County jails are unintended fallback for people with mental illness

Alexander Shur, Jackson Hole News&Guide via Wyoming News Exchange
Posted 10/15/21

Dennis Gross is sitting in the Teton County Jail, where nearly everyone involved in his case agrees he shouldn’t be.

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County jails are unintended fallback for people with mental illness


JACKSON — Dennis Gross is sitting in the Teton County Jail, where nearly everyone involved in his case agrees he shouldn’t be.

This isn’t his latest run-in with the law or the first time he’s been ordered to go to the Wyoming State Hospital. Nor is it the first time he had to wait, according to county officials and mental health experts, far too long for his evaluation or to go to the hospital.

Five years ago, Gross, who has been diagnosed with bipolar disorder and alcohol dependence, was in a similar position: He waited for a state hospital bed for four months sitting in the Teton County Jail after being charged with touching a girl’s leg.

He isn’t alone. Jails and prisons have been overwhelmed by people with mental illnesses for years, Teton County officials say.

“We’re using our jail as dorm space for people like Dennis, and the criminal justice system as a whole is being used to warehouse the mentally ill,” said Elisabeth Trefonas, his attorney and Teton County public defender.

Today, as in 2016, Gross sits in a jail with no staff psychiatrist. There is a nurse practitioner who can prescribe medication, but that nurse is there only on demand. There is also a team of nurses on staff who cannot prescribe medication, but otherwise, people in the jail are attended to by Teton County Sheriff’s Office deputies who Sheriff Matt Carr said don’t have adequate training for people like Gross.

Rather than an anomaly, Gross’ case represents a routine result of a mental health system that is overwhelmed and frequent witness to funding cuts. And he is an example of how the criminal justice system, and especially county jails, fills the spaces left vacant by the lack of mental health infrastructure in Wyoming.

In early July the Teton County Prosecutor’s Office alleges, Gross started a fire along West Gros Ventre Butte. When firefighters responded, Gross allegedly obstructed them by standing in the way of the only road with access to the fire, according to an affidavit signed by Teton County Sheriff’s Office Deputy Bret Bommer.

Gross continued blocking access as firefighters asked him to move and honked their horn at him, the affidavit states. Carr then placed Gross under arrest for preventing the extinguishment of the fire, negligently burning the hillside, violating the county fire ban and interfering with a firefighter.

At his initial hearing, Gross appeared shirtless and didn’t seem coherent. On July 9, Teton County Circuit Court Judge James Radda signed an order to suspend proceedings and have Gross evaluated within 30 days of the order, court files state.

That evaluation, Radda said, would include detailed findings on Gross’ mental health condition; an opinion on whether he has an illness or deficiency, and its probable duration; and a recommendation on whether he should be held in a designated facility for treatment pending determination on whether Gross is fit to proceed.

On July 15, Radda signed an order for a psychiatrist from the Wyoming State Hospital to evaluate Gross at the jail on an outpatient basis. It would be far easier and less time-consuming than if Gross were to be evaluated at the state hospital, for the facility wouldn’t have an open bed space for months.

So, Gross waited.

On Aug. 3, Gross sent a letter to the court promising to leave Teton County, where his criminal history is long, and head to Green River: “I will never come back to Teton County or the Town of Jackson,” it read.

On Aug. 16 the state hospital requested a 30-day extension to evaluate Gross. On Aug. 30, nearly two months into Gross’ stay at the jail, the court granted it.

Somewhere in between, Gross had not cooperated with his evaluator, exacerbating the need for the extension. In any case, that extension wasn’t surprising to Trefonas, who represents Gross in this case and has represented dozens of clients who have waited extensively for evaluations.

“In my cases in the public defender’s office, extensions past that 30-day deadline are the norm,” she said.

Finally, on Sept. 24, Radda ordered Gross to go to the Wyoming State Hospital based on the report that stated he lacked the mental fitness to proceed in court.

Gross had spent two and a half months in the Teton County Jail by that point. He spent most of that time waiting for an evaluation to determine whether he had a mental illness or deficiency that would make him unfit to proceed in court. The deadline for that evaluation is 30 days.

But there was no space, so Gross remained in jail.

  1. Neil Gowensmith, an associate professor of psychology at the University of Denver who researches public forensic mental health systems across the country, said Gross’ case of waiting extensively and not receiving adequate care isn’t unique.

“It’s not an unfamiliar story at all,” he said. “It’s a sad and tragic one and one that can be fixed, but it’s not uncommon.”

According to a 2017 U.S. Department of Justice study, 37 percent of people incarcerated in prison and 44 percent of people incarcerated in jail have been diagnosed with a mental health disorder. The most common disorders are major depressive disorder, bipolar disorder, personality disorder and post-traumatic stress disorder.

Additionally, about 1 in 7 people incarcerated in prison and 1 in 4 people incarcerated in jail have had an experience meeting the threshold for serious psychological distress in the 30-day span before they completed the Justice Department-administered survey. The department defines the people meeting that threshold as having a “current mental health problem,” which, in prison and jail, is typically mended with prescription medication. In the general population, about 1 in 20 people meet the threshold for serious psychological distress.

According to Gowensmith, the numbers would be far different under a better health care system.

“What we’re seeing these days is that most people [with mental illnesses], if they had adequate mental health care, would not be in the criminal justice system. A lot of these people are mental illness first, criminal justice second.”

Mental health care is not evenly distributed across the country. In fact, it doesn’t get much worse than Wyoming, according to Mental Health America, a nonprofit that seeks to address the needs of those living with mental illness.

According to Mental Health America’s 2021 report, 23 percent of adults with a mental illness in Wyoming are uninsured, ranking 51st on the list. At the top of the list is New Jersey, where only 2.5 percent of adults with a mental illness are uninsured. The nationwide average is 10.8 percent, totaling 5.1 million adults.

Mental Health America ranks the 50 states and District of Columbia according to the prevalence of mental illness and rates of access to care. The higher the prevalence and the lower the access to care, the lower a state ranks.

In terms of adult access to care in 2020, Wyoming is the 48th worse state; in terms of juvenile access to care, it is 50th. That may partially be because of consistent budget cuts to the Wyoming Department of Health, which manages the Wyoming State Hospital and other mental health care providers.

Just this year, the Legislature cut the Department of Health’s Behavioral Health Division’s funding by $7.5 million, or about 17 percent of the funds it typically receives. Those cuts, Executive Director of the Wyoming Association of Mental Health and Substance Abuse Centers Andi Summerville told Wyoming Public Media, would cause mental health centers to cut inpatient and outpatient care.

In August 2020 the Wyoming Department of Health announced a $116.5 million budget cut for the years 2021 and 2022 because of a “decline in state revenues.” In the Health Department’s Biennium 2021-2022 Budget Reduction Plan, the department proposed a $650,000 budget cut to mental health and substance abuse services and a $153,435 cut to the Wyoming State Hospital budget.

“It’s especially unfortunate when you realize most of our programs serve Wyoming’s more at-risk citizens, including our older residents, disabled individuals and those with very low incomes,” Health Department Director Michael Ceballos said in a press release announcing the $116.5 million in budget cuts.

In June 2021, WyoFile reported, The Greenhouse, a supervised group home in Campbell County serving adults living with mental illness and experiencing homelessness, closed because of Wyoming’s budget cuts.

Reduced budgets aren’t new for the Health Department: There had been a $143 million budget reduction in 2016 as well.

These budget cuts have hit the Wyoming State Hospital. But according to Wyoming Department of Health spokesperson Kim Deti, who corresponded with the News&Guide over email, that’s not the state hospital’s greatest concern.

“It is not a funding issue,” Deti said regarding the cause of the state hospital consistently missing court-ordered deadlines for evaluations. “It primarily revolves around staffing challenges with forensic evaluators and the number of evaluations being ordered at a certain time.” Specifically, Deti clarified, she was referring to nurses, psychologists and forensic psychologists.

Those challenges are exacerbated by the number of evaluations being requested for misdemeanor cases, Deti added.

The Wyoming State Hospital has 72 beds for civil and voluntary patients and 32 beds for forensic patients, or patients in the criminal justice system, Deti said. (Sometimes, forensic patients stay in the civil geriatric unit, Deti said.)

In fiscal year 2020, running from July 1, 2019, to June 30, 2020, an average of 13 people were waiting for an opening at the state hospital to receive forensic inpatient care, and 31 were waiting for forensic outpatient care at any given moment.

In fiscal year 2021, an average of 21 people were waiting for an opening at the state hospital to receive forensic inpatient care and 41 for forensic outpatient care. As Gross’ case shows, those waits can take months.

The waits may soon become shorter, Deti said, when the department adds a skilled nursing facility to the Wyoming Life Resource Center in Lander next spring. When that opens, she said, there should be more available beds at the state hospital by virtue of there being additional space elsewhere.

There are other, cheaper ways to overcome delays at the state hospital, researchers say: local diversion programs.

In an ACLU research paper called Blueprint for Smart Justice Wyoming, researchers suggest mental health diversion programs as a productive, safe and affordable way to move people who are mentally ill from the criminal justice system into supportive community treatment. In a diversion program, people would be in a mental health facility — not jail — where they would remain in the community and receive proper care from specialized doctors and nurses.

“When implemented effectively,” the study reads, “diversion reduces arrests, encourages voluntary treatment in the community, and saves money. Unfortunately, current mental health diversion efforts in Wyoming have proven ineffective because of a lack of adequate up-front funding.”

In the early 2010s, Teton County had a state-funded program that provided four supervised apartments and services for people with mental illnesses, some of whom were in the criminal justice system, said Deidre Ashley, executive director of the Jackson Hole Community Counseling Center.

The program ended when the state pulled its funding, Ashley said, leaving a funding gap that the apartments’ residents couldn’t fill.

“The people who need those services and that kind of level of support, in most cases, don’t have the ability to pay,” Ashley said.

The nearest such facility is in Rock Springs, about three hours away. Ideally, Ashley said, there would be a facility in Teton County again, but the county would have to look for funds elsewhere than from the state.

“As a growing community we need to look at some of the next level of care issues and how we fund it because looking to the state to solve those issues is not working for us right now,” Ashley said. “I do think that we’re going to have to come up with some local solution.”

With no better system, the Teton County Jail and county jails around the country are picking up the slack left by budget cuts, staffing shortages and, according to mental health experts, inadequate state support.

“We can take a snapshot anytime in the history of our jail and point to people that are in there suffering from mental illnesses,” Carr said. “That’s the sad story of a county jail.”

And a county jail isn’t the right place for people like Gross, Gowensmith said.

“For a typical defendant who is mentally ill and awaiting a competency evaluation or awaiting restoration services in jail, county jails usually don’t have the resources and facilities to manage serious mental illness or acute mental illness,” Gowensmith said.

Sheriff Carr agreed: “He should not be in our jail. We’ve had hundreds of people that don’t belong in our jails because of mental health issues.”

Another person waiting for the state hospital is Riley Sills, who allegedly stabbed a man Dec. 30 and was charged with attempted murder in the second degree. Sills pleaded not guilty on the grounds of mental illness, triggering the need for an evaluation, which the court ordered June 18.

The state hospital wasn’t able to complete the evaluation by the required deadline and asked the court for an extension. Teton County District Court Judge Timothy Day granted an extension to Nov. 30.

Trefonas said Gross and people like him need more specific and comprehensive care.

“The jail staff works hard to keep people calm, and they do a good job to treat people humanely,” Trefonas said. “But they’re not psychiatrists.”

Carr said, “He’s not getting the help he needs here, and he displays that with behaviors that challenge both our staff and our facility.”

Gross has destroyed property and stuffed items down the toilet, for example.

As budget cuts and an overwhelmed mental health care system illustrate, though, moving Gross to the hospital is easier said than done.

“Until the system gets fixed in Wyoming and we have more bed space available and there’s funding allocated towards the state hospital, I don’t see it changing,” Carr said.

In his latest hearing, Gross appeared calmer than normal. But he was wearing socks on his hands, and he kept flashing a torn-up piece of paper saying he had evidence he wanted to present.

Due to medical privacy concerns, the Health Department’s Deti couldn’t provide an exact time frame for when a bed might become available for Gross. She could not provide the average wait time for a bed by press time on Oct. 12.

In the meantime, Gross remains in the county jail.