ON EDGE: Novel city program works to draw some criminal suspects into mental health treatment to keep them from coming back

Kara Mason | Sentinel Staff Writer

On a recent Monday morning, Chief Defender Doug Wilson said six of the eight inmates in the Aurora municipal jail were flagged with a “Code 9,” which signifies the person may be experiencing some kind of mental health issue.
That’s been the norm since Wilson arrived in Aurora in 2020. He said he quickly found that there weren’t any resources for local inmates experiencing mental health problems — which likely caused the person to be sitting in jail in the first place — so he started brainstorming with staff at the Aurora Mental Health Center.
The answer was a program called Aurora Sustained, and the premise is fairly straightforward: Four days a week, a trio of forensic psychology graduate students from the University of Denver arrive at the detention center at 7 a.m. and evaluate inmates for any behavioral health issues prior to seeing a judge. They provide crisis services information, talk about treatment options and make a plan.
“Before this program, we were just arguing for bond and hopefully getting people released. They were getting dumped back on the street and it was on them to seek treatment,” Wilson said. “Now we’re taking them by the hand and helping them get treatment so that we can stop this revolving door of ‘hit the street, come back to jail, hit the street, come back to jail.’”
At its core, Aurora Sustained is aimed at getting people mental health care who are in need and likely haven’t sought it out. So far, the program, which has been running since June, has found that about 90 percent of the inmates agreed to participate in services provided by Aurora Mental Health.
Patient health questionnaires used to screen for depressive symptoms have revealed that nearly 30 percent of inmates in the Aurora jail rank “moderately severe” and about 30 percent are at a moderate risk for suicidality or had a reported history of suicide ideation.
Those early statistics mimic what’s happening at detention centers across the state. Colorado Department of Corrections data from June concluded that roughly one-third of inmates in state prisons have mental health needs.
Captain Jamison Brown, the president of the Colorado Jail Association, told a state legislative committee in September that “the Department of Corrections is technically the largest mental health provider in the state of Colorado.”
Advocates for people drawn into the criminal justice center are less diplomatic, saying that Colorado jails and prisons are dumping grounds for the state’s most troubled, and often troublesome, residents.

"Before this program, we were just arguing for bond and hopefully getting people released. They were getting dumped back on the street and it was on them to seek treatment. Now we’re taking them by the hand and helping them get treatment so that we can stop this revolving door of ‘hit the street, come back to jail, hit the street, come back to jail.’"

CHIEF DEFENDER DOUG WILSON

But getting mental health services to people early on — before they’ve reached the point of finally seeking mental health care in prison — could be the best bet in helping people and reducing recidivism, said Erin Ralston, clinical director for access, homeless, and residential services at the Aurora Mental Health Center.
“We wanted to be able to get in front of them as quickly as possible so that we were able to spend some time with them, identify any of those mental health concerns, certainly do a risk assessment, and then that could inform the public defender’s team and the judge,” she said.
Since Aurora’s municipal jail can only hold a person for 72 hours, Wilson and Ralston had to devise a program that would allow inmates to seek mental health help quickly.
When a city public defender goes to court, they argue for mangeable bonds for those arrested the day before or over the weekend. Unless the client can post bond, or their case is resolved, they are sent to one of the three county jails that serve Aurora.
“You really have to see them before they’re in to see the judge, because as soon as they see the judge, then they’re either moved to a different location or released, and then they kind of start to get lost in the system,” Ralston said. “And once we’ve made that initial contact, we can track them in the system.”
Aurora Sustained is unique in that it pairs offenders with mental health professionals before they ever appear in court, but the effort to draw mental health services into the judicial system has been evolving over the last decade in Colorado.
District courts across the state have implemented speciality “problem solving” courts to attempt alleviating a system bogged down where mental health is a factor. In the 18th Judicial District, which covers the bulk of Aurora, a “wellness court” program is available to people charged with a felony and must have a diagnosed mental health illness, excluding sex offenders.
A “recovery court” is available to people diagnosed with substance dependence and a “veterans treatment court” focuses on “veterans struggling with service trauma-related issues.”
In July, District Attorney John Kellner announced a “recovery diversion program” that allows qualifying residents accused of possessing an illegal substance or drug paraphernalia to opt in to treatment with the nonprofit mental health group AllHealth Network.
Unfortunately, Colorado ranks near the bottom in nation in funding for behavioral health resources. When resources are limited, those charged with crimes, including the poor and people of color, do not get them. — James Karbach, Colorado State Public Defenders Office
Nationally, about 4% to 5% of Americans are seriously mentally ill, compared with as many as 18% of those in jails, according to Risë Haneberg, who leads the initiative on behalf of The Council of State Governments Justice Center. That number is dramatically lower than what many jails report, but Haneberg says that’s because jails often use a broader definition of mental illness and may include substance abuse disorders.
Justice experts — and Wilson agrees — that the issue of mental health in jails began in the 1970s when state psychiatric hospitals, many with appalling living conditions, began closing.
Mental health care was supposed to shift to community-based centers.

It never really happened, experts say. Although community based centers are often charged with being a safety net for mentally ill people without resources or allies, they’re often overwhelmed with patients and requests or ill-suited to adequately meet the need. “On Edge,” a recent special investigation by the Colorado News Collaborative, a consortium of news agencies statewide, which includes Sentinel Colorado, revealed a bevy of shortcomings.
Despite years of funding and efforts to expand the community mental health system, a flood of underserved communities across the state, including people in jails and prisons, have created a crisis.
The promise to invest in local services didn’t ever materialize, leaving many former psychiatric patients without treatment, says Michele Deitch of the LBJ School of Public Affairs at the University of Texas at Austin. “We still aren’t putting money in community mental health care the way we should,” she says.
Instead, more of those people are turning up in the criminal justice system.
“For years, as a society, we routed more and more mentally ill people into the criminal justice system, which is not designed to treat mental illness,” said James Karbach, who has been an attorney with the Colorado State Public Defenders Office for 18 years. “As public defenders, we see the growth of untreated mental health problems in our clients and see every day the devastating effects to them and our community.”
Karbach said it’s a public health criss and should be treated like one.
“Nationally, and in Colorado, more people are voicing their support to the concept of diverting the mentally ill out of the system or providing services to those who are mentally ill. Unfortunately, Colorado ranks near the bottom in nation in funding for behavioral health resources,” he said. “When resources are limited, those charged with crimes, including the poor and people of color, do not get them.”
Law enforcement policies can exacerbate the problem. When the homeless, for example, are arrested for offenses such as disorderly conduct, they often cycle in and out of jail without their mental health needs addressed. Mentally ill inmates may also remain locked up longer because they often can’t afford even relatively low bonds in misdemeanor cases.
Separate from this is a state-recognized problem where suspects are so mentally ill they are unable to legally take part in their own defense and remain imprisoned. State officials intervened in the problem last year, working to ensure that jails find resources to screen prisoners for competency and speed up treatment. Often, especially mentally ill or addicted prisoners are finally released, only to be booked again on similar or other charges.
It was such a situation that at the end we kind of let out this big sigh of like, ‘OK, if we hadn’t had a mental health professional to walk through that situation, someone probably would have gotten hurt. — Erin Ralston, Aurora Mental Health
In the Aurora Sustained program, the goal is to stop that cycle before it ever begins.
Ralston said the interns recently worked with a man who was set to be released back into the community. He was calm but “not connected to reality.” They feared he would either reoffend once out of the detention center or hurt somebody. Eventually, the team was able to get the man help and he was placed on a mental health hold. An ambulance came to get him.
“It was such a situation that at the end we kind of let out this big sigh of like, ‘OK, if we hadn’t had a mental health professional to walk through that situation, someone probably would have gotten hurt,’” Ralson said.
Wilson is also proud of the fact that the program hasn’t cost the city a dime — the interns work with Aurora Mental Health, which agrees to provide the services — and it may actually end-up saving the city dollars on referring clients to psychiatrists for competency evaluations. Aurora Mental Health is funded by client fees, often reimbursed by Medicaid, and other state revenue sources.
“What we’ve seen in the past three months is the number of referrals (to psychiatrists) have reduced because the fellows can tell us, ‘Well, they have a mental health issue but it’s not to the level of incompetence,’ and we know we’re going to get them back into treatment or give them a couple of days to come down (off of a substance).”
So far, the creators of Aurora Sustained see the program as a win-win-win. It’s introducing mental health services to some of the city’s most vulnerable, attempts to interrupt a cycle of crime and it’s free to the city for now.
The defender’s office has also been given a $100,000 grant from the state to assist in competency evaluations. That may result in hiring a social worker, Wilson said.
In addition to the new program, Aurora Mental Health also runs a Community Transition Counseling Center that works with people on probation and parole to manage their mental health. The center also operates two residential houses that serve a total of 21 probation, transitional, and wellness court clients.
“Much more is needed, but we do what we can,” Ralston said.