Program in Carson City helps mentally ill inmates

CARSON CITY — Sheriff Ken Furlong said getting help for mental health patients was something that had been pushed aside for a long time in Carson City.

Saying it was an issue that “needs to be resolved,” the sheriff and other community leaders have partnered with the state in a new program.

The Forensic Assessment Services Triage Team, or FASTT, is a partnership between the state and local governments to bridge a gap in mental health services from when someone is arrested on a low-level offense to after they are released but fail to engage the state’s mental health services.

“With these low-level cases, they’re in and out so quick, that’s why we call it FASTT,” said Dr. Joseph McEllistrem, the Carson City Jail’s director of forensic health services .

“Many of these people are known. They’re known to law enforcement, they’re known to the mental health service system, but it was the breakdown between the two systems, or not a formal relationship between them. That really is the crux of it,” said Richard Whitley, administrator of both the Division of Mental Health and Developmental Services and the Department of Health and Human Services’ Health Division.

Whitley has been one of the key players in so quickly organizing the FASTT program, Furlong, Partnership Carson City’s Kathy Bartoz and other participants said.

“The people that would qualify for the FASTT team intervention are going to be most readily identified by the arresting agent, the booking officer or the forensic health services team at the jail, because they’re now not seen by a judge for at least three days,” McEllistrem said.

McEllistrem said once people who are in need of intervention are identified they fill out a referral form. “We do that just to get some buy-in from them. Tell us what’s going on, help us quickly identify your needs. While they’re filling that out, Lisa Treinen is contacted.”

Triage Assessment Coordinator Treinen, along with psychiatric caseworker Kathleen Buscay, come to the jail and meet with the referral and do a clinical interview. Their findings allow David Ramsey, the jail’s nurse practitioner, to write prescriptions and to make sure clients make their first, and continuing, appointments with Carson Mental Health Center.

“In less than 24 hours, someone from Carson Mental Health and the FASTT team coordinator are on site interviewing (the inmate),” McEllistrem said. “Before they leave that interview, they have identified their needs, they have set an appointment with Carson Mental Health and developed a treatment plan.”

So far, 41 people have been interviewed, and five people have voluntarily enrolled in the program.

“There are very few names I don’t recognize” from previous contacts, Treinen said. “These are people whom we know.”

McEllistrem has been seeing the same people for many years. He is a clinical psychologist and known by most in the jail simply as Dr. Joe.

“We have been dealing with how to integrate community collaboration between mental health providers, law enforcement and family,” McEllistrem said. “We kind of knew if we would integrate these groups, we could really reduce the number of crisis calls.

“It was always reaching a crisis point before we were intervening.”

bridging THE GAP

The problem everyone saw was the gap. When the jail released a low-level offender, usually arrested on a mis­demeanor, an appointment had been made for the Carson Mental Health Center, but the person rarely made it there. While the person was an inmate, he would be getting the proper medications but as soon as the jail bars closed behind him, he was left to his own devices. The gap in services had to be bridged.

An October meeting between state and local leaders was called to discuss the issue.

“They mobilized so quickly,” Whitley said. “I think it’s because they were seeing the problem anecdotally and in­dividually. They knew the problem.”

Bartoz praised Whitley’s bottom-up approach. “He’s allowing the community to take charge of our issues.”

Before, Ramsey couldn’t write prescriptions for longer than an inmate’s stay. With the FASTT program, he can write prescriptions to last a few more days, just long enough for the client, as Whitley calls them, to get to his appointment with Carson Mental Health.

Getting to the appointments, for many clients, can be more complicated than just continuing to take their medication. It’s about their life skills, some of which many members of the community take for granted.

“This isn’t just about people being mentally ill,” Bartoz said. “It’s about them not having the skills they need to function in society. It may be they can’t navigate bus systems or have a difficult time with their social interactions skills and turn people off, don’t get hired. It’s people who are having a hard time functioning.”

Those bridge medications, between the care they receive in the jail and the first appointment with Carson Mental Health, are a key part of the equation.

“David Ramsey will write bridge medications,” McEllistrem said. “Once we verify the appointment with Carson Mental Health, if they’re on meds, we want to keep them on their medications when they leave us, which in the past we weren’t able to do because there was no guarantee of follow-up.”

Whitley sees bridging the gap in services to be part of his duty.

“I think it’s negligent if we don’t take an action to connect our systems because this is where the failure is occurring,” Whitley said.

Furlong said he thought case management and proper hand-off are key. Often, once a person was released from jail, they were really released not into the world or even back into Carson City but into “a dark hole.”

“That dark hole was really the problem. They went right back to the street,” he said.

UP AND RUNNING

The problem has been here for a long time, Ramsey said. At 63, he’s been in and around the medical field for 20 years. He went back to college at 43, graduated, and then bounced around before finally finding himself at the Carson City Jail.

“This is kind of great,” Ramsey said. “Ever since we lost our mental institutions, those people were basically turned out onto the street and a big percentage of them ended up in jail. County jails have been the new mental institution. That’s how it’s been, so this is kind of a step in a new direction, which I appreciate.”

Whitley was impressed by Furlong’s own willingness to emerge from his silo. Furlong was the first sheriff to attend the meetings between the state and the local governments on the issue.

“He’s been directly involved,” Whitley said. “I thought it would be more challenging.”

“This has come together quicker than any dealing I’ve had with the state in 30 years,” Bartoz said.