Editor's note: This is the second in a two-part series about the mentally ill in the Douglas County Jail.
Douglas County Jail isn't just a jail.
"We've become the mental health unit of Douglas County," said Undersheriff Kenny Massey. "We deal with a lot of people here who really ought to be dealt with somewhere else. We're not set up for this."
Last year, Massey said, the jail logged 40 suicide watches at Level 3, which is considered "very serious."
"It means they're in a special cell," he said. "It means you have to check on them every few minutes.
"That's not easy when you've got a lot going on, like last weekend. We booked 61 people into jail," said Massey, who oversees the jail. "That's a lot."
Massey and his boss, Douglas County Sheriff Ken McGovern, said using the jail to house mentally ill offenders was shortsighted and ineffective. But at any given time, they said, about 15 percent of the jail's 192 beds are filled by people who are mentally ill. The national average is close to 30 percent, but the local numbers are still a lot to handle.
"There needs to be a better way to help the mentally ill than jail," McGovern said. "There needs to be something that's long-term."
It's expensive: 40 percent of a recent $18,000 pharmaceutical bill at the jail was for psychotropic drugs.
It can be violent, and it can be messy. Some mentally ill inmates trash their cells, smear feces or throw food.
"Bathing is a huge issue," Massey said. "If they refuse to bathe, the staff assists them. It's a health issue."
Massey and McGovern said it was especially frustrating that many of the mentally ill inmates - they don't have an exact count - don't fare well in the community and end up back in jail.
"We don't have any programs that help them long-term because they're not here long enough," McGovern said, noting the average stay is about nine days.
It's not unusual, he said, for mentally ill inmates to leave the jail - they're driven into town and dropped off at 11th and Massachusetts streets - without medications, a job or a place to live.
They are, however, strongly encouraged to call or visit Bert Nash Community Mental Health Center. Some do, but many don't.
"The biggest gap in the system is what happens after they leave the front door of the jail," said Christy Blanchard, coordinator of forensic services at Bert Nash.
Blanchard is on a newly formed committee that hopes to hasten inmates' access to Bert Nash and to housing and employment opportunities. The committee next meets April 17.
"The connection (with Bert Nash) needs to be made, and the resources for housing, employment and supervision need to be there," Blanchard said.
But Bert Nash employees can't do much more than plug former inmates into existing services, most of which already are stretched thin.
"We don't have the money" for new programs, said Bert Nash executive Dave Johnson.
"So much of what we're talking about is tied to Medicaid - it's what we've built our health care system on," he said, referring to the federal- and state-funded program that underwrites health care for the poor. "But Congress is doing everything it can to reduce Medicaid spending, to rein in the budget."
The jail's troubles come nine years after lawmakers voted to close Topeka State Hospital, which offered care and treatment for mentally ill patients.
"A lot of people we're seeing now would have been sent to Topeka State Hospital back when it was still open," McGovern said.
The state hospital in Osawatomie continues to treat Douglas County residents whose illness is so severe they cannot safely remain in the community.
But their stays are short-term, usually two or three weeks. After their conditions stabilize, they are returned to Douglas County where they may or may not take advantage of the services at Bert Nash.
Some end up at the Salvation Army shelter for the homeless, 946 N.H.
"It's not a good thing," said Mathew Faulk, a Salvation Army case manager. "It's a situation that's exacerbated by the fact that we live in a society that thinks nothing about paying ballplayers millions of dollars a year but gets up in arms over spending a few thousand dollars helping people in their own community."
Faulk opposes adding beds to - or lengthening stays in - the state hospital system.
"We need something in between the big hospitals that are run like prisons and a society that's dog-eat-dog," he said.
Several attempts at interviews with mentally ill adults who had spent time in the Douglas County Jail were unsuccessful.
Robert Shipp's son, Ed, has been in and out of jail several times.
"It's a sad, sad situation," said Robert Shipp, of Lawrence. "It's like a revolving door - they go in, they come out, they go back in."
Shipp said his son, who's paranoid schizophrenic, was in Osawatomie State Hospital last fall.
"They did a good job with him," he said. "But when he got out, the first thing he did was go off his meds. He's back in Lawrence now. He's living in our basement, but there's no communication. He doesn't talk to us.
"We don't want him there; we don't think it's good for him," Shipp said. "But there's no place else for him to go. We're afraid that if he was out on his own, he'd end up back in jail, and we don't want that either."
In Lawrence, the jail situation isn't expected to show much improvement anytime soon.
"Over the years, there have been so many cuts in funding and resources at both the local and state hospital level that, in a lot of circumstances, jail is just about the only place left to go," said Douglas County Dist. Atty. Charles Branson. "The alternatives just aren't there."
But Gary Daniels, secretary at the Kansas Department of Social and Rehabilitation Services, said change was on the horizon.
"This isn't just an issue in Douglas County or in Kansas; it's nationwide," Daniels said, noting Gov. Kathleen Sebelius has convened a planning council on mental health policy, and a legislative committee is reviewing possible changes in state laws affecting the mentally ill in jail.
"Just about everybody agrees the burden doesn't belong on the jails," he said.