Falling Through The Cracks

ust after lunch in the Shelby County Jail, some bare-chested inmates on the medical floor peer through the bars of their cells. Several call out as we tread

carefully through the K-pod, trying not to slip on the yellowish soup they've spilled all over the floor. One young man stands stiffly against the wall of his dark cell, naked, unkempt, and mesmerized by something at his feet.

When we reach the last cell, a young man comes to the window. John Perry, the jail's mental-health coordinator, asks him how he's doing. The man sticks his arm through the bars to show Perry the railroad tracks of fresh stitches stretching across his left forearm. Older scars from where he slashed himself repeatedly extend from wrist to shoulder.

Like a growing number of people in this jail, the young man is a repeat offender and a mental patient. Some mentally ill people are jailed for felonies. A great many others, however, serve time for misdemeanors, such as disorderly conduct and trespassing -- minor crimes they probably would have never committed had the mental-health system not failed them.

Since the state privatized mental-health care under the TennCare Partners Program last year, the number of mentally ill people charged with misdemeanors in the jail has grown. Under the new program, mental-health centers have had a hard time keeping up with Shelby County's non-institutionalized, mentally ill population. In order to stay open, they have cut services and laid off employees. Now what mental-health advocates have feared most has come true: The mentally ill are falling through the cracks in the system and ending up in the jail.

"They didn't believe us at first," says Perry, who is responsible for finding mentally ill inmates and making sure they receive the proper treatment. "They let the problem grow. Now it's going to be even harder to control."

The jail, built to house 1,500 people, frequently holds more than 2,500. Steve Campbell, director of Correctional Medical Services, the private company that has administered the jail's medical services since January 1996, says there are more than 500 mentally ill people in the jail every day, many of whom are scattered throughout the general jail population.

"We try to maintain some form of control over where they are, but as the jail becomes overcrowded, the number exceeds our resources," Campbell says. "The risk or danger is that people could get lost in the system."

On his daily trips through the jail, Perry checks on mentally ill inmates he knows about and attempts to find others who were not identified at intake. He cannot walk past a pod without inmates calling his name. On this trip, several men give him slips of paper with the names of their case workers and medications written on them. Some inmates just want to talk to him.

"I'm cracking up in here," says one man, compulsively dusting the bars separating him from Perry with a rag. "I was on something when I was a teenager. My sister's looking it up."

The county has only recently acknowledged the problem.

Nancy Lawhead, Mayor Jim Rout's special assistant for health policy, says more than 500 names of inmates taking psychotropic drugs on one day in June are being cross-checked with mental-health centers to find out how many were clients and how they ended up in jail. She says many were former clients of Spectra Behavioral Healthcare Systems, formerly the county's largest provider of mental health services, which closed in January because of a funding crisis resulting from the TennCare Partners Program.

The current jail situation suggests the other mental-health centers have not picked up Spectra's former clients as the state had hoped. But Lawhead suspects the problem stems from other reasons as well, including an increase in arrests made by the police and sheriff departments.

While the causes have changed somewhat over time, advocates for the mentally ill have been fighting the jail-as-safety-net problem for almost a decade. In 1989, Midtown Mental Health Center found the "severe and persistent" mentally ill population to be less than 3 percent, lower than jails in many other urban areas. The Memphis Police Department's Crisis Intervention Team, a group of officers specially trained to recognize mental illness, usually take individuals in crisis to The Med. From there, they can be committed to a mental institution such as Memphis Mental Health Institute or released once their conditions stabilize.

This keeps the most severely mentally ill people out of the jail much of the time. But there are other mentally ill populations the officers tend to miss. There's the group that does not follow treatment plans or take prescribed medication, another group that abuses alcohol or drugs, and still a third group that does both.

Mental illness can be so camouflaged by alcohol and drugs that the police do not recognize mentally ill people who are under the influence. Or mental patients may not be exhibiting behavior that warrants emergency commitment to The Med's psychiatric emergency room at the time of arrest.

To address the issue, the county has applied for a grant from the U.S. Department of Justice that would enable it to reduce the number of people jailed for misdemeanors committed because of their mental illness. Lawhead says the grant would establish a system for recognizing this population, getting them back in treatment, and keeping them from the jail. The details of the plan should be forthcoming in the next few days.

"I think this problem can be addressed," Lawhead says. "The mental-health centers used to have a good liaison program with the jail. If they could do it before, they could do it again."