A new hire for the Denver Sheriff Department hopes to increase the focus on mental health in the Denver jail system, one of Colorado's largest psychiatric providers.
"In order to truly make some changes to the system and focus on the treatment of these individuals, we need to have someone at this level who is able to drive that strategy and change," says Nikki Johnson, a clinical psychologist who started as the department's chief of mental health services in early January.
The position was created by Elias Diggins, a longtime member of the Denver Sheriff Department who was tapped to become sheriff by Mayor Michael Hancock in July 2020.
"I believe that creating an executive-level position to oversee all mental health services is an absolute priority. The idea was born after conversations with the office of the mayor, city council, director of safety, internal DSD staff and community members," says Diggins.
Johnson has spent much of her career working at the nexus of mental health treatment and correctional institutions, most recently as the mental health director at the Jefferson County Detention Facility in Golden. Her new job marks the first time a high-level department position will focus on mental health in Denver jails, which is handled by Denver Health clinicians.
"I think in general it is somewhat of a paradigm shift, but I also think it comes with its challenges for me in my position to really help to get the buy-in from sworn staff to truly make some differences," says Johnson, who notes that the best way to get that buy-in from deputies is to build relationships between civilian staff and deputies. "We all have to appreciate each other and work together for the department and incarcerated individuals, and for all of us to go home safely at night, as well."
Johnson has already identified three main areas of focus: creating a competency restoration program housed within Denver County Jail, establishing a crisis response team, and ensuring that the sheriff's department is abiding by best practices regarding mental health services.
The Denver jail system is the second-largest mental health provider in the state, after the Colorado Department of Corrections. The average population in the system over the last seven days was 1,363, with 1,022 detainees housed in the Downtown Detention Center and the rest at the Denver County Jail. Those figures represent a significant decrease from non-pandemic times.
As of March 31, 61 percent of the system's inmates had a past or current mental health alert, signifying that they had or were currently on some mental health medication, had previously or were currently receiving mental health treatment, or had been hospitalized in the past for a mental health issue. At the same time, 37 percent of the detainees were on psychotropic medication and 22 percent were on antipsychotic medication. Many of these inmates had been experiencing homelessness before they landed in the system.
Some of the common mental health issues exhibited by detainees include "hallucinations or delusions or some level of disorganization in their thinking," PTSD that manifests in anxiety or depression, and mood disorders, such as bipolar disorder and major depressive disorder, according to Johnson.
The competency restoration program will reserve twelve beds at the Denver County Jail for individuals deemed by the court to be not competent to stand trial. The Denver jail as well as others across the state typically send individuals deemed not competent to stand trial to the Colorado Mental Health Institute in Pueblo. For the Denver County Jail program, a pilot that will start this spring, such individuals will still be considered in the custody of the Colorado Office of Behavioral Health but will remain in Denver.
Between August 2020 and January 2021, the state saw 915 cases involving someone declared not competent to stand trial; Denver dealt with 169 of them. For the small pilot program, the department will prioritize people who are "relatively stable mentally and behaviorally," Johnson says.
"We’re looking at people who are either on medications already or maybe someone who is developmentally delayed who doesn’t necessarily need medications and is able to manage adequately in jail-based restoration versus in a hospital setting," she explains.
The number of defendants being found not competent to stand trial has increased almost tenfold over the past two decades in Colorado; Johnson attributes that rise to the de-institutionalization of mental health facilities that began in the mid-twentieth century, as well as the increased knowledge across society about mental illness.
Johnson also plans to create a crisis response team that will feature round-the-clock mental health staff postings at the Downtown Detention Center and the Denver County Jail, so that a clinician can assist deputies in responding to crises involving individuals with serious mental illness.
"For the crisis response team, ideally we would see a decrease in use of force for individuals with serious mental illness. We would see the ability to de-escalate and have rapport and relationship with individuals where that situation could be de-escalated because of that more therapeutic type of relationship versus the us-versus-them mentality that often comes with a correctional setting," Johnson says. The Denver Sheriff Department is not yet sure when that program will start, she adds.
Johnson also plans to audit all behavioral health services at the jails to ensure that the system abides by best practices.
Denver City Council representative Paul Kashmann, chair of the Safety, Housing, Education, and Homelessness Committee, says that he's long thought it important for the sheriff's department to "take a more comprehensive approach to the treatment of those in their custody with mental health [issues]," adding that "I look forward to the substantive changes Dr. Johnson has proposed."
Johnson's success in the role would be a big win for the Hancock administration, which has already gone through multiple sheriffs, some of whom were at the helm when in-custody deaths from use of force occurred.
In 2015, for example, Michael Marshall, a homeless inmate at the Downtown Detention Center who had been arrested for trespassing, died as a result of force used by deputies while Marshall was going through a mental-health crisis. The City of Denver ended up paying $4.65 million in a settlement to Marshall's family.
Marshall's death came five years after the in-custody death of Marvin Booker, a homeless man who was in jail on a drug possession warrant and became the victim of excessive force by deputies. Denver ended up paying out $6 million in a settlement related to that incident.
Denver is one of just two counties in Colorado that has an appointed rather than an elected sheriff. Appointed by the mayor, the sheriff reports to both the mayor and the executive director of the Department of Public Safety, another mayoral appointee. Under a measure referred to voters by Denver City Council and approved last November, the next sheriff and other major mayoral appointees will require council approval.
Aside from her three main preliminary projects, Johnson hopes to work with Public Safety "to create more diversion programs so these individuals do not come into our custody to begin with," she says.
And she also wants to ensure that Denver is "housing these individuals in the least restrictive environment," Johnson concludes. "Some of that will do with training and educating our sworn staff on the different types of mental health symptoms that they see in individuals and how to best manage these situations."
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