Ky. program targets jail's revolving-door offenders

LOUISVILLE, Ky. -- On a recent December morning, 33-year-old Michael Stults shuffled from jail in handcuffs into a courtroom to face charges of public intoxication — a trek he has made dozens of times in the past two years.

"Michael, are they giving you your medication in jail?" Judge Donald Armstrong asked Stults, who later was released with a warning to stay out of trouble. "I don't want to see you for at least a week or so, OK?"

But a few hours later, Stults had panhandled enough for two 22-ounce cans of fortified beer that he drank in a park. Within a week, he'd be arrested twice more.

A diagnosed schizophrenic who is chronically broke and homeless, Stults is among the Louisville Metro Corrections jail's most frequent patrons.

Michael Stults leaves jail in Louisville, Ky. on Dec. 5, 2012.(Photo: Aaron Borton/The (Louisville, Ky.) Courier-Journal)

He has been jailed on criminal charges 160 times since 2001, including more than 48 times since 2011 — mostly for trespassing, shoplifting and public intoxication, court records show. He's spent 2,657 days in the jail in 11 years, more than anyone else in that time.

While behind bars, he detoxifies and receives psychiatric medication, but he admits that as soon as he is back on the streets he drinks, skips his medications and misses most of his social-service appointments. He panhandles, sleeps in park bathrooms and is a regular at University Hospital's ER for seizures and psychiatric treatment, he says.

Stults is now the poster child for an intense new treatment program planned by Metro Corrections and Seven County Services that will target the jail's 50 top revolving-door offenders, whose chronic struggles with mental illness, substance abuse, homelessness and criminal recidivism rack up millions of dollars in taxpayer costs at jails, courts, police, hospitals and treatment centers.

Louisville would be the largest of as many as 14 such voluntary "assertive treatment" programs across Kentucky that state officials plan to begin this spring, pending federal approval to use Medicaid funds to pay for it. The state would pay $1.8 million toward a $6 million effort over the first two years.

Under the program, a team of as many as eight people, including a nurse, psychiatrist, social worker and case manager, will place inmates most at risk of re-arrest in a publicly funded apartment and provide 24-hour support as long as needed.

Team members will visit several times a day, if needed, ensuring their clients make medical, mental health and social-service appointments, qualify for Medicaid and food stamps, take psychiatric medicine, follow substance-recovery plans and shop for food so they can remain healthy.

They may also provide medical injections, counseling, connections with churches, library cards, help with completing a GED and, if possible, a job. They would accompany them to court, ensuring they aren't continuously facing bench warrants for failing to show up.

It's an expensive approach; state officials say it will cost $16,000-$20,000 a year per person in addition to federal housing subsidies and other aid.

Cheap at the price

But officials say that is far cheaper than the present piecemeal approach that not only isn't working but can cost $200 a day at jails, $1,300 a day for psychiatric hospitals and $1,000 per ER visit — not to mention the untold hours that prosecutors, police, judges, medical crews and counselors spend dealing repeatedly with the same offenders.

"This is a fairly expensive service," acknowledged Louis Kurtz, acting director of the Kentucky Division of Behavioral Health. "But it's designed for a severely ill population who put a disproportionate burden on the system. They have a criminal history. They go to the emergency room for psychiatric care. They clog the court system. Their behaviors get them arrested. They get evicted from apartments. They can be very difficult to deal with."

A study by the University of Louisville's Kent School of Social Work conducted in 2004 and 2005 found that the total public cost for such people living in emergency shelters was $107,912 a year, about twice as much as for those in permanent supportive housing.

Most important, said Kurtz, a raft of studies has shown it's more effective in improving lives than the present patchwork of public services.

And it would address a critical need in Kentucky, which ranks near the bottom among states for mental-health funding, Kurtz said.

"More than half the states have something like this; we're laggards in a way," he said.

Metro Corrections director Mark Bolton, who is working with Seven Counties Services CEO Tony Zipple to create the program, argues it will not only cut costs but can help break the cycle of homelessness, incarceration and substance abuse common among his jail's "frequent fliers."

Bolton said there are about 50 "revolving door" inmates who have been in jail as many as 140 times — staying an average 18 days before they are released and then eventually reincarcerated.

Zipple, whose counselors and social workers often deal with people in such cycles, said a strong, sustained effort is required for some to help "give people their lives back."

Stults says he would welcome the help, acknowledging that has a hard time making it to appointments, and his lack of housing makes it tough to establish stability. He said he rarely has money to continue medication once his 10-day jail supply runs out.

He said his arrests are "mainly trespassing, shoplifting, A.I., (alcohol intoxication), a whole bunch of silly stuff," he said, including a recent charge of trying to "steal beer from Kroger."

Begun in the 1970s

Assertive Community Treatment programs were first tried in the 1970s in the heyday of mental health deinstitutionalization.

Since then, various versions have spread to states such as New York and Michigan, said John Fallon, a program manager for the Chicago-based Corporation for Supportive Housing, a nonprofit that helps set up such programs.

Chicago, for example, identified its revolving-door offenders at the Cook County Jail in the 1990s. Many were costing the city a fortune — one person over the course of two decades cost more than $1.6 million in jail and hospital time alone, Fallon said.

But after the program was put in place, jail, hospital and arrest rates were reduced by 80 percent, he said. Some participants left the program after learning to become more independent. Others remained in subsidized housing and were able to move to less intense supervision. Some dropped out.

Fallon said many are initially skeptical of a program that offers such costly support to people who — on the surface — don't seem to be trying very hard to turn their lives around.

"You get a visceral reaction. ... 'Why should we spend money on people in jail when there are so many people who need affordable housing?'" said Fallon, who says he tells them, "You don't understand — you're already spending money on these people anyway."

http://www.usatoday.com/story/news/2013/01/05/revolving-door-offenders/1566074/