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NAMI Wake CountyThe IrisPage 4Crisis pointMentally ill and incarcerated in the Rutherford County jailReprinted from article in the Daily Courier, Forest City, NCMar. 02, 2014 @ 05:00 8019/CrisispointSTEPHANIE JANARDEditor’s note: Due to the sensitive topic of this story, “Kim” is notthe real name of the subject.Like other parents before her, Kim confused the onset of herson’s mental illness with normal teenage behavior. “He wouldisolate himself in his room for days at a time,” the RutherfordCounty native recalled. “I thought maybe he was just being atypical teenager who didn’t want to see his parents.”According to Kim, it turned out her son was hallucinating. Andhearing voices. It would take years, she said, before he wasfinally diagnosed with schizoaffective disorder, one of the moredifficult mental illnesses to correctly diagnose.It’s also one of the hardest to have. People who suffer fromit can experience schizophrenic hallucinations and delusionswhile swinging from one extreme mood to another. Withouttreatment, it can be impossible to hold down a job or evenmaintain a stable relationship.Her son’s own diagnosis, Kim said, marked his tenuous returnto sanity. Now that his condition had been identified, doctorscould prescribe him a specific plan of treatment, which includedanti-psychotic medication. The journey back to mental stabilitywasn’t without detours, however.Her son went on and off his medication, Kim said, and whenhe was off, trouble usually followed. But once back on, hecould go long stretches without hospitalizations; eventually,a full two years. Towards the end of 2012, her son startedto talk about gaining more independence. Maybe even gethis own apartment. According to Kim, around this same timehe also started seeing a new doctor with a behavioral healthorganization in Forest City.Unlike previous doctors who had treated her son, she said, thisone took a dim view of medication – and told her son he mightbe better off without it. Kim said this advice frightened her somuch she went to see the doctor herself. “I told him he didn’tknow my son like I did. I said that he could get real ‘out there’when he was off his medication,” she recalled.Nor would the organization confirm or deny if patients withsevere mental illnesses are indeed being encouraged toeliminate medication from their treatment plans - and if so, whatsteps are taken to mitigate the risks of withdrawal and the returnof mental illness symptoms.While she acknowledged that HIPAA privacy laws limit providersfrom discussing their patients, Kim said the doctor didn’t seemworried by her concerns, or even much interested in her son’smedical records that she’d brought with her. “I asked his officeto make copies of them anyway. And I waited there until theydid,” Kim said.A parent’s plea to be heardKim ultimately ended up filing a complaint about the doctorwith the now-defunct Western Highlands Network, the quasistate agency with regional oversight of publicly-funded mentalhealth services. Since acting on his doctor’s suggestion thathe might be better off without medication, Kim wrote to WesternHighlands, her son had been evicted from his apartment,banned from an area grocery store, repeatedly hospitalized,and arrested twice - the first time for assaulting a male nurseat Rutherford Hospital; the last for breaking and entering into astranger’s home.At the peak of all this chaos she’d attempted to get him helpby calling Crisis Mobile, Kim continued. The response from thecommunity service tasked with de-escalating emergency mentalcrisis situations was that no one could come out unless her sonrequested the help himself.“A person with mental illness and that is off their medication isalmost like a person with Alzheimer’s,” Kim wrote. “They don’trealize they need help. They don’t even know they’re sick.”Western Highlands responded with a form letter that advisedKim that inquiries had been made and any concerns deemednecessary relayed to the provider. Although the letter providedno insight into what those concerns might be, or what specificactions, if any, would be taken by the provider, the letterconcluded by telling Kim she had 15 working days to appeal.“Every which way I turned was a roadblock,” Kim said. Monthslater, her son remained incarcerated at the Rutherford CountyDetention Center.When contacted by the paper, both the doctor and thebehavioral health organization declined to be interviewed.Continued on page 5

NAMI Wake CountyThe IrisContinued from page 4Lt. Greg Cochran has personally witnessed an inmate switchback and forth between three personalities in the span of15 minutes. “The first was a God-fearing family man, asrespectable as anyone you’d meet in the community. And thenright in the middle of our conversation he told me he was goingto kill me,” the Rutherford County Detention Center administratorrecalled. “He just spit out the words, with venom. And then justas suddenly he started talking about how someone was going tokill him.”It was a conversation that would leave most people shaken.For Cochran and his staff, it’s just another day on the job. “Wedeal with mental health issues every hour of every day,” hesaid. He estimated that approximately 60 percent of inmates atthe Detention Center are on some sort of mental illness-relatedmedication, although rarely when they first arrive. In fact, formany of the inmates, going off their medication is what triggeredthe events that landed them in jail.“That was the case with the gentleman with the threepersonalities,” Cochran noted. Jail, he added, is not the rightplace for many of these inmates to be. “At the most basic level,they need someone to talk to. I’ve watched inmates stay postedat their bars waiting for a guard to pass by, just to have a coupleof minutes of conversation with someone,” he said. Whenasked if doctors sometimes call or visit the jail out of concernfor mentally ill inmates who were previously under their care,Cochran couldn’t recall a single incident of this ever happening.The jail, however, does attempt to stabilize mentally ill inmates.A mental health screening is performed at each new intake, andthe jail nurse will initiate contact with providers to obtain inmates’medication history and other information.The county also contracts with a doctor who Cochran saidspends up to half of his time on mental illness-related issues.While the detention center did not provide The Daily Courierwith an estimate of what these services cost, similar contractsin other counties run in the hundreds of thousands of dollars peryear. Cochran did provide estimates for the Rutherford CountyDetention Center’s mental illness medication costs, whichCochran said run annually about 14,000.As for what happens to mentally ill inmates after release, few ifany processes are in place to keep them from coming right back.Rutherford County does not have a special mental health court,Page 5for example, that could divert more mentally ill offenders tocourt-ordered treatment instead of jail. Even if it did, a shortageof residential facilities, including state psychiatric hospital beds,is another obstacle. For Kim, it is a particularly bitter pill that herson was waiting for a bed to open up at the state psychiatrichospital in Broughton when he assaulted the male nurse atRutherford Hospital.There is also the matter of an inmate’s ability to pay formedication after release. A large number of the mentally ill relyon Social Security Disability Income and Medicaid, both of whichare automatically suspended while a recipient is incarceratedand won’t resume until official notification from the jail of therecipient’s release. Obviously, the sooner that jails send thisinformation, the less time inmates have to wait to receivecoverage for medication and other treatment expenses. ButCochran said that the detention center only sends out thesenotifications upon request.Finally, the system is simply not structured in a way thatmotivates providers to keep track of clients who stop services- and few appear to take the initiative to do so anyway. Kimfigured her son has been treated by five or six different doctorsin the close to 10 years he’s struggled with mental illness. Afterhis incarceration this past fall, she left messages with several ofthem. None, she said, ever returned her calls.Meanwhile, her son’s court date was repeatedly pushed backuntil a mental health evaluation could be scheduled. When onefinally took place, Kim was told he had been found mentallyincompetent to stand trial at that time. However, he remainedincarcerated for several more months, until finally, he wasassigned another court date on Jan 30.On that morning, Kim watched from her seat in the gallery as herson was led handcuffed into a Rutherford County courtroom. Hewas the thinnest she’d ever seen him. While officials conferredover his case, Kim strained forward in an attempt to hear whatwas being said. Eventually she was informed that after almostsix months of incarceration in the county jail, her son was finallybeing remanded to treatment at Broughton.To reach the writer of this story, contact Stephanie Janard atsjanard@msn.comThe above article is about a family living with serious mental illness in the western part of NorthCarolina. Even so, it is the same situation here in Wake County. With our population nearing 1Mresidents, the Wake County jail is the largest institution housing people with mental illness in theentire state. The same problems and issues described by the Rutherford County Sheriff exist in Wake County. Withthe shortage of psychiatric beds, fewer people are being deemed to be ill enough to warrant commitment. Often, theyare released from the Emergency Room or Crisis Center with or without an outpatient appointment with a mental healthprovider. But, how many actually fol

funding for mental health, have built a new facility (WakeBrook), and more recently, a new small (16 bed) inpatient unit has been established and is operating under UNC Healthcare. In addition, a new private hospital, Strategic Behavioral Health, has been built in Garner with 20 Child/Adoles