Roughly three in five inmates at the Arapahoe County Jail have a mental health condition, according to recent data — and that number may be even higher when taking into account substance use problems, according to Arapahoe County Sheriff Tyler Brown.

It’s an issue that Carl Anderson, a registered nurse who oversees medical and mental health at the Arapahoe County jail, knows well.

During one week alone in April, staff used medicine to reverse two overdoses at the jail, Anderson said.

In March, 59% of the jail population was treated with some kind of psychotropic medication, according to Anderson. That can include anti-anxiety, anti-depressive or anti-psychotic medications, or mood stabilizers.

The jail also sees large numbers of people struggling with drug use. In March, 4% of the jail’s population was on medication-assisted treatment — and 21% were on other substance use disorder protocols, Anderson said. That number includes opioid use disorder and alcohol use disorder, Anderson said, calling it an “all encompassing” statistic.

The inmates who are treated with mental health medications are not necessarily the same ones who experience substance use disorders. But there is some overlap: Some inmates have co-occurring diagnoses, meaning a person has a substance use disorder along with another mental health disorder, Anderson said.

When inmates are placed, or “booked,” into the jail, they take a medical history questionnaire. The booking nurse can access what’s called the Colorado Regional Health Information Organization, or CORHIO, and verify what the inmate says on the questionnaire, Anderson said.

In terms of mental health crises, a person can self-report anything ranging from generalized anxiety disorder or major depressive disorder to schizophrenia, Anderson said.

And if the jail’s health staff cannot verify a condition through the CORHIO database or other means, “then we lean on that subjective and objective data, and how does the patient present?” Anderson said, using a term for how inmates may appear to have certain conditions.

During an April question-and-answer session on Facebook Live, Sheriff Brown said: “Self-reported (in the jail), we’re looking at approximately 50% to 60% are dealing with some sort of mental health crisis. If you add in substance use and unreported disorders, we’re probably (in the) 80% to 90% of people who are dealing with mental health (issues).”

Because not all self-reported mental health crises at the jail may meet the criteria for a diagnosis, that higher percentage of jail inmates who are dealing with mental health problems includes people who are experiencing issues such as an isolated episode of depression without major depressive disorder, for example, or a panic attack without having panic disorder, according to Anderson.

But that doesn’t mean those cases aren’t important, Anderson said.

“Not each of those mental health crises requires an intervention with medicine or a diagnosis,” Anderson said. “Sometimes it just means we need to get our mental health team or our medical team to help them get through that crisis. I don’t want to downplay (those cases).”

In some cases, mental health crises could be situational. For instance, an inmate may experience a mental health crisis due to being incarcerated, receiving a troublesome telephone call or having a negative experience at a court hearing, the sheriff’s office said in a statement.

Improving care

Before a few years ago, when a person would enter the jail, they would take a questionnaire and say whether they have a certain condition. Historically, sheriff’s office personnel would then review and send a fax of that information to the relevant medical entity, such as Kaiser Permanente or another medical system, Anderson said.

Providing care to inmates became more efficient after the sheriff’s office entered into an agreement in 2019 with the State of Colorado and the Colorado Regional Health Information Organization. That database allows the sheriff’s office to verify current medications, current diagnoses, and past medical or mental health interventions more efficiently than with the old process.

Amid concerns about addiction in the public discourse in recent years, the Arapahoe County jail began offering what it calls a full-service medication-assisted treatment program — which means medication and the counseling that goes along with it — for substance use disorders. The jail started to offer that full-service program in June 2018, Anderson said.

Before 2018, “ethically, I would have a problem as an RN,” Anderson said.

Someone might explain that they were at one point addicted to heroin but for the last five years they’ve been taking methadone, for example, Anderson said.

Prior to the June 2018 change in policy, “unfortunately, I would be unable to continue their medication,” said Anderson, who has been a registered nurse for over 20 years.

The full-service program allows the use of the three Food and Drug Administration-approved MAT medications: methadone, buprenorphine and naltrexone, or Vivitrol, according to Anderson.

The program at the sheriff’s office is a partnership with three community-based opioid treatment programs: Behavioral Health Group, Addiction Research and Treatment Services (ARTS) and the Denver Recovery Group, the sheriff’s office said in a statement.

Jail amid the opioid crisis

Managing substance use disorders among inmates continues to be an issue, Anderson said.

“Last week, we had inside of our detention facility — last week alone — we had two Narcan saves,” Anderson said in late April, referring to overdose reversals.

For the sheriff’s office, carrying Narcan — a medicine that can treat a narcotic overdose in an emergency situation — started among detentions, or jail, personnel in 2015, according to Anderson, who serves as an administrative manager of the sheriff’s office and is assigned to the jail.

“And then, ultimately, our vision was to make sure (the sheriff’s office) Patrol Division had access to it,” Anderson said. He added: “Beginning of 2016, our patrol team started carrying Narcan and still do to this day.”