TRAVERSE CITY — A contract that provides mental health services to the Grand Traverse County jail expired at the end of December, leaving inmates without two specialists that have worked there for about two years.

The $163,000 contract is with Northern Lakes Community Mental Health and negotiations have hit a stumbling block, Sheriff Tom Bensley said.

Bensley said CMH wants to continue with its current program that is modeled after one used in Harris County, Texas, and offers therapy and skills development in a group setting. It is completely voluntary and has to be requested by those who want services.

But that program doesn’t reach enough inmates, according to a study done in July by NCCHC Resources. The program is also not ideal for the size and layout of the Grand Traverse jail, which is much smaller than the Harris County jail, Bensley said.

“We’re trying to put a square peg in a round hole with this program,” Bensley said. “That’s unfortunate because I think there’s a need, but we can’t force inmates into this.”

Joanie Blamer, chief population officer for mental health services with CMH, said she is working with Bensley and others to come up with a program that better suits the jail’s needs.

“We are negotiating services to include reaching more inmates,” Blamer said. “We would like to see more people served, so that has been our focus — how do we reach more people?”

As part of the now-expired contract, CMH provided a behavioral health specialist and a peer support specialist for the jail, each of whom worked 40 hours per week. Neither is now working at the jail since the contract expired.

A meeting is scheduled for next week to continue negotiations.

The county also is working with the Michigan-based Kona Medical Consulting to find alternatives to the way services are now offered. Whether the county goes in another direction for mental health services is a decision that will ultimately made by Bensley, county Administrator Nate Alger said.

“What the consultant had to offer in terms of replacement for that contract was encouraging,” Alger said, though no steps have been taken.

Blamer said she was not aware the county had hired a consultant.

The study by NCHHC Resources, which provides consulting services for correctional health care systems, was commissioned by the jail about a year. The county paid $24,600 for the study, which was prompted by complaints from some former inmates and their families.

The company visited the jail in July and, among other problems, found mental health services were too narrowly focused and were fragmented, with a disconnect between CMH professionals and a psychiatrist provided under the Wellpath medical program at the jail. The study also found a lack of documentation, with disorganized and incomplete paper health records and evidence that mental health services are not being provided.

In addition, mental health assessments that are supposed to be done on all inmates admitted to the jail are not being done, treatment planning is lacking, and about half of inmates assigned to the mental health caseload have had no contact with the CMH specialists, the study found.

A discharge planning program is robust, the study found, but is based on self-referrals, with many inmates not receiving the important service.

Blamer said she doesn’t agree with many of the study’s results.

“The report is not accurate in many ways,” Blamer said. “The reality is they spent less than 10 minutes with our staff and came away with these conclusions.”

Blamer agrees that more people could be reached in the jail and CMH is now offering services that would assess more inmates and develop plans that provide a continuum of care.

“We’re here to advocate for what the best thing for the inmate is,” Blamer said.

Bensley said part of the problem in not reaching enough inmates is the layout of the jail, as those in the program have to be segregated. Another problem is the jail is not able to mix inmates with different security classifications, he said.

The jail has 168 beds, though that number is often reduced by classifications and now by COVID-19, which requires some inmates to be isolated.

Blamer said that when the program was first introduced there were two cellblocks being used — one that could house 12 men and another for women. That later changed to just one cell that can house up to six male inmates.

“We didn’t have the interest from the female population,” Blamer said.

An inmate at the jail must request mental health services, she said. When the program was put into place it was supposed to include a mental health survey that is given to every inmate; Blamer said the survey never came to fruition.

Bensley said he does not know why it was never put into place.

Some recommendations from the NCCHC Resources study are that all mental health services should be provided under one authority and should follow NCCHC standards for things such as assigning responsibilities, completing assessments, discharge planning and more.

The requirement that all inmates in a group program be housed in one cell should be eliminated, the study said, and the county should adopt an electronic health record system to store and keep records organized and accessible to all who provide care.

The jail should also do a psychological autopsy on all suicides, something that is an industry standard but was not done on two suicides the study looked at.

Since the contract expired, CMH is providing services for inmates who are in mental health crisis under an enabling agreement that has been in place between CMH and the six counties it serves since 2003. The agreement allows CMH to draw down Medicaid to provide behavioral health services, with county funds used to pay the required match dollars to Medicaid and the State of Michigan.

Grand Traverse County pays CMH $682,000 per year under that agreement.

“We believe that payment entitles us to some of this care in our jails,” Alger said.

He said the consultant has reviewed the $163,000 contract and said it could do better. Options include providing a level of care from incarceration to post-incarceration by having multiple contracts with several local providers.

“We just need to know what direction the sheriff wants to go and we can go from there,” Alger said. “The sheriff wants to get it right and he’s trying to work with CMH to do that.”

Bensley said the jail could decide to go with the consultant’s recommendations, it could have Wellpath provide mental health services, or it could stay with CMH.

“It would be nice to continue working with CMH,” Bensley said. “They know us and we know them. There’s a lot to be explored. Unfortunately it’s taking time.”

Blamer said she is very supportive of the jail and the work they are doing to try and improve services.

“Despite the challenges, we are still working together to identify what the mental health needs are and how they are best met,” she said.

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