Debate rages over holding mentally ill patients

9NEWS at 4 p.m. 05/03/16.

DENVER - Colorado state lawmakers are debating an uncomfortable aspect of how mental health issues are handled in Colorado: Holding people in jail during episodes.

Jails are already being used for this purpose when authorities can’t find a psychiatric hospital beds. Lawmakers are debating the issue, in part, because sheriffs in the state found themselves on sketchy legal ground holding patients in jail beyond 24 hours. The bill has already passed in the Senate and is now in the House.

If a person is a danger to themselves and/or others, the thinking goes, it’s better to hold them in the controlled environment of a jail than to simply turn them out on the streets.

But that belief is not universally accepted. Some mental health advocates worry sticking an unstable person in a prison-style environment with no actual therapy would only make things worse in many cases.

Just about everybody in the field thinks jails are a bad place to stick a person in a crisis.

“It’s not a therapeutic environment,” 9NEWS psychologist Dr. Max Wachtel said. “What happens when somebody is on suicide watch in a jail is they have no privacy. They get checked on every 15 minutes. They’re isolated. They’re being watched all the time, wearing something weird, and knowing that they’re in jail when they haven’t done anything wrong.”

Wachtel also says that knowing jail could be a consequence of speaking up could itself prevent patients from doing so.

“It’s already hard to get people to talk about if they’re suicidal or homicidal because most people know that will land them in a hospital, which can be an unpleasant experience,” Wachtel said. “That is then magnified if a person knows they’re going to jail.”

The question is: What’s better for somebody who has committed no crime but seems intent on killing themselves or others? Should they sit in a jail cell until something better opens up? Or should they be set loose?

The culmination of this debate is SB 169 which aims to address the issue by granting sheriffs specific authority to use jails for an additional 24 hours with court approval.

“We are trying to find that balance to get people help as soon as they can,” house sponsor Rep. Tracy Kraft-Tharp (D-Arvada) said.

The bill does not count weekends and holidays against the additional 24-hour limit. Its language admits that it is meant as a stopgap—that jails are not ideal.

“They should only be used as a last resort when other, more appropriate facilities are unavailable when an individual is placed on an emergency mental health hold,” the bill declares.

By law, patients being committed to a 72-hour involuntary mental health hold are supposed to be taken to what’s called a “designated” mental health facility. But those facilities aren’t always able to accommodate new patients, nor are they easy to reach from some of Colorado’s more rural counties.

The bill started as an attempt to allow rural emergency rooms which lack that designated status to hold mental patients. ER’s had a conflict, too. They are legally forbidden to turn away patients who walk in the door, but lacked authority under state law to hold on to patients for mental health holds.

That’s when sheriffs came forward to complain of a similar issue.

Kraft-Tharp says some rural counties struggle to connect patients with services. The additional time would help locate an appropriate facility and allow time to transport patients.

The bill also includes a study of the issue that will make recommendations to the legislature to improve how these cases are handled, with the aim of preventing the need for jails and non-designated emergency rooms to take in mental health patients.

That group is likely to call for more funding of mental health services.

“Mental health has always been a low priority in terms of funding,” Kraft-Tharp said.

Copyright 2016 KUSA


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