When prisons, jails are biggest providers of mental health, that's not healthy

Editor's note: Today The Rochester Voice begins a four-part series on how and why those with mental health issues often end up in the penal system, what are some of the strategies posed to mitigate the problem and why all too often those strategies fail.

Today an overview of what prompted this series and the massive scope of the problem.

Sunday, we'll take a look at one professor of psychiatry's vision that calls for restoring some degree of re-institutionalization - he calls it sanctuary - for those most severely ill.

Monday, New Hampshire's chief advocate for those suffering from mental health issues argues that re-institutionalization would be a bad thing and why funding for more community involvement and outreach is the only humane direction to take.

Tuesday, a look at what Strafford County and Rochester are doing to try to make the local Mental Health Court work for those in need.

ROCHESTER - Last month Rochester police were called to a downtown intersection three times in one day for reports of a person running into traffic and screaming at motorists. The individual was arrested during police officers' third response.

Following a request for details of the arrest by The Rochester Voice, police released the statement below, which has been edited to protect the identity of the individual arrested:

"Officers responded to the area of Portland Street and Columbus Avenue for a report of someone standing in the middle of the street screaming at cars. Shortly after the officers made contact with (name deleted). As a result of that incident and the information received, an officer completed an investigation and drafted a warrant for disorderly conduct and contempt.

Later on that same day, officers responded to another call, where it was reported that (name deleted) was in the road screaming again.

Officers responded a third time for a report of (the same person) in the street. While the officers were speaking (same person) had their hands in their pocket and were moving them around. When asked to take their hands out of their pocket, (they) threatened officers by asking if they wanted to get stabbed, however did eventually comply with their request, removed their hands from their pockets and dropped an uncapped needle."

Since that day, the person - like hundreds of thousands of others across the country who are experiencing severe psychological distress - is behind bars.

In fact, many may not realize it, but "the largest provider of mental health in this country are its prisons and jails," said Dr Daniel Yohanna, an Illinois psychiatrist and assistant professor at the University of Chicago.

The Cook County Jail, which averages around 6,000 inmates, normally has about 1,500 housed there who exhibit symptoms of Serious Mental Illness, or SMI, Yohanna said.

Other 2017 statistics from the U.S. Bureau of Justice show:

14% of prisoners and 25% of jail inmates had past 30-day serious psychological distress, compared to 5% of the general population.

37% of prisoners and 44% of jail inmates had a history of a mental health problem.

More jail inmates (26%) than prisoners (14%) met the threshold for serious psychological distress (SPD) in the past 30 days.

Among those who had ever been told they had a mental disorder, the largest percentage of prisoners (24%) and jail inmates (31%) reported they had a major depressive disorder.

More prisoners (14%) and jail inmates (26%) met the threshold for SPD in the past 30 days than the standardized general population (5%).

Prescription medication was the most common treatment type for prisoners and jail inmates who met the threshold for SPD in the past 30 days.

Fourteen percent of prisoners and 10% of jail inmates who met the threshold for SPD in the past 30 days were written up or charged with assault.

Many of the same metrics are at play locally at Strafford County Jail, said Strafford County Attorney Tom Velardi, who noted a wide variety of data shows some 60 to 70 percent of jail inmates have either SMI or substance abuse issues, or both.

So who would be liable if the person running into traffic at a busy Rochester intersection last month had caused an accident that resulted in property damage, injury or death?

While some might think the city could be held liable for breach of duty - as in when a retail store is sued for having a wet spot that causes a fall - probably not in this case, said a Somersworth lawyer.

"The city has what's known as municipal immunity," said Att. Peter Mathieu of the Coolidge Law Firm. "If there were a sidewalk trip and fall and (the city) was put on notice and it happened again, maybe; but they probably can't lock (them) up for running into traffic, it's not a law. Now if (they) were running down the street with a gun that'd be different."

But who does get sued are hospitals and psychiatrists, Yohanna said.

"Hospitals get sued for premature discharges," he said. "And psychiatrists are not good predictors of longterm outcomes, but they are still held liable."

City of Rochester staff attorney Terence O'Rourke declined to comment for this story.

Tomorrow, The Rochester Voice takes a look at one professor of psychiatry's vision that calls for restoring some degree of re-institutionalization - he calls it sanctuary - for those most severely ill.