Stuck in jail: Minnesotans with mental illness languish in lockup

FERGUS FALLS — Dawn Saxton's son is not supposed to be in the Otter Tail County jail.

Court officials agree that Gavin, who has schizophrenia, should be in a secure treatment facility after a delusion-spurred attack on his roommate. But like hundreds of Minnesotans with mental illness waiting to enter a state treatment program, including about 50 in jail, there's nowhere for him to go.

So the 27-year-old has spent about 100 days in a holding cell.

"This isn't OK. This is a terrible system," said Saxton, who has contacted all of her elected officials. "I feel like it falls on deaf ears."

Last year, the state suspended a decade-old mandate that inmates be transferred within 48 hours after they are civilly committed. Lawsuits were mounting as Minnesota repeatedly failed to meet that deadline, so state lawmakers temporarily altered the law and asked a task force to find fixes.

In a new report, the task force outlines reforms, but Minnesota has limited money available for the sweeping changes.

In the meantime, Gavin and others with mental illness remain stranded in poorly equipped jails where staff struggle to meet their needs and handle dangerous outbursts.

"We cannot be a hospital," said Cass County Sheriff Bryan Welk, who served on the task force. "They don't belong in jail. This is about patient care, treating people like people."

Report proposes fixes; funding needed

Jailed Minnesotans needing treatment face the longest wait time ever, the task force reported. What took an average of two days in 2019 averaged more than two months in 2023. And that's after prisoners wait weeks or months in jail for the courts to refer them to treatment.

Staff shortages, increasing behavioral health issues exacerbated by pandemic isolation and insufficient space at mental health facilities have contributed to a "perfect storm," Human Services Commissioner Jodi Harpstead said.

The storm is hitting emergency rooms and acute care hospitals, too; both compete with jails to get patients into state mental health hospitals or secure treatment facilities. Some hospitals have had patients awaiting a treatment bed for a year or longer, the task force said.

In its report, the group suggested helping some of those patients by making a limited exception to the law that generally gives jail prisoners priority admission to state facilities.

The task force offered nine recommendations. The first is to increase capacity and access at key state treatment facilities. Among the others:

• Expand community services to prevent people from needing hospitalization and to help them succeed after they leave the hospital.

• Change the process for prioritizing admissions to state facilities.

• Give people in jail or prison access to Medicaid benefits.

• Add forensic examiners to determine if someone with mental illness is competent to proceed in a criminal case.

Harpstead said the Department of Human Services is already working on some of the recommendations such as collaborating with partners on a case-by-case basis to move people out of state treatment facilities into community settings, such as group homes.

Amid staffing challenges last year, the department eliminated 14 forensic mental health program beds in St. Peter, which serve people with chronic, serious mental illness. But Harpstead said they will be made available again.

Minnesota's latest budget forecast showed a $3.7 billion surplus, but officials warned of a projected deficit in the next two-year budget. Even with the looming deficit, Rep. Heather Edelson, DFL-Edina, said she is optimistic lawmakers will devote money to the issue this year. She is drafting legislation on fixes.

"It will be an incredibly large investment. But the reality is, it's costing us right now," Edelson said. "Minnesotans understand that this is a massive crack in our system, that there are a lot of very tragic stories that are tied to this. People's constitutional rights are being violated."

Jail workers aren't equipped to handle need

At the Otter Tail County jail, staff said they usually have a couple of prisoners waiting for an open mental health treatment bed.

They often are kept in spartan single-person holding cells with a bed, a toilet and a pane of glass facing an interior hallway. There is limited social interaction, and the jail doesn't have an outdoors area for prisoners. Depending on the person, they may need two or more staff to accompany them when they leave their cell.

Staff try to swap out library books for people and have occasionally placed a television in the hall outside a cell for a prisoner to watch at night, Jail Administrator Beth Carlson said. Prisoners have phone access so they can call, text and access self-help materials. But Carlson said staff are frustrated that they are not helping people get better and are watching their mental health deteriorate if they aren't getting their medication or refusing to take it.

"My staff aren't nurses, definitely aren't psych nurses," Carlson said. "A lot of times it's like, 'What do we say? How do you talk to them?' They are trying to navigate that the best they can."

When a prisoner becomes violent, she said, there are other worries. Incidents of self-harm and harm to jail staff are rising, according to the task force.

Inmates have a constitutional right to medical care. But some jails don't have a professional trained to safely administer mental health medication, such as antipsychotics, and they struggle with situations where someone won't voluntarily take a drug and must be restrained, the task force reported.

The report includes a recommendation that funding be allocated to train staff and ensure a qualified person can deliver medication. Harpstead said that wouldn't require much money and should happen as soon as possible.

That change could "significantly prevent the need for hospitalization of some individuals, improve safety within jails, decrease recidivism, and improve outcomes for people living with mental illnesses," according to the report.

Welk, the Cass County sheriff, said it would help to have regional psychologists assisting jails across the state. He said his staff feel "helpless" and fear intervening in situations that could require use of force, like changing someone from their clothes — which could be used as a noose — and into a suicide-prevention smock.

Welk said a violent prisoner once was kept in the Cass County jail for about 84 days.

"That's not huge compared to what we're seeing in the numbers statewide," the sheriff said. "But when you are thinking 84 straight days, 24 hours a day, constant issues, it seems like 84 years."

Stuck in a holding cell

Dawn Saxton's son Gavin was staying in a community-based intensive residential treatment facility in November when he stabbed his roommate with a pen. He later told law enforcement he believed the roommate was the anti-Christ.

"It was his illness, not him," Saxton said of the attack.

Her son was charged with second-degree attempted murder.

In her Fergus Falls home, she has kept a pile of posters from Gavin's high school graduation party and photo albums that show him when he was healthier. There are pictures of her son posing with friends, camping on the North Shore and fishing with his dad, who died when Gavin was young.

They captured an easy-going National Honor Society student who played football and basketball and participated in track; he liked art and science and was good with kids.

He was diagnosed with schizophrenia at the start of his senior year of high school. He's since been in many treatment facilities, but has had more stable periods during which he worked a part-time job.

"I still am hopeful that with the right treatment he can live a life where he's able to be in society and hopefully work and be all the things that you hope for for your kids," said Saxton, a retired social worker.

She wishes she could see him in person. She worries about whether he is getting the right medication and wants him to be able to go outdoors, or at least have a window to see outside.

"They are doing what they can at the jail, but it's just not set up," Saxton said.

Gavin writes her letters. He asks how his mother is doing and tries to reassure her, telling her the food isn't so bad and that he's been drawing and reading. In one letter, he mentions talk of sending him to Anoka-Metro Regional Treatment Center.

He wrote that letter on day 43.

Tuesday is day 100.