S. Dakota pilot project reduces number of inmates with mental health, behavioral issues

About Katti Gray

Katti Gray (@kattigray) is AHCJ's core topic leader for behavioral and mental health. A former Rosalynn Carter Mental Health Journalism Fellow, Gray is providing resources to help AHCJ members expand their coverage of mental health amid ongoing efforts to de-stigmatize mental illness and to place mental health care on par with all health care.

Photo: Chris Landsberger, courtesy of The OklahomanThis photo from Jaclyn Cosgrove’s series for The Oklahoman shows a male inmate in the Oklahoma County Jail’s mental health unit.

Amid a nationwide push to pare the number of incarcerated people with mental and/or behavioral disorders, a South Dakota pilot project giving law enforcement officials 24/7 online access to mental health clinicians has diverted from lockdown and into community-based care about 75% of people confronted by police during a mental/behavioral crisis.

Launched in January 2020, Virtual Crisis Care is among the first endeavors of its kind in rural America. It mirrors a comparatively small but slowly growing number of mainly urban projects that, along with virtually connecting police and probation officers with social workers, psychologists and other mental health clinicians, have sometimes placed those professionals in a cop car.

“For rural America, this is a big deal,” said Chris Burbank, a former Salt Lake City police chief and vice president of law enforcement strategy at the Center for Policing Equity. “Most rural communities are not in this ballgame at all.”

Still, South Dakota, where the federal Office of Management and Budget designates 59 of the state’s 66 counties as rural, is not the only rural region aiming to revamp how law enforcement personnel manage their interactions with people in mental or behavioral crisis. The Idaho Sheriffs Association, for example, backed a successful ballot initiative expanding Medicaid in that state — where 35 of the 44 counties are rural — specifically because those elected officials wanted to boost funding for mental and related health services that might lower incarceration rates especially for those who might be guilty of non-violent or other lesser infractions. Those mental health care dollars started rolling out in January 2020.

Likewise, voter referendums in Nebraska and Utah also resulted in more Medicaid spending on mental health, including for those at-risk for incarceration, with those expenditures starting in October 2020 and January 2020, respectively.

Florida Southern University criminologist Risdon Slate, Ph.D., who trains law enforcement officials nationwide in crisis-intervention techniques for de-escalating mental health crises, has been tracking the trend. Despite advances on this front in places like South Dakota, there is much work to do, he said.

“Rural areas typically are desperately in need of mental health services,” Slate said, adding that, even in better-resourced urban areas, it can take weeks, if not months, to get into treatment. That’s because of a years-long, worsening shortage of mental health and behavioral health clinicians.

South Dakota’s pilot program, kicked off with $1 million from the Helmsley Charitable Trust (an AHCJ funder) and extended through June 2022 with $360,000 in state funds, has outfitted sheriff’s departments in 24 counties with tablets linking those arresting officers with health care professionals.

“Using tablets and having clinicians provide critical info based on their video observations to officers in the field confronted with facing people with mental illness in crisis can lead to successful resolutions and save lives,” Slate said.

Those interactions, he added, also do not violate federal laws forbidding disclosure of a patient’s medical status or history. Those virtual clinicians “are merely focusing their observations and possible real-time video contact with a person with mental illness in crisis.”

A 2017 analysis by Families Against Mandatory Minimums concluded that 45% of federal prison inmates reported having a mental or behavioral disorder. A 2015 Urban Institute analysis concluded that 56% of inmates in state prisons and 64% of those in jails, which mainly hold pre-trial detainees, had those disorders.

An array of policy-makers, prison-reform activists and legislators — from the left-leaning Prison Gerrymandering Project to the libertarian/conservative Charles Koch Foundation — have inveighed against incarcerating especially non-violent convicted and alleged offenders. Among their critiques are that such incarcerations are inhumane, a poor use of criminal justice tax dollars and a misuse of frontline police, sheriffs and correctional officers.

The fact that South Dakota is running such a program might bode well for law enforcement agencies and the communities they serve in other disproportionately rural states.

“One of the things about law enforcement, historically,” said former police chief Burbank, “is that when it comes to tactics, training, tasers, body cameras … police [agencies] copy one another. If it’s perceived as working well, it will be replicated.”

Potential story ideas

  • Find out what fluctuations in mental health funding mean to online and in-person pairings of mental health clinicians and law enforcement officials.
  • Explore municipalities that have replicated the work of the award-winning Polk County (Florida) Sheriff’s Department.
  • Conduct interviews with formerly incarcerated people with mental/behavioral disorders as they are a part of a growing cadre of peer support specialists being paired with those who are diverted from incarceration.

Additional sources

National Sheriffs’ Association. (In most of rural America, sheriff departments often are the first to encounter people in mental/health crisis; they also run jails they say disproportionately house those kinds of inmates.)

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