For the past two months, WFAE has been exploring the crisis brewing in North Carolina’s mental health system. That includes a shortage of state hospital beds.
Hundreds of North Carolinians in crisis wait weeks in emergency rooms, before they can get a state hospital bed. And criminal defendants who are too sick to stand trial can wait more than a year to go to a hospital, just so they can get enough treatment to be able to stand trial for their alleged crimes.
Now North Carolina is piloting a program it hopes will alleviate the crisis. And it’s starting in the Mecklenburg Detention Center.
Mecklenburg County Sheriff Garry L. McFadden walked toward a new unit, the first in-jail restoration program in the state. It’s a basic correctional environment, with concrete walls and floors, and 10 cells that open onto a large group space, McFadden said.
“It’s got more space than some other units,” he said. “We have a space where there is a dayroom and a place where [inmates] can use the phone and see TV.”
All 10 inmates are living with mental impairments so severe they can’t understand their charges or assist their lawyers. They’re in the unit to get enough mental health care for their cases to move forward.
This program isn’t open to everyone. Inmates who are extremely ill or dangerous still need to wait for a hospital bed. But those who have been living peacefully in jail and taking their medications can try to get well enough here.
“You’re going to have a caseworker or social worker,” McFadden said. “You’re going to be seen daily, you’re going to go through therapy, you’re going to go through the medication, and we’re going to have you in settings where you are heard.”
A psychiatrist is available by telehealth two days a week to adjust medications. Four hours a day, two social workers provide therapy and group sessions, including classes that help inmates understand the legal system. They may learn by watching clips from courtroom films or by performing mock trials. That education is usually a big part of capacity restoration.
The first inmate arrived in the Mecklenburg program in December. So far, 17 jail residents have entered the program, the staff said. Ten have been deemed “restored” by the program’s psychologist. That means they were well enough to assist in their defense, but it doesn’t mean they were cured. One inmate was so sick, he’ll have to go to the hospital program, the psychologist said. Another was “unrestorable.”
North Carolina’s Department of Health and Human Services said it’s pleased with the early results.
“We want to be a model for the state,” McFadden said. “Because if you talk to sheriffs across the country, this is what they deal with: People being incarcerated and [they] do not have the capacity to proceed.”
Preliminary good reviews
The program is run by Wellpath Recovery Solutions, a private equity-backed contractor. It runs in-jail capacity restoration programs in three other states – including a six-year-old program in California, similar to the Mecklenburg jail pilot. Results in California show that three-quarters of the patients were restored last year. Restoration took an average of 61 days per patient.
Wellpath Recovery Solutions is a division of Wellpath, one of the largest jail and prison health care companies in the nation. It operates in more than 350 jails and 135 prisons across the country – including Mecklenburg’s.
Wellpath and its predecessor company have been sued repeatedly for providing inadequate health care, and a recent report by the Massachusetts Disability Law Center criticized a Wellpath hospital there, writing that it was unsafe. But a 2022 review of the lawsuits involving Wellpath Recovery Solution’s inpatient psychiatric facilities by the New Hampshire assistant attorney general found the amount of litigation was in the normal range when compared to similar facilities. And it found “no red flags” with regard to quality of care.
Wellpath Recovery Solutions’ Senior Vice President Teresa Koeberlein told WFAE that Wellpath agrees with that assessment. And, so far, its capacity restoration program, called RISE, is getting some good preliminary reviews in Mecklenburg.
Mecklenburg-based defense attorney, Tim Emry, said so far he’s impressed with the jail’s RISE program.
“I had one client who was successfully restored through RISE,” Emry said. “And I think they did wonders for … that client.”
Emry won’t mention his client’s name because of attorney-client privilege. Police arrested the 32-year-old on May 24, 2022, for misdemeanor trespass at the Charlotte Convention Center. But then his client spit on the arresting officer’s shoe – that’s a felony. He was subsequently found incapable to proceed, and was in custody for about a year by the time he went to the jail restoration unit. Emry said someone who wasn’t mentally ill would have been out of jail months earlier.
“It was great because in that situation, what he had was a gob of misdemeanor charges, basically nuisance crimes,” Emry said. “And it allows him to get out and get into a therapeutic probationary wellness court program.”
But the program isn’t a magic bullet. Even with the added care he received through the wellness court program, Emry’s client died a few weeks later of a drug overdose. Emry said he would like to see more emphasis on treatment and less concern about just restoration.
“The goal was to get that person restored so they’re capable to be prosecuted, right?” Emry asked. “The goal is not to help them have a mental health transformation where they are successful.”
A national competency crisis
North Carolina’s Secretary of Health and Human Services Kody Kinsley said outpatient restoration units not only help inmates, they also shorten the wait time for anyone else who needs a psychiatric hospital bed – including those who wait weeks or even months in state emergency rooms.
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