Jail Report Flags Concerns With Mental Health Services, Over-Prescription Of Addictive Drugs
By Beth Milligan | Aug. 31, 2020
An independent firm hired to review conditions at the Grand Traverse County Jail found that overall medical care in the facility is good, but flagged numerous concerns with mental health care, calling it “fragmented and discontinuous” and noting that an “unusually high” amount of potentially addictive drugs are prescribed to inmates. The report also stated that after two inmates died by suicide in the last four years, psychological autopsies – a “universally expected” procedure – were not completed, a lapse the report called a “highly significant deficiency.”
Grand Traverse County commissioners agreed in May to hire NCCHC Resources for $24,640 to conduct an independent review of inmate services at the jail. The consulting group is a nonprofit entity of the National Commission on Correctional Health Care and works with approximately 500 jails and prisons across the country to provide technical assistance and expertise on best practices for jail operations. Grand Traverse County Sheriff Tom Bensley brought forward the contract proposal, saying it would help answer lingering questions about whether jail services are adequate or in need of improvement.
The county has outsourced medical care for inmates since 2010 at an average cost of $460,000 annually, according to figures previously provided by Bensley. That contract – with a company called Wellpath – spiked to $555,000 in 2018 and is expected to climb to $615,000 in 2020. The county also contracts with Northern Lakes Community Mental Health Authority (NLCMHA) to provide two full-time mental health professionals at the jail at a cost of $163,000 annually. Bensley previously told commissioners that he and other Sheriff’s Office staff aren’t medical experts and don’t have the skillsets to evaluate the quality of services provided by Wellpath and NLCMHA, but that an independent company with relevant expertise could.
Consultants conducted Zoom conference calls with Bensley and other key jail staff this summer and conducted two days of on-site visits in July, during which they interviewed inmates and jail, Wellpath, and NLCMHA staff. In a report outlining the consultants’ findings, NCCHC noted that Grand Traverse County Jail “doesn’t have the most ideal layout, but it is functional and can meet the medical needs of inmates.” In terms of medical care provided by Wellpath, “it appears that the general care is adequate and the staff are committed to the performance of their assigned duties and to the provision of care to patients,” the consultants wrote.
NCCHC suggested several areas where medical care could be improved, including moving from paper-based health records to an electronic system and increasing documentation, such as dating signatures and making records of text messages that are sent or received related to inmate care. More seriously, the report found that both medical and psychiatric providers “prescribe many potentially abused drugs and sedatives…the use of these seemed unusually high compared to facilities of similar size.” The consultants recommended asking about and documenting inmates’ alcohol and benzodiazepine use, and discontinuing Tylenol-codeine as a medication bridge for pregnant individuals. NCCHC added that “on a positive note, sick call requests through the kiosk system appeared to be answered pretty quickly” and that other types of care were delivered in a timely and thorough fashion, concluding that “overall medical care appeared to be good despite all the suggestions above.”
However, the consultants flagged numerous serious concerns regarding mental health care services in the jail. NCCHC said there was “pervasive evidence that essential mental health services are not currently provided to jail inmates,” pointing to a “significant disconnect” between NLCMHA and Wellpath staff and a lack of NLCMHA documentation in jail records. “The health records (paper charts) at the jail are disorganized, incomplete, and scattered…the most urgent issue relative to health records is the conspicuous and consistent absence” of mental health reports, the report found.
A NLCMHA behavioral health specialist assigned to the jail spends a “disproportionate” amount of his time – up to 40 percent – on just three inmates and has seen only 50 percent of the patients assigned to the mental health caseload, according to the report. “It is inconceivable that up to 16 hours per week of the specialist’s time can be legitimately devoted to three patients while essential mental health services are not delivered to the entire jail population,” consultants wrote. The report praised a NLCMHA peer support specialist who assists inmates with discharge planning, saying she does so in a “robust” and “timely” manner largely compliant with industry standards, but noted that not all inmates “are afforded this important service.”
According to the report, NLCMHA doesn’t conduct initial mental health assessments for any inmates admitted to the jail – implying to consultants that such work “falls outside the scope of their contract with the county” – and does not conduct “post-suicide watch follow-ups in a systematic way.” Consultants also said “there is no evidence of any kind of treatment planning” at the jail. Psychological autopsies, a procedure that is “universally expected” after an inmate suicide, were not conducted for two inmates who died of suicide at Grand Traverse County Jail in the last four years. According to consultants, that “highly significant deficiency” is likely the result of fragmented service delivery in the jail and unclear delineation of responsibilities. “It is imperative that all facets of the mental health service delivery system are integrated under a single administrative authority and that specific areas of responsibility and accountability are defined,” the report concludes.
NLCMHA Chief Executive Officer Karl Kovacs took a leave of absence from the organization effective August 10 and could not be reached for comment. In a written statement to The Ticker, NLCMHA Acting Chief Executive Officer Joanie Blamer said: “NLCMHA leadership has met with the leadership of the County Jail to review the findings of this report. We agreed there was misinformation and several errors of reporting contained in it. We also agreed Capt. (Chris) Barsheff would take the lead role in pulling together key people to review and assess the recommendations, and develop an action plan for the jail to move forward.”
Bensley confirms his team met with NLCMHA and says there may be some inaccuracies in the report, such as how the mental health patient case load was calculated. However, he says overall the consultants’ findings were “fair” and that he believes the assessment was worth the price. “On the medical side, we have good marks,” he says. “Mental health, we have some work to do.” Bensley says that although the jail’s mental health care program “works, it’s only serving a few. We will need to pivot and look at that. I think there will be changes to the program.” The sheriff says he believes NLCMHA is “committed to working with (the county)” and improving services, though he notes some changes – like increasing staffing – could require more funding, with budget changes subject to county commission approval. County commissioners Betsy Coffia and Bryce Hundley have requested to have a board discussion with the sheriff on jail oversight at the commission’s 8am virtual meeting Wednesday.Comment