Mentally ill people in Rapid City who have committed no crimes will probably end up in jail because of a major policy change recently announced by Rapid City Regional Hospital.
The hospital is no longer taking in certain types of mentally ill patients and will instead contact the Pennington County Sheriff’s Office to take them into custody.
The move has prompted criticism from local law enforcement officials, who say the decision was made suddenly and without their input.
“In my view, this is the biggest step backward our community has experienced in terms of health care for mental health patients,” said Rapid City police Chief Karl Jegeris. “And though it’s legally permissible by statute to put someone in an incarceration setting, it doesn’t mean that it’s the right thing to do.”
This is the second major policy change to come out of Regional in recent days that places limits on the type of mental health care the hospital will provide.
“I don’t think it’s any one entity's problem,” said Barry Tice, director of Pennington County Health and Human Services, “but if we don’t choose to try to figure this out together, in 10 years we’re going to have the same discussion and ask, ‘Why didn’t we do something different?’ It’s not good for the human side of things. It’s not good for people. It’s not good for people to be locked up in jail cells while we determine where they should be placed. And it really sets us back.”
On Jan. 26, Jegeris received a letter from Regional stating, “Effective Feb. 1, 2017, we will no longer admit behavioral health patients who do not have acute medical needs to the main hospital when the Behavioral Health facility is at capacity.”
It used to be that a mentally ill person looking for help could go to one of two places at Regional: The Behavioral Health Center on Mountain View Road or, if that was full, the main hospital building on Fifth Street. But from now on, a mentally ill person without “acute medical needs” can no longer expect accommodation in the latter situation.
What they can expect, as made clear in the hospital’s new policy, is to spend a night in the Pennington County Jail.
“Unless we hear differently, we will contact the sheriff’s office to take custody of involuntarily detained persons when the Behavioral Health Facility is at capacity,” the letter reads.
“This is fundamentally flawed,” Jegeris said, “because we’re using a criminal justice response for what should be a medical situation.”
Under state law, a person who has not been charged with a crime can be detained by law enforcement for only 24 hours maximum. After that, Sheriff Kevin Thom said, “I guess I don’t know what we do with them. Turn them loose into the community?”
Chief nursing officer Lori Wightman said Regional officials changed the policy once it became clear that the hospital was ill equipped to handle mental health patients.
"Our facility is not designed to provide safe care for behavioral patients," she said. "And our acutely ill patients have been impacted by having behavioral health patients housed in the same patient room or unit. It’s not the best practice for us to admit them into an acute medical facility.”
Dr. Stephen Manlove is a psychiatrist who oversees the limited mental health services that are available to inmates at the Pennington County Jail.
“It’s horrible on so many different levels,” he said of Regional’s policy change. “It’s highly stigmatizing to mentally ill people. That’s probably the least severe piece of it. It’s poor health care.”
Asked if he and his small team at the jail – two certified nurse practitioners – would be able to handle a sizeable influx of non-criminal mentally ill persons, Manlove replied, “Not a chance.”
“There’s not, at this moment, a plan for how to deal with them in the jail. There’s no provision to get them any kind of psychiatric or mental health care there.”
Jegeris and Thom share Manlove’s frustration.
“We have other collaborative efforts with Regional Hospital, but this is the first time they’ve drawn a line in the sand with little to no notice, and very little room for discussion. It’s kind of out of character,” Thom said. “OK, you want to do a major systems change. Let’s sit down and talk about it and figure out all the ripple effects, instead of drawing the line in the sand and saying, ‘in three days we’re changing this.’”
This most recent policy change is separate from but related to another that came to light last week pertaining to patients with “neurodevelopmental/cognitive disorders” such as dementia, Alzheimer’s, and autism spectrum disorder. Also as of Feb. 1, people with those diagnoses who exhibit violent behavior won't be admitted to the Rapid City Regional Behavioral Health Center.
With nowhere else in the community for these and other mentally ill people to go for inpatient or residential services, Thom said that “theoretically” it is possible that an elderly person suffering from a safety-threatening episode of dementia could wind up in jail.
Jeannette Pacheco is worried about that. Though her 82-year-old father doesn’t have dementia or a mental illness, she dreads what would happen to him if he did.
“It makes me sick,” she said. “I can’t imagine my dad going to jail because he developed dementia. This is crazy. What were they thinking when they did this? People need help. Sending him to jail is not going to help.”
Jegeris said he might resist taking certain mentally ill persons to jail.
“I don’t know that we would cooperate with that,” he said of jailing individuals with dementia. “It opposes our moral compass in law enforcement to do that.
“I don’t think this decision represents all of the wonderful hard-working health care professionals we have in our community. I think it’s an administrative error, made when the health care system is obviously in a difficult situation. But when you’re in a difficult situation, you’ve got to put your patients’ needs first, and in our case, we need to put our community first, and that’s not what’s taking place right now.”
What's more, Regional spokeswoman Denise Dancy said, community stakeholders such as Jegeris, Thom and Manlove were notified of the policy change via two brief letters, both signed by Dennis Millirons, the hospital's interim president.
“This has been under discussion for some time with our physicians and our nursing leaders and of course our executive team, as well,” she said, adding that how best to help people with mental illness is one that the community will have to come together to answer.
“We are happy to participate in any future dialogues with community members about how to best serve patients in our community,” she said.
Though displeased with Regional’s policy changes, Thom said: “We need a West River solution. Everybody needs to be at the table: the hospital, the medical community, the city, county, any nonprofit that has a vested interest. No singular entity can solve this. It’s bigger than any one of us.”