Last month, Regional Jail Administrator Bryan Brandenburg described a recent day at the regional jail that stood out for a frustrating reason: at one point, every inmate in the booking area belonged in a mental health facility.
Instead, as regularly happens, they were put behind bars. Booking felt like an acute psychiatric unit, Brandenburg told the Northern Oregon Regional Corrections Facility board at its October meeting.
He said four people had to be put in restraint chairs, and three needed emergency medication to control them.
Those types of situations are usually much more infrequent, he said.
“I wish I could videotape some of the people we had to deal with last week. It’d break your heart,” he said. One was a retired teacher who had been trespassed from Mid-Columbia Medical Center. “It was sad,” he said.
Gilliam County Sheriff Gary Bettencourt said, “We have no facility to take these people where they can be properly treated by mental health professionals. It continues to be jail.”
The jail in The Dalles is operated by Wasco, Hood River, Sherman and Gilliam counties.
Brandenburg has recently started a mental health unit at the jail that treats qualifying inmates. The 12-bed unit is treating about eight inmates at a time on average.
“With Bryan and his ideas, we already are way beyond other jails in the state,” Bettencourt said.
He said it was disturbing when hospitals were refusing to take the mentally ill and forcing jails to take them. “It happens every day.”
In the jail board meeting, Brandenburg said he was incredulous when an emergency room doctor in Hood River once wrote instructions that a mentally ill patient should be taken to jail.
“Now the hospital brings them to us to do a mental health hold? That is the mental health director that is directly responsible for that,” Bettencourt said.
Brandenburg contended hospitals needed to take more responsibility for the mentally ill. He said he believed the law required hospitals to provide mental health holds.
Liesl Peterson, director of emergency services at Mid-Columbia Medical Center, said MCMC is not an inpatient mental hospital or a psychiatric hold hospital, which would have that kind of legal obligation. In fact, no hospital in the gorge is in that category, she said.
She said if a person needed spinal surgery, they’d go to a facility with a higher level of care. “Psych treatment is the same way, you go to a psychiatric facility.”
Even so, the hospital does do mental health holds on patients, and in fact averages about 26 a month, she said. Of those, about four go to a higher level of care and the rest are discharged from the emergency room with a safety plan, she said.
She said the law does require the hospital to do a medical screen of people brought in for mental health evaluations to rule out medical problems such as being drunk or ingesting a drug or having an infection.
But if all that is ruled out, and it seems clear the issue is psychiatric in nature, then the local mental health authority, the Mid-Columbia Center for Living, comes to evaluate the person for their risk to self or others, she said.
“They are the mental health authority, they are the ones that make the decision on whether you’re placed on a mental health director’s hold or not. But they do that up at ER,” Peterson said.
If the hospital can’t safely hold them, then law enforcement gets involved.
Peterson said the hospital sits on a task force with local law enforcement and the Center for Living to address mental health issues.
She said how to treat the mentally ill is “a huge problem… We’re all very frustrated.”
She said, “It’s a crisis.” Even in Portland, the waiting time in emergency departments for inpatient psychiatric placement can be days.
Some of the people placed on a mental health hold at MCMC are there for mere hours, but one was there for a month. “Nobody wants anyone to live in the ER for a month,” she said.
It depends on how complicated their case is and how hard it is to get a bed in a psych facility.
“We need more inpatient psych beds in the state,” she said.
Sherman County Sheriff Brad Lohrey, the sheriff representative on the jail board, said at the jail board meeting, “All four sheriffs agree it’s not fair to take someone chronically mentally ill to jail.” But they also agree that it is the safest place available for them.
He added, “This has been a problem since the doors opened” for the jail, which was in 1999.
Amber DeGrange, Sherman County’s juvenile director, said mentally ill people are “not meant to go to jail, which is terribly triggering and traumatic. It’s a terrible system.”
Bettencourt encouraged counties to put more pressure on mental health entities.
“From the county level, being the mental health authority, there is so much more you can do,” Bettencourt said.
Wasco County Administrative Officer Tyler Stone said, “I’m hearing you guys need political help in this situation” and need help with messaging. If need be, the Association of Oregon Counties could be brought in, he said. Stone later said the AOC has already weighed in on the matter.
Brandenburg said when mentally ill people have come to the jail, jail staff have ended up finding mental health beds for them. In some cases, they even drive the person to the facility. “We’re doing the job that should be done by the hospital and CFL,” he said.
But even so, he said in a later interview, “It’s not necessarily their fault, is the thing.” He said, “Those guys do a good job and they do the best they can, and they struggle with us.”
Barb Seatter, executive director of the Center for Living, said CFL “totally agrees with the concerns of the other community partners that jail is not the place for people with mental illness.”
She said it was a national problem that stems from di-institutionalization 30 years ago. “And the communities have not been provided enough resources to serve people with these issues successfully in the community.”
She said law enforcement, hospitals and county officials have “worked tirelessly trying to make improvements in the system with what we have, and I think we have been successful.”
“And as many people who are still going to jail, we have many people diverted” from jail, she said.
The Center for Living’s jail diversion program serves people with severe and persistent mental illness. Started in 2014, a jail diversion team can respond to clients on the street, in the jail, in their homes, or at an office.
The diversion team works directly with law enforcement to divert people from being arrested.
In 2017, it has helped divert two people from the Oregon State Hospital and has prevented seven arrests of enrolled clients.
“These numbers may seem small, but represent a large savings in staff time and finances to local emergency rooms, law enforcement agencies and NORCOR,” said Al Barton, clinical services manager for Center for Living.
Most of the persistently mentally ill commit minor crimes such as trespassing or littering. The most common crime is probation violation, often due to substance abuse. The program serves about 30 people a month, and each person is often seen 2-4 times a week.
Seatter said it is a complex issue of people not understanding the mentally ill and their rights, plus lack of funding and legislative issues, she said.
“We all need each other,” Seatter said. “This is a community issue and it has to be dealt with at all levels of the community agencies, not just mental health, and we have been doing that.”
She said, “I think everybody is stepping up to the table to try and have impact on this issue and there will always be people who wind up in jail regardless of those efforts, and for that we are grateful that Bryan [Brandenburg] has developed a mental health and substance abuse program in the jail.
“They’re really helping those people if they do wind up in the jail.”