Before the Durham County jail opened its mental health housing unit, some of its inmates asked to be voluntarily locked in theircells all but 90 minutes a day.
“They were having paranoid thoughts or were afraid of the other people in the pod,” explained Dr. Patricia Knaudt, the mental health director of the jail in downtown Durham.
Now, some inmates have a refuge of sorts with the opening of a jail pod that can house up to 23 men with severe mental illnesses, such as bipolar disorder and schizophrenia. Inmates on suicide watch will also be placed in the pod.
The Sheriff’s Office, which runs the jail, plans to request money for a mental health pod for women next year.
In 2015, more than 7,300 people were incarcerated in the jail, and at least 20 percent of those were referred for mental health services.
“We had to recognize changes in state funding and resources for mental health care have changed the way facilities like ours have to prepare and care for inmates,” Sheriff Mike Andrews said.
“This issue isn’t going away,” he said. “I’m confident our new mental health pod will make a difference in the lives of inmates while they’re in custody.”
In June 2016, the Durham County commissioners approved funding for 10 new jail positions for the new pod, which was set to be funded in early 2017.
Finding staff delayed the opening. When Col. Anthony Prignano was appointed to lead the jail in May, Andrews told him the pod was a priority, Prignano said.
The jail has continued to see an increase in the number of those with severe mental illnesses being incarcerated.
Today 25 percent to 28 percent of inmates have a serious mental-health issue, said Gudrun Palmer, director of the county's Criminal Justice Resource Center.
About 15 men are currently in the mental health pod. Officials want to move slowly as they pull people with severe diagnoses into a pod together, Knaudt said.
Mental health services at the jail
The team that oversees mental health services at the jail includes four licensed clinicians, a peer support worker and a contract psychiatrist, Knaudt, who works 12 hours a week and has been in the position since 1999.
They make sure inmates with mental illnesses receive medication. They also contact families and providers if there is a problem and help establish a discharge plan when the inmates leave.
Everyone who’s booked into the jail has a medical screening. If someone comes in with a diagnosis but without their medicine, a nurse typically seeks their medication records right away.
If a mental illness is identified, then a mental health staffer will follow up within 24 hours, said Kelli Egnaczak, a mental health supervisor at the jail.
County officials are using a $228,000 federal grant to explore improving the screening process.
Before the pod
Before the mental health pod opened, staff would work to find a “best fit” for male inmates with severe mental illnesses, Prignano said. That process continues with women.
That might mean keeping them in a protective custody pod, placing them in a single cell instead of one that is doubled up, or keeping them in an initial pod where male inmates go before they are classified and moved.
In general, inmates with mental illnesses are seen twice a month, unless they put in a sick call.
In the mental health pod, one clinician is assigned to the pod every week and visits it twice a day.
“We do rounds, kind of like you do in a hospital,” Egnaczak said.
Prignano assigned 13 deputies who have received crisis intervention training to the pod, which means the staff is consistent.
“Clients with mental illness, consistency is really important,” Egnaczak said.
Deputies get to know the inmates. They recognize if they don’t come out of their cell, take a shower or are upset after a phone call, and inform the mental health staff.
Recently, an inmate didn’t want to take his medication, which isn’t uncommon. The deputy called the mental health staff, who talked with the inmate who ended up taking his medicine.
“We can’t force treatment here, so that is why relationships are crucial,” Egnaczak said.
The mental health pod is also quieter and inmates more comfortable socializing because they feel safer, she said. Social activities includes working with crafts on Fridays, such as creating posters with positive affirmation that decorate the pod.
“What I see is them interacting more because I feel like they are with people that are similar to them,” she said.
Concerns about jail deaths
While the push for the mental health pod began in 2015, the opening comes as inmate advocacy group the Inside-Outside Alliance and others are expressing concern about seven inmate deaths at the jail since 2012. Three were suicides.
In the latest case, James Earl Staton Jr. died Nov. 5 in the jail. Preliminary findings suggest Staton, 40, died of natural causes, according to the Sheriff’s Office. His body was taken to the state medical examiner’s office in Raleigh for an autopsy.
In response to concerns expressed by the state about jail procedures related to three of the deaths, the jail has added policies and protocols to make sure inmate checks are done regularly and require that any information suggesting inmates are threats to themselves be brought to the attention of supervisors and mental health staff, Prignano has said. Two of the cases that the state had concerns about involved suicide.
People on suicide watch will be moved to the mental health pod, but one measure can’t stop suicides, Knaudt said.
“Every prison or jail in the entire country will have completed suicides,” Knaudt said. “All we can do is employ as many preventative measures as possible.”
A building boom
Capacity at state mental hospitals in North Carolina has dwindled since 2001 as state leaders tried to shift care away from institutions into community services.
The state closed Dorothea Dix Hospital in Raleigh, one of its four public psychiatric hospitals. It began cutting its capacity at psychiatric facilities in half.
But some argued the reduction in bed space came too swiftly, putting pressure on local hospitals and law enforcement to manage patients with severe mental health issues in need of longer-term treatment. Those patients include people whom the courts have ordered to be committed because they pose a danger to themselves or others.
Since 2010, the state embarked on a building boom in psychiatric facilities. It allocated $139 million to replace Cherry Hospital in Goldsboro, adding about 120 more beds than the existing 19th century facility could hold. Legislators invested in a new Broughton Hospital in 2012, allocating $129 million for a facility that would serve 385 patients, nearly 100 more than the aging hospital.
Central Regional in Butner began operating in 2008, with beds available for about 380 patients. Cherry Hospital opened its doors last summer, with space for 313.
Staff writer Lynn Bonner