A CALL FOR HELP ; Jails wind up being treatment centers by default – often in Jacksonville

The largest provider of mental health services in Northeast Florida requires the patient be brought in with handcuffed, fingerprinted and put into a jail cell.

It has an $89 million budget and is called the John E. Goode Pre- Trial Detention Facility - or the jail. After staffing, the largest cost for the jail is inmate health care. And the largest cost associated with jail health care is medication.

Jacksonville Sheriff John Rutherford said of about 3,000 inmates incarcerated at the jail daily, about 300 of them have a severe and persistent mental illness that requires medication. It's estimated that 60 percent to 80 percent of the inmates across the country have a diagnosable mental illness, he said.

Rutherford, St. Johns County Sheriff David Shoar and Candace Hodgkins, chief executive officer at Gateway Community Services, spoke Wednesday on a Jacksonville Community Council Inc. panel about issues arising from the criminal justice system being the default system to care for the mentally ill.

About 33,000 calls for service relating to mentally ill people in Jacksonville were logged in the last three years. Most calls resulted in involuntary hospitalization under the state's Baker Act. The calls involved 21,428 people. Police saw some of them dozens of times. One person racked up 83 mental health contacts with police.

Rutherford said the numbers are indicative of a system that doesn't work. "A jail is not a therapeutic community," he said. "It's never going to be. It can't be and that's why they need to receive treatment in the community and not in jail."

Shoar said when he joined law enforcement 33 years ago services were available that are no longer provided today. One problem is money, but not just pure dollar amounts, he said.

"When we get them [dollars] we need to figure out how to spend them," Shoar said.

Shoar questioned how the state and federal money is allocated. He pointed out that Flagler and Volusia counties receive $20 million for substance abuse and mental health services while St. Johns receives $2 million.

"Together they have more people than St. Johns, but they don't have 10 times as many."

For-profit companies also are issues.

Rutherford said some mental health services that are provided by for-profit companies shouldn't be.

"Some of the worst cases we get in the jail is mentally ill folks from an ALF [assisted living facility] who have left and haven't been reported missing," Rutherford said. "... That's a problem, folks. That needs to stop."

He also said some Duval facilities advertise for other jurisdictions to send their mentally ill here. He called the system driving this practice broken. That system allows Social Security insurance benefits and other funds received by the patient to be paid to the caregiver.

"They [patients] are out on the streets for months until they end up at my jail ... but nobody reported them [missing], nobody is looking for them because their check is going to the representative payee, and you know what, they get that check whether they are there or not," Rutherford said.

Also, Rutherford said the structure of the statewide mental health system funnels people with mental health issues to Jacksonville. He said many of the mentally ill inmates housed at Union Correctional Institute and Florida State Prison in Raiford wind up in Jacksonville.

Northeast Florida State Hospital in Macclenny does a great job serving as the Middle District of Florida's mental health hospital but it also feeds mentally ill patients into the Jacksonville area, Rutherford said.

"So we need to look at how this statewide system is funneling them [the mentally ill] to Jacksonville," he said.

Hodgkins presented statistics from the Department of Juvenile Justice.

There are about 62,000 children in Duval County schools and about 4,200 arrests of Duval students with 476 of those happening at school.

Children are screened for mental illness and substance abuse issues at detention facilities, she said. Of those students, 2,140 were directed to have a full mental health assessment. But the problem is the Juvenile Assessment Center currently has one person processing the screenings.

"Our assessor can see 35 percent of the youth that need an assessment at the Juvenile Assessment Center," Hodgkins said. "So we have all these youths falling through the cracks because we don't have the resources to pay for more assessors."

Part of that problem will be addressed with a recently awarded grant from Florida'sDepartment of Children and Families, which will allow the center to hire three more assessors.

She said the good news is statewide youth arrests have gone down 36 percent the past eight years. She said civil citations help cut youth arrests.

Hodgkins said research shows that if children with mental health issues receive treatment in elementary school, "you have a better chance of getting the family engaged and the youth engaged and getting treatment."

"But like a cruise ship or a big ship in the Navy, it takes a long time to make that turn and go in a different direction," she said.Derek Gilliam: (904) 359-4619