By Leslee Kulba- The Buncombe County Commissioners were asked to support a national effort called the Stepping Up Initiative. The program asks leaders to sign up to pool resources to “do something” about the two million people with serious mental illness booked into US jails each year.
It only stands to reason that people who commit serious crimes against society might not score within the norms of psychiatric evaluations. The problem is, jails work more as detention than correction facilities. Stories are told of jails being schools where criminals share tricks. Although much has been done to change this, prisoners are often released worse for the wear. As one conman up north shared, he was discharged with nowhere to stay, no money, no clothes, and no food. He asked the guard what he was supposed to do, and she said, “Do what you do best.” He was a normal kind of guy, so it’s not hard to imagine what the maladapted, confused, insecure, delusional, etc. do in the same situation. They do things that get them back in the system.
Chief Glen Matayabas shared some statistics and measures the county is taking to improve them. He was standing in for Sheriff Van Duncan who was attending a National Night Out community crime prevention event. Matayabas said the 604-bed Buncombe County Detention Facility booked 13,825 inmates in 2014. The average daily population was 438. If the county keeps its detainee count low, it has room for state and federal inmates. The federal government pays $100 and the state pays $45 per day per inmate. The state and federal government also cover costs, like billable medical expenses, for their prisoners. All told, the jail collected about $2 million from state and federal sources in 2014.
One of Matayabas’ slides showed a sentence oft-quoted in the North Carolina Sheriff’s Association: From the moment an inmate enters a county jail, whether awaiting trial or convicted, they gain access to complete medical care including prescriptions, dental, and mental health. So, another thing the county does to keep costs down is it screens patients for physical and mental illness immediately. The state only requires they be screened within fourteen days, but early detection pays off. Psychological evaluations are conducted in a private setting with a healthcare professional in order to minimize cover-ups. The county determines what insurance the prisoner carries, but since many are indigent, they are added to the NC FAST database, if they aren’t already enrolled, with the hope they will qualify for Medicaid.
For non-emergency sick calls, inmates pay $20 out-of-pocket, and they copay $10 to fill a prescription, unless they are indigent. It is believed a slight increase in the copay dropped the number of sick calls from 150 in FY14 to 119 in FY15. The county routinely spends anywhere from $11,000-14,000 a month on prescription medications for detainees. In an average month, the county jail population will include 100 persons with chronic conditions; 34 in detox; 3.6 in prenatal care; and 132, comfortably over 25 percent of the population, on psychotropics. For expensive medical services, state law requires the county to pay either 70 percent of the uninsured portion of the provider’s rate or twice the Medicaid rate, whichever is less. The problem is many providers won’t share the Medicaid rates. To get around that, the Buncombe County jail sends medical bills back to Mission Hospital, and then the hospital finds a way to work in a third-party insurer, which is usually Medicaid. Matayabas estimates the county has saved about $500,000 by “working through the Medicaid process.”
The county is also invested in programs to try to keep the mentally ill out of jail. Its annual report on behavioral health shows point-in-time counts of Asheville’s homeless population. The total count went from 502 in 2005 to 533 in 2014 and then 562 in 2015. The report refers to an inferred trend as “relatively steady.” Counts for the chronically homeless in the same years number 169, 47, and 74. Since the onset of the 10-Year Plan to End Homelessness in 2006, 620 of the area’s chronic homeless have been housed with wraparound services provided by the county and its partners. Do the math if you can.
On tap, is an apartment complex that will mix shelter and services for 24 more of Asheville’s hard-to-house with 48 units of workforce housing. Now that the 16-bed Neil Dobbins detox facility operates at capacity, the county will be setting up a second treatment center at 356 Biltmore Avenue with state funding. It will feature sixteen beds for stabilization and detox and eight chairs for observation and stabilization.
The annual report stressed the importance of signing people up for services. It applauded AHOPE for being the “principal referral point for the community” and Pisgah Legal Services for identifying disability candidates and fast-tracking their applications. Buncombe boasts once again having the most SSI/SSDI Outreach, Access and Recovery applications in the state, because it represents an effective transfer of line items from the county budget to the federal budget.
Among jail diversion strategies employed by the county are Crisis Intervention Team (CIT) training, Drug Treatment Court, Family Treatment Court, DWI Treatment Court, and Veteran’s Treatment Court. The last two are run with state funding. The county is also making intentional headway in rehabilitating high-users of community resources.
Each year, 15-20 percent of the county’s behavioral health funding goes toward prevention. Substance abuse programs include collections of unwanted medications at various dropoff points and delivery of Alcohol Merchant Kits to help retailers with carding. For victims of domestic abuse, the county has a federal grant to “identify interventions” for school-age children, and it avails screening for adults. For perpetrators, the county offers treatment that may include facilitated group sessions to help with the negative self-talk and esteem issues that lead to acting out. To encourage participants to stick with the program, the county may help with “housing, employment, child custody, health, transportation,[and/or] financial concerns . . . looking at utilizing available community resources wherever possible.”