MONCKS CORNER — Berkeley County is taking steps to prioritize mental health by launching a new pilot program at the county detention center covering inmates with mental illnesses.
The program is a partnership between the Hill-Finklea Detention Center and the Berkeley Community Mental Health Center and made possible by a $373,000 earmark from the state Legislature.
It’s the first program in South Carolina to receive specifically designated state funds to follow inmates with mental illnesses from the time they enter the detention center to when they leave, while encouraging them to visit the mental health center following their release, center Executive Director Matt Dorman said.
According to Dorman, 40 percent of those incarcerated in Berkeley County have a mental illness, and roughly half of those have a serious persistent mental illness, such as schizophrenia, bipolar disorder with psychotic features or a major depressive disorder.
Sheriff Duane Lewis hopes the effort encourages other counties to follow Berkeley’s lead.
“I think this is the first step in really trying to acknowledge that we have a mental health crisis in Berkeley County and in this state, not just inside the detention center or correction facility,” Lewis said.
Erica Shaw, a clinician, assesses an inmate’s mental health during a meeting at Berkeley County’s Hill-Finklea Detention Center on Nov. 23, 2022, in Moncks Corner. Gavin McIntyre/Staff
What is the pilot program?
Before the program, the detention center had only one psychiatrist who worked two hours a week, and a bachelor-degree level clinician who worked three months out of the year.
At the same time the detention center has been dealing with overcrowding. Lewis said the jail’s capacity is supposed to be 291 inmates but houses an average of 450. At one point, there were 500 inmates in the detention center.
Lewis attributes part of the overcrowding to people with mental illnesses being consistently incarcerated.
Randy Demory, the detention center director, said inmates with mental illnesses require more attention from staff than other inmates because they cause more conduct problems: not taking care of themselves by taking showers or using the toilet, inciting violence through words, and going on hunger strikes.
“They’re improperly and poorly managed out in the community, obviously, then they come to jail, and we’re just not equipped to give them the care that they deserve,” Demory said.
State Rep. Sylleste Davis, R-Moncks Corner, said when Lewis and Demory reached out about applying for an earmark, they told her the recidivism is high with people who are mentally ill.
Lewis compiled information he, Demory and Dorman had gathered — the program proposal, cost breakdowns, data on mental illnesses within the incarcerated population — to give to Davis. Davis in turn wrote a letter to Gov. Henry McMaster requesting he consider giving state funds to the proposed program.
Davis said the effort has several goals: reduce the number of mentally ill people going to jail and help them get the help they need; improve the recidivism rate; and improve public safety.
Dorman said they started working almost immediately after the county received the funds in October.
With the funds, Berkeley Community Mental Health Center is providing two master’s-prepared clinicians working 40-hour weeks, and a clinician for four hours each on Saturday and Sunday. The center is also providing a psychiatrist working 12 hours a week to prescribe psychiatric medication.
As of Nov. 29, the clinicians have seen between 175 and 200 inmates.
Erica Shaw (left), a clinician, and Stacy Keller, director of emergency and forensic services, walk back to their office after meeting with an inmate at Berkeley County’s Hill-Finklea Detention Center on Nov. 23, 2022, in Moncks Corner. Gavin McIntyre/Staff
Inside the detention center
Inside what used to be a holding cell — the doors have been removed and the walls painted baby blue to add a more friendly vibe in this newly transformed office — two clinicians look through computer systems to see which inmates they’ll be talking to.
The clinicians receive an average of 10 referrals per day.
Stacy Keller, director of emergency and forensic services, said there are multiple ways for the clinicians to receive referrals: through a database where inmates themselves can request to see a counselor, a referral from the medical team and referrals from detention officers.
The clinicians put all the information they need on a white board: who they need to see, who’s on suicide watch, who’s in the hospital and who’s going home. That way, it’s easier for the clinicians who come to the detention center the next day to pick up where the previous clinicians left off.
The clinicians conduct a mental health assessment with each inmate they meet.
They ask questions like what the inmates are feeling, if they’ve had suicidal thoughts, what medications they’re taking, and if they’ve been in counseling or therapy before. Depending on the answers, the clinicians then determine if the feelings are due to environmental issues they can help fix or a mental illness requiring further involvement.
They had to work through the backlog of approximately 90 inmates who already needed attention before moving on to new inmates. Erica Shaw, one of the clinicians who works at the jail, said she was flipping through multiple pages of inmates who were waiting to see a clinician when she started.
The clinicians went through the backlog of inmates within 30 days.
When the clinicians talk to the inmates, it’s friendly and comfortable. It sounds more like a conversation between friends than a clinician evaluating their mental health. In between questions asking about feeling suicidal thoughts and what medications inmates are on, jokes and stories are exchanged between the two.
Demory said having such an extensive amount of care for the inmates is like nothing he’s ever seen inside the detention center.
“Aside from the only two hours of psychiatrists’ time, we’ve never had anywhere close to 80 hours a week of master’s-level clinicians working with these inmates,” Demory said. “We’ve never had a master’s-level mental health clinician in the jail, working with the inmate population for any number of hours per week.”
Keller said she’s already seen a positive impact.
“There was this tendency for residents to say, ‘I don’t feel safe,’ and other things to get themselves put in a seclusion cell so they can get a break and their own bed,” Keller said. “In the first month (of the pilot program), that got cut down easily. We were able to ask questions like, ‘Is this a safety issue?’ or ‘Do you need a break?’ because if that’s it, let’s help you another way. (Being put in a seclusion cell) is for emergencies. This is not a vacation spot.”
Part of the pilot program includes follow-ups when people get out of jail. Before the program, Dorman said the mental health center never kept track of who was in jail and who was released, and in turn acknowledged that inmates didn’t know the mental health center is still a resource they could use after being incarcerated.
Now, the clinicians keep a list of those who were released, as well as who they’re keeping in contact with and who they recommended come to the mental health center for follow-up.
Dorman gave an example: A newly incarcerated inmate was being held at the detention center under a court order and started receiving mental health services. The mental health center’s jail team then coordinated and facilitated discussions with the court, inmate and attorney to form a follow-up treatment plan upon release.
“The inmate was released and immediately was assigned a BCMHC therapist and psychiatrist,” Dorman said. “I’m confident that more of this will occur going forward.”
Dorman said the mental health center will soon provide transportation to drive newly-released people to the center from their homes.
The follow-up also includes helping newly released inmates get jobs, Dorman said. The mental health center has three employment specialists who find employers who don’t hold incarceration against people, as long as the Department of Mental Health is involved in the process.
Erica Shaw, a clinician, asks a line of questions to an inmate while doing a mental health assessment at Berkeley County’s Hill-Finklea Detention Center on Nov. 23, 2022, in Moncks Corner. Gavin McIntyre/Staff
Looking forward
Despite only being two months into this program, Lewis said they’ll reapply for the funds for next year, and hopes legislators will see it as something worth continuing.
Dorman said one year may not be enough time to gather enough data to see the recidivism difference. That could take up to five years to draw a conclusion. In other aspects, the program seems to show promise.
Those who are involved believe it will prove successful. Davis, Lewis and Demory all have hopes for the program to be replicated throughout the state.
“I have a lot of confidence in our ability to make a difference,” Davis said.
Keller said she is also hopeful with the work the clinicians are doing in the detention center, and believes the compassion they show the inmates while working has a positive impact on the inmates’ mental health.
“There’s a lot of judgment for why people are in jail. For these folks, they’re carrying that in here with them,” Keller said. “When they get this opportunity to get — sometimes for the first time in many years — regular medical care, mental health care, and they’re treated like a human being when they come in, that makes a huge difference. I hope that helps with their rehabilitation.”
