Giving vulnerable residents help before mental health issues land them in jail

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• William Brangham:

  But first, each year, an estimated two million people suffering from mental illness are booked into county jails.

  Police, emergency responders and courts are all looking for better ways to handle these individuals, in some cases by diverting them from the criminal justice system in the first place.

  John Yang visited one such effort in Kansas City, Missouri, part of our ongoing series on broken justice.

  This story was done in partnership with the Pulitzer Center on Crisis Reporting.

• John Yang:

  Wednesday morning in a Kansas City courtroom.

• Joseph Locascio:

  You're entering a plea of guilty to a shoplifting matter.

• John Yang:

  Inmates appear before a county jail appear before a judge. One man seems agitated, refuses to cooperate. Then, as another inmate's sentence is handed down,

• Joseph Locascio:

  I will impose a sentence of 90 days in city jail.

  Typically, the people that we see on the custody docket, they have just a complex array of problems. It's not just behavioral health, not just mental health and substance abuse issues, but also homelessness, a history of trauma, no family or social supports whatsoever, no job skills, no social skills. They will cuss at me in court.

• John Yang:

  Joseph Locascio is the senior judge on the municipal court bench.

• Joseph Locascio:

  If the conditions of probation are followed, Mr. Stokes, and at the end of the year the case is closed, off your record.

• John Yang:

  He estimates that as many as a third of the defendants in custody who come before him have some sort of mental health issue.

• Joseph Locascio:

  It's pretty much obvious to everyone in court. These are not people that it's hard to determine what's wrong, because they are just — they're saying nonsensical things. And their lawyer like going, I don't know what to do here.

  And that's sort of symbolic of the entire community. We don't know what to do here.

• John Yang:

  This is where many offenders with drug abuse problems or mental health issues end up, the county jail. But here in Kansas City, like in other places around the country, they're looking for a better way to get those people the help they need and back on their feet.

• Aric Anderson:

  He was staying in an abandoned house.

• John Yang:

  The next morning, community health workers Cheryl Reed (ph) and Kansas City Police Officer Aric Anderson search for a man well-known to police.

• Aric Anderson:

  The number of police contacts triggered us to go out and see him, because there's enough reports made on him detailing that he was mentally ill, that we had a basis to talk to him.

• John Yang:

  Their first stop, an abandoned house where he often stays.

• Aric Anderson:

  He told us, when we had contact with him on Tuesday, he said that he would like us to take him to one of the community mental health centers.

• John Yang:

  Anderson is part of the Police Crisis Intervention Team, trained to teal with those suffering from meant illness and substance abuse does orders. The goal is to intervene before minor violations, like disturbing the peace, trespassing or public drunkenness, land them in jail.

  So, this is crime prevention.

• Aric Anderson:

  It is. It is. But it's a nontraditional crime prevention.

• John Yang:

  They come up empty and move on to another case, a young man Anderson spoke with a few weeks earlier.

• Aric Anderson:

  He is probably starting to have delusions, probably his first psychotic break, that his mom is putting cameras up in his house to look at, watch him.

• John Yang:

  They meet him at a convenience store near a community health center. He tried to get an appointment there, but was told he would have to wait until June.

• Aric Anderson:

  I will drive you. The crisis center is right here on Prospect.

• John Yang:

  So he agrees to come here, the Kansas City Assessment and Triage Center.

• Aric Anderson:

  OK. So we will stop right here again.

• John Yang:

  This crisis center opened in late 2016, funded by the sale of two nonprofit hospitals, along with money from the city, local hospitals, the Missouri Department of Mental Health, and the state legislature.

  Before, police and other first-responders essentially had two options when dealing with someone suffering from mental illness or drug abuse, the jail or emergency room. Stephanie Boyer is the program manager.

• Stephanie Boyer:

  The idea was to create sort of a no wrong door, particularly for police officers, you know, where, when they're not sure really what's going on, they had a place that they could bring people and they could be evaluated.

  And we could kind of see what is going on and see how we could help them, what kind of services they might need to get into, you know, if they need medications, things like that.

• John Yang:

  Three-quarters of the patients are homeless men. Most have both mental health and substance abuse disorders and no insurance.

  Here, they sober up, have a meal, sleep. Nurses and counselors fill in gaps in their mental health care, directing them to the help they need. It's all voluntary. They can leave any time they want. They have to leave after 23 hours, a limit that allows the center to operate as an outpatient center and help as many people as possible.

• Stephanie Boyer:

  Everything we do here is to really bridge them into whatever that long-term need is. And so we will continue to provide whatever it is that they need during that time, whether it's medications, case management, housing, whatever it might be, working with an employment agency, if their goal is to get a job, whatever it might be for that person.

• John Yang:

  After leaving, case workers follow up on those needs, in many instances helping place them in transitional housing, a critical need.

• James Butler:

  I was worthless on them streets. I mean, worth — I don't know the words. One officer called me a bottom-feeder. That hurt.

• John Yang:

  Sixty-one-year-old James Butler says he spent nearly 35 years on the streets, drinking and using cocaine, suffering from undiagnosed schizophrenia. About 10 months ago, a police officer picked him up. Butler assumed he was headed to jail again.

• James Butler:

  The next thing I know, I'm pulling up at 12th and Prospect to the crisis center, which I didn't even know that's what it was.

• John Yang:

  After being evaluated, a case worker directed to a bed at Benilde Hall, a sober home for men.

• James Butler:

  I drug myself in that gutter, what I call a rut. Well, now I quit digging that rut. I'm kind of slowly filling it back in. And it feels good to have people smile at you, instead of step out of the way.

  It really feels good. And I couldn't have done it, I'm not going to kid you, without this place, without help.

• John Yang:

  Not far away, Cassie Leeper has a house, job, her three boys and a puppy. A year ago, things were very different.

• Cassie Leeper:

  I had a big mess. My kids were taken by DFS and in foster care. I was facing prison and court cases in different counties and all of that stuff.

• John Yang:

  Addicted to methamphetamines and suffering from depression, she went to the only place she knew.

• Cassie Leeper:

  I went to the emergency room at Truman Medical Center and told them what was going on and everything. And I had actually been to an emergency room prior to that. And they couldn't do anything.

  And they actually paid for me a cab and sent me to the crisis center.

• John Yang:

  Is this the right place for those people?

• Dr. Kevin O’Rourke:

  If they're having an acute emergency, an acute mental health break, then, yes, we're equipped to deal with that and equipped to take care of them.

• John Yang:

  Emergency room physician Kevin O'Rourke works the overnight shift at Truman.

• Dr. Kevin O’Rourke:

  For most of the patients, these are chronic problems that need intensive resources, need case management, need housing, need help with their medications. And the emergency department, we are ill-equipped to kind of help those chronic problems.

• John Yang:

  O'Rourke also points out that E.R. visits are very expensive. Sending people to the crisis center instead could reduce costs by 50 percent to 75 percent.

  It's too soon to know whether Kansas City's crisis center is actually saving money or reducing the number of people receiving care in the county jail or emergency rooms. In some ways, it is highlighting the extent of the need, the big cracks in the long-term mental health care system.

  Already, critical funds that allow case workers to place people in transitional housing, get medications and follow-up care have been cut in half by Republican Governor Eric Greitens.

• Joseph Locascio:

  All those funding streams are in jeopardy. So it comes down to a matter of showing statistically that we're helping this population, keeping these people in treatment and out of the judicial system and out of the hospitals, in order for those funding sources to continue.

• John Yang:

  Everyone we talked to, the judge, the doctor, the police, the head of the crisis center, the patients, say treating people with respect is key to changing behaviors.

• James Butler:

  That's what turns people around, like me, is finally seeing that people out there do have a heart. And I have found out I'm still searching for who I am, because I have never known me. I have never been clean and sober, or wanted to be.

  It's amazing. It puts a smile on my face every day, and I have got a future coming.

• John Yang:

  One that he and those helping him hope is far different from his past.

  For the "PBS NewsHour," I'm John Yang in Kansas City.