Ronald Gene Given thought someone was trying to kill him.

On a Tuesday morning in January 2019, he went into a Tractor Supply Co. store in Shawnee, grabbed a shopping cart and started to ram it against the shop’s windows. He pulled clothes off racks and threw them onto the concrete floor.

He was trying to make a commotion, he told store employees, urging them to call the police. After all, Given said, his life was in danger.

Shawnee police officers took Given, 42, from the store to St. Anthony Hospital Shawnee Hospital for evaluation, where health care workers cleared him medically but deemed him in need of emergency detention at a state behavioral health center, according to an incident report.

But every state mental health center in Oklahoma was full. Given died a week after officers restrained him during a struggle at Pottawatomie County jail.

Given’s death illustrates the challenges and shortcomings law enforcement and detention facilities grapple with to care for people with mental health or substance use problems, a group that steadily floods county jails.

More than three years after Oklahoma voters approved a measure to fund county-level mental health and substance abuse treatment services, the Legislature has yet to send any of the promised funds. For years, a lack of resources and funds have plagued both the prevention and crisis treatment sides of Oklahoma’s mental health and substance abuse system, experts and advocates say. By default, many who need treatment end up in the state’s jails.

Tossed into a criminal justice system that is neither designed nor equipped to effectively handle the tide of individuals with mental illness or substance abuse issues, and with little oversight from state regulators, the result is sometimes injury or death.

Sheriffs and jail staff often are the first to admit they are ill-equipped to handle these people, who come with a unique set of needs, such as heightened monitoring and specialized medical care.

The issue is especially acute in Oklahoma’s rural counties where there are fewer treatment options and limited emergency mental health professionals to aid people in the throes of mental health crises. Law enforcement officers typically are the lone first responders.

Compounding the problem is a lack of effective oversight over county jails. The state’s jail inspection division, which falls under Oklahoma State Department of Health, surveys jails and investigates deaths, but can do little to penalize jails when it identifies shortcomings.

The outcomes can be deadly.

With no mental health beds available in the state, Given stayed the night at the hospital in Shawnee.

Officers waited with him, taking turns in shifts until they could transport him to a facility.

About 12 hours into the stay, Given stood up from his hospital bed and decided it was time to leave. He stripped off his hospital gown along with one of his socks and started to walk toward the room’s door.

“Get out of the way. I’m leaving,” Given told officers, according to an incident report.

Officers told the man to get back in bed, but instead Given got into a “fighting stance,” balled up his fists and said he was going to make them move. He stepped forward and pushed one of the officers in the shoulder.

Police arrested Given. As an officer started to lead him to a patrol car, the incident report states, he was “passively resisting” by pushing against the officer and rambling indecipherably. Once in the car, he strained his body in an attempt to break free from the cuffs.

Given was booked into Pottawatomie County Public Safety Center for assault and battery on a police officer just before 1 a.m., where he stayed for less than 10 hours before he was released on a medical bond, according to a jail release report. He died in an Oklahoma City hospital about a week later.

It’s unclear what happened to Given at the jail. A report from the state’s medical examiner found Given died from organ failure caused by cardiac arrhythmia from struggling as officers restrained him. Given became ill or injured at the jail and the death was ruled a homicide, the report stated. The report noted he had a violent mental disorder.

The jail staff did not report his death or injuries to the state Health Department’s jail inspection division. The jail was not required to report the incident because Given did not die at the jail, said Health Department spokeswoman Jamie Dukes.

Breonna Thompson, director of Pottawatomie County Jail, did not return multiple messages from The Frontier requesting an interview.

Oklahoma State Bureau of Investigation opened an inquiry into Given’s death in 2019 and passed the findings along to Pottawatomie County’s district attorney. District Attorney Allan Grubb refused to release the investigation’s findings after a spokesman for his office initially offered to let a Frontier reporter review the document.

Grubb has not filed criminal charges in connection with Given’s death.

Not enough attention

“You’re asking sheriffs in rural counties who operate these jails to take care of, essentially, individuals who have untreated mental illness while they’re in their jail with almost no resources,” said Mike Brose, CEO of Mental Health Association Oklahoma.

County Community Safety Investment Fund was supposed to offer county jails some relief.

Oklahoma voters passed State Questions 780 and 781 in 2016. While SQ 780 lessened penalties for simple drug possession and theft, SQ 781 directed that the money saved from lessening those penalties go into a fund for counties to provide community-based mental health and substance abuse services.

The Oklahoma Legislature has yet to appropriate any money into the County Community Safety Investment Fund promised by SQ 781.

Though Gov. Kevin Stitt initially called for $10 million to go into the fund, he later signed a budget that instead sent the money to Oklahoma Department of Mental Health and Substance Abuse Services’ Smart on Crime Initiative, which aims to divert nonviolent offenders living with mental illness and addiction away from the criminal justice system, and into intervention and treatment programs. The program also provides training to law enforcement responding to mental health crises.

ODMHSAS used the $10 million to fund 175 residential substance abuse treatment beds across the state, which are expected to shorten the state waiting list for those beds by 75%, according to the agency’s fiscal year 2021 budget request.

In the agency’s request, ODMHSAS originally requested $80.2 million to implement Smart on Crime programs, which include treatment and diversion services. The agency later amended the request to about $115.7 million in order to fund misdemeanor diversion programs.

“We have not given mental health and substance abuse issues due attention. In the end, this has led to a fractured and fragmented system of care,” the request stated.

State leaders determined that putting the funds into the initiative would “best achieve everyone’s shared vision,” said Baylee Lakey, a spokeswoman for Stitt, in an email. The program, among other initiatives, aims to expand mental health services and drug courts in each of the state’s 77 counties, she said.

Lakey said largely because of SQ 780 reforms, Department of Corrections has seen a 7.6% decrease in the prison population.

Dewey County Sheriff Clay Sander is on a 22-member council that is chaired by Attorney General Mike Hunter. The council recently recommended SQ 781 funds be distributed on a county level.

“I can tell you in Dewey County we have not seen any benefits from that program,” Sander said of the Smart on Crime Initiative.

The Dewey County jail typically houses 20 to 30 inmates on any given day, Sander said. About half of them have mental health or substance use problems. The county has no treatment facilities, he said. The closest is almost a 40-minute drive away.

Between 700,000 and 900,000 Oklahomans need behavioral health services, according to ODMHSAS. However, only one in three accesses treatment.

There are 632 state-operated crisis and inpatient mental health beds across Oklahoma, which are considered the mental health system’s safety net, advocates say. The state also has about 670 inpatient substance use treatment beds. The wait time for those beds recently has stretched up to six months, according to ODMHSAS.

About 10 years ago, ODMHSAS requested state funding for five additional crisis units. So far, the agency has been able to fund three. However, as funding has diminished for outpatient services, the demand for crisis care has grown. The state now could use three more facilities, agency officials have said.

Ill-equipped jails

Many people come into detention centers with serious untreated medical and mental health issues that few Oklahoma jails are equipped to treat.

State jail standards require facilities to complete intake screenings on inmates using at minimum, a medical and mental health questionnaire approved by Oklahoma State Department of Health. The process does not require medical personnel.

When an inmate shows “significant” signs of mental illness, jail staff are required to monitor them “frequently,” the standards state, and the inmate must be evaluated by a medical professional.

Few Oklahoma jails have in-house health care delivery services, but some have nurses who will visit periodically, advocates and experts say.

Jail standards require facilities to have a plan for medical emergencies, such as identifying a designated emergency room or ambulance service. Determining what constitutes a medical emergency frequently falls to jail staff.

Damion Shade, a criminal justice policy analyst at Oklahoma Policy Institute, a think tank, said the state particularly lacks resources in rural areas and was critical of the fact law enforcement officers are expected to be the first responders to someone in the midst of a mental health crisis.

“A lot of times, it’s very unfair what we do to police. … Many of them want to do the right thing for their community,” Shade said. “They want to do good.”

Shade said there are many cases when officers are “forced” to take people to jail when there are a lack of treatment options in the area.

“If we really value our police officers, if we really value our law enforcement, we should not force them to have to decide what to do with someone who needs treatment when their only option is jail,” he said.

‘The system is not equipped’

Oklahoma Criminal Justice Reclassification Coordination Council, chaired by Attorney General Mike Hunter, released a report on Dec. 31 that listed recommendations on how to improve the state’s criminal justice system, including increased mental health and diversion program access.

Mental health and substance abuse issues were two of the main focuses of the council, which met throughout 2019.

“Throughout the meetings, it became clear the criminal justice system is becoming saturated with individuals with mental health and addiction issues,” the report states. “and the system is not properly equipped to meet all the needs.”

Cleveland County Sheriff Todd Gibson noted in the report that jails were housing an influx of people with mental health and substance misuse issues in jails because of fewer felony possession arrests and more misdemeanor possession arrests following the passage of SQ 780.

Voters passed SQ 780 and SQ 781 because they wanted people struggling with addiction or mental health to get treatment before law enforcement involvement, Shade said. Because the counties were promised those funds, the money should be invested in treatment, he said.

“Because that’s what people voted for,” Shade said. “In the process of decriminalizing, we’re creating a system where more people are in the county jail structure. The only way not to be overburdensome is if we invest in treatment that allows many, many more people to go into treatment before jail.”

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