With the responsibility of treating the mentally ill often falling on an already strained criminal justice system, North Dakota officials are looking for ways to keep people with mental illnesses out from behind bars and in treatment.

While Cass County is the only county in the state with a jail-diversion program for people with severe mental illness, legislators are hoping to kick-start similar programs in Burleigh and Ward counties in the upcoming legislative session, according to Lynette Tastad, clinical mental health coordinator at Cass County jail.

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The program in Cass County was launched using federal grant money after Cass County sheriff's deputies noticed that certain individuals with mental disorders were being booked into the jail over and over again. The jail-diversion program is a way to try to thwart the "revolving door." Studies have also shown that incarceration can exacerbate the symptoms of mental illness.

As part of the booking process, the jail screens inmates for possible mental illness using a series of "yes" or "no" questions widely used in jails across the nation, Tastad said. The inmate could then be referred to have an evaluation done and if that inmate meets a set of diagnostic criteria, could choose to enroll in the program, which allows them to leave jail as long as they follow through with treatment and meet regularly with a review panel.

"No jail time is like the carrot dangling," Tastad said.

The American Psychiatric Association has recommended that all correctional facilities screen inmates for mental illness. While many states mandate jails to use the widely-accepted screening tool that Cass County uses, Tastad said North Dakota is not one of them.

Problem-solving courts, like Drug Court, are also rising in popularity across the country as a way for courts to deal with the influx of people with drug addictions or mental disorders coming before judges for criminal offenses. Problem-solving courts aim to address the underlying issues behind a person's criminal behavior, steering offenders to treatment rather than jail or prison.

While Grand Forks County has Drug Court for offenders with substance abuse issues, there is no equivalent for people with mental disorders. In fact, nowhere in the state is there a Mental Health Court, said State Court Administrator Sally Holewa.

According to a journal article called "Mental Health Courts in America: Promise and Challenges," there are more than 250 Mental Health Courts across the country.

Holewa said that lawmakers will introduce a bill in the upcoming legislative session for the creation of a committee on problem-solving courts, made up of officials from the criminal justice system, Human Services and the Legislature.

"One of the issues has been getting all the right people at the table to talk about this," she said. "It sounds like a bureaucratic solution, but honestly until we can get everyone at the table and determine what the problem is and decide how to approach it, we're spinning our wheels."

Holewa said the idea of a Mental Health Court has been thrown around by state officials multiple times in the past. She said part of the problem is a lack of statistics on the state of mental illness in jails and prisons statewide, especially when many county-level jails do not screen or keep tabs on mentally ill inmates.

A Bureau of Justice Statistics report published in 2006 estimated that about a fifth of jail inmates nationwide had been diagnosed with a mental disorder, had taken prescribed mental health medication or had received mental health therapy in the prior year.

"There's a gut-feeling that there may be a need, but right now we don't have any statistical data about the population we would serve or where that would be located," she said.



Series on mental health issues: