Early last year, two suicidal patients showed up at a hospital emergency room in Pierre, S.D., seeking help. Although the incidents happened weeks apart, both patients ended up in an unexpected place: jail, according to The Marshall Project.
Across the country, and especially in rural areas, people in the middle of a mental health crisis are locked in a cell when a hospital bed or transportation to a hospital isn’t immediately available. The patients are transported from the ER like inmates, handcuffed in the back of police vehicles. Laws in five states — New Mexico, North and South Dakota, Texas and Wyoming — explicitly say that correctional facilities may be used for what is called a “mental health hold.” Even in states without such laws, the practice happens regularly.
“It is a terrible solution...for what is, at the end of the day, a medical crisis,” said John Snook, executive director of the Treatment Advocacy Center, a national group that advocates for the severely mentally ill. Research shows that the risk for suicide, self-harm and worsening symptoms increases the longer a person is behind bars.
But in a shift, Colorado recently outlawed using jail to detain people in a psychiatric crisis who have not committed a crime. The state delegated just over $9 million — with $6 million coming from marijuana tax revenue — to pay for local crisis centers, training for law enforcement and transportation programs.
The new law was passed after Colorado’s sheriffs lobbied the state to extend the amount of time a person could be detained. In rural counties, sheriffs testified, lack of manpower meant they were forced to hold onto people longer than the 24-hour legal limit. A state task force instead recommended ending the practice entirely.
There are no national figures on how many people are held each year in jail just because they have nowhere else to go in a mental health crisis. Reports from the federal agency overseeing hospitals — the Centers for Medicare and Medicaid Services — offer a glimpse. Since 2011, at least 22 hospitals in 16 states have been cited by CMS for failing to stabilize patients in need of mental health help, instead handing them over to law enforcement to wait for a psychiatric evaluation or a bed. The hospitals span the country, from Alabama and South Dakota to New York and Ohio.
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