Normally, Kellie McBride would be leery of dedicating one particular month to mental health.
“Because this isn’t something that we’re just doing this month,” said McBride, director of criminal justice services for Lewis and Clark County. “This is something Lewis and Clark County is committed to, and it’s something that we do every day.”
County commissioners proclaimed May the Stepping Up Month of Action to commemorate the county’s 2015 entry into the Stepping Up Initiative, a campaign founded by the National Alliance on Mental Illness to divert people with mental illness away from incarceration and into treatment. Lewis and Clark County stands with 489 other American counties participating, but only Missoula joins them among Montana’s 56.
“As much as we have to do in Lewis and Clark County, as many goals as we have set for ourselves surrounding behavioral health, the reality is we are so much further ahead than most counties, and we have so much to be proud of,” McBride said.
The initiative holds special importance in Lewis and Clark County, where county staff estimates 60% to 80% of the inmate population could have co-occurring disorders, which involve substance abuse coupled with mental health issues such as depression, and 17% to 19% could have a “disabling" form of mental illness. But both of those estimates are about on par with national averages.
“We know that if those people can be connected with mental health services or some level of treatment, stay on their medication, those kinds of things, their (chance) of re-engaging the criminal justice system is much less,” said Lewis and Clark County Commissioner Andy Hunthausen. "So it’s to the benefit of all of us, including that person.”
To that end, the county has a therapist and case manager on-site and administers a mental health questionnaire at booking time to gauge an inmate’s risk of suicide. Hunthausen also expects that the expanded county detention center will help improve those services through expanded meeting spaces and a dedicated booking area.
“As you go down the line, we know that this remodel of the jail is really a short-term fix,” Hunthausen said, referencing ongoing expansion of the county detention center. We know that if you look at the projections of growth in our community and the percentage of people that are incarcerated … that our jail, at current rates, prior to this intervention, this reform that we’re doing, we would outgrow our jail (almost) before we pay it off.”
In 2016, county voters approved a $6.5 million bond sale that funds most of the $8.3 million detention center renovation that will bring the capacity from 80 to 156 beds. The detention center often holds 100 or more inmates on a given day.
“(If) Capt. (Alan) Hughes’ team identifies someone who’s got some suicidality, right now they’re meeting in a hallway or a closet or they may not even be able to meet with them because there’s nowhere to meet with them, because it’s so full of people,” Hunthausen said. “So we have some designated space for programming, for meeting space, and we can have people sit down and be evaluated more fully.”
Though there is confidence among county staff that the reforms are working, McBride admits the data isn’t yet there, and might not be for some time, though the county has begun identifying data systems that would allow them to point to a number. For now, there are anecdotal successes and, most recently, the county’s partnership with Western Montana Mental Health Center for direct admissions to their local mental health center, Journey Home.
“It used to be that someone would have to have a crisis response team assess them and then they would have to be in St. Peter’s Hospital, and then they could be transported to Journey Home,” McBride said. “And all of that trauma for somebody who is working through a mental health disorder just compounds the situation. Our providers in this community have recognized the need.”
The county’s crisis response team also responds to the detention center somewhat frequently — 185 times in 2018, according to Brandy Vail, Helena clinical program manager for Western Montana Mental Health Center.
Vail believes there is work to be done, as at present there is only one therapist and one case worker on staff at the detention center. However, she appreciates the county’s emphasis on mental health services, which could help relieve inmates of perceived stigma surrounding mental illness.
“They’ve definitely made that a priority, which has made our jobs extremely easier,” Vail said. “All of the detention officers really do take part in being able to observe or monitor inmates, so even if they’re not requesting services on their own, those concerns are brought to the jail diversion team and addressed.
“I think that’s why the program is so important. Because we are able to show them what mental health services can do for them,” Vail said. “If they are able to work with our jail diversion team, we see a lot better outcomes for them.”