Jailing mentally ill people who have committed no crimes is unacceptable in the eyes of Gilbert Gonzales, a psychologist from San Antonio who visited Rapid City last week to promote and praise mental health services in the Black Hills.
“Putting people in jail because there is no treatment is effectively criminalizing mental illness,” Gonzales said in a phone interview with the Journal on Wednesday. “I think it is really the wrong message, the wrong approach."
Yet that is the approach proposed in a major policy change by Rapid City Regional Hospital, communicated to certain local officials via a letter sent Jan. 23. The announcement has sent shock waves through the community and left many looking for leadership to provide immediate solutions to the severe lack of mental health resources in the area.
“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,” the letter from Regional said.
It goes on to say that from now on, “we will contact the sheriff’s office to take custody of involuntarily detained persons when the Behavioral Health Facility is at capacity.”
Regional says it also can no longer provide inpatient mental health services for any individual with “neurodevelopmental/cognitive disorders” such as dementia, Alzheimer’s and autism spectrum disorders.
Regional’s new approach has come as a surprise to many local mental health service providers and drawn criticism from local law enforcement officials, who say their input was not sought.
“It’s going to cause very damaging consequences for our community, especially mentally ill people,” Rapid City Police Chief Karl Jegeris said.
“It’s very disheartening,” said Lori Atkins, nursing supervisor at Behavior Management Systems. “These people who are in crisis because of an illness are, to me, being categorized as criminals and put in jail. The community is in crisis because of it.”
BMS, a local nonprofit, offers limited inpatient mental health services, but not for people in crisis. It has only 12 beds, and with most patients enrolled for 12 to 24 months, openings are rare and quickly filled by names on a waiting list.
"They are human beings," Dr. Stephen Manlove, a local psychiatrist, said of Rapid City's mentally ill population. "And they deserve as much health care as someone with a heart attack. They deserve to be treated with respect and professionally in a caring manner."
Gonzales, director of the Department of Behavioral and Mental Health in Bexar County, Texas, visited Rapid City on Feb. 2 — a day after Regional’s new policies went into effect — to speak to an audience of 200 people at Dahl Arts Center.
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His remarks focused on Haven for Hope, a 22-acre campus for the homeless and mental health treatment facility in Bexar County that has received nationwide praise for its effectiveness. Gonzales also praised Rapid City's mental health service providers, saying that “the path that you all are on (in Pennington County) is accelerated from the path that we had.”
On the phone Wednesday, Gonzales was less complimentary.
“The one rule in health care that guides us all is ‘do no harm,’” he said. “If that is our guiding line, ‘do no harm,’ we just violated it by incarcerating.”
In a statement Wednesday night, Regional drew a distinction between calling the sheriff's office when no beds are available and the decision to incarcerate.
“We agree with Mr. Gonzales, and we are not suggesting that anyone be placed in jail," the statement said. "The decision to hold a committed behavioral health patient in jail is exclusively the decision of the county.
"Behavioral health patients should be placed in a secure community setting where they are safe and can be assessed properly. ...
"Regional Health will continue to hold patients who are committed on behalf of the county based on bed availability at our Behavioral Health Unit. When the behavioral health beds are occupied, we have no additional capacity to hold committed behavioral health patients on behalf of the county.”
Gonzales’ speech was organized by Rapid City Collective Impact, a citizen-led nonprofit aimed at improving social problems such as homelessness, substance abuse and mental illness in the community.
With a renewed sense of urgency injected into Rapid City's need for more comprehensive mental health services, Collective Impact director Albert Linderman is unsure what the next step should be.
“I would say that it is a bit premature to say what possible direction we can head in,” he said. “At the same time, I have some optimism that we’re going to see something emerge out of this that is going to be a better solution than what we’ve had thus far.”
Asked if his group would be leading efforts to increase services and prevent the probable jailing of Rapid City’s mentally ill, Linderman said, “I would not characterize what we’re doing as taking a leadership role. I would characterize it as a facilitative role that is critical, but in no way are we leading.”