LANSING — Unpredictable behavior, irrationality, confusion, loss of control: all are symptoms of mental illness and signs of drug abuse.
Although the two can be similar, problems of addiction and mental health have long been dealt with separately in county jails, Michigan Sheriffs’ Association Executive Director Terrence Jungel said.
Mentally ill inmates with drug addictions seeking help for their illnesses often are turned away from treatment because of their substance abuse problem and vice versa, Jungel said.
When substance abuse counselors turn away drug addicts because of their mental illnesses or mentally ill patients are turned away because they have substance abuse problems, Jungel said the system is working against itself.
“You’ve got two people pointing fingers at each other,” he said.
Gov. Rick Snyder created a 14-member Mental Health Diversion Council under the Department of Community Health to better manage inmates with mental illnesses and drug addictions. That step, Jungel said, could lead to more jails creating dual diagnosis programs, or at least could better equip them for dealing with mentally ill, drug-dependent inmates.
“The more mental health inmates you have, the more problems you have with your population,” Jungel said. “Nobody should be in jail because they’re mentally ill, but just because you’re mentally ill doesn’t mean you don’t belong in jail.”
About 30 percent of county inmates are mentally ill, Jungel estimates, and many were misusing their prescribed medications or turning to illegal substances to self-medicate prior to their arrests.
Community Health public information officer Angela Minicuci said while it might seem odd to treat mental health and substance abuse separately, part of the reason for Snyder’s directive is because mental health is in the public spotlight.
“It’s easy to say now that they go hand in hand,” she said. “But in the past not a lot was known about mental health, so they would just look at the substance abuse and treat the addiction without considering the mental health aspects.”
The Mental Health Diversion Council has not yet developed a statewide solution for the problem, Minicuci said, but at the local level, some community mental health boards are tackling both issues simultaneously.
Each sheriff’s department is autonomous in how it deals with mental health and substance abuse.
Macomb County, which has one of the state’s largest jails with 1,458 beds, has had a dual diagnosis system for years, jail administrator Michelle Sanborn said.
Of the about 1,200 inmates in the jail, about 82 percent are substance abusers and 34 percent have a mental health problem, Sanborn said. Most mentally ill inmates were self-medicating through drugs and alcohol before being incarcerated, she added.
All incoming inmates are screened for mental illness and substance abuse, Sanborn said, and then may choose — or are forced by court order — to join a treatment program that suits their needs.
“Usually, if you’re treated by two different programs, the two aren’t on board to help the one person,” she said. “Continuity is care. If you have a heart disorder and cancer, a hospital treats you for both.
“It’s always better when you treat the person as whole.”
The county pays for most of these programs. Others are handled by Macomb County Community Corrections, a rehabilitative program aimed at reducing the number of inmates and funded by the Department of Corrections, the U.S. Bureau of Justice Assistance and the county.
Between 20 and 30 percent of inmates in the Ottawa County Jail have mental health problems, jail administrator Lt. Steve Baar said. About a quarter to a third of those with mental illnesses are categorized as “severe and persistent.”
The 460-bed facility assists mentally ill patients by providing a case manager, and a jail diversion program relocates eligible inmates to a secure mental health facility. However, Baar said few options are available for inmates with substance abuse problems, in part because most stay only a few months.
“Many people look at the correctional facilities just as a place to clean up,” he said. “In many cases they are afraid of leaving because they don’t want to fall back into that lifestyle on the outside.”
Baar said the jail does what it can to work with inmates with mental health problems despite not having formal programs.
“I suspect that we have been dealing with it, but we haven’t been dealing with it under a formal title,” he said.
Crawford County Jail, a 56-bed facility in Grayling, allows some inmates to attend Alcoholics Anonymous meetings but provides no other assistance to treat other types of substance abusers, jail administrator Lt. Randy Baerlocher said.
Crawford County is part of a six-county public mental health authority, Northern Lakes Community Mental Health, which receives state funding. It also includes Grand Traverse, Leelanau, Wexford, Missaukee and Roscommon counties.
Baerlocher said a Northern Lakes mental health worker routinely visits the jail and it has professionals who respond to urgent mental health situations.
“Unlike the bigger counties, we’re able to work with the agency to address our mental health population,” he said. “These bigger counties have been forced to hire their own, budget their own mental health services.”