Vicki Roberts turned Cell #106 into an office a year ago to turn around a chronic problem at the Fulton County jail: inmates locked up for months or years because they are too delusional for a court to decide their case.
Judges have deemed these inmates incompetent to stand trial on various charges, some serious but mostly minor, because of their mental illnesses. They can’t be adjudicated until they receive the medication or therapy they need to become lucid enough to enter a plea.
Such inmates traditionally are placed on a waiting list to get into Georgia Regional Hospital, which may take months, or longer. “There are people who are mentally ill who have been sitting in jail for … a year or two” until they can be evaluated, said Putnam County Sheriff Howard Sills, president of the Georgia Sheriffs’ Association.
That’s changing in Fulton County.
Sheriff Ted Jackson has partnered with Emory University to set up an intensive psychological unit inside the jail to treat the inmates rather than sending them to the hospital. The jail went from a backlog of 62 for Georgia Regional to zero.
“I think we need to get this program in other jails,” said Roberts, the program administrator. “We don’t have anybody in Fulton County waiting to get into the hospital.”
Establishing such a service in all of Georgia's 159 counties might be a little dear. The state Department of Behavioral Health and Developmental Disabilities provided a $1.3 million grant to run the Fulton program from October 2011 to June 2013. The state has to review the program each year to decide whether to renew the grant.
“There has been some progress,” Jackson said. “It is less than what we want, but at least we’re going in the right direction.”
About 40 percent of the Fulton jail’s 2,400 inmates suffer from a mental illness, said Col. Mark Adger, chief jailer. An average of 261 are on psychotropic drugs at a cost of $41,000 a month. Many are well enough to face a judge for sentencing or release. But scores of others need to be made competent through medication, therapy or both.
“A lot of these people don’t have serious offenses, but they are in the hooks of the system and they are doing more time now than if they had stood trial and received a sentence in prison,” Adger said. “It is an epidemic in all jails because we become a depository for mentally ill individuals other agencies don’t know what to do with. The courts don’t know what to do with these people.”
Peter Ash, director of the Emory program at Fulton County jail, said the 8-person psychological team has admitted 60 inmates over the last year to the jail’s 16-patient unit for intensive therapy.
Of the first 35, Ash said 14 became competent for trial and about 15 were diverted out of the jail either to a hospital to get a court-order for medication or to some other program with the consent of the court. A handful were deemed unable to be helped.
Before the program, the inmates were on a waiting list to get into Georgia Regional, with the hospital taking the oldest — not necessarily the most treatable — first, Ash said.
“This is much faster for the inmate,” he said. “Some of them had been found incompetent to stand trial three years earlier and the system had forgotten about them.”
Roberts, who retired from Georgia Regional, said the jail program’s success rate at restoring competency mirrored the hospital’s, except that at the jail they couldn’t forcibly medicate a patient if he proved a danger to himself or others.
The pilot program in the Fulton jail is the only one like it in the state, and Ash said there are only a few others like it around the country.
Jails are usually viewed as among the worst places for therapy. But the Fulton program establishes a therapeutic environment for inmates deemed incompetent for trial.
“We’re kind of figuring it out as we go along, but it seems to be working,”Ash said.
Not all counties have as great a need as Fulton for an in-house unit, even though their jails are filled with mentally ill people.
Maj. Karen Johnson, administrator of the Cherokee County jail, said a random check showed inmates on psychotropic drugs took up 114 of the 512 beds during one month last year. But she said the suburban county generally was able to rotate out the mentally ill to the care of their families or a community resource, whereas many in Fulton are homeless.
“Some have committed serious crimes, but most of them have committed what we call nuisance crime,” Johnson said. “They don’t know what they are doing. They are in a convenience store and they think they are at home opening their refrigerator.
“A lot of these folks just need to get back on their medication to be stabilized,” she said. “We’re still such a small community, and defense attorneys work with prosecutors to work out a plan. … I don’t remember the last one I had waiting here so long because they needed to be made competent for trial.”
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