Kentucky voices

Starving for help; Stop revolving door of mentally ill in prisons

May 11, 2014 

"Kentucky Inmate Starved to Death in State Penitentiary," the headline read.

As a mental-health advocate and mother of a son with serious mental illness, I am outraged that an inmate starved to death in the Kentucky State Penitentiary after repeatedly reporting the need for medication. Not only was he denied medication that could have saved his life, but it was also reported that he was later denied medical intervention when he was within hours of death.

Enough. Enough. Enough.

I sat down with my laptop to chronicle this unbelievably sad story. Then, there they were — staring back at me from beneath the headline — the eyes of 57-year old James Kenneth Embry, the inmate denied treatment who as a result of his hopelessness, starved himself.

I knew those eyes. I had seen them countless times; blue, sad, tired and — just like the others — haunting and penetrating. I see those eyes every day in many who are poor, severely mentally ill, possibly with a co-occurring substance-abuse disorder, and struggling mightily.

I see his eyes when, on rare occasion, I can interact with my son.

My son, like many living with severe mental illness, has come in contact with the criminal justice system, both times as a direct result of the untreated symptoms of schizophrenia. Luckily, he had not alienated his entire family and was able to have interventions that worked to return him, with the help of the judge, to lifesaving treatment.

Treatment is lifesaving. I don't mean just swallowing-a-pill treatment. I mean an entire continuum of care, which includes emergency care and crisis intervention, hospital care, ongoing outpatient therapy, housing, access to state of the art medication, supported employment and programs that build recovery skills.

Individuals with severe mental illness present many complicated issues to jails and prisons — problems that result in senseless death and avoidable tragedy.

Among these problems, according to a 2010 report sponsored by the National Sheriff's Association, are:

■ Mentally ill offenders are "frequent flyers" in the corrections system. Since the county and state corrections systems are separate from, and usually not coordinated with, the mental-health system, most mentally ill persons leaving jails and prisons receive little, if any, psychiatric aftercare. Consequently the recidivism rate is thought to be higher than it is for other released prisoners.

■ Mentally ill inmates cost more for a variety of reasons, including but not limited to, increased staffing needs, medications and recidivism.

■ Mentally ill inmates stay longer. Many find it difficult to understand and follow jail and prison rules. In one study, mentally ill inmates were twice as likely (19 percent versus9 percent) to be charged with facility rule violations.

■ Mentally ill inmates are often major management problems because of their impaired thinking.

■ Mentally ill inmates are more likely to commit suicide. Multiple studies have shown that approximately half of all inmate suicides are committed by inmates who are seriously mentally ill. In Kentucky the Telephonic Jail Triage System, used to assess suicide risk among inmates, came about as a result of an alarming increase in jail suicides.

■ Mentally ill inmates are sometimes abused. Men and women who work as correctional officers apply for the job expecting to work with criminals. Many of the officers do not understand, and have little or no training in, how to work with mentally ill inmates.

For the past year and a half, NAMI Lexington has hosted the "Take Down the Wall" Decriminalization Committee in Fayette County. All the panelists were community experts in the recidivism cycle of individuals with serious mental illness who regularly trek from hospital to jail to the streets.

After viewing the documentary, Stopping the Revolving Door, by the Treatment Advocacy Center, which focused on assisted outpatient treatment, committee members discussed the possibility of starting a mental health court in Fayette County.

Fayette County has many problem-solving courts such as drug court, juvenile court, veteran's court and family court. Hopefully, in the coming months a voluntary mental health court will be implemented through cooperation with the Department of Public Advocacy, the Fayette County Attorney, District Judges Kim Wilke and Julie Goodman, bluegrass.org, Fayette County Sheriff's Office and Lexington Police as well as many local agencies that serve the homeless and other mentally ill in Lexington.

Many recent studies have shown that spending more money on appropriate treatment in the community equals fewer mentally ill individuals in jails and prisons.

The federal government can also help solve this problem by comparing the states and connecting the existing federal block grants to better results.

It would also be helpful to abolish the "institutions for mental diseases" Medicaid restriction of payment for psychiatric inpatient care for individuals over 18 and under 65 years of age.

NAMI Lexington believes that any state can solve this problem if it has the political will to fully fund and invest in a community-based continuum of care that includes proven evidence-based programs like specific and targeted assisted outpatient treatment and mental health courts.

Kelly Gunning is director of advocacy and public policy for the National Alliance on Mental Illness Lexington

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