“I’m at a crossroads …” Pat says. “This last bout of drinking tipped me over the edge.”
It’s November 2016, and 53-year-old Pat is living at a St. Paul treatment facility for people who have mental illness and chemical dependency disorders. Before that, he was in jail.
Jail’s not an anomaly for Pat, who’s cycled in and out of the criminal justice system so many times he’s lost count. But this time he’s receiving a different set of supports through Hennepin County’s Criminal Justice Behavioral Health Initiative.
Since its launch in 2014, the program has worked to quickly identify people in the criminal justice system with mental illness and co-occurring chemical dependency disorders -- like Pat -- and to make it easy for them to access appropriate care.
The Hennepin County Behavioral Health Initiative works to quickly identify people in the criminal justice system with mental illness and co-occurring chemical dependency disorders and to make it easy for them to access appropriate care.
Each day close to 100 people are booked into Hennepin County’s jail, an 839-bed detention center in downtown Minneapolis. That’s 36,000 per year.
When local leaders looked at who was being booked, two themes emerged:
First, those being booked have high rates of recidivism (i.e., they've been booked before). Though most aren't in jail long -- the average stay is seven days -- three-fourths have been booked previously (and nearly half have been booked in the past year).
Second, those being booked have a disproportionate rate of untreated mental illness and chemical dependency disorders. Twenty percent of the jail population screen positive for a major mental illness. And close to one-third have mental health indicators (as identified by a psychiatric nurse at intake). Additionally, 60 percent are receiving publicly funded medical assistance.
Stats like these prompted the question:
If we can more readily identify people with mental health and chemical dependency disorders while they’re in jail, and connect them to supports, can we mitigate the county’s “revolving door” of incarceration and save taxpayer dollars?
The Hennepin County Criminal Justice Behavioral Health Initiative, now in its third year, is testing different strategies and collecting data to find the answer.
Under the Criminal Justice Behavioral Health Initiative framework, every person who’s booked into jail is screened for mental illness and chemical dependency disorders using tools like the SAMSHA Brief Jail Mental Health Screen and a jail medical intake form.
Individuals are also screened for their risk to public safety (and their likelihood of returning to jail) – using a Service Priority Index tool.
Those with medium to high behavioral health needs and high risk to public safety (e.g., they’ve been arraigned for serious felonies or domestic violence) remain in jail -- but they are transferred to a secure mental health unit to receive appropriate care.
But those like Pat -- with medium to high behavioral health needs and low public safety risk (e.g., they’ve been arraigned for crimes like trespassing, loitering, or open bottle) -- are connected to supports like the Integrated Access Team Program, the Local Competency Restoration Program, and/or the Mental Health Pre-trial Release Program.
Program participation is voluntary.
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Pat’s foray into alcohol use began in high school.
Despite getting caught up in “hardcore hard booze,” he managed to graduate, get married, and hold jobs in restaurant management, metal finishing, and civil service.
Eventually though, it all went south.
Pat racked up DWIs and domestic altercations (and with them, court dates and jail time).
He was admitted to treatment facilities and sober houses, but relapsed each time he was released. During this period, he was also diagnosed with bipolar disorder and PTSD. According to the Substance Abuse and Mental Health Administration, this is common; about 40 percent of people with substance abuse also have a mental illness. Nonetheless, Pat’s treatment for alcoholism did not always include mental health care.
In the span of several years, he lost his job, his marriage, his relationship with his mother and sisters, and his home.
“I never thought I’d see the day I was homeless,” Pat says. “I was raised upper-middle class. My wife and I were very [financially] comfortable …”
On his first holiday at a shelter, “The reality hit me,” says Pat. “I’m at St. Stephen’s … Its Christmas Eve and we’re watching a Christmas movie.” He admits that it’s the lowest he’s ever felt.
Around this time, Pat also began having seizures from his alcohol use, and was hospitalized for injuries he sustained while seizing. One hospitalization lasted a month. To avoid additional injuries, Pat took to rearranging his furniture or drinking on the floor.
One memorable seizure startled Pat awake. He thought he was dying, and he instinctively ran toward a nearby alcohol bottle. Mid-drink, he realized the insanity of what he was doing. He set down the bottle, called 911, and was admitted to a detox program. But even that experience was not enough to break his destructive cycle.
“I tried again and again until I burned out all the resources,” Pat says. “My retirement funds. I drank that away and the years went by.”
Pat’s life assumed a routine. He’d get up in the morning, leave whatever shelter he was staying (when he wasn’t in shelter, he’d sleep outside), drink, panhandle for drinking money, drink more, and occasionally have a seizure.
“I never thought I’d flash a sign …” he says of the panhandling. "But the first time I did I got 11 dollars. And I thought, wow, now I can go get a bottle.”
But panhandling wasn’t reliable, and sometimes Pat didn’t have enough money for alcohol. Once, he was so desperate he drank mouthwash.
During this time, Pat continued to have run-ins with the criminal justice system, usually because of altercations he had while intoxicated.
The Hennepin County Criminal Justice Behavioral Health Initiative’s Integrated Access Team (IAT) is made up of social workers, a chemical health counselor, a housing specialist, and a case management assistant.
The team helps program participants develop a plan to link to services in the community and provides them ongoing support in jail and for 90 days post-release.
Each morning the team receives a list of inmates who meet program criteria (i.e., medium to high behavioral health needs and low public safety risk). Then they go into the jail’s housing quads to meet these inmates and inform them of the IAT program and its services. They make sure to stress that participation is voluntary. (If the individual has already been released from jail, they send them a letter with contact information.)
Meeting clients while they’re still in jail is preferable, though, because many don’t have a home address or a cell phone, making them difficult to reach after they’re released.
If an inmate agrees to participate in the program, the team will zero in on their medical, behavioral health, and social service needs. Sarah Schachtele, an IAT social worker, says it’s important to meet clients where they’re at and to listen to what needs are most important to them now. For some of her clients, that’s been replacement eye glasses, replacement dentures, or a new Minnesota ID.
In August 2016, Pat’s name came up on Sarah Schachtele’s list. When they first met to discuss his needs, Pat asked Sarah for new eyeglasses. (He’d accidentally stepped on his while sleeping outside in a rainstorm and was having a hard time seeing the board during chemical dependency treatment.)
Schachtele also helped get some of Pat’s outstanding bench warrants transferred to the Hennepin County Mental Health Court – a 12 to 18 month voluntary program that serves defendants with serious mental illness and/or co-occurring disorders. The program offers services like one-on-one judicial reviews, probation supervision, medication monitoring, and substance abuse and mental health counseling.
Through the program, Schachtele also helped Pat connect to a provider at the Hennepin County Mental Health Center.
“Pat’s motivated and he’s resourceful …” says Schachtele. “We provide these wrap-around services to continue to get him where he wants to go.”
Reflecting on his years in treatment facilities and sober houses, Pat says, “I realized that [mental health care] was the thing I was missing the whole time. I want to continue that.”
Then, matter-of-factly, “I either beat this [alcoholism] or I die.”
Written by: Lori Imsdahl