SALT LAKE CITY — A mentally ill woman who was featured in a Deseret News investigation about how inmates are waiting five months or more to get into the state psychiatric hospital in Provo was transferred to the facility on Tuesday.
A woman named Diane, 62, of Provo, was still in jail nearly eight months after she had been ordered to receive treatment from the Utah State Hospital when her case was profiled last week. Diane had been arrested nearly a year ago on misdemeanor charges but could not proceed with her case until she was healthy enough to participate in her own defense.
Aaron Kinikini, legal director of the Disability Law Center in Utah, said news of Diane’s transfer was met with “relief tempered by frustration.”
"The frustration is constant that there is this waitlist," said Kinikini, who is representing inmates in a class-action lawsuit against the Utah Department of Human Services over how long it takes to get a bed at the psychiatric hospital. "It would be so much more productive if some high-level decision-makers could be proactive about looking at this issue rather than waiting until someone files a lawsuit.”
Thirty-five men and women with severe mental illnesses are still vying for one of 100 beds at the Provo facility.
Another 28 inmates are receiving regular visits from social workers through the hospital’s outreach program but remain incarcerated despite being deemed by mental health workers to be too ill to participate in their own defense.
Gov. Gary Herbert’s spokesman, Paul Edwards, said on Tuesday that the governor is “deeply concerned” about the people on the waitlist and would like to see legislators address the issue in interim session.
Edwards also said the governor is interested in large-scale mental health reforms undertaken by places like Miami-Dade County in Florida, but that autonomy in those issues is usually given to counties.
“We would love to see that kind of solutions approach because we do believe that an ounce of prevention is worth a pound of cure in these instances,” Edwards said. “We very much welcome a full discussion of that and what it means from a cost-benefit analysis.”
Other top elected officials in Utah were largely silent on the issue. Senate President Wayne Niederhauser declined to comment. House Speaker Greg Hughes did not respond to texts or calls.
Heather Barnum, a spokeswoman for the Utah Department of Human Services, said the hospital could not discuss what happened in Diane’s case. But she said the department is open to engaging with lawmakers on improving the mental health system in Utah, whether that involves a special session convened by the governor, a meeting of experts or any other format.
"Whatever they decide, there can't be any harm in dialogue on something that we share as a critical issue for the state," Barnum said.
The Utah State Hospital spends approximately $20 million a year — or 1 in 5 mental health dollars — rehabilitating mentally ill inmates so that they can continue with their court proceedings.
In the last legislative session, the hospital lobbied for and received $3 million to open an off-site facility in what will likely be the Salt Lake County Jail to begin treating male inmates without having to move them to the hospital.
But Kinikini said lawmakers are playing whack-a-mole with stopgap solutions that don't address the real issue and criticized a “lack of vision and leadership at the top” for the problem.
"Who knows whether the demand is going to outstrip that thing right when it opens," Kinikini said, referring to the off-site unit.
Utah Senate Minority Leader Gene Davis, D-Salt Lake City, recalled when the forensic unit was first established at the state hospital as a way to alleviate pressure at the Utah State Prison.
Davis said he's not surprised to see that the same problem continues today, only in a new location.
"It's just frustrating to see that we're this far behind the eight ball and nobody has been decrying this issue," Davis said. "These individuals that are being incarcerated in jails waiting for a bed in the forensic unit is criminal within itself.”
Davis, who worked for 16 years in public relations for what is now known as Valley Behavioral Health, suggests the state focus on mental health services for juveniles in order to eventually decrease Utah's population of mentally ill adults.
Rep. Steve Eliason, R-Sandy, also voiced his concern, saying he is "deeply troubled" by the revelations that Utah has the longest waitlist out of the seven Western states surveyed by the Deseret News.
Eliason added that he is committed to running legislation on the issue next session but said he didn’t know what the solution is yet.
"It's clear that we currently have a crisis on our hands," said Eliason, who pushed for a statewide suicide hotline in the latest legislative session and helped legalize needle exchanges in Utah last year. "The numbers speak for themselves.”
Many advocates and elected officials said that programs that were supposed to help people like Diane and others on the waitlist — such as the Justice Reinvestment Initiative — faltered because of the state’s decision not to expand Medicaid.
A 2016 study by the Utah Association of Counties showed that the Justice Reinvestment Initiative had successfully diverted more than 6,000 low-level nonviolent offenders away from incarceration but had failed to provide them the necessary substance abuse or mental health treatment afterward. Thus, the number of drug-related charges has actually gone up, not down, the report said.
The cost of treating those offenders' mental health and substance abuse problems is $21 million, according to the Utah Association of Counties.
Salt Lake County Mayor Ben McAdams said that the result is that cash-strapped counties have been left with the responsibility of treating residents' mental health and substance abuse issues without getting enough funding.
“The reinvestment never happened,” McAdams said.
A small-scale Medicaid expansion program meant to help several thousand low-income parents and childless adults who are homeless, criminally involved and have a mental illness or substance abuse problem has also been stalled since last year, pending federal review.
Edwards said Herbert has been in “direct conversations” with U.S. Health and Human Services Secretary Tom Price about getting those waivers approved, which he said would help low-income Utahns get mental health care.
Davis County AttorneyTroy Rawlings floated the idea of convening a panel of mental health and criminal justice experts to bring recommendations to the legislature to fund.
The five-month waitlist, Rawlings added, is an “unacceptable embarrassment to Utah.”
"We're better than that. As a state we're better than that. As a people we're better than that,” Rawlings said, adding that he would like to see an expansion of mental health courts in Davis and other counties.
In 2010, Davis County created a mental health court modeled after Salt Lake County's successful program. The idea is to help those who are mentally ill and charged with a crime resolve their cases without jail time. Graduates regularly credit the program for helping them break the cycle of recidivism, Rawlings said.
"The sooner we can get these people treated, out of custody in appropriate placements, on the proper medications, with therapy and treatment to keep them out of jail, in the long run, the more money it saves taxpayers," Rawlings said.
Some communities around the country, like Miami-Dade County, have undertaken large-scale mental health reforms that involve retraining police to divert mentally ill offenders to treatment instead of jail and providing follow-up care for up to a year after inmates are released from jail to ensure that they are getting housing, medication and other services.
But Rep. Edward Redd, R-Logan, said he would prefer to see how the off-site unit in Salt Lake County jail works before taking any bigger steps.
An internal medicine doctor who works as a psychiatric prescriber at Bear River Mental Health and at the Cache County Jail, Redd acknowledged the “huge” need for community mental health resources.
But "I think we're doing the best we can at the moment," Redd said. "We've got a good program going, it's a funded program. I think we run that for a year or two and see what happens."
Redd said he agrees that the state would likely see cost savings if officials were to invest in preventive medical care instead of catching patients once they're already involved in the criminal justice system. But getting the mental health community, state agencies and the Legislature to unite around a solution is "not something you can get done overnight,” Redd said.
"Quite honestly, some of us on the front lines are so busy trying to take care of patients that we sometimes get distracted and don't try to address the bigger issue," Redd said. "We get stuck in our silos."