". . .But many leaders still do not appear to understand that serious mental illnesses are brain diseases, not moral failings."
-Care of the Seriously Mentally Ill: A Rating of State Programs, in its summary of Utah programs Kathy Reimherr and Hunter Finch talk to each other a lot."Hunter," she might say, "you need to sit Joe down in front of you and watch him take his medicine. I think he's cheeking it and he's about to blow up."
"We've got a discipline problem," he might respond, "How are we going to handle it?"
Reimherr, a Valley Mental Health employee, is program supervisor for the mentally ill offender program at Orange Street Community Correctional Center. Finch, who works for the Department of Corrections, is the staff supervisor there. Their day-to-day collaboration is unique. But so is Orange Street, a Corrections-operated halfway house with a component for mentally ill offenders.
The 12-bed section of Orange Street that treats mentally ill offenders represents a big step toward dealing with people who have mental illnesses and commit crimes. Orange Street is finding the workable middle ground between Corrections' need to control an offender and Mental Health's responsibility to treat mental illness.
The water they sail is generally uncharted. But such collaboration by Corrections and Mental Health programs is the key to success in treating a mentally ill offender.
A recent article in Insight Magazine claims that "with deinstitutionalization of the seriously mentally ill - which began in the late 1960s and stilldumps large numbers into American communities - jails have by default taken over the hospital's job of removing the mentally ill from the streets when their behavior is disruptive or threatening."
"It's true that we have fewer beds for the mentally ill," said Janina Chilton, public information officer at the Utah State Hospital in Provo. "And the forensic (criminal) commitments are taking more and more of the space we do have. But the biggest problem is failure to treat people who are mentally ill and criminal. Without treatment, it becomes an unending circle."
"The prison does a poor job of treating acutely psychotic prisoners," said Dallas Earnshaw, Utah State Hospital. "They can't be managed, so they end up in cells. That atmosphere feeds into the problem."
More ominous, according to Corrections officials, is that most of the people in prison will be out some day. And if they haven't been treated, they'll probably victimize someone and be back.
"We're just not geared up to deal with seriously mentally ill people," said Allen Anthony, Adult Probation and Parole.
There have been reports that mentally ill prisoners are sometimes preyed upon by other inmates. "A person who's mentally ill goes out to the Point of the Mountain and sits, mostly without any help," said Salt Lake attorney Ross C. Anderson. "There have been crimes against people, where they are beaten by other inmates. And no one besides a guard can intervene or he'll get written up. Instead, it's like watching a cock fight. A lot of the inmates should be hospitalized.
"People are languishing, but not getting better. It's expensive to not provide treatment. It punishes the victims and taxpayers mostly. When you've got someone who's mentally ill in prison for stealing $500 and it costs $17,000 a year to keep him there; well, you could be buying him a lot of help, instead."
The most serious need, according to Michele Parish-Pixler, director of Utah's American Civil Liberties Union, is expansion of forensic psychiatric facilities at the prison. Her sentiment is echoed almost universally by prison advocates and critics.
But decisions to build - or not build - better medical and psychiatric facilities are not made solely by Corrections officials. The Legislature must appropriate the money. And that hasn't happened.
"Prison inmates are not the most popular people," said Dale Schipaanboord, director of habilitative service for Corrections. "When funding's tight, priorities are often elsewhere."
The Legislature will have to address the same problem for the State Hospital, and sooner is better than later, officials there agree.
"We desperately need to expand our forensics unit," said Superintendent Robert Verville. "The forensics unit is housed in a 70-year-old building that wasn't built to be secure. All the literature suggests it has to be built secure. For now, we're doing our best to upgrade monitoring equipment and beef up security staff."
A bill passed last week by the Legislature will give security staff enhanced authority while they're on the hospital grounds.
The biggest change, according to Joy Verde, Utah Alliance for the Mentally Ill, needs to come from society. "People need to drop preconceived notions," she said. "When we talk about mentally ill offenders, people always think of the serious, violent crimes. Well, most of the mentally ill offenders aren't violent. They cost society in other ways."
Change is painful and slow. But it does occur, Chilton said. A few years ago, women with criminal behavior were set free or inappropriately sent to the State Hospital because of reluctance to incarcerate them. Even further back, Mental Health and Corrections officials didn't cooperate with each other.
But community services must be willing to give up what one agency staff member describes as "turf wars." Sometimes, she said, a lot of time is wasted because there's insufficient communication - and trust - between agencies.
There are other milestones that show a system can evolve. The Salt Lake County Jail now has onbe of the best mental health units in the country -- and the only one in a Utah jail. It has drawn praise from leading national health experts like Dr. E. Fuller Torrey.
But community services must be willing to give up what one agency staff member describes as "turf wars." Sometimes, she said, a lot of time is wasted because there's insufficient communication -- and trust -- between agencies.
"The most important thing for all of us is protecting the public," Reimherr said. "I've never felt so much responsibility and pressure in my life to protect somebody. We are very, very careful about releasing people into the community."
"These are not problems that will go away by throwing someone into prison," Parish-Pixler said. "Almost all will one day return to the community. It's much more humane and cost-effective for everyone if there's intervention."