Polson, Montana — When somebody accused of against the law on this small northwestern Montana city wants psychological well being care, likelihood is they’ll be locked in a basement jail cell the dimensions of a walk-in closet.
Prisoners, some held on this isolation cell for months, have scratched initials and the phrase “love hurts” into the steel door’s brown paint. Their pacing has worn a path into the cement ground. Many are held in a type of limbo, not convicted of against the law however not secure sufficient to be launched. They sleep on a slender cot subsequent to a bathroom. The one view is a fluorescent-lit hallway seen via a small window within the door.
Lake County Legal professional James Lapotka stood on the cell’s heart speaking in regards to the folks he helps confine right here. He stretched out his arms, his fingertips simply shy of touching reverse partitions. “I’m getting anxiety just being in here,” Lapotka mentioned.
Katheryn Houghton / KFF Well being Information
Final 12 months, a person sentenced for stealing a rifle stayed in that cell 129 days. He was ready for a spot to open at Montana’s solely state-run psychiatric hospital after a psychological well being evaluator deemed he wanted care, in response to courtroom information.
A person within the subsequent cell across the identical time was on the identical waitlist roughly 5 months. He confronted near-daily stints within the jail’s emergency restraint chair — a metal contraption wrapped in foam with straps for his shoulders, arms, and legs. He often noticed the jail’s psychological well being physician. Nonetheless, Joel Shearer, a Lake County detention commander, mentioned the person routinely skilled psychotic episodes and requested to be locked within the chair when he felt one approaching and stayed there till his screams subsided.
“Somebody who’s having a mental health crisis — they don’t belong here,” Lapotka mentioned. “We don’t have anywhere else.”
Katheryn Houghton / KFF Well being Information
Lake County’s two, roughly 30-square-foot isolation cells are an instance of how communities nationwide are failing to supply psychological well being companies — disaster care, specifically. Practically half of the folks locked in native jails within the U.S. have a psychological sickness.
Greater than half of Wyoming’s 23 sheriffs informed lawmakers there that they have been housing folks in disaster awaiting psychological well being look after months, WyoFile reported in January. Nevada has struggled regardless of a $500 day by day tremendous for every jailed affected person whose therapy is delayed. Incapacity Rights Oregon has mentioned delays in that state proceed after two folks died in jail whereas on the state’s psychiatric waitlist.
In Montana, counties are jailing psychological well being sufferers they’re not geared up to deal with when the Montana State Hospital is at capability. Few native hospitals have their very own inpatient psychiatric beds. Consequently, folks arrested for something from petty theft to felony assault will be jailed for months or longer as their psychological well being worsens. Many haven’t been convicted of against the law.
Montana officers have identified for years they’ve an issue. State officers have mentioned they don’t have house for all of the folks ordered to the hospital. The psychiatric hospital has 270 beds, with 54 for folks within the prison justice system. Staffing shortages can shrink that capability additional.
The Montana Division of Public Well being and Human Companies backed two payments this legislative session that would defend the state from legal responsibility for delays when the Montana State Hospital is full. Forward of the payments, the company wrote the hospital has “struggled to maintain appropriate levels of care” as a consequence of cash and staffing constraints, an absence of community-based companies, and having no management over the circulation sufferers Montana courts ship its method.
The company additionally introduced April 23 that $6.5 million was obtainable via one-time grants to assist arrange jail-based psychological well being stabilization companies.
Officers have mentioned sufferers deserve care nearer to dwelling, in much less restrictive settings. However counties say the native companies wanted don’t exist.
“You have to do the hard things first,” mentioned Matt Kuntz, govt director of the Montana chapter of the Nationwide Alliance on Psychological Sickness. “You have to build the beds.”
Well being advocates have backed a proposal that may require the state to pay for neighborhood commitments. That measure is headed to Republican Gov. Greg Gianforte after passing the state Home and Senate. One other invoice that was nonetheless pending would create a brand new psychiatric hospital for folks within the justice system. However implementing these concepts might take years.
The variety of inpatient beds for folks with a severe psychological sickness nationwide has plummeted. At one time, that drop was intentional, a part of a motion away from locking folks up in state-run psychological hospitals. However the meant repair, native homelike facilities, hasn’t stuffed the void.
One in all Montana’s greatest suppliers, Western Montana Psychological Well being Middle, needed to shut a few of its disaster websites due to cash issues, mentioned Western’s CEO, Bob Lopp. That features a facility lower than a mile from the Lake County jail.
“If that’s not where the funding is, you can’t just do it for the sake of argument and hope that it comes,” Lopp mentioned.
Gianforte has promised to pour cash into rebuilding the state’s behavioral well being system. Psychological well being employees in small cities discover such guarantees onerous to belief after seeing native companies come and go for years.
Well being division spokesperson Holly Matkin mentioned the company is happy with its work to repair “systems that have been broken for too long” and that it’ll enhance companies for individuals who want inpatient care of their communities.
Lake County is understood to outsiders as an Instagram-worthy cease on their option to Glacier Nationwide Park. It overlaps with the Flathead Indian Reservation, land of the Bitterroot Salish, Higher Pend d’Oreille, and Kootenai tribes. It’s dwelling to a slice of the Rocky Mountains and a gateway to hundreds of thousands of acres of wilderness. Polson, the county seat and web site of the jail, is a city of 5,600 on the southern shore of Flathead Lake, one of many largest lakes west of the Mississippi River.
Vincent River has labored because the jail’s sole psychological well being clinician for 25 years. He mentioned he’s not all the time obtainable as a result of he’s the one psychologist in 4 northwestern Montana counties evaluating whether or not an individual in jail wants psychiatric care.
Some are launched with out care in the event that they linger too lengthy on the state hospital’s waitlist.
“I talk to these family members. I hear them plead with me with their fear in their voices and tell me all that’s been going on for days or weeks or months,” River mentioned. “And then I can’t get people into the hospital. That is a giant crisis.”
It’s not simply the state hospital. River mentioned he can’t get folks into any psychiatric mattress in Montana as a result of there are too few. As an alternative, he tries to stabilize folks whereas they’re jailed. That has shortfalls.
The jail can’t drive somebody in psychosis to take treatment and not using a courtroom order and a professional physician available to manage the prescription. Lake County’s getting older facility has confronted lawsuits due to poor situations amid overcrowding, and River has to see sufferers wherever there’s room.
There isn’t even house for the jail’s restraint chair. Jail employees depart strapped-down prisoners in a hallway or locker room.
River mentioned many regularly get higher and depart isolation. Some don’t.
“They languish there, psychotic and lonely,” he mentioned, “at the mercy of what the voices are telling them.”
Locals are working to fill some gaps. A cell crew launched in February is staffed by individuals who have lived with psychological and substance use issues to supply peer assist. However somebody really in disaster has solely two choices: jail or an emergency room.
The room reserved for folks in disaster at Windfall St. Joseph Medical Middle in Polson leaves sufferers each remoted and with out privateness. The locked door’s thick glass appears onto a busy emergency room hallway.
Those that deteriorate sufficient to be deemed harmful to themselves or others are despatched down the highway to jail.
Rebecca Bontadelli, an ER doctor, mentioned sufferers will be housed within the room for days as hospital staffers scour Montana and close by states for an open psychiatric mattress. Some reject care within the meantime.
“We’re not really helping them,” Bontadelli mentioned. “They feel like they’re in prison.”
KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is among the core working packages at KFF — the unbiased supply for well being coverage analysis, polling, and journalism.
