ST. MARYS — Ill-equipped, under-staffed and over-crowded, a local county jail is struggling to care for a wave of mentally ill inmates entering the facility in record numbers as state support services dry-up and law enforcement search desperately for a straight forward solution to an endlessly complex problem. 

“I’m here to tell you the mental health system in Pennsylvania is broken,” exclaimed Elk County Prison warden Greg Gebauer. “There are inmates who are seriously mentally ill who should not be in the prison system,” he added from behind his desk inside a 19th century office space adjacent to the Ridgway detention facility he oversees.

That facility has been exceeding its 88 person capacity in recent months. Gebauer estimates as much as 65 percent of the population suffers from mental health problems and 75 percent from substance abuse issues, with the issues often intermingled and at times indistinguishable, he explained.  

Currently, jail staff and the facility itself are not equipped to care for, or house, those individuals presenting the most severe symptoms. But cuts and closures of state hospitals and public psychiatric units have left them nowhere else to turn. 

“We struggle a lot with our mental health inmates and how to manage them … and there is no help with the state mental health system — none,” he said. “We figure it out as we go, basically.”

With the closure of the state’s Warren Forensic Unit in 2010, local county jails are now forced to transport inmates to Torrance State Hospital in Derry for treatment, or to complete court-ordered psychiatric evaluations. The trip is twice as far and the backlog up to three months long, according to Gebauer, who added “nine times out of 10 they won’t take them, so what do I do with them? 

“The only option is they come back to the county jail, and if they have a successful suicide attempt, now what?” 

Perhaps no case speaks to the systemic dysfunction better than that of Joshua Coffey. 

At 26-years-of-age, Coffey has spent more than a year in custody on misdemeanor charges, being bounced between county jails and state hospitals as courts and lawyers commission competency evaluations and prisons find themselves unable to manage his erratic behavior.

His legal odyssey began in June of 2013 when Coffey, then a 25-year-old St. Marys resident, was charged with threatening his mother and a man at knifepoint inside their East Eschbach Road home. According to court records, Coffey grew irate over a dinner of pork served to him by his mother, claiming the meat was poisoned and that eating it would have violated his “Muslim beliefs.” 

The case drew national attention due in large part to its religious overtones, although Coffey’s religious affiliation has never been confirmed by the court.  

Coffey was charged with two misdemeanor counts each of making terroristic threats and simple assault. It was not long before his mental status was called into question in court hearings and after 15 months in custody, Coffey has yet to plead guilty or be sentenced.

Instead, he continues to undergo mental competency evaluations. 

A court-ordered mental health screening at Torrance State Hospital in July of 2013 found Coffey competent to stand trial. 

But in a rambling and bizarre court hearing this March, Coffey spontaneously rejected a plea that would have seen him released to a halfway house with credit for time served. 

His defense attorney later said his client had discontinued his medication since his time at a state hospital, causing him to slip into a “decompensated state.” 

Coffey is currently committed to Torrance State Hospital after undergoing a new mental health evaluation. 

There is no further action currently scheduled in his Elk County Court case. 

“Once they (mentally ill individuals) end up in the criminal justice system, Pennsylvania totally washes their hands of them,” Gebauer said, recalling Coffey’s as a “unique case” and one of those his jail was unable to accommodate.

“They (the state) will say ‘This is not a mental health issue, this is a criminal justice issue’ when in fact it’s not true. In reality, it’s a mental health issue that’s causing their criminality.”

For his part, Elk County district attorney Shawn T. McMahon said at least 80 percent of the county’s criminal cases involve underlying mental health issues, substance abuse issues, or both. He said local courts are on par to exceed 500 criminal cases this year, an all-time record. 

McMahon said without added state investment in treatment and prevention services, Elk County could see 700 criminal cases in five years time. 

“We’re up against obstacles in getting people down avenues of treatment and addressing their underlying, individual needs,” McMahon said. “Sometimes the perception is publicly that nothing is being done. More often than not the court system and mental health system is confronted with limited resources and you’re doing the best that you can. It goes back to funding and is it going to be made a priority.” 

Dickinson Mental Health Services, the Ridgway-based treatment provider which administers in-house psychiatric services at Elk County Prison, indicated the demand for the service has grown and funding should follow suit. 

Dickinson spokesperson Michelle Straub said the number of Elk County inmates in need of psychiatric care has grown exponentially in recent years, prompting Dickinson to add therapists to help cope with the growing caseload. 

Three full-time therapists are responsible for tending to as many as 50 inmates weekly, or more in severe cases, a ratio Dickinson calls “adequate.” 

But if the demand continues to increase, Straub said state funding and grants like those through the Pennsylvania Commission on Crime and Delinquency and the Department of Justice, which support the service and staff additions, will need to increase as well. 

Straub said Dickinson is constantly looking for new grant opportunities to either expand its prison program or maintain it, adding, “At this point it has been enough to serve the population that is referred to us.”

Pennsylvania’s upcoming budget includes a six percent increase in mental health funding, but only after years of cuts and services being shuttered.  

The County Commissioners Association of Pennsylvania (CCAP) is urging the governor and the General Assembly to begin a three-year restoration of the $55 million cut from community mental health base dollars and the $4.8 million reduction to the Behavioral Health Services Initiative that occurred in Fiscal Year 2012-13.

State Rep. Martin Causer, R-Turtlepoint, said he supports restoring, and ultimately increasing, mental health funding in Pennsylvania, but said the state’s bleak financial picture means it may be a gradual process. 

As for whether the six percent increase included in next year’s budget is sufficient given the emerging mental health crisis, Causer said a billion dollar budget deficit and lagging tax revenue collections mean it is “the best we can do this year.” 

“We’re going to be looking at those numbers very closely in the next budget also,” Causer said. “Knowing the issue and the amount of services that are needed I’m sure this is an area we’ll continue looking at to try and provide more funding for more services.”

Services like those offered by Dickinson in Elk County are costly to provide. 

Theirs even extend beyond the prison walls to mobile therapy and out-patient programs intended to help prisoners stay on the right track and out of trouble once released. 

These options, while proven effective, are far from foolproof, according to Straub, who said Elk County inmates are most commonly diagnosed with mood and personality disorders, along with substance abuse or dependence — notoriously difficult conditions to treat. 

“We have individuals who are definitely successful cases for us that have not reoffended and gone back to jail, and we have some who fall off the face of the Earth and we never hear from again,” she added.

In the courthouse adjacent to the Ridgway prison, McMahon eyes a record high case load this year and said the area faces losing an entire demographic to the criminal justice system if mental health, substance abuse issues are not properly addressed. 

“It’s almost as though this area is losing an entire generation,” McMahon said of the local crime rate and what he believes are its primary contributing factors. 

“The issue becomes this: What do we value? What are our priorities? Does the (state) Legislature need to step up? Do they need to look long-term here and determine what is going to be the impact of this if we don’t do something now?”