Gaps remain in jails’ suicide prevention
By Tegan Wendland, Rory Linnane and Kate Golden
Wisconsin Center for Investigative Journalism
Brenda Mombourquette tried three times to kill herself while in jail custody. She was not on suicide watch at the Monroe County Jail, despite a doctor’s recommendation. Her final attempt, in November 2002, left her with serious brain damage.
Her sister sued the jail on Mombourquette’s behalf, accusing the jailers and nurses of deliberate indifference to protecting Mombourquette. Her lawyer claimed the Cashton woman had reported a night shift supervisor’s sexual assault of another inmate with mental illness, before that supervisor failed to follow the doctor’s orders to put Mombourquette on suicide watch. The jail, which had been repeatedly criticized in state inspection reports for its lack of suicide prevention efforts, agreed to pay a maximum of $13 million.
Since 2003, 52 Wisconsin county jail inmates have taken their own lives. Department of Corrections jail inspector Nancy Thelen said that generally, Wisconsin’s 72 county-run jails are doing “a very good job with their suicide watches.”
But a Wisconsin Center for Investigative Journalism review of the counties’ most recent jail inspection records found that at least one-third of them had, like Monroe County, been cited for problems with their suicide prevention efforts.
Even the La Crosse County Jail, which an inspector described as “a leader and model for other jails throughout the state and nation,” was not properly documenting actions relating to potentially suicidal inmates, the report found.
In a 2009 DOC survey of jails about their mental health services, less than half of the 47 respondents said inmates were routinely screened by a registered nurse or mental health professional.
Suicides sometimes hard to predict
Mombourquette’s suicide attempt came after warnings. But sometimes inmates don’t betray their suicidal tendencies. An October hanging at the Winnebago County Jail took Sheriff John Matz by surprise, he said.
“He exhibited no suicidal behavior,” Matz said. “That was one that nobody saw coming, including his parents. I don’t know what it was, other than fate.”
Roy Sindelar of Weyauwega wasalive when officers found him, but their efforts to resuscitate him failed. Citing a demand for mental health services, Matz said he is requesting an increase in counseling services from 30 to 40 hours a week.
In a Feb. 15 inspection of the Winnebago County Jail, Thelen had recommended that the jail examine its mental-health services to ensure they were adequate.
What the Monroe County Jail did in response to Mombourquette’s suicide attempt 10 years ago is unclear.
Mombourquette’s case was one of three successful lawsuits that alleged mistreatment of inmates with mental illness at the Sparta jail. Another inmate killed himself in 2008, according to the DOC. And a June inspection found “minor” problems with officers failing to check on potentially suicidal inmates at proper intervals.
The Monroe County Jail administrator did not respond to multiple messages over two weeks seeking comment.
In at least three county jails —Adams, Crawford and Green —inspectors noted lack of suicide prevention measures for the sixth year in a row. Thelen said inspectors work with deficient jails to improve their procedures.
“Occasional lapses may be inevitable,” countered Larry Dupuis, legal director of the American Civil Liberties Union of Wisconsin. “But repeated warnings of deficient suicide prevention procedures suggest these jails are a ticking time bomb.”
But placing inmates on suicide watch is far from ideal, because it may exacerbate their mental-health problems. Suicidal inmates may been isolated. And most suicides are hangings, so jail officials must remove anything that could be made into a noose, leading to sparse accommodations.
Sam Kalinoski of Madison said he was isolated on suicide watch for three days in the Dane County Jail while incarcerated four years ago for violating terms of his probation. Kalinoski said he had only a blue vest to sleep in and none of his medications for bipolar disorder. He called the experience “disturbing,” with “crazy people around me, making noise in nearby rooms.”
Dane County Jail officials declined to confirm or deny Kalinoski’s account.
“You watch the person 24 hours —but you’re also subjecting the person to great distress in doing so,” said Ron Honberg, policy and legal director for the nonprofit National Alliance on Mental Illness. “The ultimate solution is to significantly decrease the number of people with mental illness incarcerated.”
Yet suicide watch is an essential prevention tool for jailers.
Said Mombourquette’s attorney, Michael Devanie: “Suicide watches are extremely effective -- if they do them.”
The nonprofit Wisconsin Center for Investigative Journalism () collaborates with Wisconsin Public Radio, Wisconsin Public Television, other news media and the UW-Madison School of Journalism and Mass Communication.
All works created, published, posted or disseminated by the Center do not necessarily reflect the views or opinions of UW-Madison or any of its affiliates.