On Thursday, a Carbon County Correctional Facility inmate was found dead of what officials said was a possible suicide.

Rodney Hudock was found less than six months after another inmate hanged himself in his cell.This was the second incident in the Carbon facility in the last year.In Schuylkill County prison, staff and emergency medical technicians on Oct. 22, 2014, scrambled to save the life of an inmate who used a shoelace to hang himself in his cell.As he investigates the latest suicide, Carbon County Warden Timothy Fritz must also cope with a 54-year-old inmate suffering dementia who is accusing of causing the death of an elderly woman he had pushed at the former county nursing home in May 2013.“They realize he didn’t know what he was doing at the time. But he needs full-time care. It’s challenging because he probably has the mind of 7- or 8-year-old,” Fritz says.The dementia patient and the men who ended their lives are among a growing number of mentally ill prison inmates who are stressing staff, straining budgets, and suffering more as they fail to get the treatment they need. The increase is a consequence of the closing of state mental hospitals, begun in the 1950s, experts say.The domino effectThe influx of mentally ill people into prisons has its roots in the decline of state mental hospitals, says Laura Usher of the National Alliance on Mental Illness.“When the hospitals were closed, the vision was that there would be a robust system of community-based mental health care to support people who have serious mental illness. In 1963, Congress passed the Community Mental Health Centers Act that was supposed to fund this system of community mental health centers.“Only about half of the needed centers were ever built, and most were not well-funded, leaving people with serious needs without the support they needed, resulting in really tragic outcomes like homelessness, substance abuse and criminalization,” Usher says.Adoratia T. Purdy of the U.S. Department of Justice cites a 2014 joint report by the Treatment Advocacy Center and the National Sheriffs’ Association finding that as of 2012, there were about “356,268 inmates with severe mental illness in prisons and jails. There were also approximately 35,000 patients with severe mental illness in state psychiatric hospitals. Thus, the number of mentally ill persons in prisons and jails was 10 times the number remaining in state hospitals,” she says.Francis J. Komykoski, vice president of operations for PrimeCare Medical, Harrisburg, which manages health care at 41 correctional facilities in the state, including Schuylkill, says mentally ill people sometimes “end up in jail after committing a minor offense because their families can’t take care of them, their community can’t take care of them. They really shouldn’t be in jail. But state hospitals are so limited in beds it could be months before a person gets a bed.”It can be an endless cycle, Usher says.“Many times, when a person experiences a crisis, the family doesn’t know how to get help, so they call the police to get the person to the hospital; of course, that often leads to arrest. People with very serious illnesses are the most likely to fall through the cracks and get no support. Many wind up in jail for minor offenses (often related to homelessness, substance abuse or symptoms of illness) and the people with the highest need seem to recycle through jails, emergency rooms, homeless shelters and other costly emergency services,” she says.Local prisons under pressureWarden Fritz feels the frustration.“We’re doing the best we can, but we are not trained to handle mentally ill inmates,” he says.Because Carbon County’s prison is already close to capacity, it has converted the gym to a housing area for elderly and mentally ill inmates.“We keep them away from the stronger inmates to keep them safe,” Fritz says.Schuylkill County Warden Eugene Berdanier is also seeing the numbers of mentally ill inmates rise.“Police do their best to screen and divert. If they see indications of mental illness, they take the person for an evaluation. If they qualify, psychiatric treatment could be three days to two weeks. After that they could be jailed for the crime. We’re seeing more and more of that. People languish in jail. It’s difficult to place people. Their cases take much longer to process through system due to (their lack of) competency,” he says.The longer stays and special needs take their toll, he says.“The needs for services are increased over and above normal. Medication costs are higher, and observation, care and custody is heightened because of their conditions,” Berdanier says. “Sometimes they can’t be around other inmates and have to be isolated. It’s a delicate balance. In a correctional system, we have to ensure their safety and the safety of others.”Monroe County Commissioner John Moyer at a candidates’ forum last month spoke about the increase in mentally ill inmates and the impact it’s having on the county prison. The inmates do not have access to the services they need to keep them out of jail, driving up the population to almost double the prison’s 250-person capacity.What can be done?“With the closings of state hospitals, and the lack of resources, county jails are becoming known as the mental health facilities of the 21st century,” Berdanier says.“Every warden I talk to has similar concerns. I think we’re doing a fairly good job, working with county agencies. But something has to give. It’s hurting the individual mostly because of lack of proper treatment.”Komykoski says inmates’ stays in county jails, typically 35 to 120 days, are too short for effective treatment.“That makes our job in just trying to identify and figure out what’s going on with this person. Most of the time, by the time we get it figured out and get them stable, their jail sentence is over,” he says.NAMI’s Usher says some effective programs include crisis intervention teams (training police on how to respond to mental health crisis situations and building better coordination between criminal justice and mental health systems so that police can easily transfer a person for mental health care).Other ideas are mental health courts, which take a person charged with a crime and put them through a court-supervised period of treatment (usually 18-24 months) instead of jail.Re-entry planning helps people leaving jail get the services that they need to be successful on the outside (such as health insurance, housing, mental health and substance abuse care, education and employment services).