A disheveled and disoriented woman walks into a Lubbock restaurant and begins serenading the patrons sitting at the tables. Although she is not threatening anyone, many of the customers find her behavior disruptive and a nuisance. The restaurant manager asks the woman to leave the building, but she continues to serenade and harass the customers. Unable to get the woman to leave, the manager calls local law enforcement for assistance.

In many cases, the woman would be taken into custody and booked into the local jail for a minor offense, but instead, Lubbock County Sheriff’s deputies call the local mental health and mental retardation center and a staff member is dispatched to the scene. The mental health professional evaluates the woman and determines that her unusual behavior is a result of a mental condition rather than any criminal intent.

The sheriff’s officers agree with the MHMR representative that the woman would be better served at the mental health facility rather than at the local jail and they do not arrest her.

To many familiar with the historically contentious relationship between law enforcement agencies and mental health providers, this might seem like an unlikely scenario. But, in the past three years, a spirit of teamwork between the Sheriff’s Office, the local MHMR center and the county hospital district in Lubbock has helped agencies provide better continuity of care for the mentally ill.

As a result of the collaboration, Lubbock officials say not only are more mentally ill individuals being diverted from the county jails, but the mentally impaired are now receiving medical services that might not have been available to them in the past.

Mary Gerlach, adult behavioral health director for the Lubbock regional MHMR, acknowledged that in the past her agency and the Sheriff’s office did not have a good working relationship. MHMR staff did not go into the jail and there was little communication between the agencies.

Historically, MHMR and sheriff departments don’t get along because they believe they are using two totally different ways of thinking, Gerlach said. Law enforcement officers are often viewed as hard cases because they want to prosecute offenders, while MHMR staff might be looked upon as too soft because they are more focused on treating inmates rather than locking them up.

Gerlach credits Lubbock County Sheriff David Gutierrez with taking the initiative to finally open the lines of communication between his agency, MHMR and the local hospital.

Gutierrez, who became sheriff in 1998, said he was increasingly concerned about continuity of care for the mentally ill in his jail.

“Most of the time, the sheriff’s department is not aware that someone in their jail is on medication or under someone’s care, so 24 to 48 hours later the individual continues to deteriorate,” he said.

Gutierrez took a step forward and invited MHMR staff to the jail to openly discuss ways the agencies could work together to better serve the mentally ill.

“Basically, we all sat down and tried not to look at turf issues,” Gerlach recalled of the meeting. “We just tried to figure out who was the best equipped to handle different things. We didn’t get any additional funding. So, the agencies had to be willing to dig down and figure out exactly how much we could afford to do and do that little bit extra.”

Now, the two agencies have an understanding that allows MHMR staff to go into the Lubbock County Jail and conduct mental health screenings on all the inmates. The screenings help determine if any of the inmates are current or former clients of any mental health facility and identifies those inmates who need mental health services. For the sheriff’s office, having MHMR staff on site prevents jail staff from having to transport inmates back and forth from treatment centers.

Inmates identified as in need of services are then monitored and MHMR staff keep in contact with them to make sure they are getting the medications and services they need, Gerlach said.“We make sure the jail has the correct medical orders and medication. If they don’t have a medication, we try to assist in purchasing the medication and take it to them so (the inmates) are not switched to another medication that might not be effective,” she said.

Essentially, the MHMR staff take on many of the responsibilities normally left to jail staff who are not as trained in mental health services. The MHMR staff also do a great deal of discharge planning to make sure they keep in contact with the individual when he or she is released.

MHMR staff also assist officers on the scene. If an officer stops someone violating the law and feels the crime might be the result of a mental impairment, the officer contacts a local crisis team that comes to the officer’s location and evaluates the individual. That individual then could be diverted to a hospital or out-patient treatment if the officer is agreeable, bypassing the local county jail.

If an individual has already been arrested and booked into the jail but is in need of mental health services, then the local District Attorney’s office also gets involved.

Gutierrez said, “If it’s a minor offense we work with our local District Attorney and they will release the inmate and pending filing charges if the individual receives treatment at a local mental health facility.”

Gerlach said the local DA has been very supportive about helping the MHMR center and the Sheriff’s office move people out of the jail if they would be better served in a mental health setting.

Both Gerlach and Gutierrez said the collaboration has benefited mentally ill individuals both in and out of the county jail.

“First of all, people are getting mental health services while they are in jail,” Gerlach said. “We’re also helping to identify people who may not even need to be there. It’s a benefit for the jail and a benefit to the people because we’re offering them what they need.”

Beyond that, collaboration between the sheriff’s office, the hospital and the MHMR center has built a valuable relationship between the three entities that allows them to help each other in other areas, she said. MHMR staff will often assist law enforcement officers during a crisis situation involving a person with a mental impairment. Gutierrez also said the system has improved operations at the jail.

“Because of the continuity of care, our assaults in the jail facility have been reduced dramatically between inmates and officers and between inmates,” he said.
But, Gutierrez stressed that cooperation between the different agencies was imperative for success.

“Everyone needs to participate and understand their role. You need to break down those territorial issues and work together toward the end result, which is providing care for these individuals,” he said.

Sheriff departments working together with local MHMR centers is not a new concept. Dee Kifowit, director of the Texas Commission on Offenders with Mental Impairments, said state law currently requires every MHMR center to create a memorandum of understanding (MOU) with local jails in every county. The memorandum should lay out procedures and processes for the jails and MHMR centers to work together to identify inmates with mental illness.

State law requires every county jail to report and screen inmates with mental illnesses or mental retardation. Chances are, the local mental health provider has provided services to an individual with a mental health problem. Therefore, it’s in the jail’s best interest to work closely with the local MHMR to help divert mentally ill inmates from the jails, Kifowit said.

In reality, Lubbock County is one of the few counties that is actually doing it. Although implementing collaboration between the agencies was a relatively simple task in Lubbock, Kifowit said, breaking down the communication barriers has been a major obstacle in fully implementing MOUs statewide.