They pinball from one place to another at dizzying rates.
And now leaders of those public safety and health institutions are sharing notes about how best to slow the revolving door.
Since taking office in July, Sheriff Ty Trenary often has questioned whether some inmates with mental health problems belong at the jail. John Lovick, the county's executive and the man Trenary replaced as sheriff, has a panel of volunteers working to identify ways to better help those affected by mental illnesses, such as schizophrenia, bipolar disorder and depression.
Both are well aware of a recent county study that found more than 90 percent of the jail's most frequent visitors have high rates of mental illness or addiction and, in nearly half of those cases, both.
The county human services department drilled down into data involving 23 inmates who in 2012 were booked into the jail at least nine times during a 10-month stretch. More than 60 percent had been diagnosed with some form of mental illness.
Those 23 people accounted for 399 trips to mental health centers and hospitals or calls to paramedics during the period of study.
"The data highlights a crisis in our community — that a disproportionate amount of public resources are used by a small number of high-need individuals," Trenary said. "Bouncing the mentally ill, homeless and/or addicted from one service to another is an expensive way to treat the symptoms, but not an effective treatment of the root cause of their problems. Our community deserves better."
Once they are in jail, the entire cost of care, which often includes pricey medications, falls on the county. The study suggests that it would save taxpayers money if some jail-bound people with mental illness were sent straight to another setting where their needs could be better met.
The research also found that an effective dosage of medication at the jail is unlikely because of the inmates' frequent and lengthy stays.
"Under the status quo, it is likely that frequent jail utilizers will not receive the comprehensive care they need upon release, continue to have multiple encounters with emergency and medical services, and eventually return to jail," the report found.
"They tend to bounce into all of these different systems," said Robin Fenn, a member of the research team. "That all costs a lot more money than if we were to provide them with the services they needed in the first place."
The county is considering revamping the Carnegie building next to the jail to provide 20 beds of transitional housing along with space for mental health and chemical dependency services, employment training and other social services. The building could be used to divert some people who otherwise would end up in jail or help with the transition out of jail so they are less likely to return.
"We really need as a community to begin to look at the bigger picture," Snohomish County Human Services director Ken Stark said. "We know that jails are expensive, that law enforcement, courts and prosecutors are expensive, and we need to ask ourselves: Is there a cheaper and more effective solution?"
County officials estimate it could cost up to $2 million in improvements to the Carnegie building. It would hire a nonprofit agency to operate on the site under an annual budget of up to $1.1 million, according to preliminary estimates.
Julie Zarn is a registered nurse and director of critical care, emergency and observation at Providence Regional Medical Center Everett. She also recently joined an advisory committee Trenary convened to help fix problems at the jail.
She said she was surprised to learn how interrelated the jail, emergency room and paramedics are in serving some people who live with mental illness and addictions. She, too, feels that there must be a better way than continuing their cycle of jail and emergency room visits.
"I am very interested in helping them address their issues because they are our issues, too, and they are the community's issues," she said. "We all own them."
Other agencies also are thinking outside the box about ways to deal with people who make frequent use of their emergency services.
Snohomish County Fire District 1 recently started a community paramedic program it hopes will cut down the calls from its most frequent 911 emergency service users. It has a paramedic who visits homes to check on frequent callers and offer health and safety advice before there is a need for them to call.
The county human resources department analyzed data from the top 29 users of EMS services across the county during a 10-month period in 2012. Those 29 people were seen by EMS crews 553 times during that period, resulting in 420 trips to emergency rooms. The most common causes for the calls were mental health issues as well as diabetes symptoms and varying forms of pain.
In a separate jail study, county human services workers interviewed 36 inmates about their lives and how the jail might help them with their transition back into the community.
More than 90 percent were found to have a mental health problem or substance abuse addiction, or both.
Among other things, they said it would be helpful to have more Alcoholics Anonymous and Narcotics Anonymous support groups, more alcohol and drug treatment and a list of community resources when they are released.
They also suggested the jail not release inmates in the middle of the night.
One inmate hammered home the last point, telling the researchers: "Stop with the midnight releases. When you get out at night, there is nowhere to go and no one to help you. No one is waiting for you except your (drug) dealer. If he's all you got, you will call him and then it will be right back in here."
Eric Stevick: 425-339-3446, firstname.lastname@example.org.
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