Mental illness and criminal justice: Muskegon-area police, jail cope

Jeffrey Lewis, Muskegon director of public safety

MUSKEGON, MI – Jeffrey Lewis, Muskegon’s public safety director, has had a close-up look at the impact of closing state psychiatric hospitals.

Lewis worked for the Ypsilanti Police Department in the 1990s. Early in that decade, Ypsilanti State Hospital – which once housed thousands of mentally ill patients – shut down.

“One thing we noticed right away: Transitional homes in our community went from just a few to like 70," Lewis said. One result of the influx of city residents formerly housed in the hospital was a noticeable increase in police calls and arrests, he said.

In Muskegon, as in Ypsilanti, police regularly have to cope with crimes committed by mentally ill people, Lewis said. Some also present an “easy target for street crime.” Both situations pose extra challenges for officers.

While it’s all part of the job, “It is a burden,” he said. “I don’t have the answers. I don’t think that locking up people forever is the answer. I just think it’s something that’s a real challenge for the community at large to deal with.”

Part of the answer has been training for police officers in handling potentially violent situations, including those involving people with mental disorders.

“It requires an officer to think very quickly on their feet as to how to de-escalate,” Lewis said – or, if necessary, move appropriately into the “force continuum” to subdue a resisting suspect. “It’s really important for us to quickly assess who this individual is standing in front of us.”

With some disturbed individuals, “that uniform immediately signals to them a negative,” triggering a combative or flight reaction, Lewis said. ”That uniform is a very intimidating feature that they can’t quite process.”

While police agencies don’t keep statistics on the number of mentally ill suspects or victims they arrest or encounter, officials say it’s a significant part of police work.

“Off the top of my head from my 42 years in law enforcement, I’d say that at least two out of 10 people that we deal with have a mental problem,” Muskegon County Undersheriff Dan Stout said.

The sheriff’s department that Stout works for also deals with the next stage in the criminal-justice process: running the county jail.

Nationwide, Muskegon County Sheriff Dean Roesler said, “jails and prisons are the de facto mental-health institutions in the country now. ... It’s a drain on resources.”

Unlike with street-level police work, some estimates are available about the impact of untreated mental illness on Muskegon County Jail operations.

• According to Lt. Mark Burns of the sheriff’s office, the jail administrator, jail staff refer an estimated average of about 25 people per week to Community Mental Health Services of Muskegon County staff for mental evaluation. Of those, CMH staff say roughly 70 percent have some type of mental illness that needs support.

Burns calls CMH a crucial partner in the jail's work, along with the jail's medical contractor. "CMH is the component that helps us in the jail. ... They work together to make assessments, referrals and figure out the needs of a person, and then do the treatment."

• Those numbers compare with total volume of 7,288 inmates booked at the jail in 2013 up to Nov. 22, Burns said – an average of 156 total inmates per week.

• The average cost per day to lodge an inmate at the jail is about $39, including health care, Burns said. The jail doesn’t keep separate statistics about the cost of lodging a mentally ill inmate, but Burns believes that cost is higher than the average because of a more frequent need for treatment and more expensive treatments, especially psychiatric medications.

• Overall, the jail pays its contracted health-care provider about $875,000 per year for all medical services, Burns said. Separate statistics weren’t available for the psychiatric portion, but jail officials believe it’s a significant chunk of the whole.

Once in awhile, someone who’s arrested is “so sick we don’t accept them,” Burns said.

Muskegon County Sheriff's Lt. Mark Burns, Muskegon County Jail administrator

When a suspect is first brought to the jail, staffers ask a series of medical and mental-health assessment questions -- a kind of triage process. If someone is in a serious mental-health crisis, the jail tells the arresting agency to take the person to a hospital emergency room for evaluation and treatment. “Not everybody should be coming to jail,” Burns said.

That doesn’t happen too often. Burns said 25 incoming arrestees were diverted from jail before being booked in the fiscal year that ended Sept. 30, or a little more than two per month.

Beyond simply filling jail beds they wouldn't be occupying if they'd received adequate treatment that prevented them from committing a crime in the first place, mentally ill inmates do create some additional work for jail staff.

Most of that's at the beginning of the process, Burns said.

"Every inmate is treated individually," the jail administrator said. "We have to make assessments on every person that comes into the jail, and treat every individual on a basis of assessment, and sometimes it can require some extra work.

"The review by our medical office starts with a triage as people come in the back door. If there is anything that's noted by our correctional staff, that information is passed on to medical."

The assessment process is complicated and lengthened if a mentally ill person is "non-compliant," Burns said -- not taking prescribed medication or abusing drugs or alcohol. Especially in the latter case, "if somebody has to go through withdrawal while in the jail ... that can be really difficult... It can take a long time to sort through it.

"We have to look at every individual, and there's a lot of people in the jail," Burns said. "You can't speed it up. We have a limited amount of space. We have to make sure we're properly assessing people ... It can be difficult."

But once a mentally ill jail inmate has become compliant with his or her treatment program and detoxified if necessary, there's little extra work involved beyond the dispensing of medication and consultation by Community Mental Health staff, Burns said. Mentally ill inmates whose disorder is under control, and who aren't diverted outside the jail to other programs, aren't segregated from other inmates.

Like Chief Lewis, Burns said patrol officers nowadays get training in how to deal with mentally ill people, including making a determination of who may need treatment rather than incarceration. That means some people taken into custody never get to the jail in the first place.

On a much larger scale, the Michigan Department of Corrections deals with some of the same issues in the state prison system. State prisons house convicted criminals, mostly felons, who have been sentenced to incarceration for longer than one year.

“The shuttering of the state mental-health hospitals through the ‘80s and ‘90s have led to more people sent to prison who would have gone to psychiatric hospitals,” MDOC spokesman Russ Marlan said. “But we get who we get, and we try to address that and treat that population as best we can.”

Marlan said roughly 17 percent of the total state prison population is diagnosed as mentally ill when they’re admitted, with varying levels of severity. The prison system gives every incoming prisoner a diagnostic test to determine if the inmate requires mental treatment.

About 9 percent of the total population is kept on psychotropic medications, Marlan said. “Those would be the ones considered seriously, chronically mentally ill,” he said.

“They do cost more,” Marlan said. He estimated the average cost to house an MDOC prisoner for a year at about $30,000, with annual costs in the $44,000 or higher range for seriously mentally ill prisoners.

Back at the street level, Lewis said, police officers have had to get better at recognizing and dealing appropriately with mental illness.

“This is not viewed by us as a negative,” Lewis said. “It’s just part of our job. We’re evolving.

“As communities change, law-enforcement officers are generally the first ones who pick up on how these changes affect the community at street or ground level.”

John S. Hausman covers courts, prisons, the environment and local government for MLive/Muskegon Chronicle. Email him at jhausman@mlive.com and follow him on Twitter.