Local income tax helps support inmate mental health programs in Boone County

Boone County Sheriff Mike Nielsen has expanded mental health programs available to inmates, through agreements with Quality Correctional Care and Integrative Wellness. Inmates are offered participation in faith-based, drug counseling and anger management programs.

“We went from 60 hours a week of medical care to 84 hours a week; we now have medical staff on site 12 hours a day, seven days a week,” Nielsen said. He said that will allow the jail to provide “exceptional” medical care to inmates.

It will also allow for the expansion of mental health services.

When Nielsen became sheriff, inmates had access to only two hours of mental health counseling — per month. “That is absolutely nothing when you consider that 70 percent of my inmates have some type of mental health-related issue,” he said.

Those two hours are paid from a portion of the county’s mental health tax levy, which raises $293,000 annually. Most of that money goes to assisting the underprivileged, Nielsen said.

About 16 percent of current prison inmates have a diagnosed serious mental illness, according to the Indiana Division of Mental Health and Addiction. More than half of the state’s prison inmates have a substance abuse disorder.

To help inmates not return to the jail, both those categories have to be addressed, Nielsen said.

Integrative Wellness will provide 24 hours a week of mental health counseling, while Quality Correctional Care will provide another 24 hours a week.

“They focus on nutrition, they focus on exercise, they focus on health, they focus on all those things to keep them off the mental health psychotropic medications,” Nielsen said.

He does not want his inmates “walking around like zombies” because they are on heavy doses of Xanax, Ativan, Zoloft, Lexapro or other medications, he said.

Crafting a way to ensure inmates don’t return requires a multi-disciplinary approach both within and without the jail, Nielsen said.

“Where we fail our inmates is when they leave,” he said. “They either end up dead, or they end up back in jail.”

Boone County’s recidivism rate is 79 percent; the national average is about 64 percent, Nielsen said.

His goal is to cut that by 12 percent over the next few years.

“It may not seem like a whole lot, but that is pretty monumental,” Nielsen said. “That will at least bring us below the national average, and that’s where I want to go.”

He believes that inmates return in part because they fall into the same bad habits that landed them in jail.

“What we’ve got to do,” Nielsen said, “is figure out a way to kind of hold their hands when they leave.”

“They go right back to those environments; they go right back to what they’ve been doing,” he said. “They violate their probation and they come back to us, or they overdose.”

Overdoses can even occur while the person is in police custody. A prisoner lapsed into an overdose about noon Friday as the police vehicle transporting him pulled into the jail’s sallyport. The prisoner was revived with a dose of naloxone.

Neilsen hopes that the expanded mental health counseling being made available to inmates by Quality Correctional Care and Integrative Wellness (Inwell) LLC, will increase the odds that a released inmate won’t be a returning inmate.

Nielsen and Lynette Clark, director at Integrative Wellness LLC, Lebanon, received a grant from Recovery Works of Indiana to fund a pilot program that will provide mental health counseling for inmates.

Nielsen and Clark haven’t met with Recovery Works — “they’ve been really, really busy,” Nielsen said — but are expecting to meet in the next few weeks.

Recovery Works was created by the General Assembly in 2015 through the Criminal Justice Funding Act, establishing the Forensic Treatment Services Grant operated by the Division of Mental Health and Addiction. It made available $30 million for Recovery Works vouchers, to be awarded in 2016 and 2017.

Boone is one of 13 counties that will operate Recovery Works pilot programs, Nielsen said.

“Providing that intensive mental health (counseling) while here and transitioning that mental health when they leave will be key in reducing that recidivism rate,” Nielsen said.

Clark said it’s hoped Recovery Works will cut that recidivism rate by giving inmates tools and guidance to make better decisions. “What may have been causing someone to maybe not be making the best choices will hopefully be treated and that will be eliminated, that choice process, decision making process,” she said.

She said that once released, inmates face many challenges.

“A lot of times it’s balancing all the things they need to do,” Clark said during an interview at Inwell’s North Lebanon Street office. “Oftentimes it’s needing to look for employment, being in treatment so they can work toward recovery, in addition to trying to pay for health care.”

The program helps inmates begin the recovery process while incarcerated, “From there we can begin providing therapy,” Clark said. Once released, participants are already in an established treatment protocol, she said.

“They’ll be receiving connections to other types of resources as well,” she said. “Between Quality Correctional Care and Inwell, we would make sure they are being lined up with a primary care physician. If they need health coverage, that would be part of what we would help them navigate.”

Designing a recovery program is not a one-size-fits-all task, Clark said. And it’s not possible to say a person can be successful in a specific time frame. “It is going to dependent on the person and the diagnosis,” she said.

“I would say on average we’re probably looking at six to nine months in a treatment program,” Clark said. The Recovery Works program is a specific evidence-based protocol.

“A lot of what we can offer is increasing or improving the functioning in individuals, which giving them the proper hopefully will help them to make better decisions,” Clark said. That, she believes, will help ultimately decrease the recidivism rate.

“Additionally, it’s treatment,” she said. “So what may have been causing someone to maybe not be making the best choices will hopefully be treated and will be eliminated.”

Individual treatment programs will be determined for each participant, she said. “There will be goals and objectives, and as they are going through treatment we are reviewing their plan as far as meeting those goals.”

If a psychotropic medicine is indicated, Inwell can provide it, Clark said

“We can do any type of psychotropic medications that would be indicated for whatever it is the individual is dealing with,” she said. That includes the medication-assisted treatment in which probationers are given an injection of Vivitrol, an opiate-blocker, before they are released from jail, and then receive additional monthly injections as a requirement of probation.

“We have a licensed clinical addictions counselor who is very experienced in this area,” Clark said. “He’s the one that’s going to continue to run our extended outpatient program.”