Early this May, San Miguel County in southwest Colorado experienced a one-man crime spree. According to the allegations, an individual we’ll call Joseph broke the windows out of one home and tried to burn down another. He stole a piece of equipment from a construction site and a bicycle from outside a school. He then falsely reported to law enforcement that he had been attacked by a mountain lion. A criminal record check showed Joseph had a string of suspected crimes in other states, including attempted murder for a domestic violence incident. When county Sheriff Bill Masters contacted Joseph’s family, a weeping relative told him Joseph had been in and out of jail and mental health treatment programs for much of his troubled life.
Joseph was already known to local law enforcement, according to Masters. A year ago, when he was traveling through the area, Joseph stopped at Masters’ office to report that he was a contract killer working for the Central Intelligence Agency; he wanted deputies to know where he was in case the CIA needed to send him on an assignment.
After his criminal activities in May, Joseph was sent to a treatment program at a mental hospital in Grand Junction. But he spent just three days there; upon release, Joseph was arrested on outstanding warrants and sent to the Mesa County jail, where he was held on suicide watch. After five more days in the hospital, where he was reportedly stabilized on medication, he returned to the San Miguel County jail to face charges. There, mental health services consist of a visiting counselor and occasional telemedicine sessions with a psychiatrist. Law enforcement authorities are attempting to send him to a state mental hospital, but the waiting list for a facility in Colorado is usually around three months, according to Masters and other sheriffs in the state.
The cycle between jail and treatment for people with mental illness who have committed crimes is a familiar one. Inmates deemed unfit to stand trial will often rotate between jail and competency restoration programs designed not for rehabilitation, but to stabilize inmates just enough that they can attend hearings. Masters calls the system “hopelessly broken.”
He doesn’t base that assessment on a single case. In the past year alone, numerous people with mental illnesses have ended up behind bars in his jail outside the high-dollar resort town of Telluride. It’s a national problem heightened by the isolating geography of the rural West, where small jails like San Miguel County’s have become de facto psychiatric wards. They are designed to detain lawbreakers, not to care for those undergoing mental health crises, but that is the situation they have been forced into.
“My jail is the largest mental health facility in my county,” said Masters. “We have people all the time in our jail who shouldn’t be there because they are insane. They have caused trouble and have to be taken off the streets, and there is usually no place to take them, so the fallback is, ‘Let Bill handle it.’ They land in my jail, and I don’t have the resources to help them. None of us sheriffs signed up to run the mental health hospitals for the nation.”
Masters knows his frustrations are shared by other sheriffs. Two years ago, he attended a conference of the Stepping Up Initiative, a program designed to help sheriffs deal with the problems of mental illness in jails, in Washington, D.C. Masters said the consensus among sheriffs there was that many of their detainees with mental illnesses sit in jail with little or no meaningful treatment. From there, they either assault jail personnel or commit new crimes upon release, and end up with additional time to serve. In essence, they are serving life sentences 30 days at a time.
Some urban jails have psychiatrists on call and counselors on staff. They often employ social workers to slow down the revolving door by lining up services and medications for inmates after release. Some jails divide inmate populations by mental health needs, such as placing veterans with PTSD in one unit and those with schizophrenia in another. Certain counties have mental health courts that divert inmates away from jails and into more appropriate treatment.
Such is not the case in San Miguel County. Its 37-bed jail tucked away next to a gravel pit, out of sight of the main Telluride downtown area, relies on on-call counselors and occasional, and expensive, psychiatrist visits. Nonetheless, the jail serves as a stand-in for mental health care because few services exist in this mountainous area. San Miguel is one of 11 Colorado counties without a hospital. The county seat of Telluride has a medical clinic, but no mental health crisis center or detox clinic.
The closest mental health clinic with crisis care is in Montrose, 62 miles and a mountain pass away. There is a mental hospital 125 miles away in Grand Junction, but it doesn’t provide court-ordered competency services. The only state-run inpatient psychiatric hospitals are across the Continental Divide in eastern Colorado. And they are overcrowded.
Psychiatrists visit San Miguel County inmates only occasionally, and sometimes through video conference. Other mental health clinicians are in short supply because they can’t afford to live in a costly place like Telluride.
But those who need mental health care in jail are in anything but short supply. Masters estimates that more than half of the inmates in his jail have varying degrees of mental illness.
No matter the state, rural areas don’t have many resources for people in need of mental health care, in or out of jail. In Colorado, there are a dozen beds in psychiatric hospitals per 100,000 people. In western Colorado, away from Denver and its suburbs, that drops to six beds per 100,000. Combine that shortfall with the ethic of preferring to “tough it out” rather than seek help that is common in the rural West, and rural sheriffs find their jails crowded with people who they believe shouldn’t be there at all.
“I don’t have data. I don’t have statistics. I just have the anecdotal, and I think this problem is epidemic in rural jails,” said Ted Mink, interim director of the County Sheriffs of Colorado. “This problem is out there — not just in Colorado — and it is growing.”
Some have attempted to pinpoint data on the problem beyond the anecdotal. According to a 2009 study, an estimated 2 million people with serious mental illnesses are admitted to a local jail each year. The National Alliance on Mental Illness estimates that at least 83 percent of them do not have access to meaningful treatment.
This crisis has been building for more than 50 years. When Medicaid was created in 1965, it excluded funding for those in “institutions for mental diseases.” Decades of federal and state funding cuts followed, leading to the shuttering of many state hospitals and the release of their patients. Many ended up on the streets, and some eventually landed in jail.
Masters, the longest serving sheriff in Colorado — he began his 11th term this year — calls the increase in detainees in need of mental health care the most troublesome problem he has faced. It is also one of the more easily overlooked. To the outside world, his office appears to be focused on the challenges of an area with a surfeit of mountain peaks: avalanche rescues, mishaps on ski slopes, cars sliding off steep passes, wildlife encounters. Episodes of psychosis don’t often make headlines.
The mental health crisis in the San Miguel County jail is indicative of problems in many isolated, rural jails. But it stands out in part because of the stark contrast with Telluride’s affluence, evident in sprawls of massive log-and-rock mansions owned by the likes of Oprah Winfrey and other moguls. A main street that once was a dusty, rowdy hangout for gold and silver miners and, later, nature-obsessed hippies is now dotted with high-priced bistros and western-wear boutiques frequented by tourists. Telluride has only 2,400 residents, but it is known for its hardy party scene and numerous festivals — celebrations of music, food, film, mushrooms, cars, balloons, fire, and ideas.
But the town is more complex than it seems from the outside — and not everyone there is a mogul with a mansion. “This town has the facade of a world class resort with the pressures of a working-class community,” said Paul Reich, the behavioral health program manager of the Tri-County Health Network, a nonprofit agency trying to ease these problems in San Miguel as well as two neighboring counties. “There is a really challenging landscape here around mental health. We have spent a lot of time trying to figure out how you do crisis intervention when you are far away from most services.”
That fact is not being totally overlooked by locals. Last November, San Miguel County voters agreed to a levy that will funnel $600,000 each year toward mental health services through an increased property tax. Masters has yet to see whether any of that money will come his way.
In nearby Montezuma County, in the southwest corner of Colorado, Sheriff Steve Nowlin is also in wait-and-see mode. He is hoping new state legislation that included increased funding this year to beef up behavioral and mental health services at rural jails will lead to significant improvements in his county, which lacks Telluride’s wealth. So far, thanks to the funding, he has been able to more often utilize a crisis center in Durango, 45 miles away. And a counselor from Durango now travels to Nowlin’s jail five days a week.
Nowlin said the new state funds only address immediate crisis needs, however, not the root causes of recidivism.
“I am just so frustrated by it taking so long to get us help. All of the time and all of the bills aren’t really helping,” he said. “I just know that I need help. We have been kicking this can down the road for too long.”
Moffat County Sheriff KC Hume, in northwest Colorado, has an inmate who has been waiting since December for space in a state competency restoration program. During that time, he has assaulted two jail personnel.
“We have tried numerous things here over the years to try to address this problem of mental health,” Hume said. “But when you are isolated like we are … you can have all the money available to you, but if you don’t have the clinicians, there’s not much you can do.”
Many Western states are mired in the difficult work of balancing mental health care with criminal justice. The Arizona Supreme Court established a task force in 2018 to look into how the state can better address mental illness in criminal court cases, where the justice system can be delayed for years as the state’s Restoration to Competency program plays out. Maricopa County — formerly led by Sheriff Joe Arpaio, who was found guilty of criminal contempt in 2017 for detaining undocumented immigrants — has long been mired in lawsuits over its mental health care program for inmates.
Last year, Oregon held a record 718 people at the state mental hospital who were found incompetent to stand trial. A statewide program called “aid and assist” that orders inmates to Oregon State Hospital for competency restoration hasn’t slowed down the steep increase, and last month the hospital was held in contempt for not admitting defendants in need of mental health treatment quickly enough.
Los Angeles County has had one of the most high-profile problems — an estimated 70 percent of inmates in the county jail system there are medically or mentally ill — and is trying unusual solutions. The county’s Men’s Central Jail is slated to be torn down and replaced with a mental health treatment facility overseen by mental health officials rather than the Sheriff’s Office.
A string of lawsuits originally filed in 2011 by disability activists against the Colorado Department of Human Services recently ended with a federal court agreement, under which the state agreed to pay hefty fines until they are able to get inmates needing mental health care into competency evaluations and treatment much more quickly. The most recent suit came after the state failed to move inmates into treatment within 28 days, as ordered by a federal judge in 2016. The suit charged that inmates in need of court-ordered treatment were waiting more like four to five months in jail. According to the state’s department of health, they struggled to meet the original deadlines in large part because of the massive increase in need: The number of orders for inpatient competency evaluations grew 592 percent between 2000 and 2018, and treatment orders for inmates ballooned 1251 percent in the same time period.
The consent decree requires that inmates with the most urgent need for care must be admitted for treatment within seven days. Those who are less ill must be admitted within 21 days. The state is reconfiguring its hospitals to make room for more competency-restoration cases, but nonetheless anticipates having to pay millions in fines because it can’t meet those deadlines.
The Equitas Project, a Colorado-based nonprofit dedicated to disentangling mental health and criminal justice nationwide, recognizes the dilemma for rural counties. Equitas has been working on the problem for five years, issuing white papers and organizing summits to bring together mental health providers with criminal justice officials.
“We need to get ahead of this crisis,” said Vincent Atchity, executive director of The Equitas Project. “We need to look upstream and redirect people and assess needs and head this off at the pass before the criminal justice system gets involved.”
Equitas’ efforts helped pass the bill last year that augmented funding for the Jail Based Behavioral Services program that began in 2011 — the same funding Montezuma County’s sheriff is already using. The bill makes $7.7 million available to increase the availability of screening, treatment, and connection to services once inmates are released. A lobbying group, Mental Health Colorado, also worked with state legislators on the law, and helped craft a plan that set up a Mobile Crisis Response system. Jails can call the system and a mental health professional is supposed to respond within two hours.
“We are trying,” said Lauren Snyder, state policy director for Mental Health Colorado. “Change doesn’t happen overnight.”
There is national help available, too. The Stepping Up Initiative is a collaboration of the Council of State Governments Justice Center, the National Association of Counties, and the American Psychiatric Association. More than 450 counties, including San Miguel, now participate. The initiative promotes the use of screenings to identify inmates with serious mental illnesses, and it facilitates mental health training for jail personnel; Masters has sent two deputies to crisis-intervention training so far.
Masters hopes all the measures collectively will help even in his mountain-ringed bailiwick. Looking forward to the new state funds, he is considering hiring a full-time mental health counselor. That represents a softening — or, perhaps more accurately, a wearing down — of his stance that jails should not be in the mental health business.
But the dilemma of having too few mental health professionals in rural areas remains. “You get away from metro areas anywhere, and the resources take a dive,” said Mink, who previously served a dozen years as sheriff in populous Jefferson County, Colorado. “The ability to hire professionals to address the problem is very limited.”
For now, the presence of psychologists at the newly opened crisis stabilization unit in Montrose — an hour-and-a-half drive from Telluride in good weather — gives Masters and five other rural sheriffs a new outside-jail option for assessment and treatment. Combine that with the jump in state funds, an increase in on-call and remote counselors, and the expanded hospital in Grand Junction, and Masters sees the possibility of relief.
But Masters still releases people who he is certain will quickly be back behind bars — somewhere. Earlier this year, he had a deputy drive a released inmate to Montrose, where the man could catch a bus. The inmate had been in the San Miguel County jail for more than 150 days for minor disturbances. He was a repeat offender, and known to have mental illness. It bothers Masters that the man was sent off with no help.
The news that Joseph, his recent crime-spree offender, was on suicide watch also saddened Masters. Now that Joseph is now back in San Miguel County, his case is under advisement. In more than four decades as sheriff, Masters has repeatedly witnessed the plight of inmates with severe mental illness. He feels the only reason some of them are incarcerated at all is because of their need for mental health care.
“And that should not be a crime. These people need help—help that I can’t give them,” he said. “Jail is not a place to get well.”
