"Jail and prison are a part of our mental health system, and if we are going to use that as a place to institutionalize and house people with severe mental illness or any mental illness, we need to admit that it is part of our mental health system and provide the care that people need." — Dantia MacDonald, NAMI Connections facilitator<br>
By CRISTINA JANNEY
One inmate's sister was just murdered, another is facing an extended prison sentence and is mourning the time he will miss with his child, yet others are battling scars from growing up in the foster care system.
Dantia MacDonald sees a lot of pain in her job as a National Alliance on Mental Illness Connections peer facilitator at the Riley County Jail.
Many of the people in her fledging support group are dealing with extreme trauma, substance abuse and untreated mental health issues.
"Even if they have done bad things, they have definitely had bad things happen to them — a lot of them their whole lives," she said.
Mental illness prevalent among inmates<br>
NAMI is bringing mental health support groups and education classes to jails and prisons across the state.
NAMI is offering its Connections support groups in jails in Butler, Douglas, Reno, Thomas and Riley counties and will soon add a group in Ellis County. The Ellis County support group will be offered virtually. The jail is waiting on an order of tablets for the inmates to use.
The organization is offering Peer to Peer education classes at the Hutchinson Correctional Facility, Norton Correction Facility and Topeka Correctional Facility.
During fiscal year 2020, 41 percent of the average daily incarcerated population in Kansas had some form of mental illness, according to the Kansas Department of Corrections annual report. That jumps to about 80 percent when addiction is added to statistics.
About 63 percent (three in five) of people with a history of mental illness do not receive mental health treatment while incarcerated in state or federal prisons. About 55 percent of people with a mental illness do not receive mental health treatment while held in local jails.
NAMI was awarded a federal justice assistance grant in 2021 to fund the new programs, said Brittany Brest, director of NAMI's Justice Involved Project.
Building rapport through peers
The Connections support groups are run by NAMI employees who have mental health diagnoses and who also have some experience with incarceration in the criminal justice system.
Dantia works with a co-facilitator, and they offer support groups for both men and women in the Riley County Jail.
Dantia, 47, has a diagnosis of schizoaffective disorder. She spent a night in jail on a charge of criminal trespass, which she received at the height of a psychotic episode.
Peer to Peer is also taught by peers, but is an eight-week education class during which people learn skills to live better in recovery, what the brain looks like and types of treatment, Brest said.
"We are trying to meet residents of facilities where they're at," Brest said. "It is a lot easier to build rapport and trust and understanding if you have someone with similar experience leading that group than if you have someone who doesn't have those similar experiences."
People who have mental health diagnoses, as well as a history of incarceration, have an additional stigma to overcome, she said.
"I wanted to have people in those positions so [inmates] can see that you can work past it and you can achieve the things that you want to do and they are valuable people in society," Brest said.
"By putting someone in a leadership role who has that experience and has overcome those stigmas and is doing well in their life it shows they can do it too. It provides a more solid role model."
Dantia said she thinks the inmates are much more willing to talk to facilitators they see as peers.
"I think they are much more open," she said. "They feel much safer emotionally. We are not going to be shocked about symptoms or judge or dehumanize them or treat them as lesser because of their mental health symptoms.
"We talk about our issues too. That creates a power-sharing dynamic and more of a community feel. ... We are all in this together trying to get better."
Dantia said she hopes she is helping people deal with their pain and find healthier coping skills.
Drug use, especially methamphetamine addiction, is common among the inmates Dantia has encountered in the Riley County groups.
The inmates with mental illness or who are dealing with trauma have used substances to self-medicate, and now they are without even that negative coping skill, Dantia said.
Stigma, as well as a lack of access to mental health resources, continue to be barriers for many to seek and maintain a treatment plan, she said.
"I think one thing we are doing is modeling that it's OK to get help. It's OK to admit you need help. It's OK to admit you have a mental health problem," Dantia said. "I think the stigma and the fact people don't want to be associated with mental health blocks a lot of people from getting help."
Suicide in jail, reducing recidivism<br>
One goal of the grant is to reduce the number of suicidal and self-harm behaviors among incarcerated individuals.
From June 2020 to May 2021, inmates in Kansas correctional facilities had 535 episodes of self-harm, 531 suicide gestures, 67 suicide attempts and four suicides, according to the Kansas Department of Corrections.
Brest said incarcerated individuals tend to have higher rates of suicide completion than those who are not incarcerated.
NAMI's helpline regularly receives calls from incarcerated individuals who are struggling with mental illness or their friends or family members, according to NAMI.
The secondary goal of the program is to help connect inmates with resources they can use in their recovery when they are released in hopes of reducing recidivism.
The results from the program are still preliminary, but Brest said the detention facilities that participated in the NAMI programs are on track to have fewer suicides, attempted suicides and crisis placements.
One of the members of the Riley County Jail Connections group joined the NAMI Connections group in the community after her release, Dantia said.
Still a lack of treatment behind bars<br>
The state prison system has a mental health team that oversees inmate screening and treatment. Not all medications that are available in the community are available to incarcerated individuals, Brest said.
Treatment in jails varies from site to site, Brest said.
"I have some jails that do have mental health services on staff. They do the same thing that prisons do," Brest said, "but people do report issues with medication, obtaining it, not getting the same medication they have in the community, not being able to access mental health as much or as often as they would like. ...
"Then we have jails that do not have mental health services. They do not have a partnership with a community mental health center or service provider," she said. "People aren't receiving medications or mental health services."
Dantia sees barriers to treatment even within the Riley County Jail.
One of Dantia's friends, who suffers from bipolar disorder, was recently in the Riley County Jail. He was in solitary confinement and not invited by jail staff to the Connections group. He also was not receiving the proper medication, she said.
"Jail and prison is a part of our mental health system, and if we are going to use that as a place to institutionalize and house people with severe mental illness or any mental illness," Dantia said, "we need to admit that it is part of our mental health system and provide the care that people need."
This situation is more common in western Kansas where fewer resources are available, Brest said.
The lack of services can be extremely detrimental to inmates who are under great stress, which can worsen their conditions, Brest said.
Inmates who are released without any treatment have little stability and are more likely to end up back in jail, she said.
"It's a continual cycle that doesn't end until there is some type of intervention," Brest said, "if that is the root cause of their criminal behavior."
Often these criminal behaviors are misdemeanors or non-violent crimes. It is a myth that people who have mental illness are violent. Brest said the percentage of people with severe mental illness, such as psychosis, who are violent is very small.
"The vast majority of people with mental health conditions will never be violent," she said. "They will seek the appropriate treatment. They will learn how to manage their anger. They will learn how to manage their illness. They will do just fine in the community."
Often incarcerated individuals who also have mental health issues are in jail because of addiction issues. The co-morbidity of other mental health issues and addiction is about 86 percent.
Dreams for a different future
The NAMI justice program is not in youth detention facilities, but the organization is hoping to expand its programming to that age group, Brest said.
Dantia said her dream is jail and prison will not be part of the mental health system someday and people will get help before law enforcement has to intervene.
Dantia's brother, who is schizophrenic, was in prison. He had repeated minor infractions when he was sick that ultimately led to him being incarcerated because of probation violations.
He did not receive adequate treatment for his illness while he was incarcerated, Dantia said. He was attacked in jail and beaten and lost several teeth.
"This is part of my motivation," she said. "This could have been me. I was very delusional and very sick and not believing that I was sick and it went on for months and months.
"I could have ended up in jail or prison and maybe someday I will."
Cover photo courtesy of Pixabay
Editor's note: Cristina Janney is a NAMI member.