Jail Substance Abuse 7

Mary Lou Emerson, the director of the Utah Substance Use and Mental Health Advisory Council, goes over Senate Bill 205 during a meeting at the Utah State Capitol on Tuesday, Oct. 2, 2018. The bill was passed earlier in 2018 to address the record number of people dying from drug and alcohol withdrawal in county jails in Utah.

SALT LAKE CITY — A state committee has recommended a five-point plan to help Utah’s county jails prevent deaths among an incarcerated population increasingly afflicted by substance addictions and mental health problems.

The 27-member workgroup, formed at the direction of the Legislature, released a report Monday aimed at stemming suicide and substance-related deaths that attracted scrutiny after a record 27 deaths were reported in 2016.

Utah lawmakers will now decide whether to implement the plan, which has an unknown price tag.

“Everything you’re talking about involves cost,” said Reed Richards, a Weber County deputy attorney who represented the Utah Sheriffs’ Association on the workgroup.

The recommendations:

Funding: The Legislature and counties should jointly set priorities for adequate and effective health care in jails. They should allocate the funds and personnel needed for medical, mental health and substance use screening, assessment and treatment.

Screening: Inmates should undergo physical, behavioral health and suicide risk screenings before or immediately after booking. If indicated, they should undergo further assessment to determine possible disorders, including risk of overdose or withdrawal, medical or mental health crisis, or suicide. Screening and assessment personnel must have adequate training.

Tele-health: Use technology, with intergovernmental agreements and pooled funds, so medical, behavioral health or other staff authorized to perform assessments or prescribe medication can work remotely with jail staffs to care for inmates.

Model policies: Form a committee to identify or develop model evidence-based policies, procedures and protocols for treatment of jail inmates experiencing substance use and mental health disorders. Training recommendations for correctional officers on suicide prevention and behavioral health also should be considered.

Treatment after release: Recognizing that repeat drug offenses are common, establish evidence-based substance use and mental health treatment programs in jails that include referrals on release to community-based treatment and recovery support.

Tax incentives: Give tax breaks for medical, mental health and substance use professionals who provide treatment services for jail inmates.

At the group’s final meeting Wednesday, county representatives pushed back against potential one-size-fits-all policies from the state level.

Consequently, the workgroup added to the policy recommendation a qualification that rules should “take account of the needs and limitations of correctional health care, particularly in smaller or rural county jails, and the requirement that medical and behavioral health providers must exercise professional judgment on a case-by-case basis when treating patients.”

But Kyle Ovard, representing the Utah Association of Criminal Defense Attorneys, said too many jail doctors and staffs withhold needed medications from inmates.

Ovard suggested the state “set policy for jails giving their medications.”

“I had a guy go 45 days not getting his medications,” Ovard said.

Alan Bennett, a registered nurse with the Utah County Jail, challenged the prospect of state-dictated uniformity.

He said inmates often lie about needed medications.

“Everything’s BS,” he said.

“Where’s the medical autonomy,” Bennett asked. “A doctor on the outside can’t tell a jail doctor how to practice.”

Darcy Goddard, workgroup chair, said the panel would relent on the issue and “leave it squishier for now.”

Goddard, a deputy Salt Lake County attorney, said, “I’m totally biased. I think we already do a good job in the county jails.”

Vivitrol kit

Part of a Vivitrol kit is shown Thursday, Aug. 31, 2017, at Davis Behavioral Health in Layton. U.S. prisons are experimenting with the medication, which could help addicted inmates stay off heroin and other opioid drugs after they are released. Jails in Weber, Davis and Salt Lake counties also are also running Vivitrol pilot programs.

The workgroup suggested the state commence a pilot project to further assess the benefits of using the withdrawal drug Vivitrol to help inmates stay off opioids after they leave jail.

Tim Whalen, head of Salt Lake County Behavioral Health Services, said the jury’s out nationally on how well Vivitrol works.

A Vivitrol shot is given to an inmate upon release. The drug blunts opioid cravings and also leads to illness if the person ingests drugs afterward.

Keeping inmates in close involvement with follow-up treatment on the outside seems to be the key, Whalen and others said.

“There has to be some kind of follow-up,” said Dale Bench, another Utah County Jail registered nurse. “We tracked (released) inmates who had Vivitrol shots at three, six, and nine-month intervals ... over 60 percent were back in jail within nine months with new drug charges.”

Bench added, “We can blame this on lack of follow-up or whatever. It’s not a miracle drug.”

Vivitrol usually is administered once a month for 12 months.

Goddard said it costs Salt Lake County $798 per injection.

“Unless we have pre-planned follow-up when they leave jail, our efforts are totally wasted,” said state Rep. Edward Redd, R-Logan, who is the contract medical doctor for the Cache County Jail.

“Without continuity of care in the community, a lot of this is going to be wasted money,” Redd said.

The workgroup also recommended the state and counties try to obtain Medicaid funding to help with some jail health care costs, and that any savings should be plowed back into the jails for care improvements.

“Opioid withdrawal results in needless suffering ... masking of symptoms from other life-threatening illness . . . [and] has resulted in deaths.”

“All correctional facilities, regardless of size, should have a system for screening, diagnosis, and appropriate treatment of alcohol, sedative/hypnotic, and opioid withdrawal, and post-release linkage to treatment.” — National Commission on Correctional Health Care

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