Montana inmates with mental illnesses languish in jail awaiting treatment before trial

By Aaron Bolton

On October 1, 2023

Montana inmates with severe mental illness can languish for months in jail. They are too ill to stand trial, and there’s only one state hospital that can treat them.

AYESHA RASCOE, HOST:

Some inmates awaiting trial in Montana remain in jail for months because of severe mental illness. They can’t go to trial until they can get mental health treatment. As Montana Public Radio’s Aaron Bolton reports, there’s only one hospital in the state where they can go, and it’s completely overwhelmed.

AARON BOLTON, BYLINE: At the Flathead County Jail, there’s a separate mental health wing. As jail Commander Jen Root walks down the cinder block hallway, a psychiatric inmate yells from behind her steel door.

UNIDENTIFIED PERSON: (Inaudible, yelling).

BOLTON: Root takes me farther along to another cell door where we peer through a small window.

JEN ROOT: So you’ll see this is her living condition right here.

BOLTON: A young woman is curled up on a mattress on the floor – a blanket pulled over her head. Only her bright-pink fingernails stick out. She is charged with burglary, and she’s been here longer than anyone else.

ROOT: She’s been here almost a year just laying on her bed. Like, that’s what she’s been doing for a year.

BOLTON: Commander Root says the woman has a severe mental illness. She refuses to take showers. She won’t go outside. And most crucially, she won’t take medications prescribed by the jail’s psychiatrist.

ROOT: We can’t force medicate or anything like that.

BOLTON: Like many here and in other Montana jails, this woman can’t stand trial until she goes to the Montana State Hospital. It’s the only place in the state that can force criminal inmates to take their medication. The waitlist for the state hospital has nearly doubled over the past year, often hovering around 70 people. Wait times can vary from a month to over a year, and women tend to wait longer because only six beds are reserved for them out of 54 total. Montana isn’t alone. More than 2 million people with serious mental illness are jailed nationwide each year. And research shows they tend to get sicker while there and remain in jail longer than other inmates. Root says her staff members often feel helpless.

ROOT: Probably my biggest frustration with our whole system is the mentally ill and having people in here that should not be criminally charged. Yes, they broke the law. Yes, they’re not safe to be out in the public. But being in jail is not the answer for them, either.

BOLTON: The Montana State Hospital is run by the state health department, but it’s local judges who decide who should be sent there for involuntary psychiatric treatment. As the waiting list grows, state health officials like Chad Parker say they are being unfairly blamed for the bottleneck.

CHAD PARKER: When there are no available patient beds or they are not available for some time, the department can be held in contempt or receive another sanction.

BOLTON: Parker wants lawmakers to give the health department more control over the involuntary commitment process. He argues there are other options. Judges could send inmates back to the community to be mentally stabilized.

PARKER: There’s room for community care to be ordered. It is underutilized, if rarely utilized, through the court ordering process.

BOLTON: But many say that’s unrealistic. Those local psychiatric services have shrunk as Montana’s population has boomed. In her role as Kalispell District Court Judge, Amy Eddy oversees many criminal commitments to the state psychiatric hospital. She says there are no other options for these inmates.

AMY EDDY: If someone needs to be involuntarily medicated, which the vast majority of people do in order to stabilize, the only place that can be done is at the state hospital.

BOLTON: Meanwhile, the woman who has been waiting a year inside the Flathead County jail has been slowly moving up the state hospital’s waiting list.

ROOT: She’s still only No. 2 on the list.

BOLTON: Commander Jen Root says the jail just doesn’t have enough space for inmates with mental health conditions. Some are eventually released because they’ve waited too long for care at the state hospital.

ROOT: It’s like this revolving door. They don’t have the resources or the support to help them maintain their medications or housing or any of that. And then they end up right back in here.

BOLTON: This spring, state lawmakers set aside $300 million for the state’s mental health system. The money could go to community services or be used to build two new state-run mental health facilities. That would help take pressure off the state hospital, but it’ll be years before they become a reality. For NPR News, I’m Aaron Bolton in Kalispell, Mont.

RASCOE: That story comes from NPR’s partnership with Montana Public Radio and KFF Health News.

This piece was republished from NPR.