Most inmates have mental illness

A high rate of mental illness among Wadena County jail inmates is one of the health care concerns prompting county officials to recommend South Country Health Alliance develop a pilot benefit program.

A high rate of mental illness among Wadena County jail inmates is one of the health care concerns prompting county officials to recommend South Country Health Alliance develop a pilot benefit program.

The county spent $43,264.76 to cover inmate medical expenses during 2006, according to Jean Birch, administrative assistant. Most of the money went toward medication, emergency room visits and dental care.

The county is obligated to cover certain immediate medical expenses for uninsured inmates, said Wadena Social Services Director Paul Sailer. Many inmates were covered by medical assistance prior to being incarcerated, but federal law requires that inmates lose MA when they are in jail.

"We're aware that this problem exists and is costly to the county," he said.

A 52 percent rate of inmates with mental illness diagnosis and medication is of particular concern to the county, according to Wadena County Public Health Director Karen Nelson.


"Since the closing of the regional treatment facilities, we do see more people in the county jail because of their mental health issues," she said. "They get into trouble and they wind up here."

Nelson said this problem affects not only Wadena County but the entire state of Minnesota.

In a 2006 report by the State Community Health Services Advisory Committee and Correctional Health and Local Public Health Work Group, local health departments ranked mental health issues as the most important correctional health concern ahead of all other issues including meth use, chronic disease and staffing.

"If you have a psychiatric condition it's a chronic condition that doesn't go away," Nelson said.

Because of the impact of mental illness, the county really wants to address that target population, she said.

"It's both an issue of cost ... as well as a human issue," Nelson said.

If special populations such as inmates, pregnant teenagers and the elderly are in poor health, it affects the whole community, she said.

"If they have bad health it affects their whole family," Nelson said. "If they've been abusing alcohol and they're pregnant, if they've been abusing alcohol and abusing their family. It's all a factor."


Nelson and Sailer have recommended that during 2007, SCHA study whether it could create a very basic benefit set that would cover certain health needs of people in jail, he said. Depending on the findings, this study could lead to the development of a pilot program in 2008.

"[We're] not sure how high on their radar screen this thing will flash," Sailer said. "It's not going to happen until the joint powers board sees it as one of its priorities this year."

A benefit set could allow the county to negotiate better rates with providers, Sailer said.

Jail Administrator Tom Speed said medical facilities like to receive full price when payment is in cash.

Improving the local health infrastructure and reducing the tax payer's burden are some of the reasons Wadena County joined SCHA last year, Sailer said.

In addition to creating a benefit set, Sailer and Nelson would like SCHA to provide funding for better health prevention for inmates.

Sailer said helping inmates to understand the consequences of health problems such as smoking and alcohol abuse while they are in jail may save SCHA money in the future.

"It isn't just a money thing," he said. "The reality is that they're a captive audience."


People in jail may in the future become the most expensive people the county has to provide with health care, he said.

Nelson would also like to see better discharge planning for inmates, she said. The planning would include evaluating health insurance options and finding out if the inmate has a place to live.

"I think everybody with chronic conditions needs better disease management when they're there in preparation for when they get out," Nelson said. "And follow-up for those that really need follow-up."

Nelson said it's important for all of the stakeholders including the sheriff's department, jail, Public Health and social services to become more interconnected in addressing the health of inmates.

She said the combined efforts of the county and SCHA can make a better life for inmates and save the county money.

"And that's why social services and us are trying to make a path so that we can connect more and serve this population better," Nelson said. "And we think we can do a better job. We'd like to anyway."

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