MANTI, Utah \u2014 Garrett Clark estimates he has spent about six years in the Sanpete County Jail, a plain concrete building perched on a dusty hill just outside this small, rural town where he grew up.<\/p>\n

He blames his addiction. He started using in middle school, and by the time he was an adult he was addicted to meth and heroin. At various points, he\u2019s done time alongside his mom, his dad, his sister, and his younger brother.<\/p>\n

\u201cThat\u2019s all I\u2019ve known my whole life,\u201d said Clark, 31, in December.<\/p>\n

Clark was at the jail to pick up his sister, who had just been released. The siblings think this time will be different. They are both sober. Shantel Clark, 33, finished earning her high school diploma during her four-month stay at the jail. They have a place to live where no one is using drugs.<\/p>\n

And they have Cheryl Swapp, the county sheriff\u2019s new community health worker, on their side.<\/p>\n

\u201cShe saved my life probably, for sure,\u201d Garrett Clark said.<\/p>\n

Swapp meets with every person booked into the county jail soon after they arrive and helps them create a plan for the day they get out.<\/p>\n

She makes sure everyone has a state ID card, a birth certificate, and a Social Security card so they can qualify for government benefits, apply to jobs, and get to treatment and probation appointments. She helps nearly everyone enroll in Medicaid and apply for housing benefits and food stamps. If they need medication to stay off drugs, she lines that up. If they need a place to stay, she finds them a bed.<\/p>\n

On the day of her release from Sanpete County Jail in rural Utah in December, Shantel Clark hugs Cheryl Swapp, the jail\u2019s community health worker, at the sheriff\u2019s office. Clark\u2019s sweatshirt had just been pulled from a supply of clothing for people who are released at a different time of year than when they were booked.(Lillian Mongeau Hughes for KFF Health News)<\/span><\/figcaption><\/figure>\n
Then Swapp coordinates with the jail captain to have people released directly to the treatment facility. Nobody leaves the jail without a ride and a drawstring backpack filled with items like toothpaste, a blanket, and a personalized list of job openings.<\/p>\n
\u201cA missing puzzle piece,\u201d Sgt. Gretchen Nunley, who runs educational and addiction recovery programming for the jail, called Swapp.<\/p>\n
Swapp also assesses the addiction history of everyone held by the county. More than half arrive at the jail addicted to something.<\/p>\n
Nationally, 63% of people<\/a> booked into local jails struggle with a substance use disorder \u2014 at least six times the rate of the general population, according to the federal Substance Abuse and Mental Health Services Administration. The incidence of mental illness in jails is more than twice the rate in the general population, federal data shows. At least 4.9 million people are arrested and jailed every year, according to an analysis of 2017 data<\/a> by the Prison Policy Initiative, a nonprofit organization that documents the harm of mass incarceration. Of those incarcerated, 25% are booked two or more times, the analysis found. And among those arrested twice, more than half had a substance use disorder and a quarter had a mental illness.<\/p>\n
\u201cWe don\u2019t lock people up for being diabetic or epileptic,\u201d said David Mahoney, a retired sheriff in Dane County, Wisconsin, who served as president of the National Sheriffs\u2019 Association<\/a> in 2020-21. \u201cThe question every community needs to ask is: \u2018Are we doing our responsibility to each other for locking people up for a diagnosed medical condition?\u2019\u201d<\/p>\n
$\"A$
Folders fill several drawers in the office of Cheryl Swapp, a community health worker at Sanpete County Sheriff\u2019s Office in rural Utah.(Lillian Mongeau Hughes for KFF Health News)<\/span><\/figcaption><\/figure>\n
$\"A$
The library and therapy room at Castle Ridge Behavioral Health in Castle Dale, Utah, is meant to be a peaceful place to study and think for people recovering from substance use disorder.(Lillian Mongeau Hughes for KFF Health News)<\/span><\/figcaption><\/figure>\n
The idea that county sheriffs might owe it to society to offer medical and mental health treatment to people in their jails is part of a broader shift in thinking among law enforcement officials that Mahoney said he has observed during the past decade.<\/p>\n
\u201cDon\u2019t we have a moral and ethical responsibility as community members to address the reasons people are coming into the criminal justice system?\u201d asked Mahoney, who has 41 years of experience in law enforcement.<\/p>\n
Swapp previously worked as a teacher\u2019s aide for those she calls the \u201cbehavior kids\u201d \u2014 children who had trouble self-regulating in class. She feels her work at the jail is a way to change things for the parents of those kids. And it appears to be working.<\/p>\n
Since the Sanpete County Sheriff\u2019s Office hired Swapp last year, recidivism has dropped sharply. In the 18 months before she began her work, 599 of the people booked into Sanpete County Jail had been there before. In the 18 months after she started, that number dropped to 237.<\/p>\n
In most places, people are released from county jails with no health care coverage, no job, nowhere to live, and no plan to stay off drugs or treat their mental illness. Research shows<\/a> that people newly released from incarceration face a risk of overdose that is 10 times as high as that of the general public.<\/p>\n
Sanpete wasn\u2019t any different.<\/p>\n
\u201cFor seven to eight years of me being here, we\u2019d just release people and cross our fingers,\u201d said Jared Hill, the clinical director for Sanpete County and a counselor at the jail.<\/p>\n
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Nunley, the programming sergeant, remembers watching people released from jail walk the mile to town with nothing but the clothes they\u2019d worn on the day they were arrested \u2014 it was known as the \u201cwalk of shame.\u201d Swapp hates that phrase. She said no one has made the trip on foot since she started in July 2022.<\/p>\n
Swapp\u2019s work was initially funded by a grant from the U.S. Health Resources and Services Administration, but it has proved so popular that commissioners in Sanpete County voted to use a portion of its opioid settlement money<\/a> to cover the position in the future.<\/p>\n
Swapp doesn\u2019t have formal medical or social work training. She is certified by the state of Utah as a community health worker, a job that has become more common nationwide. There were about 67,000 people working as community health workers in 2022, according to the U.S. Bureau of Labor Statistics<\/a>.<\/p>\n
Evidence is mounting that the model of training people to help their neighbors connect to government and health care services is sound, said Aditi Vasan, a senior fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania who has reviewed the research<\/a> on the relatively new role.<\/p>\n
The day before Swapp coordinated Shantel Clark\u2019s release, she sat with Robert Draper, a man in his 50s with long white hair and bright-blue eyes. Draper has been in and out of jail for decades. He was sober for a year and had been taking care of his ill mother. She kept getting worse. Then his daughter and her child came to help. It was all a little too much.<\/p>\n
\u201cI thought, if I can just go and get high, I can deal with this shit,\u201d said Draper. \u201cBut after you\u2019ve been using for 40 years, it\u2019s kinda easy to slip back in.\u201d<\/p>\n
He didn\u2019t blame his probation officer for throwing him back in jail when he tested positive for drugs, he said. But he thinks jail time is an overreaction to a relapse. Draper sent a note to Swapp through the jail staff asking to see her. He was hoping she could help him get out so he could be with his mom, who had just been sent to hospice. He had missed his father\u2019s death years ago because he was in jail at the time.<\/p>\n
$\"Cheryl$
Cheryl Swapp, a community health worker, makes notes between meetings with new detainees at the Sanpete County Jail outside Manti, Utah, on Dec. 18. Swapp usually meets with people inside the jail but was using a visitation room to accommodate a visiting journalist.(Lillian Mongeau Hughes for KFF Health News)<\/span><\/figcaption><\/figure>\n
Swapp listened to Draper\u2019s story without interruptions or questions. Then she asked if she could run through her list with him so she would know what he needed.<\/p>\n
\u201cDo you have your Social Security card?\u201d<\/p>\n
\u201cMy card?\u201d Draper shrugged. \u201cI know my number.\u201d<\/p>\n
\u201cYour birth certificate, you have it?\u201d<\/p>\n
\u201cYeah, I don\u2019t know where it is.\u201d<\/p>\n
\u201cDriver\u2019s license?\u201d<\/p>\n
\u201cNo.\u201d<\/p>\n
\u201cWas it revoked?\u201d<\/p>\n
\u201cA long, long time ago,\u201d Draper said. \u201cDUI from 22 years ago. Paid for and everything.\u201d<\/p>\n
\u201cAre you interested in getting it back?\u201d<\/p>\n
\u201cYeah!\u201d<\/p>\n
Swapp has some version of this conversation with every person she meets in the jail. She also runs through their history of addiction and asks them what they most need to get back on their feet.<\/p>\n
She told Draper she would try to get him into intensive outpatient therapy. That would involve four to five classes a week and a lot of driving. He\u2019d need his license back. She didn\u2019t make promises but said she would talk to his probation officer and the judge. He sighed and thanked her.<\/p>\n
\u201cI\u2019m your biggest fan here,\u201d Swapp said. \u201cI want you to succeed. I want you to be with your mom, too.\u201d<\/p>\n
The federal grant that funded the launch of Sanpete\u2019s community health worker program is held by the regional health care services organization Intermountain Health. Intermountain took the idea to the county and has provided Swapp with support and training. Intermountain staff also administer the $1 million, three-year grant, which includes efforts to increase addiction recovery services in the area.<\/p>\n
A similarly funded program in Kentucky called First Day Forward took the community health worker model a step further, using \u201cpeer support specialists\u201d \u2014 people who have experienced the issues they are trying to help others navigate. Spokespeople from HRSA pointed to four programs, including the ones in Utah and Kentucky, that are using their grant money for people facing or serving time in local jails.<\/p>\n
Back in Utah, Sanpete\u2019s new jail captain, Jeff Nielsen, said people in small-town law enforcement weren\u2019t so far removed from those serving time.<\/p>\n
\u201cWe know these people,\u201d Nielsen said. He has known Robert Draper since middle school. \u201cThey are friends, neighbors, sometimes family. We\u2019d rather help than lock them up and throw away the key. We\u2019d rather help give them a good life.\u201d<\/p>\n
$\"The$
The sun rises over the Sanpete County Jail and Sheriff\u2019s Office outside Manti, Utah, on Dec. 19.(Lillian Mongeau Hughes for KFF Health News)<\/span><\/figcaption><\/figure>\n
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On the day of her release from Sanpete County Jail in rural Utah in December, Shantel Clark hugs Cheryl Swapp, the jail\u2019s community health worker, at the sheriff\u2019s office. Clark\u2019s sweatshirt had just been pulled from a supply of clothing for people who are released at a different time of year than when they were booked.(Lillian Mongeau Hughes for KFF Health News)<\/span><\/figcaption><\/figure>\n
Then Swapp coordinates with the jail captain to have people released directly to the treatment facility. Nobody leaves the jail without a ride and a drawstring backpack filled with items like toothpaste, a blanket, and a personalized list of job openings.<\/p>\n
\u201cA missing puzzle piece,\u201d Sgt. Gretchen Nunley, who runs educational and addiction recovery programming for the jail, called Swapp.<\/p>\n
Swapp also assesses the addiction history of everyone held by the county. More than half arrive at the jail addicted to something.<\/p>\n
Nationally, 63% of people<\/a> booked into local jails struggle with a substance use disorder \u2014 at least six times the rate of the general population, according to the federal Substance Abuse and Mental Health Services Administration. The incidence of mental illness in jails is more than twice the rate in the general population, federal data shows. At least 4.9 million people are arrested and jailed every year, according to an analysis of 2017 data<\/a> by the Prison Policy Initiative, a nonprofit organization that documents the harm of mass incarceration. Of those incarcerated, 25% are booked two or more times, the analysis found. And among those arrested twice, more than half had a substance use disorder and a quarter had a mental illness.<\/p>\n
\u201cWe don\u2019t lock people up for being diabetic or epileptic,\u201d said David Mahoney, a retired sheriff in Dane County, Wisconsin, who served as president of the National Sheriffs\u2019 Association<\/a> in 2020-21. \u201cThe question every community needs to ask is: \u2018Are we doing our responsibility to each other for locking people up for a diagnosed medical condition?\u2019\u201d<\/p>\n
$\"A$
Folders fill several drawers in the office of Cheryl Swapp, a community health worker at Sanpete County Sheriff\u2019s Office in rural Utah.(Lillian Mongeau Hughes for KFF Health News)<\/span><\/figcaption><\/figure>\n
$\"A$
The library and therapy room at Castle Ridge Behavioral Health in Castle Dale, Utah, is meant to be a peaceful place to study and think for people recovering from substance use disorder.(Lillian Mongeau Hughes for KFF Health News)<\/span><\/figcaption><\/figure>\n
The idea that county sheriffs might owe it to society to offer medical and mental health treatment to people in their jails is part of a broader shift in thinking among law enforcement officials that Mahoney said he has observed during the past decade.<\/p>\n
\u201cDon\u2019t we have a moral and ethical responsibility as community members to address the reasons people are coming into the criminal justice system?\u201d asked Mahoney, who has 41 years of experience in law enforcement.<\/p>\n
Swapp previously worked as a teacher\u2019s aide for those she calls the \u201cbehavior kids\u201d \u2014 children who had trouble self-regulating in class. She feels her work at the jail is a way to change things for the parents of those kids. And it appears to be working.<\/p>\n
Since the Sanpete County Sheriff\u2019s Office hired Swapp last year, recidivism has dropped sharply. In the 18 months before she began her work, 599 of the people booked into Sanpete County Jail had been there before. In the 18 months after she started, that number dropped to 237.<\/p>\n
In most places, people are released from county jails with no health care coverage, no job, nowhere to live, and no plan to stay off drugs or treat their mental illness. Research shows<\/a> that people newly released from incarceration face a risk of overdose that is 10 times as high as that of the general public.<\/p>\n
Sanpete wasn\u2019t any different.<\/p>\n
\u201cFor seven to eight years of me being here, we\u2019d just release people and cross our fingers,\u201d said Jared Hill, the clinical director for Sanpete County and a counselor at the jail.<\/p>\n
\n
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\n\t\t\tEmail Sign-Up\t\t<\/a>
\n\t<\/h4>\n
\n\t\tSubscribe to KFF Health News’ free Morning Briefing.\t<\/p>\n<\/div>\n
Nunley, the programming sergeant, remembers watching people released from jail walk the mile to town with nothing but the clothes they\u2019d worn on the day they were arrested \u2014 it was known as the \u201cwalk of shame.\u201d Swapp hates that phrase. She said no one has made the trip on foot since she started in July 2022.<\/p>\n
Swapp\u2019s work was initially funded by a grant from the U.S. Health Resources and Services Administration, but it has proved so popular that commissioners in Sanpete County voted to use a portion of its opioid settlement money<\/a> to cover the position in the future.<\/p>\n
Swapp doesn\u2019t have formal medical or social work training. She is certified by the state of Utah as a community health worker, a job that has become more common nationwide. There were about 67,000 people working as community health workers in 2022, according to the U.S. Bureau of Labor Statistics<\/a>.<\/p>\n
Evidence is mounting that the model of training people to help their neighbors connect to government and health care services is sound, said Aditi Vasan, a senior fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania who has reviewed the research<\/a> on the relatively new role.<\/p>\n
The day before Swapp coordinated Shantel Clark\u2019s release, she sat with Robert Draper, a man in his 50s with long white hair and bright-blue eyes. Draper has been in and out of jail for decades. He was sober for a year and had been taking care of his ill mother. She kept getting worse. Then his daughter and her child came to help. It was all a little too much.<\/p>\n
\u201cI thought, if I can just go and get high, I can deal with this shit,\u201d said Draper. \u201cBut after you\u2019ve been using for 40 years, it\u2019s kinda easy to slip back in.\u201d<\/p>\n
He didn\u2019t blame his probation officer for throwing him back in jail when he tested positive for drugs, he said. But he thinks jail time is an overreaction to a relapse. Draper sent a note to Swapp through the jail staff asking to see her. He was hoping she could help him get out so he could be with his mom, who had just been sent to hospice. He had missed his father\u2019s death years ago because he was in jail at the time.<\/p>\n
$\"Cheryl$
Cheryl Swapp, a community health worker, makes notes between meetings with new detainees at the Sanpete County Jail outside Manti, Utah, on Dec. 18. Swapp usually meets with people inside the jail but was using a visitation room to accommodate a visiting journalist.(Lillian Mongeau Hughes for KFF Health News)<\/span><\/figcaption><\/figure>\n
Swapp listened to Draper\u2019s story without interruptions or questions. Then she asked if she could run through her list with him so she would know what he needed.<\/p>\n
\u201cDo you have your Social Security card?\u201d<\/p>\n
\u201cMy card?\u201d Draper shrugged. \u201cI know my number.\u201d<\/p>\n
\u201cYour birth certificate, you have it?\u201d<\/p>\n
\u201cYeah, I don\u2019t know where it is.\u201d<\/p>\n
\u201cDriver\u2019s license?\u201d<\/p>\n
\u201cNo.\u201d<\/p>\n
\u201cWas it revoked?\u201d<\/p>\n
\u201cA long, long time ago,\u201d Draper said. \u201cDUI from 22 years ago. Paid for and everything.\u201d<\/p>\n
\u201cAre you interested in getting it back?\u201d<\/p>\n
\u201cYeah!\u201d<\/p>\n
Swapp has some version of this conversation with every person she meets in the jail. She also runs through their history of addiction and asks them what they most need to get back on their feet.<\/p>\n
She told Draper she would try to get him into intensive outpatient therapy. That would involve four to five classes a week and a lot of driving. He\u2019d need his license back. She didn\u2019t make promises but said she would talk to his probation officer and the judge. He sighed and thanked her.<\/p>\n
\u201cI\u2019m your biggest fan here,\u201d Swapp said. \u201cI want you to succeed. I want you to be with your mom, too.\u201d<\/p>\n
The federal grant that funded the launch of Sanpete\u2019s community health worker program is held by the regional health care services organization Intermountain Health. Intermountain took the idea to the county and has provided Swapp with support and training. Intermountain staff also administer the $1 million, three-year grant, which includes efforts to increase addiction recovery services in the area.<\/p>\n
A similarly funded program in Kentucky called First Day Forward took the community health worker model a step further, using \u201cpeer support specialists\u201d \u2014 people who have experienced the issues they are trying to help others navigate. Spokespeople from HRSA pointed to four programs, including the ones in Utah and Kentucky, that are using their grant money for people facing or serving time in local jails.<\/p>\n
Back in Utah, Sanpete\u2019s new jail captain, Jeff Nielsen, said people in small-town law enforcement weren\u2019t so far removed from those serving time.<\/p>\n
\u201cWe know these people,\u201d Nielsen said. He has known Robert Draper since middle school. \u201cThey are friends, neighbors, sometimes family. We\u2019d rather help than lock them up and throw away the key. We\u2019d rather help give them a good life.\u201d<\/p>\n
$\"The$
The sun rises over the Sanpete County Jail and Sheriff\u2019s Office outside Manti, Utah, on Dec. 19.(Lillian Mongeau Hughes for KFF Health News)<\/span><\/figcaption><\/figure>\n
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