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Mental illness a silent killer in Idaho correctional system

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POCATELLO — For much of his adult life, Lance Quick was burdened with the mental and emotional toll of post-traumatic stress disorder and bipolar disorder.

Although he was prone to bouts of distress his family referred to as “manic episodes,” Quick’s parents believed that treatment and medication had helped him turn a corner.

Ten years after being diagnosed, in 2016, Quick launched his own business — Superior Home Inspections LLC. He found comfort in his service dog, a chocolate lab named Bear, and appeared to have directed his life down the path of success.

Lance Quick
Lance Quick | Courtesy photo

But two years later, at the age of 40, mental illness and a lack of proper treatment from the Idaho correctional system lead to Quick’s death. Once a large imposing man, he died in a Bannock County Jail cell, a gaunt, gangly shell of his former self.

His death sparked an investigation into how mental illness was treated at the Pocatello jail. It led to drastic changes at the facility, but shortcomings remain throughout the state.

RELATED | Prosecutor finds wrongdoing but no criminal action in death of mentally ill Bannock County inmate

“Our state is miserable when it comes to dealing with mental health,” then-sheriff of Bannock County Lorin Nielsen said following Quick’s death.

Quick was one of 200 deaths reported among inmates in the Idaho corrections system in the decade between 2011 and 2020.

There are several key contributing factors to those 20 deaths per year, according to state and local officials — accidents, acute health problems — like drug withdrawals — and long-term health problems, like diabetes. But the main factor is deaths occurring as the effect of mental illnesses, commonly in the form of suicides.

Identification and treatment for mental illness and suicidality, in many instances, does not begin until a person is in police custody, according to Brian Mecham, a psychologist and mental health director at Bonneville County Jail.

“People need to be trained, and they need to be vigilant. They need to know the warning signs of mental health issues,” Mecham told EastIdahoNews.com. “We can’t prevent that from coming in — we can’t prevent mental health issues from coming in (to the jail).”

That is the root of the issue, Mecham told EastIdahoNews.com. Shortcomings in the identification and understanding of mental illness is a societal problem that often spills in and out of jails and prisons, which serve as a microcosm of the problem as a whole.

Kelly Meacham, a physician assistant serving several east Idaho jails including Bonneville County Jail, said that filling gaps in the treatment of mental health is something “near and dear to my heart.”

“The whole system is broken, in my opinion, as far as (treating) mental illness,” he told EastIdahoNews.com.

And Meacham doesn’t just mean in Idaho. Problems with mental health and suicide in prison are on the increase across the country. According to research published by PrisonPolicy.org, deaths resulting from all unnatural causes in local jails and state prisons across the country climbed drastically between 2001 and 2018, despite populations in those facilities seeing minimal growth. The majority of those deaths, about 46%, are listed as suicide.

Besides suicide, deaths caused by alcohol or drug intoxication have also seen a major increase during the same period.

Both are concerns statewide, according to Jeffrey Ray, spokesman for the Idaho Department of Correction. But, according to Ray, the primary cause of death for inmates overall in state facilities remains disease or illness.

Still, Ray agrees that mental illness is among the state’s primary concerns, when it comes to the health of the state’s inmates.

Major contributors to inmate deaths

When considering inmate deaths there is a popular misconception that gang violence is among the primary concerns. But, as Bannock County Sheriff Tony Manu said, while that is often painted as a major issue by Hollywood, gang violence is not a huge threat. In fact, in his 30 years with the sheriff’s office, Manu cannot recall a single death resulting from gang-related violence.

Violence does remain a small factor though. Homicides accounted for 39 deaths nationwide amongst jail and prison populations in 2001. By 2018, that number had risen to 120 deaths.

In eastern Idaho, Meacham said there are very rare instances of a fight leading to a fall or a brain injury that then results in death. But natural illnesses, such as heart failure and diabetes are of much greater concern.

“There’s a lot of physical ailments, people age and they die,” he said. “We do everything we can — my job is to keep them safe and alive while they’re here.”

Along with mental illness, drug and alcohol addiction is another leading cause of deaths among inmates — though in many cases those addictions can be partially attributed to mental illness (the same can be said of some homicide cases).

Over the past 20 years, jails in east Idaho and beyond have seen addictions to meth evolve into opiate dependency. Now, Meacham said, fentanyl use is regularly combatted by his staff, leading to aggressive withdrawal symptoms and far too often, death.

Due to the dangers of drug and alcohol addiction and withdrawal, all inmates go through a general health assessment at booking.

The assessment both Manu and Meacham said, is two-pronged. The inmate being booked is asked a series of questions related to drug use and physical health ailments. The subject of mental health is also broached during this assessment.

Inmates are asked about mental illness, and treatments or medications used. But, because people facing criminal charges can be untruthful, the booking deputy is also charged with assessing the inmate using symptomatic calling cards.

Anything that, as Meacham says, “doesn’t give the deputy warm and fuzzies” is reported to jail medical staff.

In Bannock, Manu encourages his deputies to seek medical assistance or even rush inmates to the hospital at the first sign of health problems, mental or physical. He asks his deputies to treat each inmate as if it were a family member.

“I tell our staff, ‘If you see something that’s just not right, get them out of here and to the hospital,’” he said.

This was part of the process that was apparently missed in the Quick case.

According to his family, Quick went six days in the jail without access to the medication that had helped him stabilize his life. His father, Kim, said he told Sheriff Nielsen what medications Lance was taking, and what would happen if he did not take them.

Quick was never assessed by a mental health expert.

Regardless of the results at the booking assessment, all inmates are subject to what amounts to a physical by jail medical staff within their first seven to 14 days, Meacham said. At that time, any necessary mental health assessment can be requested and scheduled by medical staff, and a visit is then carried out by someone like Mecham or Marty Cooke.

Cooke, the clinical supervisor for the Idaho Department of Health and Welfare’s Behavioral Health Crisis Team, says many inmates have mental illness discovered in jails, due to a lack of awareness and a negative stigmatism attached to mental therapy.

“There’s a fair number of folks that have no insight into their mental illness, don’t believe that they’re mentally ill,” Cooke said. “Those are the toughest folks to work with.”

“I think (mental illness) can get demonized sometimes,” Manu added. “Just like anything else, it’s a disease.”

Mecham, the psychologist, agreed that undiagnosed mental illness does create a major issue.

As Mecham said, deputies go to great lengths to receive necessary training. Alas, a two-hour, two-day or even two-week course cannot replace the years it takes to achieve the expertise he employs in his own assessments.

When mental illnesses are identified, inmates rarely suffer debilitating or deadly breakdowns, or “completed” suicide attempts.

The reason?

Inmates with identified illnesses or threats are placed on close-custody watch — when deputies are either permanently stationed with them or check on them every 10 to 15 minutes, rather than every 30. They are also treated by the mental health team and medicated.

Outside a close custody cell in Bannock County Jail
The exterior of a close-custody cell in the Bannock County Jail. Cells like this are equipped with several viewing windows, allowing jail staff to monitor inmates suffering from drug and alcohol withdrawals, as well as other factors. | Courtesy Emma Iannacone

Deputies also go through regular crisis response training.

Still, deaths occur.

Quick, whose mental state deteriorated over the six days he spent in jail, missed 10 meals, according an investigation. Rather than eating the food he was given, he had taken to rubbing it on his body. Rather than drinking water offered, he sipped from an opened drain at the center of his cell. His family was never granted access to him — they were instead told that Quick was “incapacitated” — and were never able to assess him themselves.

Evolving mental health treatments in corrections facilities

Now, deputies at the Bannock County Jail are required to seek mental health assistance any time an inmate misses three meals.

The same can be said of Bonneville, where family members, friends and attorneys who are in contact with an inmate are also asked to alert deputies of any drastic change in the mental state of the inmate.

With the new checkpoints and monitors in place, local jails have advanced their treatment of mental illness.

As Mecham said, inmates who spend two weeks in an east Idaho jail now often leave in a more balanced, stabilized state.

The bigger issue has become enticing those people to continue treatment outside of the jail.

It is somewhat commonplace, Mecham said, to have an inmate discharged then be arrested and back in jail within days. Manu agreed, saying he has seen that turnaround in as little as 24 hours.

“What we need is teeth. We’ve got no teeth,” Mecham said. “If you have teeth, people get better. They don’t usually make good decisions on their own.”

By teeth, Mecham means that mental health treatment and medication use needs to be built into parole and probation requirements. For many, treatment of mental illness needs to be required, to avoid some becoming a risk to themselves and others, he said.

There also needs to be a better delineation between public risk and public nuisance, according to all experts who spoke to EastIdahoNews.com.

There are times, Manu said, when he will look at the file of an inmate and think, “That’s what he’s in here for?”

“The root problem is their mental health,” he said. “So what takes priority, the crime they committed or their mental health care?”

People in need of care are all too often arrested and placed in a cell when a bed at a local hospital is more fitting for their personal treatment.

Quick was perhaps one of those cases.

Arrested for driving under the influence, Quick’s blood-alcohol content was registered at 0.00%. He may have been on THC gummies at the time of his arrest, but his state could be described more as that of a person in the midst of an emotional breakdown.

Prioritizing mental health treatment

The issue outside the corrections system, according to most experts, is a lack of resources.

“There’s a shortage of facilities, and that’s probably nationwide,” Manu said. “I think it’s just a matter of where the importance lies, whether it’s legislators and whether they think it’s important to put money in this area towards … facilities.”

As Manu said, there are times when an inmate is determined mentally unfit and in need of a bed at a local mental health facility. But when the call is made, jail staff is informed that there are no open beds.

Mecham believes that the resources do exist, and that it is the ability to connect a discharged inmate with those resources is what’s lacking. That is why Bonneville County Jail recently hired a full-time dedicated discharge planner — someone responsible for connecting discharged inmates with needed assistance.

Still, Meacham said, jail staff are tasked with serving as those facilities.

“This is like a mini ER, slash longterm care facility, slash 60% — we’re the de facto mental health facility for the state, because there’s just no beds (in dedicated mental health facilities),” he said.

Because of this fact, Manu believed it is time jails are outfitted to serve the community the way they are being asked to serve.

“Maybe it’s time to start designing things different when you make expansions,” he said. “But then again, you don’t want this to be a permanent place for someone who has mental health issues.”

That, again, comes down to a commitment of resources.

Inside a close custody cell at Bannock County Jail
The interior of a close-custody cell in the Bannock County Jail. Inmates are placed in similar cells while detoxing from drugs or alcohol. | Courtesy Emma Iannacone

Quick might have benefitted from a more prepared jail facility, if not the availability of a bed, and a jail staff better prepared to handle his state.

At booking, an investigation into his death showed that Quick grew combative and had to be placed in a holding cell oft-used for detoxing inmates. The 6-by-10-foot cell was without a bed, toilet or sink. He was left alone, in a state in which he “could not understand the concept” of eating, according to investigation.

He remained in that cell for the final six days of his life, suffering his way to an agonizing death on Dec. 14, 2018.

“It’s been very disappointing to read what he went through,” Quick’s mother, Shauna, said following an investigation into his death. “We are very concerned about it never happening to anyone else. We’re concerned about people being held accountable.”

In the three years since, changes have been made at Bannock County Jail, along with other local facilities. The seriousness of mental health has been embraced by Bannock’s new leadership team. The onus now falls on the state and nation as a whole to follow suit.

“We don’t have enough facilities, I 100% believe that. And the facilities that we do have are full,” Manu said. “You take away more and more resources, then (people suffering from mental illness) end up in our facility because it’s a safe place. These jails weren’t built for that.”

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