Ashley Overfield first convinced herself she was Lucifer in the spring of 2005.

For weeks, the single mother unknowingly suffered a manic episode severe enough for her parents to travel from Cody to Lander to retrieve Overfield and her daughter.

The next day, Overfield shaved her head and made a series of bizarre phone calls, telling people she killed her family and that she had failed her mission to God and sent them to hell. Her insurance agent, one of the horrified recipients of Overfield’s phone calls, called police.

Overfield was hospitalized and sent to various treatment centers around the state. The delusions persisted after her release, but terrified of being shipped off again, she turned to substances to quiet them. Contact with police and stints in jail would often follow.

In Wyoming as well as around the country, jails and prisons operate as de facto mental health facilities, treating a disproportionately high number of offenders with mental illnesses, substance abuse issues and often both.

That reliance on the criminal justice system means Overfield and others with mental health problems often find themselves in a revolving door of incarceration and hospitalization, a harrowing experience for individuals and a costly burden on communities and justice facilities.

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Overfield was diagnosed bipolar with paranoid schizophrenic tendencies at age 19. Now 33, she estimates she’s been to jail 14 or 15 times. Her charges were mostly misdemeanors — public intoxication, disturbing the peace and DUIs — and products of her self-medication. She has a felony conviction for prescription fraud.

“It shuts my mind off,” Overfield said of her substance abuse. “My mind gets to going so fast, and I can’t shut it off.”

Overfield said she learned quickly after her breakdown to lie about her state of mind.

An often-cited national study by the Bureau of Justice Statistics found that about 56 percent of state prisoners, 45 percent of federal prisoners and 64 percent of local jail inmates experienced mental health problems. Measurement standards vary by study, making cross-comparisons unreliable.

Wyoming advocates say many of these inmates are not hardened criminals. Like Overfield, many people with mental illnesses will repeatedly commit minor offenses that are triggered by their afflictions. A drug addiction, some say, is preferable to acknowledging their own mental illness. For others, advocates say, treatment is simply not accessible.

There is no legislative silver bullet that will break the cycle. Catalysts for incarceration are as varied and complex as mental illness itself, and can include a variety of factors including lack of treatment, inappropriate treatment and an individual’s willingness to participate in his or her own recovery.

Regardless, Wyoming advocates say improvements to the state’s mental health system could help deflect at least some people from landing behind bars time and again.

Through interviews with patients, family members, mental health advocates and law enforcement officials around the state, the Star-Tribune has learned:

  • There is at least one state-funded treatment center in each county, but not all are equipped to deal with a patient’s specialized needs.
  • Because of this, patients may fail to receive adequate treatment, often due to time and transportation constraints.
  • Specialized treatment centers that do not receive state funds exist, but often for only those who can afford them.
  • Wait times to see a provider can result in incarceration before a mental health bed opens.
  • No counseling will be effective without the patient’s acceptance of his disease and a willingness to cooperate in treatment.

Mental health advocates say more assertive community treatment and jail diversion programs are desperately needed in Wyoming to assuage the swollen costs of incarceration and to prevent more individual tragedies.

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A 2009 report from the National Alliance on Mental Illness gave Wyoming, along with five other states, an “F” grade for its mental health system. The survey measured four broad categories: health promotion and measurement, financing and core treatment/recovery services, consumer and family empowerment and community integration and social inclusion.

The report found mental health services in Wyoming “remain sparse and inadequate, with many areas lacking psychiatric care and reasonable access to needed services and supports.”

Wyoming Mental Health and Substance Abuse Services Administrator Dr. Alice Russler said she was familiar with the report but unclear on the methodology and was unable to speak directly to its findings.

Russler said she believes statewide improvements have occurred in recent years, and that the Wyoming Department of Health is consistently striving to improve and modernize the system.

The Health Department’s mental health and substance abuse services fund 21 community-based mental health and/or substance abuse centers. Russler said most are private, nonprofit community health centers that operate on a sliding-fee scale, so everyone can afford services.

“Every county in Wyoming is attached to one of these 21 centers,” Russler said.

The state dedicates roughly $53 million annually for all of these outpatient and residential treatment services.

Russler maintains the assumption of drastically long wait times for help is an exaggeration.

Last year, the average wait time for mental health outpatient treatment was 10 days, and 11 days for substance abuse outpatient treatment.

“You are typically in in less than two weeks,” Russler said. “And in some cases, that day.”

Russler said the Health Department only started collecting this data in the past couple of years. But anecdotally, the improvement has been “drastic.”

Despite the recent statistics, it can still be difficult to get treatment for people living in the state’s many rural areas, said NAMI Wyoming Executive Director Tammy Noel. Gas costs and even road conditions can be a barrier to treatment.

Although the state-funded centers are all under the same umbrella, they don’t all come equipped with specific services.

Wyoming’s counties are divided into five regions of mental health care. Substance abuse residential beds and group homes for serious and persistent mentally ill adults are available in all five regions, but this may do little good for some rural residents.

“If I’m in a smaller community and I needed to see my psychiatrist, I may have to travel two hours for a 15-minute appointment,” Noel said.

Noel, whose son is diagnosed with a mental health condition, said Wyoming struggles to retain psychologists and psychiatrists.

“My son had a fantastic psychiatrist who moved to Colorado,” she said. “I’m not sure what the trend is and what the reason is behind that.”

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Not all of the state’s mental health advocates support Wyoming’s current system.

Cheri Kreitzmann, Overfield’s current counselor, said there’s currently a lock-in with state funds and the current contracted providers, but that the centers aren’t necessarily tailored to the needs of all individuals in the area.

“The contracted provider may not be providing the services that the client really needs,” Ashley’s mother, Rita Overfield, said.

Because state money is given exclusively to contracted organizations, Kreitzmann said it’s difficult for small agencies and specialized, individual providers to offer services in Wyoming. Many people who would require mental health services don’t have insurance or the money to pay a provider who doesn’t receive funding.

“It’s a very complicated system, with billing and certification,” she said.

Certain required certifications can cost upwards of $20,000 a year, making startups nearly impossible for a small agency, she said.

Both Rita Overfield and Kreitzmann endorsed the idea of funding model that would allow money to follow the client.

“We don’t see enough competition,” Kreitzmann said. Allowing the money to follow the client would spark competition amongst providers, she said, which she believes is essential for quality care.

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There are two ways someone with a mental illness can land in jail in Wyoming.

In some instances, an individual who receives a “Title 25” status — ordered to be involuntarily hospitalized — is held behind bars until a bed becomes available in one of state’s hospitals with a mental health unit.

Russler acknowledged this occurs at times, but insisted those cases are the exception rather than the rule. She said the state does not have any statistics that would show how often this happens.

“Honestly, it shouldn’t happen at all,” Russler said.

But by far the most common reason mentally ill individuals end up incarcerated is because they have committed a crime.

Research suggests people in the criminal justice system with a mental illness are over represented by two to four times the general population, according to a study cited by the National Institute of Corrections.

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It is expensive for communities to house and treat mentally ill individuals, especially when factoring in medication and therapy. In Natrona County, it costs $92 a day to house and feed someone in the detention center. That does not include medical needs, which are the jail’s responsibility to pay. Medicaid is not accepted.

Each inmate at the Wyoming Department of Corrections costs an average of about $127 per day, including all medical costs.

“It does seem that we receive a lot of people because of mental health issues,” said Natrona County Detention Center Lt. Jerry Clark. “There’s no place for them to go other than the detention center.”

Clark said the jail pays for any medication prescribed by a doctor, and it’s not uncommon for that to cost $5,000 to $10,000 a month.

Noel said most detention center officials are doing their best to deal with the issue, but jails simply aren’t the place to treat the mentally ill. Jails don’t have the funding or resources to properly treat the individuals, and reduce their chances of recidivating, she said.

“It’s more about appropriate placement,” she said. “If they had access to services, would they be committing crimes?”

A NAMI toolkit cites estimates that indicate assertive community treatment is more cost effective than incarceration. The price tag of one year in state or federal prison is approximately $22,600, while assertive community treatment runs between $10,000 to $15,000 a year per person.

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No one knows exactly what Niam “Keith” Labaki was thinking on May 18.

The 43-year-old Evanston man fired a shot in front of a residence and into a sporting goods store before leading Evanston police on a brief high-speed chase. Labaki lost control of his vehicle and an officer disabled it by hitting the rear with an unmarked police vehicle.

Labaki then leveled his rifle at officers, prompting both an Evanston police officer and a Uinta County sheriff’s deputy to fire. Labaki was pronounced dead at the hospital.

There is no singular cause for Labaki’s death, said his friend Carrie Ferguson, who has worked with drug addicts and alcoholics for over 14 years.

Ferguson talked to the Star-Tribune with permission from Labaki’s family.

In one respect, she said, Labaki’s death is an extreme example of the consequences of Wyoming’s deficiency in accessible services.

It was reported that Labaki, shortly before the shootout, walked to the front doors of the State Mental Hospital in Evanston and was turned away. The state mental hospital requires a Title 25 designation (involuntary hospitalization court ordered admission.) Labaki approached representatives at a state-funded facility, but agency officials did not deem him sick enough to go to the state hospital. Family said Labaki even went to the county jail, which also turned him away.

Ferguson said Labaki likely was schizophrenic and had ADHD but was never officially diagnosed. He’d been in contact with police numerous times, she said, mostly for drug charges.

He self-medicated with methamphetamine and alcohol to quiet voices in his head, and on the day of the shooting, Ferguson said Labaki was probably desperate, seeking any way possible to make it all just stop.

“When somebody decides that they need to get sober, there is no waiting even a week, because that window can close,” Ferguson said. “It’s just limited.”

Ferguson said she believes her friend died from a method known as “suicide by cop.”

Through various conversations, Ferguson said Labaki confessed he was terrified of being jailed for his pending charges.

“He didn’t want to commit suicide — he was Catholic — but he did mention to me that he would make sure the job got done,” Ferguson said. “And that’s exactly what he did.”

Mental health treatment is a complex issue aggravated by the social stigma attached to a mental illness diagnosis. In Wyoming’s often tight-knit communities, residents fear they will be effectively branded as crazy if they divulge their mental issues or seek help. Ferguson believes it’s one of the reasons Wyoming perennially has one of the highest suicide rates in the country.

“Keith was a very prideful man,” Ferguson said. “And in the end he was just scared.”

Ferguson said she herself feels more comfortable telling people about her drug addiction than her mental illness. She suffers from major depressive disorder and is a recovering methamphetamine addict.

Rita Overfield, Ashley’s mother, said Wyoming’s “cowboy mentality” prevents people from understanding the realities of mental illness.

“It’s time for mental illness to come out of the closet in Wyoming,” she said. “So many people will hide the fact that they have these issues for fear of being ostracized by the community.”

In Cody, a city with fewer than 10,000 residents, Ashley Overfield said she’s infamous around town. Newspaper articles have chronicled her sometimes-aggressive run-ins with police.

“I have gotten so embarrassed of my situation and my name,” she said.

Overfield said she wants people to understand that mental illness is just as real as any physical ailment.

“There’s a person behind the illness,” she said.

***

Several programs are emerging in Wyoming and elsewhere to divert the epidemic of mentally ill incarceration.

Noel said she’s particularly encouraged by communities’ adoption of Crisis Intervention Teams, billed by NAMI as “local initiatives designed to improve the way law enforcement and the community responds to people experiencing mental health crises.”

Law enforcement officials who undergo CIT training learn mental health characteristics to watch out for when they are responding to an incident, and work closely with local hospitals and mental health agencies to find an appropriate course of action for the individual.

Noel credits CIT programs for deferring many people that would have in the jail system to places more suitable for treatment.

Currently seven Wyoming counties have at least one CIT program — Park, Sublette, Natrona, Albany, Platte, Laramie and Goshen.

Kreitzmann said introducing mental health courts into Wyoming’s justice system could help to break the cycle for her chronically incarcerated clients.

Modeled after drug courts, judges in mental health courts can offer certain pre-screened defendants community-based treatment alternatives rather than jail time. If defendants fail to abide by the treatment regimen, they could go back to criminal court.

U.S. mental health courts are a relatively recent addition to problem-solving courts, and research on their efficacy is limited.

Critics have questioned the ethics of this carrot-or-stick approach, but proponents say what research is available suggests mental health courts are both individually beneficial and cost-effective for communities.

“What happened was, once [the defendants] started using the models, started adhering to their treatment protocols, not surprisingly, you have a reduced appearance rate in hospitals and jails,” said Kenneth Robinson, president of Correctional Counseling, Inc.

Kreitzmann said she’s also encouraged by a provision of the federal health reform law that compels most insurance plans to provide fair coverage for mental health services.

“That’s going to be a huge advantage,” she said. “At least people can get through the door now, so that’s exciting.”

Kreitzmann stressed each individual’s treatment pathway will be different, and it’s important for those with mental illnesses to figure out what works for them.

For Overfield, it’s assertive, individualized community treatment that includes vocational counseling. Kreitzmann recently helped her secure a position where she’s working with horses, a lifelong hobby. Overfield hopes to work her way up to full-time.

“She’s going to be a taxpayer now,” Kreitzmann said. “She’s going to be successful and give back to the community.”

Kreitzmann maintains that a greater variety of community options would help to treat at least those who sought them out.

“We’re not going to save everybody,” she said. “But at least give them an option…[provide] realistic choices that people could be making that would reinforce positive change.”

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