The 28-bed unit for men opened in August in a Mecklenburg County detention center. The unit currently houses six inmates.
By Yen Duong
The bottom half of a small basketball court is covered by cheerful yellow paint and speckled with marker doodles of smiling stick figures, flowers and sets of two humps to indicate birds in a sunny sky. That yellow matches stripes on the linoleum floor in the main area set off by columns in cheerful pastels. Numbered doors with small windows lead to residentsâ€™ small rooms.
The jail psychiatric unit in downtown Charlotte â€” known as â€œMcPâ€� â€” looks like a school, but itâ€™s actually North Carolinaâ€™s first behavioral health unit located in a county jail. Inmates, or residents as the sheriff calls them, take daily medications, attend group classes, and participate in therapy with the aim of getting better before returning to the general population in the Mecklenburg County Central Detention Center or being released to the outside world.
â€œI feel [being in jail] can cause mental issues because you canâ€™t just come and go as you please anymore,â€� said guard Melissa Russell, clad in a gray polo with a â€œBehavioral Healthâ€� logo rather than the usual police uniform. â€œThis program is designed to help them work through their issuesâ€¦ Itâ€™s to show them different ways to process what theyâ€™re feeling and what theyâ€™re going through.â€�
â€˜What we shouldâ€™ve been doing the whole timeâ€™
The voluntary program, which opened in August, has space for 28 male residents. Right now, six men, each diagnosed with a mental illness by a counselor upon intake, take part in the program, which is quiet and separated from the rest of the jail.
â€œOne of our goals was to make sure that theyâ€™re good to be able to function in a normal pod in another unit,â€� said Sgt. Charles Pearson, the â€œPâ€� in â€œMcP.â€� â€œSome of themâ€¦ they canâ€™t function in another pod, they canâ€™t be around a lot of people, they canâ€™t follow orders. They end up in our segregation unit, and we donâ€™t want that.â€�
Segregation (often referred to as solitary confinement) is exactly the opposite of what inmates with mental health issues need, said Luke Woollard, an attorney with the legal advocacy group Disability Rights North Carolina.
â€œThese folks with mental illness end up isolated â€¦ which often causes them to get worse because theyâ€™re not given any other care,â€� Woollard said. â€œ[They need] the ability to get out of cells, access trained professionals like psychologists and psychiatrists [and] access medications theyâ€™ve been prescribed.â€�
To join the jail psychiatric unit, residents must participate in a full day of classes during the week, take their medications, and be non-violent. Behavioral health counselors are contracted from a Tennessee-based company that provides staffing for correctional facilities and rehabilitation centers.
Pearson said they want to get a federally approved methadone treatment program running in the unit by the end of the year. Methadone is one of three drugs used for medication-assisted treatment, or MAT, to treat opioid use disorder. Residents from the general population would also visit the unit for MAT treatment.
Mecklenburg County Sheriff Garry McFadden said he put together the unit without additional funding after chatting with Pearson, modeling it after a similar unit in Nashville, Tenn. Heâ€™s looking forward to buying cozy, high backed chairs for a â€œliving roomâ€� effect and to finding funds to open a womenâ€™s unit next year.
â€œWe want to be almost a community,â€� said McFadden, the â€œMcâ€� in â€œMcP,â€� about their goals for the unit. â€œFor me, I think itâ€™s what we shouldâ€™ve been doing the whole time.â€�
â€œWhen people say â€˜Why are you doing this?â€™ [I respond] â€˜Iâ€™m preparing your neighbor,â€™â€� McFadden continued.
Per the U.S. Department of Justice, 95 percent of people who enter prison eventually return to their communities.
â€œItâ€™s helping our citizens, we want to return them backâ€¦ we want to return that citizen back better.â€�
Suicide prevention and mental health care in jails
A 2017 Disability Rights North Carolina report noted that North Carolina jail suicide rates are higher than the national average: nearly 46 percent of NC jail deaths are from suicide versus 35 percent of US jail deaths in 2014.
â€œWe see failures happening a decent amount of time in these suicide cases: failures of observation, failures to recognize that somebody is suicidalâ€¦ failure to get medication that folks are already prescribed but donâ€™t have with them when theyâ€™re arrested,â€� Woollard, the DRNC attorney, said. â€œWeâ€™re seeing a lot of these issues that continue to be major problems with the mental health care thatâ€™s given in jail.â€�
Inmates are at a particularly high risk of dying of suicide within the first 24 to 72 hours of getting arrested, said Atrium Health forensic psychiatrist Dr. Sherif Soliman.
â€œIn addition to the stress of being booked in jail and facing criminal charges, many are coping with untreated mental health symptoms, such as hallucinations or severe depression,â€� Soliman said. â€œMany are suffering the effects of drug withdrawal over these first few days, and in fact, some substance withdrawals, such as alcohol withdrawal, can be fatal.â€�
Eleven counties reported that over 30 percent of their populations had self-reported mental illnesses upon intake, with Caldwell County reporting 80 percent.
Mecklenburg is one of 47 North Carolina counties to issue a â€œStepping Up Resolutionâ€� as part of a national initiative, run by several organizations including the American Psychiatric Association, to reduce the number of adults with mental illnesses in local jails. Per the Stepping Up website, people with serious mental illnesses are booked into county jails almost 2 million times a year.
To reduce the amount of time people with mental illnesses spend in jail, Stepping Up counties collect data and run programs such as peer counseling, mental health screenings and crisis intervention training for police and correctional officers. CIT 40-hour training programs teach law enforcement and other first responders, behavioral health staff and advocates how to react to mental health crises.
â€œWhat we see common with law enforcement, when you see a person on the street whoâ€™s going through a crisis or episode, people are telling him to â€˜Get down, drop this, get up,â€™â€� McFadden said. â€œBut then you have three or four people talking to this person at the same time. Are you really knowing what youâ€™re doing?â€¦ We take training to say how to prevent the crisis [from] escalating.â€�
Stepping Up training
In Mecklenburg, about 400 of over 1,300 officers are certified in CIT, Pearson said, with a goal of all guards completing CIT and behavioral health training.
Pearson said by next year, the county will open a separate diversion building to treat people with mental illnesses who are booked for lower-level offenses such as loitering or trespassing. He gave examples of a â€œbag ladyâ€� who would not leave a store, or a homeless person camped out on church steps for weeks. Last year, Alamance County received $1.2 million in funding to open such a diversion program, which will be ready next year.
â€œSome [Stepping Up programs] are making a difference with such things as putting peer support inside the jail to help people, diversion and reentry support, more medical care and treatment,â€� said Susan Pollitt, an attorney with Disability Rights NC. â€œAll of these things are necessary in North Carolina because unfortunately, we have a problem with people dying in our jails and our regulations and our funding are not adequate to ensure that people are safe when they come into our county jail.â€�
North Carolina laws do not require jails to run standardized mental health screenings, report suicide attempts nor run suicide prevention programs. Pollitt said those rules are â€œoutdated,â€� but the Department of Health and Human Services website has a draft of new regulations which include mandatory suicide prevention plans.
But the new rules are stalled in the stateâ€™s sometimes Byzantine process for approving new administrative procedures. The new rules have been opposed by the North Carolina Sheriffsâ€™ Association, which wrote in March that a number of the changes â€œexceed the authorityâ€� of the Division of Health Service Regulation, part of DHHS. So the rules have been sent back to the legislature for consideration.
What comes after jail
Jail is a temporary place: McFadden said his team is looking for community resources to connect with people who are released and hope for eventual changes for the transition from jail to prison. Currently, the state assesses prisonersâ€™ mental health at intake to the state prison system.
â€œMecklenburg can give recommendations, but the state doesnâ€™t have to listen to them,â€� Pearson said.
â€œ[That] is difficult, because then obviously heâ€™s back to either being treated or not being treated,â€� McFadden added. â€œWe hope that one day â€¦ it could be a step program.â€�
For people who are released back to the public, McFadden and Pearson hope that keeping up with mental health resources and community resources will reduce recidivism.
â€œTheyâ€™re here to get the help that weâ€™re going to provide,â€� Russell, the jail psychiatric unit guard, said. â€œ[We] give them the tools they need to go out there and succeed. We donâ€™t want them to come back. We donâ€™t need no repeat offenders.â€�