This year’s annual legislative mental health breakfast addressed why there are so many people with mental illness in prison and what North Carolina can do to change that.

By Rose Hoban

North Carolina has about 36,900 people incarcerated in state prisons and, according to numbers from the state Department of Public Safety, at least 14 percent, or about 5,100, of those people have a severe mental illness.

Compared to the number of psychiatric beds available in the state, about 2,700, it’s clear that North Carolina’s prison system houses more patients with mental health problems than the health care system, said David Guice, who manages adult corrections and juvenile justice for DPS.

David Guice, head of both adult and juvenile services for the Department of Public Safety, told those gathered at Saturday’s breakfast that the prison system needs to focus more on incentivizing good behavior and treating mental health issues than simply locking people up. Photo credit: Rose Hoban

“Our jails and our prisons have become de facto mental health hospitals,” Guice told about 350 legislators, mental health consumers and people who work with and for them at Saturday’s 38th annual Mental Health Legislative Breakfast, held at the Friday Center for Continuing Education in Chapel Hill.

He said this means the most vulnerable individuals with mental illness who receive support are frequently placed in correctional facilities. And he admitted that a disproportionate number of inmates in the prison system are people of color.

Two years ago this month, Michael Anthony Kerr, a man with a persistent mental illness incarcerated in a Taylorsville prison, died of dehydration after being held in solitary confinement and denied water.

Now, Guice told the gathering, he’s making changes to improve care and services for people with mental health problems in prison. And he said he’s committed to breaking the cycle of people with mental health issues ending up behind bars.

Secretary of Health and Human Services Rick Brajer makes a point at the Mental Health Legislative Breakfast Saturday, while Rep. Verla Insko (r) looks on. Photo credit: Megan Griffin

Treatment slowly coming

Guice, a former Republican member of the state House of Representatives who was first appointed by Democratic Gov. Bev Perdue, worked in the prison system before becoming a Transylvania County commissioner. He said that when he first worked in the prisons, he saw the failings of a strictly punitive system.

“We built … prisons to be able to control people, not to address any programmed need, not to address changing behavior,” he said. “We assume just because we placed them in that controlled setting, that somehow things would improve and then they would be released back into the community.”

But Guice said that has not worked. He said it’s time for incentivizing and rewarding positive behavior, and also time to get help for all those with mental health diagnoses.

Troy Manns, who works with Orange County-based Freedom House Recovery Center, told his story of leaving behind a life of substance abuse at the Mental Health Legislative Breakfast Saturday morning. Photo credit: Rose Hoban

He got some assistance from the General Assembly in last year’s state budget, when legislators appropriated funds to open eight mental health units in the prison system. Four of those units will come online this year and four in 2017.

Guice also said that by moving those with misdemeanors out of prisons, placing more people on parole and lowering caseloads for parole officers, they were able to reduce readmissions to jails, close facilities and save more than $192 million since passage of the Justice Reinvestment Act in 2011.

But, he said, “We’ve only reinvested $32 million into the system. That’s not enough.”

And while Guice thanked the legislators who were in attendance at the event for last year’s funds, he also told them, ”If we do not provide the level of funding as we move forward to address re-entry issues, and programming issues within our prison system and within our communities, if we do not provide the level of funding to address the mental health needs that we face in our system, in a short period of time justice reinvestment will also fail.”

Raise the age

In an unscheduled appearance at the breakfast, North Carolina Supreme Court Chief Justice Mark Martin told the crowd that he was looking to initiate training for all justice system officials in Mental Health First Aid in order to identify people with mental health needs earlier in their court process.

“We want to make sure we can put ourselves into a position where we can divert individuals for treatment rather than imprisonment in the system,” he said to applause. “By doing so, we also hope to decrease the stigma.”

Martin, who has been co-chairing the Governor’s Task Force on Mental Health and Substance Use, said he’s also recommending that the justice system create “crisis navigators” to help families and consumers make their way through the system.

But the strongest statement Martin made was about young people in the corrections system. North Carolina remains one of only two states that routinely charge 16- and 17-year-olds as adults. New York is the other.

Panelists at Saturday’s Mental Health Legislative Breakfast included (l to r): Commissioner David Guice, Rep. Verla Insko (D-Chapel Hill), Rep. Graig Meyer (D-Hillsborough), Rep. Marilyn Avila (R-Raleigh), Gary Junker, head of mental health services for the Dept. of Public Safety and Rep. Pat Hurley (R-Asheboro). Photo credit: Megan Gifford

“We need to raise the age in North Carolina,” Martin said. “I recently saw the chief judge in New York state, and we looked at each other and said, ‘Who is going to get rid of this archaic practice first?’”

Legislation to raise the age passed the House in 2014, but the bill died in the Senate.

During a panel discussion later in the morning, Rep. Marilyn Avila (R-Raleigh) expressed belief that it would happen during the 2017 long session.

“I feel like this time, with the forces that are behind it, we may even get the Senate to see the light,” she said.

New staff, more training

One question raised during the 90-minute panel discussion was about the role of training prison staff to better handle people with mental health issues.

Guice and his director of behavioral health, Gary Junker, said they’ve been expanding Crisis Intervention Training and Mental Health First Aid for all staff.

“This issue is at the forefront,” said Junker, who told the crowd he meets regularly with leaders from professional mental health organizations, advocates and providers to talk about issues in the prison system and elicit their input.

Rep Graig Meyer (D-Hillsborough), a social worker when not at the legislature, shared his frustration with navigating the state’s mental health system to get help for his teenaged daughter. Photo credit: Rose Hoban

Junker and Guice have also received permission to more quickly hire people. Guice told of an event in early March at which they were able to make offers to 29 new nurses by the end of one day.

“We have been able to hire more of our medical staff in the last year with the new processes than we have in the past,” Guice said.

Rep. Graig Meyer (D-Hillsborough), who has worked as a social worker with the Chapel Hill Police Department, said that in his experience cops find the Crisis Intervention Training to be a huge benefit.

“Those police officers hated to show up at mental health calls because they felt so unprepared and knew that the badge and the gun and the handcuffs were sometimes going to be the least helpful things they could do in the situation,” he said.

CIT remains voluntary, however, and as yet many police and sheriffs’ departments have not yet embraced the training.

“It’s another piece I wish we wouldn’t have to put into statute, to mandate the training,” Meyer said. “There may be a role for the legislature to play in terms of expanding the funding.”

Advocates also complained that it can often take days for people with mental health issues to get their medications once they’re placed in local jails.

Avila expressed surprise and frustration that this was the case, pondering what would happen to her after several days without medication for diabetes.

“I guess my question is, ‘Do we have to legislate that kind of common sense?’” Avila asked to applause.

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