A county jail is not a mental health facility.
But as inmates with mental illnesses enter, jail staff and contractors are charged with caring for them.
Brown County Jail Commander Tony Sciscoe estimates 75 percent of his inmates have a mental illness.
Dana Ericson, 60, Nashville, has been housed in the Brown County jail since February as he waits for Brown Circuit Court to determine if he’s competent to stand trial for attempted murder, aggravated battery and battery resulting in serious bodily injury.
He is accused of hitting 18-year-old foreign exchange student Yue “Z” Zhang in the back with a hatchet last year while she was taking pictures for a class in downtown Nashville. He told police he was attempting “ethnic cleansing” and called himself a white supremacist.
In a Nov. 30 email to Judge Judith Stewart and Prosecutor Ted Adams, Sciscoe wrote that Ericson’s “mental state continues to decline on a daily basis.”
“I understand that he has committed a crime, but he needs mental health treatment that we just cannot provide,” Sciscoe wrote.
Since 2003, Ericson has been charged multiple times with intimidation, battery, criminal confinement, disorderly conduct and resisting arrest, according to online court records. He used the insanity defense in more than one case and spent time in psychiatric hospitals.
After his arrest in the hatchet attack nearly a year ago, he received four months of inpatient treatment at the Logansport State Hospital. In a typed letter to Stewart from the hospital in August, Ericson said he had made “substantial progress” in his recovery and said a new medication regimen had him “feeling better than I have for some 20 years.”
Later that month, a state doctor found him competent to stand trial, and he was moved back to the Brown County jail.
But in hand-scrawled letters the court received throughout September and December, Ericson claimed he was being over-medicated at the county jail and is in need of therapy. He claimed he was being abused and that he feared for his life.
“He is in no way shape or form being abused in this jail,” Sciscoe said. “Myself, the sheriff and the chief deputy will not allow that or put up with it.”
In other recent letters, Ericson claims there is a conspiracy against him and his family that caused him to attack the girl; he said he never meant to harm her and he was “surprised to find that she had sustained any injury whatsoever.” He also blamed “a widespread use of lesser black magic” for the “conspiracy.”
His attorney, public defender Jacob Moore, filed a notice of defense of mental disease or defect and asked for a second psychiatric examination to determine whether or not his client is competent to stand trial. That hearing is scheduled Tuesday, Jan. 17.
‘We do our best’
Brown County contracts with Quality Correctional Health Care to provide medical and mental health services to inmates. That company provides services in jails in 44 Indiana counties, including Hancock and Decatur counties, according to its website.
Sciscoe said the Brown County jail receives $71,000 from the county to pay the contract, which covers having a nurse at the jail eight hours a week, having a charge nurse come in every other week and a doctor visit once a week.
Inmates get a half-hour to an hour of therapy every other week and medications, Sciscoe said.
The doctor and nurses are also on call to provide additional help 24/7.
Sciscoe estimated that 75 percent of the funding does go to cover the medical costs in the jail instead of mental health services.
He said mental illnesses present among jail inmates include bipolar disorder, schizophrenia and depression.
“In the county jail, you just can’t get the mental health treatment you need,” Sciscoe said.
“We do our best. We do our best. We have mental health treatment here, but it’s just not enough. Jail staff, we are not mental health (experts). We have some training on mental health but not enough to be able to help the person.”
This is not just a Brown County problem, or even a small, rural county problem.
In December, Indianapolis Mayor Joe Hogsett announced a proposal to build a new jail and make changes to the criminal justice system in Marion County that would place a greater emphasis on assessing inmates for mental illness and substance abuse problems, according to the Associated Press.
Hogsett’s administration has said the new jail is expected to cost hundreds of millions of dollars, but the mayor has vowed not to raise taxes to pay for the project, according to The Associated Press.
In an ideal world, Sciscoe said the Brown County jail would have a medical and mental health staff there 24/7, but he estimated that would cost the county an additional couple hundred thousand dollars, which it doesn’t have.
Drugs and illness
Counselor Carrie Foley has been providing substance abuse treatment services in the Brown County jail for 10 years.
She runs an intensive program for male inmates using a Brown County Community Corrections grant, which pays for her to work six hours a week. The goal of the program is to help transition those men back into the community after they are released from jail, she said.
Foley also meets with female inmates a couple of hours a week.
She said many of the inmates she works with had a mental illness before they started using. She said she sees a lot of anxiety and depression, and one or two inmates could be classified as being seriously mentally ill with a disorder such as schizophrenia.
“Frankly, substance dependence is a mental illness, in that it’s an official DSM (Diagnostic and Statistical Manual of Mental Disorders) diagnosis. It’s a contributing factor in so many problems in people’s lives,” she said.
“It’s a coping mechanism,” she said of drug use. “It’s not a good coping mechanism, but people try.”
Jennifer Fillmore, director of grants and specialized services for Centerstone, said in her opinion, mental health illnesses either lead or contribute to criminal behavior 70 to 80 percent of the time.
Fillmore cited a 2010 study by the National Center on Addiction and Substance abuse that said 85 percent of the 2.3 million inmates in prisons and jails around the U.S. are substance-involved.
She also said that “on paper,” 20 to 30 percent of inmates have some type of mental illness, but in reality, that percentage is likely much higher because of the daily structure that a jail provides.
“A lot of the decisions are made for you. Sometimes, someone with a mental illness will go into prison and it’s not detected, because with the structure, they don’t need medication, for example,” she said.
Foley said she would like to see a more comprehensive assessment administered to inmates in the jail to help identify mental health problems and medication needs.
She’d also like to be able to counsel inmates individually.
Foley previously worked with seriously mentally ill patients in Indianapolis. She said some people with mental illnesses will use illegal substances to self-medicate because they don’t like the side effects of medicine that treat illnesses like schizophrenia.
“You might feel stupid and intoxicated, but you still kind of feel,” Foley said of substance abuse. “But as the drugs for schizophrenics, they tend to dull you down. You feel drugged. You don’t get through life any better than you got through life before, but maybe you’re not violent.”
Rather than mental health illnesses, Foley said substance abuse is often what leads to criminal behavior. But long-term substance abuse can also cause mental illnesses, Foley said.
“That long-term substance abuse causes a lot of depression, a lot of anxiety and may be a contributing factor to some of the serious mental illnesses that don’t get diagnosed until somebody is there,” she said.
“Sometimes there’s a pre-existing anxiety condition that maybe they try to self-medicate, but nevertheless, they have a second problem which makes it worse,” she said.
“If you look at the crimes that are a danger to society like assault, battery, assaultive behavior, aggression, domestic violence, those things are often fueled by substance (abuse).”
Centerstone, a mental health agency with offices in several communities, including Nashville, works to identify gaps in services for those with mental illnesses, including inmates, Fillmore said.
Centerstone is now involved with Recovery Works, funded through the Division of Mental Health and Addiction.
A therapist from Centerstone will go to the jail and do an assessment on an eligible inmate. Once that inmate becomes a client of Centerstone, he or she is able to receive visits from a therapist or recovery coach who will help with transition planning back into society, Fillmore said.
Eligible inmates are 18 or older and have a current, past or pending felony and a substance abuse or mental health disorder.
Similar services are available in Monroe and Bartholomew counties.
Centerstone is advertising for a recovery coach to provide life skills training or case management in Brown County. Until one is hired, only a therapist can visit with inmates who are scheduled to be released soon.
“This is the first time that any provider (like Centerstone) has had a payer source like this that will actually pay for services while someone is incarcerated,” Fillmore said.
Outside of grant-sponsored services to inmates scheduled for release, Fillmore said Centerstone does not offer therapy directly to inmates because it’s not in a “therapeutic community.”
“Opening someone up and kind of having all these feelings, then going back to a jail cell is not very therapeutic,” she said.
“In the county jail, you just can’t get the mental health treatment you need.”
Tony Sciscoe, Brown County jail commander