Incarceration cycles persist as North Dakota prisons lack resources for mentally disordered inmates, officials say


FARGO – The lack of capacity to deal with mentally disordered accused is one of the many challenges facing the criminal justice system. The repeated journeys of a 32-year-old man between Cass County Jail and North Dakota State Hospital illustrate the growing problem.

In prison, the man sometimes ate or stored his own excrement. He could not maintain his personal hygiene or be kept safe with other inmates. He was showing signs of acute mental illness.

Cass County Jail Administrator Captain Andrew Frobig described the story of the unidentified man to an interim legislative committee while advocating for more resources to adequately treat the mentally ill to avoid recurring cycles incarceration for lack of treatment.

Since 2014, the man had been arrested 21 times and had spent 1,025 days in prison as of September 28, when Frobig testified before the Legislative Assembly’s Acute Psychiatric Treatment Committee.

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After the man was arrested in early December 2020 for burglary, a judge ordered him to undergo a psychiatric assessment to see if he was mentally fit to appear in court.

In mid-January 2021, the judge ordered the man to be assessed to determine whether he was criminally responsible.

The detainee was transferred to the state hospital in early February after an emergency placement for acute psychiatric needs.

Three days later, he was returned to prison. The hospital report: “Lack of cooperation. Unable to give an opinion.

An attempted telemedicine session in mid-April for court-ordered assessments was dropped because the man refused to cooperate.

In early June, he was returned to the state hospital to attempt to complete the assessments. He repeatedly refused to cooperate and by mid-July he was back in prison. In mid-August, the judge dismissed the burglary and trespassing charges against the man for lack of jurisdiction.

The man got out of prison. Once on the street, he became homeless.

Three days after his release, the 32-year-old was arrested for burglary and possession of methamphetamine, Frobig said. He fears the cycle will start again.

Cass County Jail has more resources than any other prison in North Dakota, including services for inmates with mental illness. Even so, the prison is overwhelmed with inmates with special needs.

And the problem keeps getting worse, according to Frobig.

The prison recently lost access to a nurse practitioner with some experience in treating low-intensity psychiatric illnesses, he told the Forum.

The South East Social Service Center, located a few blocks away, may meet some inmates in need of mental health services, either in person or through telehealth visits. But, said Frobig, “We have more patients than they have time to meet.”


Cass County Jail uses iPads to allow inmates to meet mental health service providers via video.  Michael Vosburg / Forum Photo Editor

Cass County Jail uses iPads to allow inmates to meet mental health service providers via video. Michael Vosburg / Forum Photo Editor

The prison contracts with an independent psychiatrist for additional care. “This resource is limited, however, and we are constantly sorting new patients based on severity,” Frobig said. “It is not uncommon for a newcomer who needs services but is unaware of their psychiatric care or medication to wait six or eight weeks before they can be seen. “

The lack of mental health services in North Dakota has long been a recognized crisis, and even urban centers like Cass County are struggling with an overwhelming demand for services.

“The problem is a problem that gets worse every year,” Frobig told lawmakers.

The Cass County Jail is grappling with significant delays in hospital beds for acute cases, including a lack of capacity at the North Dakota State Hospital in Jamestown.

Due to the shortage of beds at the State Hospital, Frobig sometimes withholds documents requesting admission of a patient until a bed is opened.

This year, for the first time, mental health referrals exceeded the number of inmates enrolled at Cass County Jail – the result of multiple referrals for inmates because they had previously been denied admission to state hospital.

The prison is hampered by a critical lack of space for inmate stabilization care, Frobig said. Emergency rooms release patients in prison as soon as possible, turning prisons into de facto psychiatric emergency rooms, he told the Forum.

Even when a South East Social Service Center screening officer and psychiatrist agree that an inmate needs hospitalization, a bed is not always available, Frobig said.

“It’s a capacity issue,” he said. “What we are seeing is the result. The legislature is the one that can solve this problem.

Due to the shortage of hospital beds, Cass County Jail is becoming the keeper of people the mental health system cannot handle.

Once released from prison, there is often no service for inmates with mental illness or addiction, Frobig said. “They just go back to the streets”, unlike people with intellectual disabilities, who can get help in group homes.

Leaders from Cass County Jail meet weekly to discuss the special needs of inmates, three of whom were recently under suicide watch.


Cass County Jail staff meet on October 15, 2021 to discuss inmates with special needs with Lt.Chad Violet, right, in Fargo.  Michael Vosburg / Forum Photo Editor

Cass County Jail staff meet on October 15, 2021 to discuss inmates with special needs with Lt.Chad Violet, right, in Fargo. Michael Vosburg / Forum Photo Editor

The weekly meetings help coordinate the medical needs, including mental health needs, of the prison population, about 40% of whom are taking psychiatric drugs – a percentage that does not include those who refuse the drugs, Frobig said.

“It’s just a way for all of us to stay on the same page,” he said.

The coronavirus pandemic has exacerbated the problems, adding to the strain on people’s mental health. Telemedicine, while useful, doesn’t work for everyone, Frobig said.

A viable system would provide “high intensity street assistance,” he said. “A social worker can do that sort of thing,” but a heavy workload probably wouldn’t allow it at current staffing levels.

The ongoing and individualized management of released detainees’ cases would allow a case manager to intervene before a crisis erupts and the person returns to prison, he said.

The ideal solution would be something like the mental health crisis center set up by Hennepin County in the Twin Cities a few years ago, essentially a mental health emergency department, Frobig said.

This type of center, which could serve an area including Fargo, would allow authorities to better deal with people who act dangerously during a mental health crisis, such as someone threatening to jump off a bridge on the freeway, as is the case. is recently produced, he said.

Law enforcement officers could drop off patients for stabilization and treatment for short stays, typically 18 to 24 hours, and then released for follow-up by community services, Frobig said.

“It could be a stopgap,” he said. Based on what is currently available, “everyone in the system is doing what they can. “

Chad Peterson, chairman of the Cass County Commission, believes a regional approach is needed to address this complex and multifaceted problem.

The Moorhead Juvenile Detention Center is a good model of co-operation between counties. Clay and Cass counties are among 13 counties that have joined together not only to house struggling miners, but also to provide education and counseling.

“This is what I want to replicate,” Peterson said.

He believes that if policymakers and the public knew the full cost of untreated mental illness – in human and financial terms – they would support significant investments that would provide cost-effective solutions.

“They need a bed, a boyfriend and a job,” he said. “We end up putting them in jail and freeing them, hoping they get better.”

Society pays the cost in a way that is not obvious and is often invisible but meaningful. It costs about $ 45,000 to house an inmate in jail for a year, Peterson said. Other costs add up, including hospital emergency room visits and untold harm to people with mental illness and addiction.

“Investing in mental health is doing the right thing for less money,” he said. He would like to see regional treatment centers, with state financial support, for each quadrant in North Dakota.

The state, with its oil wealth and robust economy, can afford it, Peterson said. “We have the resources. “


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