Area network of mental health help for inmates is stretched thin

Jennie Amison is one of many area mental health care providers who have seen demand for her services increase.

By Randi B. Hagi, assistant editor

Every morning, Jennie Amison gets buzzed through the gate at work and walks down the red-tiled staircase and past the payphone to get to her office. At 9 a.m., her group session begins, and she leads 11 men through cognitive behavioral therapy exercises to get at the root of their drug use. 

She’s one of the many mental healthcare providers serving incarcerated people in the area – in Amison’s case, at the Harrisonburg Men’s Diversion Center, a minimum-security facility near Linville. The Virginia Department of Corrections facility is tailored to provide more services, like counseling, GED preparation, and parenting classes, than other prisons offer.

“Normally when they first come, I do interactive journaling with them to get them to start talking about their feelings and where they are as far as changing their behavior,” Amison said. “I’m talking about grown men crying and sharing their hurt from the pain from their past. And that’s how they heal and get through using the substances to relieve them of that pain.”

She said nearly all the inmates at the facility are incarcerated for drug-related crimes. That’s a trend in the area’s local jails, too. Moseley Architects, in the needs assessment produced for the proposed expansion to Middle River Regional Jail, found that drug-related charges were the No. 1 reason for arrests in the five jurisdictions that own the jail. 

For people incarcerated or recently released —and who have substance abuse and/or mental health issues — services are available both in and outside the facilities. But the trick can be knowing where to turn in a potentially overwhelming mélange of different organizations and agencies. 

“The services are there … especially in our community,” Amison said. “But this is the key – sometimes, some people just have difficulty accessing the services. Or they get out and they have difficulty asking for that outside help, and they need somebody to walk them through.” 

That’s a theme Bobby Tucker, emergency services manager at the Valley Community Services Board (CSB), also has noticed. Valley CSB, which is based in Staunton, provides mental health services inside Middle River Regional Jail, with three full-time mental health clinicians and one full-time case manager, whose positions are jointly funded by the jail and a multi-year grant from the Virginia Department of Criminal Justice Services. 

That sort of funding mosaic is part of why there are so many different organizations treating mental health and substance abuse in the area, Tucker said each cobble together their own combination of public and private funding to get by.

“For a long time, we have been grossly underfunded,” he said. “It’s a whole conglomerate of federal, state, and local funding for the CSBs,” and each of the 40 such organizations in the state have a different income profile. 

However, he said Valley CSB has come a long way in the services it provides and its relationships with other organizations and within the justice system. Valley CSB worked with Blue Ridge Court Services to introduce Crisis Intervention Training to area law enforcement officers. 

The organization also started the Pretrial Initiative on Mental Illness. Under that program, each person who is arrested and taken to Middle River is screened for mental health issues. In fiscal year 2019, 284 inmates – over a third of those screened – had a “serious mental illness.” Forty-nine of them were then referred to the Staunton-Augusta Therapeutic Docket program, a specialized court docket that gets defendants into mental health treatment and, potentially, a reduced sentence.

“Could there be more services in the community? … Absolutely,” Tucker said, although he also cautioned that “some people who have mental illness or substance abuse problems are also criminals,” as opposed to those who just “get trespassing charges because the person’s off their medications.”

Perhaps the biggest bottleneck in public mental health services around here is a shortage of psychiatrists. Some new patients coming to Valley CSB face a month-long wait before they can see one.

“It is a psychiatric wasteland,” Tucker said. 

Middle River Regional Jail contracts their psychiatry services from a Western State doctor, who spends about 12 hours a week at the jail. 

Tina Reed, the jail’s FOIA officer, wrote in a response to The Citizen that inmates who are referred to see the psychiatrist “are generally seen within seven days.” 

‘A lot of anxiety, a lot of depression’ 

The Harrisonburg Rockingham CSB, whose clients include inmates at the Rockingham Harrisonburg Regional Jail, has a full-time case manager at the jail, and a nurse practitioner who’s there three-and-a-half hours per week, said Ellen Harrison the CSB’s executive director. 

She said they’re under a psychiatry crunch, too. 

“There is a nationwide shortage of professionals able to evaluate and prescribe psychiatric medications,” Harrison wrote to The Citizen in an email. “While purchasing hours via telehealth is an option, we certainly prefer having our psychiatrists and nurse practitioners on-site.”

In 2020, the organization’s case manager saw 514 inmates at the jail, 43% of whom referred themselves for services. About half of those were related to drug and alcohol concerns. Harrison said their focus is on those with serious mental illnesses, who “cannot discontinue medications.” And she feels like they’re meeting the needs of those patients, although “if you wanted to expand that scope beyond what we’re doing now, of course we’d need more resources.”

For many of their incarcerated clients, the stress of being in jail exacerbates underlying mental health conditions. 

“Obviously, there’s a huge adjustment that’s going on when you’re in the jail. So there’s a lot of anxiety, a lot of depression, a lack of sleep,” Harrison said. 

Focus on prevention

One of the Harrisonburg-Rockingham CSB’s programs helps keep people in mental health crises from being incarcerated in the first place. The mobile crisis unit, a collaboration with the local court services unit, consists of a full-time and a part-time team of a sheriff’s deputy and a mental health clinician. 

“There’s never an identical call. We do a lot of hospital discharge follow-ups … basically wellness checks just to make sure they’re okay, and to remind them of resources that are out there to help with their needs,” said Denise Janocka, the CSB’s clinicians’ supervisor. 

When people are “decompensating,” or starting to experience mental health symptoms, Janocka said they’re more likely to get into trouble with the law. 

“If we can keep those types of people stabilized, naturally that will result in less incarceration … as well as hospitalizations,” she said. “We’ve had some very successful interventions that we are very happy to do, families are happy, and individuals have thanked us. A lot of times they look forward to our visits.”

Kelly Royston, coordinator of the Rockingham-Harrisonburg Joint Mental Health Program, is on the court services end of that partnership. She said the mobile crisis teams primarily operate during daylight hours, and take calls from a variety of sources, including the 911 call center, the Harrisonburg-Rockingham CSB, and probation officers. 

She said it would be ideal to have four teams, so that they could be available around the clock, but they’re able to manage the number of referrals they currently receive. The mobile crisis unit’s work was put on hold for part of the pandemic, but since resuming full operations in October, that unit responded to 155 people – in some cases, multiple times.

“It’s actually helping to take that [responsibility] off of patrol, making welfare checks,” Royston said.

Help beyond the gates

As Amison said, some people struggle to access the services that are available once they’re released from jail or prison. 

That’s where peer support specialists can be a boon. They use their lived experiences of recovery from mental illness or substance abuse to guide others along that journey. Amison said the Department of Corrections started hiring peer support specialists a few years ago, and she’s also the president of the board of Strength in Peers, a local nonprofit that serves those reentering society after incarceration, the homeless and others struggling with mental health and substance abuse challenges.

Nicky Fadley, executive director of Strength in Peers, told The Citizen in an email that the group works in the Rockingham Harrisonburg, Middle River, and Page County jails – starting those relationships before inmates are released. In the past year, Strength in Peers worked with more than 500 incarcerated individuals.

“Strength In Peers works to engage the most vulnerable individuals who may not otherwise seek help from more traditional service providers,” Fadley said. “Since COVID, we have been relying on jail staff to help identify individuals interested in recovery and send us those names to follow up with a one-on-one visit. A lot of people simply hear about our organization from other inmates and write us letters.” 

Once the peer support specialists start working with someone, Strength in Peers helps connect them to a whole host of services, such as counseling through the Harrisonburg Center for Relational Health and telepsychiatry through the University of Virginia. 

Fadley said she feels like the service provider network is “cohesive,” but people leaving incarceration face other significant challenges, “such as the shortage of affordable rental housing and limited public transportation systems.” 

“Unfortunately, the most effective case management can’t increase the rental housing stock or add stops to the bus line near large employers,” she said. 

Much like the community services boards, Strength in Peers also faces funding uncertainty. The organization received federal grants from the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration to support their programming, in addition to local donations. But grants have a ticking clock attached to them.

“Unless we are able to secure other funding, our programs could disappear in another two years,” Fadley said. “We are counting on our policy makers and stakeholders to recognize the value Strength In Peers brings to our communities and help us sustain services.”

Amid the ongoing debate over whether area local governments should spend $39.5 million to expand the Middle River Regional Jail, Amison said she wishes service providers would get that kind of investment.

“We spend a lot of money on incarceration,” she said. “I would like them to do something different instead of … expanding the jail. Give them some transitional housing. Refer them to the drug court. Things that they’re locking people up for, it’s kind of a waste of space, when they could actually be receiving treatment.”

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