by Sean McManus
Staff Writer
When the National Association of Blacks in Criminal Justice held its annual Training Institute at the Adam’s Mark Hotel this week, the Jacksonville Sheriff’s Office took the opportunity to talk about the largest mental health hospital in North Florida — the Duval County Jail.
According to officials there, the Mental Health Network was instituted about six years ago to combat the cycle of mental illness and crime, and has emerged as one of the most successful in the nation. It serves as a model of how to integrate community intervention with health care in prisons.
“In 1996, we had a big problem,” said Dr. Mark Joyce, director of psychiatric services for the jail. “We had a reactive approach to health care and it was creating a vicious cycle that we couldn’t get out of.”
One big problem, according to Joyce, was crack cocaine. Beyond that, those who were mentally ill were being released from jail without any psychiatric attention, which was escalating the recidivism rate to unmanageable proportions. In 1996, 10 percent of the prison population was three-time offenders. And because many of the people going to jail had mental illnesses, the average cost to book and detain a criminal was $2,000 because it costs extra for people who aren’t cooperating.
So the sheriff’s office took action. Under the direction of John Rutherford, who now serves as director of corrections, the jail began to outsource medical care.
“We outsourced a $5.2 million contract for inmate health care,” said Rutherford to a crowd of about 40 people in town for the seminar. “When you tell people that, they don’t like it. But when you say ‘public health care’ people understand.”
The way Rutherford sees it, if a program inside the prisons dramatically reduces the recidivism rate and serves as a signal about where health care is going generally, then the money is well worth it.
“Before criminals are criminals, they are members of the community,” said Rutherford. “Having a captive audience for medical testing and diagnosis of various diseases — sexual and otherwise — gives us a snapshot of what is occurring health-wise in the whole community.”
That’s Rutherford’s “sentinel chicken” argument — the idea that what occurs in prison can be a bellwether for public health. When Rutherford decided to take action, it was partly based on the understanding that a prison’s walls not only keep bad people in, they also keep people who can help the community — like doctors — out.
Today, any prisoner who appears to have a mental health issue is immediately given a battery of tests — and psychiatric care. The information is sent to a database. Other prisoners have the option for testing and many are eager to participate.
The other aspect of the jail’s new vision included creating links to the community. According to Rutherford, about 47,000 people are booked into the Duval County Jail every year. And 70 percent of those stay less than 60 days.
“The only way to comprehensively help these people is to continue care outside of prison,” said Rutherford. “Since not many of them stay long enough for us to have any real impact.”
The first step was to begin working with River Region, the contracted health care provider for the jail. There, Mike Bennet, who is director of the secure drug and alcohol program, oversees a budget of about $1 million to monitor people at their homes, get them into treatment, provide medical attention (mental and otherwise) and document their progress.
“It’s an intensive program,” said Bennet said. “But the impact on the recidivism rate is undisputed.”
According to Bennet, it’s the only way to continue the progress that’s been made in the prisons and help get people clean.
Arrests of people with mental illness is down 55 percent and total number of days in jail for that same demographic is down 64 percent. Bennet maintains that his program has saved Duval County at least $14 million in the costs associated with repeat offenders.
Dr. Max Solano, who is the jail’s director of medical services, also believes that health care must be integrated between the prisons and the community. That’s why a major focus of his work is education.
“If we educate people in jail, when they get out they can educate others,” said Solano, who is originally from Costa Rica and was educated in Texas. “Since most crimes occur in the same zip codes, these people — if we reach them — can become ambassadors for safe health practices.”
Much of Solano’s work is done helping people with HIV and AIDS. It is among that group that there is a serious lack of education, he said. “And the courts have a major role in this. If they crack down on prostitution, then there would be less disease.”
“It’s a total integration of medical care with the culture and rules of the prisons,” said Rutherford, who noted that successful implementation of the mental health network requires a complete reanalysis of how police officers think and do their job.
“There are steps you should take when handling people who are obviously mentally ill,” said Rutherford. “But until we kicked off this program, most cops would just take them to jail and book them because that’s all they knew.”
Regardless, Duval County has come a long way. According to a press release issued from the JSO, from 1997-2000, the recidivism rate dropped by five percentage points, the total number of bookings has dropped by 15 percent, and the number of medicated inmates dropped by 30 percent. In addition, the need for involuntary chemical restraint of mentally ill inmates dropped by 50 percent and the need for involuntary hospitalization for the mentally ill has all but stopped.