Screening

In 2014, Tri-County Services began to supply the county jail with clinical staffing to identify mentally ill individuals at the intake process.

“Before that our sergeants were having to identify mental health issues, and that was completely inappropriate,” Precinct 3 Commissioner James Noack said. “I made certain that the dollars that were allocated to Tri-County [are] used inside of our jails.”

A clinician screens individuals during the intake process for certain types of mental illness and prescribes the appropriate drugs, Roberson said.

The most common mental health issues the clinician finds upon intake are schizophrenia, bi-polar disorder and major depression, he said.

Due to mental illnesses the Montgomery County Jail sees about 30 suicide attempts each year.

“That’s beyond mere preparation,” said Jeremiah Richards, Montgomery County Sheriff’s Office lieutenant. “They took an active step in suicide.”

The staff identifies an active suicide attempt when an inmate ties something around his neck, cuts himself or hits his head on something, Richards said.

Clinical Health

The jail is responsible for the mental health treatment of inmates and provides all medical care, not just the psychiatric care, Roberson said. The clinician is there five days a week and sees inmates once they are booked into the jail. Some inmates bond out before the clinician is able to see them.

“We thought initially that we might have some time left over to do some group therapy, but our clinician is pretty busy doing just the screening,” Roberson said.

The mental health services at the jail are offered by an array of different providers, Richards said. A licensed professional counselor spends 40 hours a week in the jail to diagnose patients. The counselor will determine if the patient needs to see a psychiatrist who is available through video-conference equipment.

The jail also has a contract with Sam Houston State University’s psychiatric program, he said. A doctorate student offers counseling to some of the inmates through therapy sessions.

“If we can see a definite decrease in [suicide] incidences then we know the program’s successful,” Richards said.

Offsite care

Roberson said inmates are sometimes not ready to stand trial due to mental incompetence.

“They just don’t understand what’s going on around them,” he said.

These patients are sent to a 100-bed Conroe facility to restore their competence with medication and treatment. Once they are restored to competency, they are taken back to the jail to get on the trial docket, Roberson said. If they are not mentally fit enough to return to jail, the client is admitted to a civil hospital.

Improvements needed

Mental health issues contribute strongly to crime, Noack said.

“When you look at crimes trends analysis, you’ll see that the mental health factor and criminal activity is a strong component in the growth of crime,” Noack said. “From the courts to law enforcement to jail—we need to do a better job of identifying the mental illness element.”

The sheriff’s office should present mental health care issues in the jail to the Commissioners Court so the county can address them, he said.

“You can’t treat someone with mental health issues in the same way you’d treat a criminal,” he said. “We need to identify, segregate and treat mental health-related criminal activity differently so we can reduce the recidivism rate.”