by CHRIS ROGERS
Earlier this summer, Winona County social workers used a new videoconferencing system to visit with an inmate at a distant jail for the first time ever. The virtual visit saved Winona County the time and expense of sending a social worker to the neighboring county jail and enabled a Winona County inmate housed at the neighboring jail to sign up for publicly funded addiction treatment. The system is part of a $313,000 grant program that local officials hope will help make Winona County’s criminal justice system more adept at figuring out who needs to be locked up, who needs medical help, and how to respond appropriately. The grant is meant to build up programs and technology over three years. Ten months in, how is it going?
In late September 2016, Winona County was one of just a few local governments in the nation to win a $250,000 grant from the U.S. Department of Justice’s Justice and Mental Health Collaboration program (JMHC), and in October 2016, the County Board agreed to commit a $62,700 match — mostly in-kind contributions of staff time. The grant proposal was the culmination of over a year of work by police, prosecutors, defense attorneys, judges, jailers, and citizens on the Winona County Criminal Justice Coordinating Council (CJCC), who said that in Winona County and across the U.S., citizens are being unnecessarily jailed for incidents primarily caused by underlying mental health problems. Incarceration does not fix mental health problems and often makes them worse, but because of a shortage of mental health services, police, emergency rooms, and jails had become the only resort for responding to mental health crises, CJCC members said. By people steering those in need toward real treatment and away from arrest and incarceration, the county could actually improve people’s lives and, potentially, save money, they argued.
The grant has four main parts. First, hiring a jail intake worker to help screen incoming inmates for mental health problems and to help identify potential candidates for pre-trial release from jail. Second, training local law enforcement officers and other government workers on how to identify and diffuse mental health crises. Third, developing a teleconferencing system to provide Winona-based services to inmates housed at distant jails. Fourth, the creation of a health information exchange where law enforcement, social workers, health care providers, and jail nurses can all share information related to inmates’ health.
In the courtroom, Michael Kuehn’s team of public defenders and Karin Sonneman’s staff of county prosecutors are opponents. If Winona County Jail Program Coordinator Ben Klinger or other brown-shirted detention deputies show up, it is usually to escort a defendant in an orange jumpsuit. But in a basement meeting room last week, they were all working together, trying to hash out what’s working with the grant program and what needs to be done.
After months of planning, Winona County’s videoconferencing system with the Houston and Wabasha county jails went online earlier this summer. Since the state downgraded the Winona County Jail to a 90-day lockup, the county has outsourced more inmates to those neighboring jails. The videoconferencing system is for them. “The systems are set up, but they’re not being utilized as much as we might like,” Sonneman said at a small group meeting last week. Klinger reported that, so far, the system was used once by a Winona County social worker for a Rule 25 assessment — an evaluation of how bad a person’s addiction problems are and whether they qualify to receive public assistance for treatment. The system is brand new and people are still getting used to it, but the CJCC members believe there are numerous valuable applications for it. For instance, there are mental health services available at the Winona County Jail that neighboring jails lack, CJCC members say, and the teleconferencing system could allow Winona-based counselors to provide treatment to inmates in distant jails who might not otherwise get it.
Cullen Schwemer is a retired Winona Health psychiatrist who is advising the CJCC. He was a telemedicine skeptic at first, but came around to the value of the system. “There was no personal contact and it’s kind of like watching a show, but for a variety of issues that are concrete and have numbers associated with them, it’s not very personal but it works well and it’s important,” he said at the meeting. “It’s not ideal but it’s an improvement,” Kuehn said in an interview, “We’d rather see services in the jail and a jail that’s able to accommodate it … but this is better than our clients not having services,” he continued, calling the system “tremendously useful.”
Another hurdle faced by the CJCC: some inmates do not trust that their communications with social workers or mental health providers will not be monitored by law enforcement at the jail. The county needs to be able to assure inmates that the communications are private, Engel said.
On June 27, the county hosted a Mental Health First Aid training funded by the grant. This training helps people recognize when someone is having a mental health crisis, what different kinds of mental illnesses may look like, and how to respond. The CJCC planned for 30 people to attend the training, mostly local law enforcement officers and social services workers. Twelve people attended. Engel got some feedback that the training was too elementary for some of the people who were invited — including mental health case workers — and that in the future, the CJCC may steer other staff — such as court clerks — to that training and send more well-versed staff to higher level trainings. One higher level training is coming up, an immersive, 40-hour crisis intervention training for local sheriff’s deputies on how to de-escalate situations.
Trisha Chandler started work as Winona County’s new jail intake worker on June 29. In addition to checking incoming inmates for warning signs of mental health concerns, she will soon begin conducting bail evaluations on virtually every pre-trial defendant in Winona County. Bail evaluations are tools judges use when deciding whether to release a defendant from jail. The evaluations use statistical models to predict, based on a defendant’s previous history, how likely they are to flee from justice or commit more crimes if they are released. There are people who do not pose a serious flight or public safety risk who stay in jail just because they do not have money to make bail, CJCC Coordinator Kalene Engel said, and that can cause defendants to lose their job, their health insurance, and access to mental health care. Bail evaluations are already being done in certain cases where state law requires it, but Chandler will help ensure that all kinds of defendants receive a bail evaluation. Chandler is still training, but she should start completing bail evaluations by this fall, Engel stated.
Creating a health information exchange is a big challenge that could bear big rewards for the county, CJCC members said. Currently, county social workers, local health care providers, law enforcement departments, and jail-based health care providers all keep information pertaining to citizens with mental health problems, but they do not share it. For instance, under the current system, county social workers are not notified when their clients are jailed unless they check their email every day and search for their clients’ names in listings of all of the arrests made the previous day. Having all the information on a patient together on one chart is incredibly valuable to health care providers because sometimes the missing pieces of information are very enlightening, Schwemer said. For instance, he recalled having patients who did not think it was important to mention their hoarding habits to him, but that detail helped Schwemer better understand the seriousness of their condition and treat it. The CJCC grant aims to create a “one chart” system for the criminal justice system. The CJCC is still figuring out what information about what individuals would be relevant, and there is a big legal hurdle: HIPAA, the federal health information privacy law. Inmates have to agree for these various agencies to share their health information, and the CJCC is currently working on creating forms that would allow inmates to give that permission. The group is still in the early stages of planning such a health information exchange. “This is a huge process,” Engel said.
Kuehn said the exchange will help identify people who should be steered away from jail and toward mental health care. “If we’ve got the mentally ill in custody but we’re not tracking it in any kind of coordinated way and we don’t have any way of tackling it, then the first line of defense becomes the defense lawyers. We’re not doctors,” he stated.
“If we could all get information about our defendants and share that information — maybe they have an undiagnosed mental illness and we can get them help rather than incarcerate them to the point where [their illness worsens and] they need a commitment,” Sonneman said, referring an involuntary commitment to a hospital. “That is another expensive route, and it takes them away from their families and the community.”
Overall, Sonneman said of the grant’s progress, “There’s a lot of work to do, and we’ve done a lot of work already.”