Mental Health U
Mental Health U is a podcast dedicated to demystifying and destigmatizing mental health issues. If you or someone you know is struggling with depression, anxiety, trauma, or some other mental health issue, then this podcast is for you.
Mental Health U
Bridging Hope and Justice: Transforming Mental Health Care Behind Bars
Unlock a deeper understanding of the complex world where mental health care meets the justice system as Scott Knapp, the brains behind Unison Health's Jail-Based Mental Health Program, walks us through his transformative journey. From Wall Street to the corridors of Lucas County Jail, Scott's path is as compelling as it is enlightening. Our discussion peels back the layers on how targeted mental health interventions within the incarcerated population can not only change lives but potentially ripple through communities to reduce the scourge of recidivism.
Today's conversation is an eye-opener, revealing the inner mechanics of a program that's not just about managing symptoms, but about forging paths to reintegration and hope. Through candid dialogue, Scott underscores the tireless efforts of his team to deliver psychiatric care, therapy, and case management to those behind bars. We confront the barriers and breakthroughs experienced by those navigating their darkest moments, and how the right support at this critical juncture can pivot a person's trajectory towards a brighter future. Join us for a heartfelt and thought-provoking episode that will leave you with a renewed perspective on the power of compassion and commitment in the face of adversity.
But what really will impact recidivism is what happens when they're no longer with us. So if they go on to another facility and they're willing to engage in treatment and stick with it there, if they go back into the community and we're able to successfully link them either with whatever agency they were with before or newly with Unison Health, it's what happens after they leave us that has the biggest impact on recidivism, and so we try to set them up for success.
Bill Emahiser:Hello and welcome. I'm your Bill Emahiser, and you're listening to Mental Health U, the podcast dedicated to demystifying and destigmatizing mental health issues. So if you or someone you know is struggling with depression, anxiety, trauma or some other mental health issue, then this podcast is for you. This episode is proudly sponsored by Unison Health, dedicated to making lives better through compassionate, quality mental health and addiction treatment services. Learn more at unisonhealthorg. In today's episode, I am honored to introduce Scott Knapp, the program manager of the Jail-Based Mental Health Program at Unison Health, located in the Lucas County Jail, scott and his team address mental health needs and foster positive outcomes for those navigating the complex intersection of mental health and incarceration. Scott has a wealth of experience and knowledge to share. I'm really excited that he's on the show today. Welcome and thank you for being on today, scott.
Scott Knapp:Oh, it is a tremendous honor to be here with you, Bill. I've been looking forward to this.
Bill Emahiser:Well, that's great, and you have a very unique program and a unique position at Unison Health. So why don't we just start out by telling us a little bit about your professional experience and maybe how you became the manager of this unique program?
Scott Knapp:Sure, Well, I'm a Northwest Ohio guy, you know, by birth, and did my undergraduate degree in education at University of Toledo, and I actually got into the mental field after about a decade in the business world. So it gave me a little different perspective. But I started working with children and adolescents who had behavioral health psychological problems in a residential treatment facility back in the late 90s. I began working with duly diagnosed adults in 2011 at another agency here in the Toledo area and, even though I have never had or never experienced an addiction problem myself, I have some lived experience with mental health and my clients taught me what I needed to understand about. You know what was like to experience both together and have to recover. So you know any experience I do have. I have to give a lot of credit to my clients who taught me what their worlds were like.
Scott Knapp:I have been back in the Toledo area for about a year and prior to that I was working and practicing in the Cleveland area between Cuyahoga and Lake counties, and I again worked with both adolescents and adults who were duly diagnosed in a number of different settings, both residential and outpatient. I think that'd be the most exciting type of work I did was when I worked with a supervisor and assertive community treatment team in Cuyahoga County and that took us into just fascinating situations in, you know, all over the city, some of the roughest parts of the city. But there was something inside of me that just connected with it and loved it. So I found myself working at the Lake County Jail in Painesville directing a jail treatment program there. Lake County Jail is a long term incarceration facility. People serve their sentences there and we were providing both mental health and substance use services to, you know, the incarcerated population there and to try to set them up for success at the time that they were released. So I came back to Toledo about a year ago and, although I was working in another agency, I was tipped off about the position in the Lucas County Jail by a good friend of mine who works for UNISON and that Job just appealed to me a whole lot more than what I, what I had originally came back to do. So I made arrangements, I interviewed and I was given this position here to manage the program at Lucas County Jail and it felt like a homecoming to me. I really just enjoy working with this population.
Scott Knapp:I have no reticence about working in a jail environment.
Scott Knapp:For me, it just it feels like a home, but I think what I enjoy the most about it is I'm connecting with individuals in a very Unique place. Many of them have well the phrase they use on the streets Many have been ripping and running for a long time and and not facing any consequences for it, and it's been taking a toll on their. You know their bodies, their mental health, you know their relationships and and their encounter with the law brought them to a halt. It brought that to a stop, and so when I work with them in the jail, I'm actually meeting them at a point of not only tremendous need but great Opportunity for them to respond by making a change, and I think that's what I enjoy most about this kind of work Is that, for those who choose to accept the help and make a change, it makes a difference not only in their lives but, you know, for everyone that's connected to them. So that's that's been the experience that led up to me coming to this position, and I I've really enjoyed the ride.
Bill Emahiser:Can you tell us a little bit about what the jail-based program is?
Scott Knapp:Oh, absolutely Well. As the name implies, jail-based is a program that serves incarcerated people at the Lucas County Jail. So anyone who is incarcerated and and referred to us, they qualify for services and because we're grant funded, we don't have Some of the limitations that you typically see. You know, when you're negotiating with insurance, our referrals come from a variety of different sources. Incoming incarcerated people are given a mental health screening in the booking department right on the front end, so we may get referrals from. You know, the booking department. Jail staff make referrals when they suspect somebody is experiencing emotional or other mental health challenges and they might benefit from some kind of help.
Scott Knapp:Community partners, such as judges and the courts or Toledo AIDS or legal aid society rather Community partners who serve the incarcerated population contact us directly. You know, and we're always prepared to partner with other mental health agencies in our community, you know, to help them serve their clients. Not every agency has access to the jail like we do, and and occasionally we'll get a call from a family member who just has concerns about how their loved one is doing in jail. Maybe they're not presenting as well over the phone they're sounding distressed. So we've taken calls from family members before and then, every once in a while, as we're walking through the jail, somebody will Shout out to us from behind the bars and say hey, unison, I want to be seen. It doesn't matter where the referral comes from. We take the name, we get it on the list and then we try to see them as soon as possible. So and I should note that services that they receive from us, it they're all voluntary, meaning no one that's referred is obligated to engage with us.
Bill Emahiser:They do so only if they see some benefit in what we're offering did I hear correctly, everybody kind of gets a screen when they come through booking. Is that, yeah, yeah?
Scott Knapp:Not everybody presents as having needs when they go through this screen. Some people really, they don't enjoy the stigma of whatever, whatever challenges they've got, so they hold it together through the screen. But you know, then as they get in with the general population and, you know, begin to relax, some of those issues come to the surface. So, regardless of where the referral comes from, we're just grateful to have the opportunity to get in front of them and offer them some kind of help.
Bill Emahiser:Mental health. You is brought to you by unison health. Unison health making lives better. It sounds like an amazing program, but I would think that maybe the general population listening to this podcast might be thinking okay, that sounds great, you guys are providing these mental health services, but what is this program actually designed to do like? What are the goals or the outcomes, the mandates that you might have?
Scott Knapp:Well, the jail-based program was started a few years ago by unison health Sarah Grooner she's a director there and it was designed to bridge the gap between jail medical services in community mental health. So we provide behavioral health diagnostic evaluation. We try to link appropriate clients with a with a unison health psychiatric prescriber and we try to also offer behavioral health counseling and case management. You know, whatever makes sense for the client. Now, historically these kinds of services have not been available while someone's been incarcerated and the jail environment by its nature is not really conducive to restoring or maintaining a healthy mental state. So we see our services as being a help not only to the incarcerated person, you know, to improve functioning in mental state. It's also a help to the jail system and staff and that when you know when an incarcerated person is more stable it actually makes their jobs a bit easier and up to now Lucas County seems to actually appreciate and value our presence, for, you know, being here in the jail.
Bill Emahiser:I can only imagine that that's true and I would assume that there's some impact on, you know, people who have mental health issues that get involved with the legal system in some way. I would assume that there's somewhat of a revolving door. How does the jail-based mental health team contribute to preventing recidivism and promoting long-term mental health stability for individuals transitioning hopefully transitioning out of the criminal justice system?
Scott Knapp:Well, that's a great question. First, I need to clarify many of our clients are actually not transitioning out of the criminal justice system. Their stay at Lucas County Jail is usually temporary until they can be tried and sentenced, and then they'll typically be transferred to another facility to serve out that sentence. Now, occasionally we work with folks who are found not guilty of their charges and then they're released back to the community, but that doesn't happen quite so often. We connect with clients literally where they are in terms of their condition, regardless of what the future holds.
Scott Knapp:Many who get referred to us have histories of mental health and substance use challenges and they've been connected to either unison health or another service provider prior to their incarceration.
Scott Knapp:At one point or another, Not surprisingly, a lot of them can see that they're inattention to taking care of their mental health or addressing their substance use responsibly. That's what led them to committing the behaviors that resulted in arrest and incarceration. So we tend to see most of our clients for actually fewer than two months before they transition to wherever they're going next. So we have to work as fast as possible. We triage our referrals based on a criteria that we've established and we attempt to get in front of them within some designated timeframes that we think are reasonable. Once we've been able to assess their condition and needs, we'll engage with them as much as we can before they move on. Top priority for most is to consult with one of our psychiatric prescribers. We attempt to balance out our time after that between outreach and time spent in treatment, so we attempt to meet with them one on one for either therapy or case management several times a month while they're with us.
Bill Emahiser:Fantastic. I didn't even ask how many people do you serve in a given week or a given month, like how many people are on your caseload.
Scott Knapp:Well, when I came on board, I began keeping some pretty scrupulous outcomes measurements. My time in the business world was actually in manufacturing quality management, so I spent a lot of time collecting data, managing it and extrapolating information. So I've been using those skills in behavioral health for a while. On average, we get between 100 and 120 referrals a month Wow, again coming in from any source. Some of our referrals are actually active unison clients. Others are former clients that have no longer been active. Some of them have never been clients at all. Some come from courts and judges and community partners. Others are self-referred.
Scott Knapp:So we have a way of triaging these referrals and we prioritize getting to some a little bit sooner than others, just because of the amount of need or the particular source of the referral.
Scott Knapp:What we find is that, given the number of staff that I have and I would say it's a pretty regular thing for any group of treatment folks to say we don't have enough staff, and that's definitely our case in the jail we will get to about a third of the number of people who have been referred to us in a month.
Scott Knapp:The biggest reason for that figure is that many people are in and out of the jail in fewer than 10 days and with the number of staff that I have now and the number of referrals, we're averaging about 10 to 12 days before we can get in front of somebody newly referred. That's just kind of the reality we're facing with the numbers that we've got. And again, we could spend all day long just doing outreach and then we'd never do any treatment, or we could spend all day long doing treatment and then hardly ever do outreach. So we've sought to find a reasonable balance. But because people are in and out of the jail so quickly typically the ones that I call gotaways are gone within about 7 to 10 days and it's just unfortunate we're not able to get in front of them. But even if we could, the likelihood of getting them in front of a prescriber, based on the level of need right now, is actually pretty low.
Bill Emahiser:Yeah, yeah, it's always there. Seems like there's always challenges and barriers and just staff and funding and time. Yeah exactly.
Scott Knapp:Well, you know, and we kind of look at ourselves more like a mash unit in the combat zone because time is so tight you can't really do a lot of.
Scott Knapp:You know what we would traditionally call treatment. You know I do private practice. You know when I'm not working here in the jail and you know most of my clients. I'm working well and you're in private practice too. You know we work with our clients for months and maybe a year or more. These folks, if we only are working with them for about two months, we've got to get the best bang for the buck. So we're looking to stabilize them psychiatrically, connect with them interpersonally for the purpose of getting them prepared and set up for success wherever they're going to go next. So we're offering group therapy, individual therapy, case management again for those who are interested in engaging, and that's our top goal is to set them up for success at the next step, because there just is not enough time to do a lot of solid work, long-term, traditional work, in the environment that we're in.
Bill Emahiser:Well, considering that you only have that short amount of time, can you provide some examples of maybe a success story or positive outcomes resulting from your collaboration between mental health professionals, your team and the criminal justice system? Oh, absolutely.
Scott Knapp:I would say a lot of improvement for folks in the very short run is when they're able to get connected with a psychiatric prescriber. Right now we've got two prescribers coming into the jail so we're able to get people in front of them relatively quickly, like within a week to at the very most, and so the sooner we get in front of them after they've been referred, the quicker we can make that happen. Many of them are coming to us with some pretty severe psychiatric issues and again they'll admit that that, you know, not taking care of themselves, whether in the community, not following, you know, prescribed medication regimens, whatever contributed to the behavior that got them incarcerated. So if we can get them connected with the psychiatrist as soon as possible, a lot of times some of those issues begin to ameliorate. Then we try to make the interpersonal connection and for a lot of these folks that's also been something that's not been happening consistently in their lives. So you know, without mentioning any names or divulging any IDs, I think some of the best success stories we've seen are those who get involved in the therapy groups that we offer in the jail and begin to connect with other men in a way that's different from the typical bravado that you're going to have.
Scott Knapp:When they're just in a general population and they begin to loosen up, they begin to share some things that are on their heart. Occasionally they, you know, even in that short time, begin talking about some of the painful things, the traumatic things that you know have been dogging them for a very long time. And again, it's not often that we see, you know, complete healing, complete resolution, but we see a crack in a doorway that has been solidly kept shut for a long time. And so our hope is that when they go on to something else, they're going to take with them that willingness to reach out to others for help and hopefully that's going to start a positive trend.
Scott Knapp:When it comes to recidivism, quite honestly, the amount of time that we have with these folks, it does not cure recidivism. There's not a whole lot of responsibility that we can take for the program in the jail, but what really will impact recidivism is what happens when they're no longer with us. So if they go on to another facility and they're willing to engage in treatment and stick with it there, if they go back into the community and we're able to successfully link them either with whatever agency they were with before or newly with Unison Health. It's what happens after they leave us that has the biggest impact on recidivism, and so we try to set them up for success.
Bill Emahiser:That's amazing. Well, scott, I really appreciate your willingness to discuss your amazing team and your unique program. How can people get connected with you if they have questions or want to learn more? Maybe they have a loved one who is down at the Lucas County Jail. How can they connect with you? Oh?
Scott Knapp:absolutely. I can be reached at my email, which is one way sknapp, at unisonhealthorg. Or, if someone can't remember that, if they were to call the jail and just say I want to talk to Unison, a jail operator will put them right through to their office. The phone is right by my desk and I'm usually the playing telephone operator in our office, so it's usually going to be me picking up the phone. We'll take care of you whatever way you can get in touch with us. That's great.
Bill Emahiser:Well, thank you again for being on the show. I really appreciate your time and the amount of knowledge, and we're going to have to have you back on again to chat further because there's a lot more information I feel like we could discuss regarding the programming that you provide and the impact. So I really want to thank you for spending time with us today. I want to thank our listeners for spending the time with us on the podcast today and wish everybody a super fantastic day. This podcast has been brought to you by Unison Health. Unison Health is a nonprofit mental health agency dedicated to serving the Northwest Ohio community for the past 50 years. Unison Health is a nonprofit mental health agency dedicated to serving the Northwest Ohio community for the past 50 years.