Hamilton County Sheriff Jim Hammond has often said the county jail is as much mental health hospital and homeless shelter as it is a place of correction.
As many as 40 percent of inmates are on psychotropic drugs, and a large share are mentally ill or addicted, ending up in jail because they can't access treatment or social services.
After forming a team and seriously studying the problem for about a year, Hammond on Wednesday asked Hamilton County commissioners to help.
Supported by a phalanx of medical and social service experts, Hammond asked commissioners to kick in $25,000 for an ambitious plan to get mentally ill and addicted people out of the jail and into an environment offering supportive housing and a full range of treatment and services.
He said the county's contribution would be added to similar donations from BlueCross BlueShield of Tennessee and CHI Memorial. The money will go toward finding a mental health provider that will offer housing and services for the mentally ill to keep them out of the jail.
The sheriff told commissioners there was no way to accurately estimate the burden on budgets and bed space from people who are arrested because they're a danger to themselves or others but have no place else to go.
But he did share an anecdote that sheds light on the futility of locking up sick people:
"Just seven users we picked up at random over the last five years have spent more than 4,000 days in jail at about a $420,000 cost to the county and none of them are any better off than they were before we started this," Hammond said.
Standing at the podium with Hammond, Robert Scheri, vice president of mission integration for CHI Memorial, said programs elsewhere have had astounding results — up to 80 percent reduction in health care and criminal justice costs for the mentally ill/homeless.
"This is a holistic and just and compassionate way to approach these individuals, to try to intervene in their lives, to make a difference, and to change the trajectory, both of their lives as well as the expenditures that revolve around their conditions," Scheri said.
Janna Jahn, with Hamilton County's development department, said the team has looked at successful programs elsewhere.
"Outcomes in other communities have shown dramatic reductions, not only in arrests, incarcerations, but 911 calls, hospital and health care expense," Jahn said. "That's really why we want to pursue this; we want to try what's worked elsewhere and see if we can achieve cost savings for the community and at the same time improve human outcomes and make these lives better."
Hammond has been working with BlueCross BlueShield and CHI Memorial to create a program he hopes will stop the use of the jail as a warehouse for people with mental illness, addictions and homelessness. Some 30 U.S. cities now have such programs, which provide supportive housing and wraparound services. Charlotte, N.C., saved $2.4 million in the first two years of its program, Hammond told county commissioners Wednesday.
Housing the mentally ill in jail cells rather than treatment beds is a national problem. The online magazine Stateline reported in August 2016 that states cut $4.35 billion in public mental health spending between 2009 and 2012, though some states have added money back since 2012.
Stateline cited a study from the Pew Charitable Trusts documenting the national shortage of psychiatric treatment beds. According to the Pew study, mental health advocates say there should be at least 40 psychiatric beds for every 100,000 population. Tennessee has only 8.5 beds per 100,000 people, the report states.
The Tennessean newspaper reported Tuesday that Nashville's Metro Public Health Department is opening a "psychiatric emergency room" next year to help people in crisis and lessen burdens on police. The Tennessean said police spend at least 5,000 hours a year — that's between two and three full-time police officers — responding to someone in crisis.
Funding for the $3.5 million, 20-bed facility comes from the Tennessee Department of Mental Health and Substance Abuse Services, the city and the Mental Health Cooperative, The Tennessean reported.
At Wednesday's meeting, Commissioner Warren Mackey noted the funding cuts have closed some state facilities and pushed the burden of care to the local level.
"Those people are still being taken care of, but in the wrong place. They're not where they need to be. They don't need to be in jail," Mackey said.
Hammond and his team said they've looked at several successful programs, including some in Charlotte.
One example is Moore Place, an 85-bed apartment building that has around-the-clock staff, including nurses and psychiatric support, Jahn said.
It opened in 2012 with a resident group who on average had been homeless for seven years. After two years, 81 percent of the residents were still housed. Their average incomes rose 76 percent, mostly from Supplemental Security Income, and 72 percent were on Medicaid. Though 98 percent had health problems and nearly half had three or more medical conditions, their number of ambulance trips, ER visits and hospitalizations was down and their overall health was better.
They also had 83 percent fewer arrests and 89 percent fewer nights in jail, according to the evaluation.
Jahn said the seed money from Memorial, BlueCross BlueShield and the county — if commissioners vote Wednesday week to kick in for the project — will pay for technical help to write the request for proposals from mental health providers to operate the program.
Commissioners seemed supportive of the concept, but they wanted assurances this proposal won't result in an expensive new program funded by county taxpayers.
It won't be, Hammond and his team members said. Local health care and social service agencies are on board and money will come from multiple sources, including the Department of Mental Health or housing programs. People in the program also likely will qualify for a variety of benefits such as TennCare, VA benefits or Social Security, they said.
Jahn said there are many steps to take before a program could be up and running.
"Before we do anything, before we even generate a list of eligible participants, we're going to make sure we can actually serve them," she said.
"It could take a while, but we're in it for the long haul."
Contact staff writer Judy Walton at firstname.lastname@example.org or 423-757-6416.