Psychiatric care limited for inmates

An overcrowded system struggles to meet the needs of mentally ill inmates.
Sunday, March 7, 2004 | 12:00 a.m. CST; updated 5:11 a.m. CDT, Saturday, July 19, 2008

Donald Dale Clark Jr. was drunk and on sedatives the night of Feb. 24, according to police, when he stole a car from the parking lot of a bar on Business Loop 70, crossed the median at Interstate 70 and U.S. 63, and struck a pickup. He then walked to the nearby Wal-Mart Supercenter, where officers said they found him trying to shoplift several items.

Clark, 41, had spent years in the Boone County Jail on charges of driving while intoxicated, stealing, writing bad checks and strong-arm robbery.

His sister, Delaine Carpenter of Ashland, described Clark as someone who’s been “in and out of trouble, and in and out of treatment centers all his life.”

Before his latest encounter with police, Carpenter said Clark told her that he never wanted to go back to jail again.

The day after his arrest, Clark tried to choke himself with a towel wrapped around a bolt sticking out of the wall of his cell, said Maj. Warren Brewer, jail administrator. Clark was sent to University Hospital for a mental health evaluation. He was back in his cell the following day. Later that night, jail officials found Clark trying to kill himself the same way — this time with a pair of the paper shorts issued to inmates on suicide watch.

Carpenter said Clark, the brother who once had “laughing eyes” and an “ornery grin,” has a history of suicide attempts, brought on, she believes, by his life-long problems with substance abuse. It came as no surprise to her, she said, that Clark was intoxicated the night of his arrest.

“He said that’s the worst blackout he’s ever had,” Carpenter said.

No one has ever successfully committed suicide at the Boone County jail, Brewer said, and attempts are still rare. But dealing with mentally ill inmates is a growing concern among law enforcement officials.

Studies have found that about 16 percent of the nation’s jail population has serious mental illnesses, compared with about 5 percent of the general population. A report by the Council of State Governments estimates that about 75 percent of inmates with mental health problems also have problems with substance abuse.

“It’s a grim picture,” Brewer said. “Jails and prisons have become the mental health facilities of the year 2000 and beyond.”

A contractor, Behavioral Health Concepts, screens new inmates to the jail for mental health problems. County corrections officers are also trained to look for drastic changes in behavior and other signs of mental illness. Inmates on suicide watch are isolated, given paper clothing and checked every 15 minutes. Counseling is also available.

Such measures often aren’t much help to suicidal inmates, Brewer said, because they cannot be forced to accept treatment in jail.

“Jails are not set up to treat, nor should they be set up to treat, psychiatric issues,” Brewer said. “Those people need psychiatric care.”

But getting that care for inmates is challenging. Brewer said the Mid-Missouri Mental Health Center, which is adjacent to University Hospital, often doesn’t have space for inmates. The 69-bed mental health center serves 31 counties and is put on “diversion status” — meaning all of its beds are full — about six days a month, said Felix Vincent, chief executive officer of the central region of the state’s Division of Psychiatric Services.

Inmates who are under court order to receive treatment are always admitted to Mid-Missouri Mental Health Center or another facility, Vincent said. All others are evaluated on a case-by-case basis.

“Police will bring inmates to the emergency room, but if they’re not committed to us, and if we don’t believe they need to be admitted, they won’t be,” Vincent said.

Citing patient confidentiality rules, Brewer and state Department of Mental Health officials declined to say why Clark was not admitted to Mid-Missouri Health Center after his first suicide attempt. That night, the center’s adult beds were filled, but the facility had yet to be put on diversion status, said its CEO Dennis Canote. Staff had instructions to admit no more than three more adult patients for short-term stays, he said.

Clark was admitted to the facility after his second suicide attempt.

Joe Parks, medical director for the Missouri Department of Mental Health, said people with substance abuse problems, people on probation and parole, and those with severe medical illnesses are 10 times more likely to die from suicide than the rest of the population.

Although Clark seems a little more cheerful to her now, Carpenter said he “still hasn’t promised me that he’s not going to kill himself.” She knows her brother needs long-term care to recover from his drug problems and suicidal tendencies, but she fears she has already lost the brother she knew growing up.

“His family very much loves him and always has and always will,” she said. “But there comes a time when you need to have tough love. All we can do is pray for him.”

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