no place for the mentally ill: Albany County Correctional Facility.. Photo by John Whipple.

Making Corrections
Mentally ill persons facing criminal charges have been helped by an Albany County program diverting them from jail to community-based treatment—but the program’s funding is about to run out
By Travis Durfee

Before she met Louis Meunier last fall, Genevieve Plair wasn’t doing so well on her own. Diagnosed with bipolar disorder 10 years earlier, Plair wasn’t keeping up with her medication or her rent, and was frequently getting into disputes with her landlord. The 33-year-old Albany resident says that she was having difficulty taking care of herself, but an even bigger problem was her denial of her troubles. Last October, Plair’s situation got worse when she was evicted from her apartment.

“I had a puppy and that puppy grew into a full-grown pit bull,” she says, less in sentences than in bursts. “My landlord never minded that I had the dog until it destroyed something. He destroyed the door and they wanted to evict me because of it.

“So the marshals came to put me out,” Plair continues. “I had put everything in storage, I was just waiting because it would have been easier for me—the less time I spent in a shelter the better. I stayed in the apartment until the marshals came, and when the marshals came they said ‘Ma’am, there is another issue that hasn’t been dealt with,’ and it was the warrant.”The warrant stemmed from Plair’s 1997 arrest for disorderly conduct, for which she never went to court. “I thought the charge was expunged due to my illnesses,” she explains. Instead, Plair was evicted from her apartment, and subsequently arrested. She was looking at jail time, but then she met Louis Meunier.

“Louis and his boss came to court and got me out of jail after about a week,” Plair says. “They came and they waited all day because I was like the last one seen. That meant a lot to me, because they could have left and said ‘Oh, we can do this another day,’ or something. They came like riding in on their horse and I didn’t have any other option. They said, ‘We’re freeing you,’ basically. So they waited around all day and took me to the apartment, and explained the program to me.”

The program is Albany County’s Mental Health Jail Diversion Project, an experimental collaboration between the county’s mental-health and criminal-justice systems that reroutes mentally ill people from the county correctional facility to community-based treatment and mental-health service providers specific to their needs.

For example, a client facing six months in jail for disorderly conduct could agree to six months of counseling. His or her progress would be monitored by a caseworker and evaluated by a judge. Successful completion of the program can lead to the charge being removed from the individual’s record, and can take as little as three months or last as long as a year.

The new program, which is the first in New York state and only the third in the country, took on its first client in August 2002, but the program wasn’t fully implemented until January 2003.

“Going out on a limb, I would say that it is kind of a common problem for people within the mental-health population, not responding to things like appearance tickets,” says Meunier, the program’s jail diversion coordinator. “It is not necessarily getting in trouble again, it is just that contact with law enforcement that ends up bringing about possible jail time.”

And jail is no place for the mentally ill, says Meunier. “People with even moderate mental-health conditions can have those conditions exacerbated in the correctional setting,” he says. Inmates suffering from mental illness not only can have their conditions worsened in jail due to isolation and the lack of adequate care, but often are more susceptible to intimidation and violence.

Though people with mental health needs often do not receive adequate care in jail, that’s where more and more of them are ending up, as the trend away from psychiatric institutionalization continues.

“Back in the day, people [with mental health problems] were brought to psychiatric centers because nobody really knew what to do with mental illness—nobody really knew how to treat it,” says jail diversion project manager Marisa Beeble. “So it was kind of like, ‘Well, we’ll just put them all together and they’ll receive psychotherapy or see a psychiatrist or a social worker.’ But those conditions were eventually really inhumane, which translated into deinstitutionalization where they decided to say ‘OK, we’re not treating these people appropriately, so what we’re going to do is release them into the community and treat them in the community.’”

According to the U.S. Department of Health and Human Services, the average daily number of patients in U.S. state and county mental hospitals in 1950 was 592,853. By 1994, that average was down to 71,619.

“What happened was the community wasn’t prepared for the influx of needs posed by these people,” Beeble says. “Over time, these people started getting arrested, started getting in trouble, and the state psych facilities, which just pushed them out the door, no longer had the resources to serve them. So over the past 50 years, they’ve been picked up by the police and placed in jails.”

According to a 1999 study in Psychiatric Rehabilitation Journal, the number of individuals suffering from mental illnesses in jails throughout the country rose from 185,780 in 1955 to 481,393 in 1985. Albany County’s jail diversion program began to address this trend, which was referred to as transinstitutionalization.

Boundary Spanner: Louis Meunier. Photo by John Whipple.

But with funding all but dried up, the program is in jeopardy. Initial funding was provided by the Substance Abuse and Mental Health Services Administration, a subsidiary of the U.S. Department of Health and Human Services, in the form of an exploratory grant that expired in March. The program is almost broke, and at least one key service provider says it will fold in September should no new financial backing arrive.

The situation is even more troubling, say those involved with the program, considering that it was not too long ago that Albany County experienced the kind of worst-case-scenario that showed the need to divert people with mental-health needs from jail—the death of a mentally ill inmate in the county’s correctional facility.

In the early morning hours on June 10, 1999, Gregory Lee Richardson, a 42-year-old Brooklyn man who had a long history of mental illness and had been diagnosed paranoid schizophrenic, was arrested after leading police on a high-speed chase down the New York State Thruway. According to an investigation by the New York State Commission of Correction, Richardson evidenced many signs that he was mentally unfit prior to his death in the Albany County Correctional Facility, but attempts to offer him treatment came far too late.

Upon arrival at the Albany Police Department’s South Station for booking early June 10, Richardson was noticably distressed: Police reports state that the detainee was talking to himself, crying and punching himself. Richardson refused to answer questions for a suicide screening, and police called the Capital District Psychiatric Center for an evaluation, but he was never evaluated.

According to the commission’s investigation, the CDPC refused to evaluate Richardson and gave no reason, but officials at the CDPC said they were told by the Albany Police Department that an evaluation would have interfered with Richardson’s arraignment. Richardson was arraigned on June 10 and sent to the Albany County Correctional Facility with a judge’s order for a mental-health screening to see if he could stand trial. The inmate arrived at the correctional facility, but the paperwork did not.

A week later, on June 17, Richardson returned to court and was again ordered to undergo a mental-health screening, and again the paperwork was mishandled in transit and never reached the appropriate person. Over the next 11 days, Richardson’s mental conditions deteriorated rapidly.

Richardson initially refused to get dressed for a visit from his parents on June 28, and sat rocking in his chair and clutching himself after being led to the visiting room. His parents asked to speak to the jail psychiatrist after their visit was cut short when their son began roving around the room and acting strangely. They were told they’d have to speak to a nurse. Richardson’s parents told the nurse that their son obviously had not been on his medication and had decompensated (lost his psychological balance). Richardson’s parents told the jail nurse that their son had taken Depakote and Risperdal—a mood stabilizer and an antipsychotic, respectively, often used to treat severe depression, bipolar disorder and schizophrenia—prior to his arrest. The nurse told Richardson’s parents that the mental-health unit was doing all it could to help their son. Back in his cell, Richardson was rocking on his bed and screaming, “Jesus, help me.”

Three days later, on June 28, Richardson was about to be taken to a hearing in the New Baltimore Town Court when his escort realized he didn’t have the proper security apparatus to safely transport the detainee. On the way back to his cell, Richardson made a break for the door and was apprehended by a few corrections officers.

Around 7 PM, Richardson was dragged back to his cell, agitated and cursing, kicking and swinging his arms violently. Richardson was moved to a restraining cell, and he put up a fight as four or five corrections officers pinned him on his stomach. During the struggle, Richardson was noted to be foaming at the mouth as the five-point leather restraint set was applied to his arms, legs and midsection. At one point during the struggle, Richardson’s eyes began to roll back in his head and he became so quiet so quickly that an officer called for smelling salts. When he was completely restrained, Richardson was injected with the antipsychotic Haldol at 7:40 PM. No vital signs were taken, and he was left alone.

Diverted: Genevieve Plair. Photo by John Whipple.

A nurse made scheduled checks on Richardson at 7:45 and 8 PM, but when she came back at 8:10 PM, the inmate was unconscious. He died a short time later from traumatic asphyxia resulting from the application of the restraints, the commissions report found. Richardson sat in jail for three weeks, and died the very day corrections officials finally signed a release permitting him to have a psychiatric evaluation.

In the end it was the leather straps that killed Richardson, but according to Joe Glazer, president of the nonprofit Mental Health Advocates of New York State, who was an outspoken critic of the handling of Richardson’s case, the system designed to protect him failed almost every step of the way.

“There were seven different agencies at two levels of government involved in his arrest, incarceration, attempted treatment, transportation,” Glazer says. “Ultimately what it comes down to under New York’s current system, no one took responsibility for meeting the health-care and safety needs of Mr. Richardson.”

The Commission of Correction issued a number of recommendations to the correctional facility and the County Department of Mental Health, which handles the mental-health tier at the jail. The Albany County Correctional Facility issued a memorandum, “Use of Force Special Equipment Order,” to all corrections officers on the proper use of soft leather strap restraints, four days after Richardson’s death. An unnamed jail supervisor was penalized two weeks’ vacation for failing to order constant supervision for Richardson after he was restrained. A number of sources involved with Richardson’s case refused to speak with Metroland about his death, as litigation is still pending.

Glazer says that Richardson’s death acted as a springboard for new ideas about how to deal with the mentally ill in jail.

Fast-forward through two years of fund-seeking, program development and consensus building and you arrive at Albany County’s model of jail diversion, one agreed to by more than two dozen representatives from government, mental health and criminal justice at both the county and state levels.

Albany County’s model looks to divert individuals after they are arrested, but prior to arraignment—before they end up with a crime on their record. Potential divertees are low-level, nonviolent offenders who’ve had a history of mental illness. Since last year, the program has diverted 10 individuals out of the 16 referred to it. Of the six nondiversions, three backed out of the program voluntarily and one was referred elsewhere.

“At that point in time, when a referral is made, we complete a fairly comprehensive mental-health evaluation,” says Meunier. “We look at mental history, family mental-health history, substance-abuse history. When that process is complete, we look at making a decision as to whether the person is appropriate for the program, if we can provide an adequate level of care of that individual within this community, and [whether] we have an adequate level of assurance that this person is going to successfully complete the program.”

Together, Meunier and the divertee create a treatment regimen based on the individual’s needs. Through the jail-diversion program, a client can be connected to housing, counseling services, psychiatry, independent-living assistance or whatever else may be necessary.

Next, a compliance schedule is set, where Meunier and the client meet and discuss progress on a weekly, biweekly or monthly basis, and then the plan is presented to a judge. The judge has the discretion to accept the plan as is, or add to it. Meunier makes regular visits to the judge, reporting on the individual’s progress, and completion is based on the previously agreed-to conditions.

From Behind Bars: Ed Szostak, Albany County Correctional Facility’s former superintendent. Photo by John Whipple.

“This program is so obvious, it fills such a niche,” Meunier says. “It takes two systems and really gets them to work together. This is such a common-sense program, and that seems to be a problem. People seem to think ‘It’s that obvious, so why do we have to do it? Why do we have to fund it? Someone else will fund it.’”

Ed Szostak was the supervisor of the Albany County Correctional Facility when Richardson died. Exactly three years after the inmate’s death, Szostak retired and went to work as a criminal-justice consultant and an advocate for better treatment of the mentally ill within the correctional industry. Szostak says the jail diversion program has benefits for the correctional industry as well.

“For every inmate that has mental-health problems, it requires direct supervision, one-to-one supervision, one officer watching one inmate,” Szostak says. “That is well over $1,000 a day just for one officer to watch that inmate. If you now have to provide for their medical and mental-health needs, let alone are you increasing supervision and having to pay more overtime, you’re also increasing your health-care costs with costly medication.”

Further, the county’s costs for housing a mental-health inmate are increasing. According to statistics from 2000, the average length of stay for a general-population inmate in the Albany County Correctional facility is 43 days, compared to 72 days for an inmate with mental-health needs. The cost to house an inmate at the county jail is $100 a day, which does not include medical, additional-supervision or service needs.

Szostak, who said the county jail regularly rents out space to other counties and the federal government, sees an opportunity for the county to make money utilizing the jail diversion project to free up more rental cells.

“Not only is it profitable to free up beds, but you reduce liability by not bringing in a population that has such high demands for medical and mental-health needs,” Szostak says. “The more people of a volatile type that you can divert, the better you are for the facility, the correctional officers and the client themselves.”

One of the aspects Genevieve Plair most appreciated about the jail diversion program was what it provided for her immediately after she was released from jail—a place to sleep and some food to eat.

“When I first went into my apartment, the one that they gave me, it had food there, you know, it was stocked with food,” Plair says. “I had hot dogs, I had chicken pot pies, I had peanut butter and jelly, I had bread, I had juice—that they provided. When I came out [of jail], I wouldn’t have had any food had they not provided it.”

“One of the benefits specific to this program is that we can provide things for people that really eases the transition from corrections to the street,” says Meunier. “Normally, most people are being cut loose with nothing more than an appointment card saying Monday you’ve got to go visit with this provider. We relieve a lot of those anxieties.”

“This testing is based on the theory that all kids go to college. That’s misleading,” —John Polnack, principal, Philip Livingston Magnet Academy. Photo by John Whipple.

Plair—who recently graduated from the jail diversion program and has since moved into her own apartment—is studying for her general equivalency diploma, which she looks forward to receiving in a few months and then training to be a nurse’s assistant. Had she not taken part in the diversion program, Plair says she isn’t sure where she’d be today—maybe jail, maybe a homeless shelter.

“I do feel that I needed assistance like this, but I didn’t know it at the time,” Plair says. “Where would I have gone had I not had it? It gave me a chance to reflect. I was thinking on what it means for me to be sick and to have this illness that makes me act this way—I just reflected on my life, how I got into this situation. Even though I was sick, maybe I should have been taking my meds or maybe there were some things I could have done to make things turn out differently.”

Plair thinks it would be a shame if the program folded due to lack of funding, because she knows there are many people who could benefit from the services.

“It’d be a really sad thing if it were to end, because there are a lot of people that are mentally ill and in jail, they aren’t even criminals, they’re just victims of their illness, you know,” Plair says. “Like I had a warrant. Had I been put in jail on those disorderly conduct charges way back when, I would have been put in jail for what? I was sick. I have a mental illness. They should have put me in a mental hospital if that’s the case.”

The jail diversion program recently received a small endowment from the United Way, a $5,000 seed grant—a grant with which to seek more grant money, really. People participating in the program estimate that it would cost $150,000 annually to run the jail diversion project at its ideal level: a full-time presence in the court, a full-time case worker and a project coordinator. But that money has yet to materialize, says Robin Siegal, executive director of Albany County’s Department of Mental Health.

“The Office of Mental Health Services at the state level has inquired of me to report what the funding would be necessary to continue the program through the department,” Siegal says. “But we’ve yet to hear back from them. This has been a good effort in Albany County and everyone involved would like to be able to continue and support development of similar models in other counties.”

Meunier agrees that people suffering from mental illnesses throughout the state could benefit from the community services made available through the jail diversion program. Unfortunately, he says, many people with these problems fail to receive treatment from service providers or in psychiatric facilities, but rather get it in correctional facilities. Meunier sees this as a problem not just for those with the mental-health needs, but also for the communities in which they live.

“[The jail diversion program] promotes public safety not only immediately but in the long term,” Meunier explains, “because a person with mental illness who gets arrested and spends a little time in jail, when that 30 or 60 days are done, they’re coming out, and they might be worse off than when they went in.”