On any given day, about 5,000 inmates are held in Dallas County’s Lew Sterrett Justice Center. A third of them have some kind of mental illness.
'Jail was meant for people we're afraid of'
“So you have 1,500 people who need some kind of attention other than being in jail,” said Dallas County Sheriff Lupe Valdez.
Valdez has been in office and has run the jail for 12 years, and during that time, she’s said over and over again that jail isn’t meant for people struggling with addiction or mental illness.
“Jail was meant for people we’re afraid of,” she said. “I don’t want to be a mental health hospital. I don’t want to be a medical hospital."
The Dallas County jail is, in fact, the second largest mental health treatment facility in Texas – after the Harris County Jail in Houston. Many of the inmates ended up there as a result of crisis intervention – or mental health – 911 calls. In the city of Dallas alone, there were about 14,000 of these calls in 2016 – up 2,000 from the year before, according to the Meadows Mental Health Policy Institute.
Police officers are typically the first to respond to these calls, and while some are trained to handle psychiatric crises, Valdez said many aren’t. So often, cops take people directly to jail. Valdez said since jails aren’t properly equipped to care for mentally ill inmates, the majority of them – roughly 75 percent – will cycle back several times in their lives.
“We’ve done jail and criminal justice for hundreds of years a certain way. It hasn’t changed much. It hasn’t rehabilitated people. What we need to do is try and find ways to redirect people so that they don’t continue coming to jail,” Valdez said.
A 'system transformation' for Dallas County
With a $7 million grant from the W.W. Caruth, Jr. Foundation and help from the Meadows Institute, county officials are implementing what they’re calling a “system transformation,” over the next three years. It’s called the Dallas County Smart Justice Initiative.
The goal is to bring fewer mentally ill people to jail, release more of them while they await trial and connect them with services to make sure they don’t come back – all while freeing up resources and manpower so that jails can be jails.
John Petrila is the vice president of adult policy at the Meadows Institute. He said these new procedures aren’t meant to excuse crimes.
“We never want to give the impression that people with mental illness should never be in jail because sometimes folks commit crimes; they happen to have a mental illness; they ought to be in jail; we have to deal with them as a public safety threat,” Petrila said. “What we’re after with this intervention are folks who are mentally ill and engage in conduct that isn’t necessarily intentionally criminal, isn’t necessarily a big public safety threat, and really would benefit from treatment.”
A multi-step intervention
It all starts from the moment a 911 call is made.
“The approach we’ve taken is look at the different points where you can intercept someone and tailor your interventions to that intercept and where people are there,” said Ron Stretcher, Dallas County’s Director of Criminal Justice.
That first “intercept” involves Rapid Integrated Group Healthcare Teams of police officers, paramedics and mental health clinicians dispatched together on 911 calls, trained to de-escalate situations and determine if jail is appropriate. Would a simple doctor’s visit do? Or do they need medication?
If a person does end up going to jail, the first thing that happens is a mental health and suicide screening – then a more comprehensive health assessment. Is this person a danger to the public? A flight risk?
“That’ll result in a bond recommendation to a judge, saying ‘All right, we want to release this person on a personal bond – no money up front. We’re making these conditions of a bond for a connection to treatment,’" Stretcher said.
Then the person gets directed to community-based treatment, with routine followups, which Stretcher said are especially important for homeless and low-income patients, who often don’t have access to mental health services. According to research by the Meadows Institute, in Dallas, there are about 4,000 people in poverty deemed “super-utilizers” of jails and emergency services.
Stretcher said those already in jail will also have their cases reevaluated. He said comprehensive programs like these aren’t new nationwide, but it’s fresh territory in Dallas.
“We have specialty courts, diversion programs, and so often they become a ‘check the box that you make sure you do an anger management class or some other kind of class.’ So this is really taking those factors that are driving the criminal behavior and including those as you develop your treatment approaches,” Stretcher said.
Mental health advocates point to “de-institutionalization” as the primary cause for why so many people with mental illness are homeless or behind bars. De-institutionalization began in the 1950s and involved first shutting down long-stay public psychiatric hospitals in favor of community health services. By the 1980s, federal funding was slashed for those community facilities.
Community health needs to be the priority
Some question if this is truly the “system transformation” officials hope it will be.
Joe Powell is the President and CEO of the Association of Persons Affected by Addiction. His group would be the “final intercept” – helping rehabilitate those with mental illness or addiction problems. Powell said community health and peer resources shouldn’t be the last element of the process.
“Anytime that you put clinical first, that’s the old model,” Powell said. “Why don’t we at least make peers part of the team at the beginning? Because I think the people need to see recovery and people in recovery before, during and after.”
Powell said aftercare is usually an afterthought, when really it’s the bulk of a person’s recovery, the most critical factor in whether someone will end up back in jail or the ER. He knows this firsthand. He was once an addict himself.
“I can’t relate to the social worker or the clinicians or the paramedic, but someone who says ‘Hey my name is Joe, and I’m in recovery myself from drugs and alcohol, and I have a mental health challenge. I know exactly what you’re going through,’” Powell said. “That connection, that early connection, that we’re in this together and I’m here to walk with you and I’m not going anywhere.”
County leaders believe the new system is a start with room to grow and improve. Right now, it’s about making sure police officers and jails focus on public safety – and giving those with mental illness a chance at real recovery.