- 70% of people in American jails and prisons have a mental illness, substance abuse disorder, or both.

(door slams) We now have more people with mental illness in jails and prisons in this country than there are in mental health institutions.

- We need to have more resources.

And unfortunately, a lot of the people who need mental health services end up in jail, and that's exactly why they ended up in jail is they didn't get the help that they needed beforehand.

- [Robin] Our hope as mental health professionals is that we can go in and we can start helping these individuals heal instead of continuing those repeating cycles of going into the criminal justice system.

- My program don't end here.

When I leave and get out on the street, then I know that I have to have a positive support system and a safety net.

- I care about the mental health aspect.

They need the support.

They need to know that there's other people out there that can help them.

- It's not like a normal work setting.

You're working essentially with some of the most difficult people.

- 95% of these individuals are going to be my neighbors, could be your neighbors one day.

And I always ask myself, would that be somebody I'd be comfortable living next to?

- [Kayla] The Wyoming Department of Corrections has a success rate of 78%, meaning 78% of those inmates that release into the community aren't committing a crime.

- If I don't address the mental health needs of the individuals, when they're returned to community, they're only gonna be worse.

- [Kate] Our jails and prisons need to stop being the repository of the mentally ill. (dramatic music) (gentle music) - [Announcer] Funding for this program is provided by the Hughes Charitable Foundation.

Energized by love and faith and inspired by the vibrant community around us, Hughes Charitable Foundation supports organizations in helping those across Wyoming who need it most.

A private donation from Jack and Carole Nunn, providing statewide support for Wyoming citizens in body, mind, and spirit, the John P. Ellbogen Foundation, empowering the people of Wyoming to lead healthy lives in thriving communities, Blue Cross Blue Shield of Wyoming, proudly providing funding for education to raise awareness of the mental health crisis in Wyoming and connect people to available care that promotes positive mental health and hopefully saves lives.

(gentle dramatic music) (gentle dramatic music continues) (car door slams) - My name is Josh Cosgrave.

I'm a clinical therapist for High Country Behavioral Health.

I also do therapy out at the Uinta County Jail as a group therapist as well as an individual counselor.

We kind of tackle what trauma, what history has led these individuals to their substance use.

(gentle dramatic music continues) - My name is Kylie Osterling.

I'm a clinical therapist.

I work with community mental health along with substance use.

High Country works in the jail because they wanna help people with substance use disorders.

We work on most of their trauma background, depression, anxiety, or any other triggers that seem to lead them to using.

- Hey, Kylie.

- [Kylie] Hey.

- [Josh] How's it going?

- [Kylie] Good, how are y'all?

- Pretty good.

- Morning.

- Josh and Kylie work really well together as far as coordinating with what needs to be done out at the jail.

We have a contract with the Uinta County Detention Center.

The individuals who are in that intensive outpatient program, they have a probation officer.

They're on supervised probation.

They have not been successful in the community and overcoming their addiction.

- Good morning.

- [Robin] So they're sanctioned to be in jail for the 90 days to complete that portion of their program.

- [Kylie] They're on probation already, and this is their last chance to kind of get things right so they don't end up going to jail longer or going to prison, and so this is just like a hard reset for them.

How are you guys this morning?

- Good.

- Good?

They have 90 days to learn a program, learn more about themselves, and get that sobriety behind them.

So kind of just check in with emotions and where you are with those.

- [Nate] Anxiety.

- Anxiety?

Why anxiety?

- [Nate] I'm getting out tomorrow.

- Yeah.

- I'm ready to go.

- Yeah.

You guys ready to start MRT?

Today at the jail, I was doing moral recognition therapy, which is also known as MRT.

That's a 12-step program.

(gentle music) - Step 11 is about keeping our moral, ethical commitments firm.

We sometimes try to cut corners and do things in ways that are less than right.

- [Kylie] So we'll go ahead and do best of times and worst of times.

- [Nate] Yeah.

All right, yeah.

Best of times was when my children were born.

- [Kylie] MRT takes them back to where things started to go wrong for them.

- [Nate] So for the worst of times is when I went to prison twice and when I was in a drunken rollover accident, and my brother-in-law died in the vehicle wreck.

- [Kylie] Okay.

- [Nate] So.

- Most of the time, people use because they have trauma.

So the mental health aspect of it is the trauma, the depression.

They're just looking for a way to cope, and sometimes it's not the healthiest way to cope.

- For number one, it says draw a picture that represents the biggest relationship problem in your life.

So I put alcohol and drugs, pictures of.

Step two, draw a picture of the biggest problem or difficulty in that relationship.

I drew myself.

- [Kylie] The trauma that we see a lot with substance users is they tend to come from a background of users themselves.

So their parents used, they were abused sexually, physically, emotionally.

I've seen a lot of young women sell their bodies for drugs.

I've seen their parents sell them for drugs.

- I have clients who have been raped, been molested, trafficked.

I've had clients who have other older adults give them substances.

I have an individual in IOP whose parent would suggest dropping meth into their coffee in the morning.

- I've had a number of people who've talked about the only positive memories that they had with their family is when everybody in the family was using together.

(gentle dramatic music) - We know that there's a connection between mental health and drug use.

A lot of our clients are really traumatized, so they use the drugs to numb themselves so they don't have to feel that pain.

- The throughline that I see are generally two things.

One, trauma, trauma, trauma.

What has happened to you?

And then the other throughline that I see most often is poverty.

Generally, trauma and poverty go hand in hand.

We're talking about generations of families that have gone without and don't have the resources to, quote, unquote, "pull themselves up by their bootstraps."

So I'm gonna go out and find the quickest way, the easiest way to soothe my pain, and so people are finding things like fentanyl, they're finding things like methamphetamine.

Addiction, said another way, is simply ritualistic coping.

The difficult part is whatever they get euphorically and takes away their pain, once they come down from that, it's affecting their bodies and their minds in adverse ways.

- And they end up getting pulled into the cycle of the criminal justice system because they're getting in trouble with the law because of things that are happening when they're using.

(siren wailing) (police radio chatters) - At the end of 2017, 90% of the inmates in Wyoming needed substance abuse treatment.

70% of people in American jails and prisons have a mental illness, substance abuse disorder, or both.

These are shocking numbers.

We now have more people with mental illness in jails and prisons in this country than there are in mental health institutions.

And if we're incarcerating people primarily because they're mentally ill as opposed to the fact that they've committed a serious crime, we're costing our system and our state a lot of money.

In Wyoming, a year in the pen costs nearly $50,000 per person.

In jails, it's between, I think, $110 and $150 a night to incarcerate people.

What we have now is really the most expensive and least effective system for dealing with mental illness.

- A lot of times what happens is individuals get incarcerated because they might be having a psychotic episode and they go on a crime spree, and the result is them being incarcerated.

Historically, it hasn't always been a trend.

You had state hospitals that we utilized a little bit more frequently.

We've started to see the trend of shutting state hospitals down.

(gentle music) - Back in the '80s, the light began to shine on the inhumane treatment in the psychiatric hospitals through movies and through political lenses and things like that.

If you had money or if you had connections, you could put people into psychiatric hospitals without really any justification.

It became very evident that people had been misusing the psychiatric hospitals.

Without oversight, it became pretty much a dumping ground.

We started saying, "This isn't the appropriate placement for these people, so we're gonna move them back out into the communities, and we're gonna provide care for them."

However, the care on the outside didn't come.

There are no group homes that got developed.

There are no support systems basically in the community to help these people make that transition.

So instead of what they called deinstitutionalization, really the appropriate term is transinstitutionalization because now the prison system is the repository for people with mental illness who can't function in the community.

Homelessness and drug addiction are a pipeline basically to criminal activity and makes our only choice to incarcerate them, basically.

(gentle dramatic music) - It doesn't take much to have a person who has a severe mental illness to charge them with a crime.

I think we addressed what the public wanted.

The individuals were safe.

They were confined.

But they were also returned to our communities only to commit more heinous crimes.

(gentle dramatic music continues) I work at the Wyoming Medium Correctional Institution in Torrington, Wyoming.

It is our intake facility.

- So what that means is when they come in from county jail, the first thing we're gonna do is assess their needs as far as mental health needs, their medical needs.

Once all of that is completed, we then move forward with, where would they best be housed?

That also translate into substance abuse treatment, sex offender treatment.

Our mental health services provide anger management.

All those things that you can think of that would really contribute to rehabilitation, like the partnership with Black Dog Animal Rescue.

That program is unique because they train the dogs to become service animals.

And that's a really special program 'cause I think it really gives inmates a purpose, and they look at it as an opportunity to give back.

(gentle dramatic music) - We actually run the gambit of all types of therapy, you know, from adjustment disorder type all the way up to inpatient psychiatric care on the same level as the state hospital.

- We have a 36-bed mental health unit, chronic mental health unit.

- And that unit really is tailored to meet the needs of inmates who have a serious mental illness.

But in general, we see a lot of trauma, so our therapists and counselors are focused on that.

Having effective management of an inmate population, that doesn't occur with just housing inmates.

It occurs with providing them services so that they can be better functioning while they're incarcerated but also prepare them for the community.

- When people get into crisis, they generally revert to what they know.

And if we can teach them good skills, then when they get back out into the world, they can navigate those crises more effectively.

- It's a revolving door.

People are gonna keep coming back, right?

If you got them for shoplifting one time because they're not taking their bipolar meds, in a month, you'll get 'em again.

- Crime is largely a cycle.

If I've been victimized in my history, studies show that I am more likely to go victimized in the future.

As a warden, sure, I can sit here and say all day long, "Look, I know that you victimized this person or I know that you assaulted this person."

Focusing on the action really only gets us so far.

The punishment is them coming here.

They've been punished by the courts.

We are not here to punish them.

Our job as prison officials and prison employees is to rehabilitate them and get them ready to reintegrate back into society.

95% of these individuals are going to be my neighbors, could be your neighbors one day, and I always ask myself, would that be somebody I'd be comfortable living next to?

The majority of our inmates succeed.

- Individuals who are confined are not often considered our citizens.

These are citizens of Wyoming, so would we address these mental health needs in the community?

Absolutely.

Why would we not while they're confined?

(gentle dramatic music) - So we are working on two different approaches.

The first step is our Mental Health Diversion program, which we're just starting.

What our pilot program will do is nonviolent misdemeanants are identified immediately when they're brought to jail.

They have a kind of quick mental health screening.

And if that screening suggests that they might have one of four mental illnesses, schizophrenia, schizoaffective disorder, major depression, and bipolar, if they have any of those four mental illnesses, then we have a full-blown evaluation done by a mental health professional to make sure that that's the case.

And if they qualify, their charges are held in abeyance, so they're not charged, they're not kept incarcerated, and they are sent into a program where they receive medication for their mental illness, counseling, and then, if they complete that program, the charges are dropped.

In terms of the judicial branch, our treatment courts are a real success story.

Treatment courts take place after adjudication, so the person has been through the system, and this is perhaps part of their sentence.

The participants will appear in court maybe every couple weeks or at least every month.

And there's a whole team that works with them, the probation officer, the public defender, the prosecutor.

- We can connect them with food stamps, we can connect them with DVR, we connect them with case management, therapists, housing, everything we can try to do to ease that burden.

If we can get them where they're out of jail, they're working, they're benefiting society, they're paying taxes, and they're not returning to the jail, that's saving the community money.

- There are definitely gonna be people charged with crimes who need to be put in a place where they're not a threat to society.

We're talking a different population than that.

- There's a small percentage of individuals that will never get out of institutions.

They're violent, they've created so much havoc and hurt their victims.

They will not be returned to communities.

I'm very cognizant of the fact of victims.

I speak with victims almost daily, and so I certainly hear their concerns.

(siren wailing) (gentle music) Throughout my career, I've often heard the saying, "Lock 'em up, throw away the key," that that's how we should treat these individuals.

However, if I don't address the mental health needs of the individuals, then when they're returned to community, they're only gonna be worse.

- If we just locked them up, we're gonna continue to see failures, not only in our system, but we're gonna see failures when they go back into the community, and I think it's not a win for the state.

We don't want more victims.

We don't want more crime.

- If we get an individual in here and we fail the public, you know, there's more than just financial costs.

Somebody's gonna go get victimized out there.

(gentle dramatic music) - The Wyoming Department of Corrections has a success rate of 78%, meaning 78% of those inmates that release into the community aren't committing a crime for more than three years.

That's the work that staff are doing.

It's not like a normal work setting.

Prison is an isolating setting.

You know, there's not a lot of windows in prison.

That's what we often say.

There's not a lot of light.

That all kind of contributes to staff's own mental health.

And then, on top of that, you're working essentially with some of the most difficult people.

That's where things can really be traumatizing for you as a staff person.

- I think that the state of Wyoming as a whole is very blessed to have the caliber of clinicians that work inside the criminal justice system that can work with these people.

I mean, if you choose to walk into prison every day and to deal with the people that are incarcerated, you are really giving of yourself and society as a whole, I believe.

- A sense of urgency and completing goals dominates this stage.

The goals of a person in this stage include the welfare of others rather than goals being narrow and self-serving but often feel that they have overcommitted and are in risk of failure if they slow down.

- I think that communities are critical because we will not be able to divert people from jail if there isn't adequate community support.

- We need to have more resources.

And unfortunately, a lot of the people who need mental health services end up in jail, and that's exactly why they ended up in jail is they didn't get the help that they needed beforehand.

- Access to care is really hard.

The systems and navigating the systems is hard.

Finding the housing for people who are struggling with mental health is incredibly difficult.

Finding jobs for people who have struggles is incredibly difficult.

- They need the support.

They need to know that there's other people out there that can help them.

They don't need to just think, "Well, here's another lockup.

This is all I've known my whole life.

There's no need for me to do anything else anymore."

- [Kylie] Nate, what step are you on?

- 11.

- Okay.

You gonna present today?

- Yeah.

- [Kylie] He did his Step 11.

It's a huge deal.

He's done everything he's needed to do to get to where he is.

- You know, I've been in trouble all my life and always struggled with addiction and struggled to make the right choices.

And so I have a lot of healing damage that's gonna take, I think, showing people instead of, you know, telling them all day long that I'm, you know, gonna change.

So I gotta go out there and show 'em that I can do it, so.

I'm committed to change.

I'm gonna give it 100% and apply the things that I've learned and break that cycle.

My program don't end here.

When I leave and get out on the street, then I know that I have to have a positive support system and a safety net so that when things get bad and life situations happen, that I can have someone to help me, you know, not fall down through the hole, so.

- When they finally get it and they finally understand just the brightness that comes out of them, it's so amazing.

Thumbs up if you feel like he passed.

Thumbs down if there's questions.

Okay.

Okay, you can come out of the corner.

(group clapping) Okay, good job.

Does anyone have any feedback for him?

- Excellent job, Nate.

- Thank you.

- This is my last group with you.

- [Nate] Yep.

- Okay.

Good luck.

- [Nate] Absolutely.

- I know you'll do great things.

- Yeah, for sure.

I got this.

Good group, guys.

- I care about the mental health aspect at the jail mostly...

I don't wanna cry.

(laughs) Mostly because I have seen what it was able to do for my husband.

He was a former addict.

He's 11 years sober.

He's been amazing in his recovery, and it gives me hope for other people.

- My goal for when I leave is to try and rebuild.

- We all live our lives, and we develop the story about who we are.

And many times, especially with substance use, it's not necessarily the best story or image that we have of ourselves.

And so what I try to do with individuals in there is help them kind of, like, connect the dots to that, "Yeah, okay, so maybe I didn't do this good, but I did do this well.

Like, I'm a good mom, I'm a good neighbor, I'm a good friend, right?

I'm not just an addict, I'm not just a criminal, I'm not just a problem."

Like, help them see that there's more than one side to their story.

- Okay?

- Yeah.

- [Josh] We all make mistakes, right?

- We see a lot of people that don't understand the mental health aspects.

They just put them in jail, throw away the key.

There's no need for them to be out on the streets anymore.

But that doesn't help them at all.

- I will tell you this.

I was a lot less empathetic before I became in corrections.

And it's kind of stunning to say that.

I mean, like I said, I started as an officer 17 years ago, and probably when I started, it was more, you know, I didn't look at everybody in the human manner.

What I look at now is that these guys, yes, they made a mistake and they're here.

It's terrible that there's a victim out there, but let's not re-victimize, and truly some of these guys are victims.

We have to figure out why.

What led to it?

- I think there is definitely a lot of opportunities to divert people before they encounter or get very far into the criminal justice system.

With the Mental Health Diversion, we say, "We're just gonna help you, and we're not gonna lock you up."

And it works really well in other parts of the country where it's been in operation, so we wanna do it here to actually help these people and to reduce the burden on the courts and the jails.

- We have to make the decision.

Do we want to spend our money for the long term?

Do we want to have less victims?

Bottom line is these folks are gonna return to our communities, and what we don't spend up front, we're certainly gonna suffer for in the end.

(dramatic music) (gentle music) (gentle music continues) (gentle music continues)