Could Norway’s mental health focus reduce incarceration in Michigan?

Halden, Norway — Fredrik Soerfjordmo sits at an Apple computer in a sun-filled print shop, designing artwork to be reproduced on a ceramic coffee mug. 

In the past six years, the 30-year-old Norwegian has earned a high school diploma, as well as diplomas in photography, typography and digital tools. Soerfjordmo said he also has gained insight into why he once stabbed a man to death.

"I've been going to a psychologist and psychiatrist and working on all of this so I can live with myself," he said. "All of this that I did is very far from where I am."

Soerfjordmo is serving his sixth year of a 15-year sentence at Halden Prison in Norway, which is considered the gold standard for the healthy rehabilitation of inmates. The  recidivism rates in Michigan and Norway suggest his chances of remaining free after serving his sentence are greater than for inmates released from U.S. prisons. 

Norway has gained an international reputation for effectively rehabilitating prisoners, while officials in Michigan and across the country face burgeoning jail populations and costs — fueled significantly by the mentally ill. 

Small elements of Michigan's criminal justice system reflect Norway's rehabilitative approach, from drug treatment courts to art and music therapy at a facility that treats the state's most severely mentally ill inmates. States such as North Dakota and Oregon have more aggressively changed how they handle prisoners based on the Norwegian system, hoping to improve treatment and reduce the number of repeat offenders.

See the full "Healing Justice" report | About this project 

The Detroit News recently visited Halden Prison, as well as mental health programs and psychiatric hospitals in Norway, to study the intersection of criminal justice and mental health in that country. Michigan has an incarceration rate that is more than eight times higher than Norway's, and the state is studying ways to reduce crowded jails. 

Michigan's search for solutions comes as mass shootings across the country have cast a spotlight on mental health. 

Critics argue that failings in the United States' mental health system have turned U.S. jails and prisons into revolving doors for people with mental illness — a problem they say contributes to high incarceration rates while making some mentally ill prisoners sicker. They contend Norway, with a population about half of Michigan's nearly 10 million people, provides an example of how America and its states could better balance government spending between criminal justice and mental health services. 

Norway spent $129,222 per prisoner in 2018 compared with $38,051 spent per prisoner in Michigan, according to their respective government agencies. Federal prisons averaged $36,299 per inmate in 2017, the latest year available, according to the Federal Bureau of Prisons.

Norway spends more in part because its cost of living is higher than the United States'. But critics contend the United States spends more in the long run overall because its inmates serve longer sentences and are more likely to return to prison. 

"Judges who are on the front lines see these people, (and) we believe we have a serious mental health population in our jails, and a population of people struggling with addiction," Michigan Supreme Court Chief Justice Bridget McCormack told The News.  

"It’s not clear that just putting them in jail and sending them back out is good for public safety." 

McCormack and Lt. Gov. Garlin Gilchrist are leading a Michigan Task Force on Jail and Pretrial Incarceration, created in April to explore how to reduce populations at the state's county jails that have tripled since the mid-1980s even though crime is at a 50-year low. 

Skeptics doubt that Norwegian methods could work in the United States. 

"In Norway, the vast majority of the prisoners are going to all be Norwegian; they’re very much the same," said former Eaton County Sheriff Rick Jones, who served 14 years in the state Legislature before being term-limited out of office at the end of 2018.

"The United States is a melting pot, and we have many, many different cultures here," Jones said.

The presence of gangs as well as the mix of races and cultures in prisons also tends to lead to more violence, Jones added.

In the United States, black men were nearly six times as likely to be incarcerated as white men in 2017, according to the U.S. Bureau of Justice Statistics. Blacks comprise 33% of the federal and state prison populations, while whites make up 30%.

In Norway, which has a population roughly the size of Minnesota's, more than 80% of the 5.3 million residents are ethnic Norwegians, including about 30,000 indigenous Sami people. However, 30% of its prison population comes from other countries, primarily the Middle East and Eastern Europe. 

Norway's methods are being embraced by a growing number of American prison and criminal justice professionals.

"I think you have to see it to believe it," said North Dakota Corrections Director Leann Bertsch, who has twice visited Halden and has adopted reforms based on the Norwegian model.

First responders

A stark difference in how U.S. and Norwegian officials approach mental health issues can be seen in Bergen, a coastal city in southwest Norway, where a mental health ambulance responds to calls related to mental health issues. 

Staffed on all runs by three psychiatric nurses and a driver with mental health training, they're skilled at calming distraught patients. If police are also on the scene, the mental health professionals take the lead.

In Michigan and the rest of the United States, police often have first contact with the mentally ill and decide which services they will receive. More than a quarter of Michigan's 38,000 state prison inmates receive mental health treatment, according to the state.

"Our jails and prisons have become the de facto psychiatric care facilities in this country," said Tom Watkins, the former president and CEO of the Detroit/Wayne County Mental Health Authority and a former state mental health director.

Michigan should adopt a version of Norway's system, said Washtenaw County Sheriff Jerry Clayton, who developed mandatory two-day mental health training for Washtenaw deputies and pushed for a community mental health and public safety millage approved by county voters in 2017. 

"The police often are the focal point because of the decisions that they make in those moments that result in people going to jail or going to a hospital, so the training is critical," Clayton said. 

"We encourage people to call 911 if they need help," he said. "But what if you could call 211, and what if 211 linked up to that mental health ambulance … or a mental health crisis team that could respond right away? ...I think it’s exactly another piece of what we need."

As in the United States, Norway has shuttered many of its mental institutions. But it has more than three times as many mental hospital beds per 100,000 residents as the United States. The state Department of Health and Human Services doesn't track how long patients must wait for admission to one of Michigan's five state-run mental hospitals, but 138 people were on the waiting list at the end of September.

Norway has a highly developed system of outpatient treatment and social supports to help mentally ill people live independently. Access to substance abuse disorder treatment is no different than for any other mental health disorder.   

Norway spent $693 per capita on mental health care in 2013, compared with $594 per capita in the United States, according to the Organization for Economic Development and Cooperation, the latest numbers available.

Mental health consumed 12% of Norway's total health spending, while 7% of U.S. health care dollars were spent on mental health care, according to the OEDC.

People who are addicted or mentally ill end up in jails and prisons in the United States because of "poor access (to)  crisis response services in community settings," said Leo Beletsky, a professor of law and health sciences and director of the Health in Justice Action Lab at Northeastern University.

"But it isn’t just that we’ve under-invested in these services — it’s also that our over-investment in policing, prosecutors and jails/prisons has directly crowded out investment in supportive structures across the board," Beletsky said.

As in the U.S., a high percentage of inmates in Norwegian prisons suffer from depression, anxiety, personality disorders and other mental health issues. But their prison stays are likely to be shorter, and they're less likely to return after serving their time.  

"I think all of the ideas and what they’re doing can be transferable to any system if there’s the political will to do so," North Dakota's Bertsch said. 

'Restorative justice'

Mental heath care is provided by Norway's socialized health care system, and the country has a well-developed infrastructure for delivering mental health care. The United States relies more on private health insurance buttressed by government programs for the poor and seniors, and subsidized insurance. 

Michigan's prisons, like most in the United States, are focused on security rather than rehabilitation. At state prisons, high school completion and vocational training programs are reserved for the inmates closest to their earliest release dates, said Chris Gautz, spokesman for the Michigan Department of Corrections.

By contrast, Norway views the primary purpose of incarceration as a successful return to the community, not punishment. 

"The sentence is not the whole picture," said Jan R. Stromnes, deputy warden at Halden Prison. "It describes what they have done, but does not define them as a person. They are more than their criminal acts." 

Experts including Watkins, the former Michigan mental health director, contend that harsh conditions in U.S. prisons and jails exacerbate poor mental health in many inmates, setting them up for an endless cycle of imprisonment.

Norwegians call their approach "restorative justice." 

At Halden, Soerfjordmo has had time to reflect on his crime. In addition to psychotherapy, he attended a four-week cloistered retreat on the prison campus. Aided by priests and guidance counselors, he spent time in prayer, meditation and contemplative reading.

"There was no talking, only at meals," Soerfjordmo said. "You learn to appreciate the silence very much."

Under Norwegian law, the punishment for prisoners is the loss of freedom by being confined to a correctional facility. 

The $250 million Halden Prison, which opened in 2010, was designed to mimic life in a normal village. There are no steel bars, razor wire or watchtowers, though it's a maximum-security facility housing murderers, rapists, child molesters and other dangerous criminals. 

The hilly 75-acre site, located south of Oslo, is surrounded by a mile-long steel and concrete wall. While American prisons typically are stripped of vegetation due to security concerns, the grounds at Halden mirror the surrounding forested landscape.

Prisoners walk freely along asphalt paths lined with birch, pine and fruit trees to attend school and vocational programs, like culinary arts and auto mechanics. .

Inmates live in individual dorm-like rooms. Each room has a large safety-glass window for a view of the park-like outdoors, as well as a comfortable bed, desk, mini-fridge and private bathroom with a shower.

"They can control their own lights. We have closed doors," Stromnes said. "You should be able to go to the bathroom without everyone watching you."

Andre, 31, who preferred not to give his last name, is serving time for kidnapping and torturing a man. The crime was related to drug dealing, he said. He lives in a substance abuse treatment unit called "Navigator." 

Prisoners are given an allowance to buy food from the prison store, which is stocked with fresh fruits and vegetables, meat and other groceries. One meal a week is provided for inmates. The rest they cook for themselves or with others in their unit.   

A big circle has been drawn on a whiteboard that hangs on the wall, divided into segments labeled with the Norwegian words for Independence, Freedom, Inner Calm, Happiness, Self-Mastery, Health, Purpose and Belonging.

These are goals the inmates are working toward, said Monica Antila, one of two therapists in the Navigator unit. 

"It's like a continuous dialogue," Andre said. "...My goal is not just to get out of prison, but not to come back."

'Dynamic security'

There are no armed guards at Halden, though tear gas and weapons are locked away if they're needed. There are about 290 guards, administrators and other full-time personnel for 260 inmates, plus 50 or so psychologists, nurses and other specialists imported from the surrounding community. 

"The best weapon we're armed with is the mouth and the ability to communicate," said Stromnes, the deputy warden. "Most situations are solved with communication.

Prison guards eat meals, play games and socialize with the inmates. The goal is to develop relationships and build trust. It's part of the "dynamic security" practiced at Halden.

"If you disrespect them, that inmate will not sit down with that guard to discuss their future, or how to reunite with their children," Stromnes said.

There is little violence at Halden compared with U.S. prisons. Lars Skahjem, the chief of psychiatry, said he hears of a prisoner-on-prisoner assault perhaps every third month, usually a shove or a punch, "not deadly."

Asked about sexual assaults, Skahjem said, "I have never heard about that during my three years here."

Each prisoner has a "contact officer" who acts as a case manager and adviser. They meet weekly to talk about how things are going.

Contact officers work with their assigned prisoners to develop a "life plan" to achieve the inmates' education, career and personal goals. They help prisoners stay focused and steer them to counseling, substance abuse treatment or other resources. 

The 'progression' model

The inmates at Halden progress through a program of ever-increasing trust, responsibility and opportunity.

In the kitchen that houses Halden's culinary arts program, utensils including an assortment of knives hang on a wall.

In the carpentry shop, Thomas Myhre, who was convicted of a drug crime, works with hammers, drills, a circular saw and other tools. He said he looks forward to taking the "Daddy in Prison" course, a prerequisite for extended family visits.  

"Then I will be able to have an overnight visit in an apartment once every three months," 35-year-old Myhre said of the chalet-like cottage on prison grounds where families can spend a night together.  

Eventually, prisoners are allowed short trips outside the prison, accompanied by two guards. When they're ready, they can leave on their own for a few hours. More than 99% return from their furlough on time, according to the Norwegian Correctional Service. 

Then they'll be transferred to an "open prison," or halfway house, where they can work and attend school under intense supervision — an impossibility in Michigan, which forbids early release. 

"You should never be released directly from a maximum-security prison," Halden's deputy warden Stromnes said. "Progress to a low-security prison and then a halfway house."

The Michigan Corrections Department doesn't track the security levels of those released.

"(S)ome prisoners are so violent and so disruptive that we aren’t able to safely place them in a lower-custody setting prior to their maximum discharge," Michigan prison spokesman Gautz said. They are only released after serving the full extent of their sentence, he said.

Diagnosing mental responsibility

Individuals with chronic psychosis in Norway are considered not accountable for their crimes and sent to psychiatric hospitals. If a crime was likely committed as a result of mental illness, the offender is hospitalized while awaiting forensic examination.

In Michigan, such defendants are jailed while awaiting a ruling on their competence to stand trial — a process that can take six months to a year or longer. Once deemed incompetent, the current wait for treatment at a state psychiatric hospital is 127 days.

In Michigan, all incoming inmates undergo a mental health assessment, said David Dowdy, mental health director for the Michigan Department of Corrections. Prisoners referred for treatment can receive medication and therapy.

Inmates suffering a mental health crisis are sent to Woodland Center Correctional Facility in Whitmore Lake for acute treatment. 

About 80% of Norwegian inmates suffer from mental health issues or learning disabilities, Halden Prison's Stromnes said. But a focus on "normality" and humane treatment leads to improvement for many inmates, he said. 

"Talk to them, respect them, keep them in activity, lower the aggressions and tension, and most mental health issues will be resolved," Stromnes said. 

Even Norway struggles to deal with the small subset of prisoners who are considered accountable for their crimes but are extremely mentally ill and volatile. These prisoners are sent to the 124-bed, highest-security Ila Prison, which has been subject to scrutiny following reports that some mentally ill inmates are held in segregation there — a practice that is frowned upon and rarely used in Norway. 

In addition to regular prisoners, Ila houses 84 inmates who are held in "preventive detention," meaning they have finished their sentences but are deemed too dangerous to release. Only a small portion of Ila's prisoners are extremely mentally ill.

The severely mentally ill prisoners at Ila often seem not to fit in the mental health system or the correctional system, said Skahjem, Halden's chief of psychiatry. Security concerns are too great for a mental hospital, but they're too sick to be in a prison. 

"I would say we have eight to 10, 15, of them in Norway," Skahjem said.

Mentally ill people still end up in prison in Norway, provided they don't have chronic psychosis. That is when a person's thoughts are so impaired that they lose contact with reality, sometimes resulting in delusions, hallucinations or other symptoms.  

Authorities in Norway sometimes disagree on whether an offender belongs in the criminal justice or mental health system. 

Anders Behring Breivik killed 77 people in 2011 when he bombed a federal building in Oslo and then fatally shot scores of teens at a summer youth camp. A team of psychiatrists found he had paranoid schizophrenia and was not accountable for his crimes. 

Breivik was sent to a mental hospital, but psychiatrists there quickly concluded he wasn't mentally ill. Breivik was remorseful only for not having killed more people, they said. A new psychiatric team was appointed that concluded Breivik was sane. He was re-tried, found guilty and sentenced to prison. 

"We don't always agree on, is it a psychosis or is it a severe personality disorder?" noted Skahjem, Halden's director of psychiatry. "If it's a psychosis, then maybe they should be hospitalized."

A change in Mich.?

In Lansing, a "sea change" is underway in Michigan's criminal justice approach, said state House Judiciary Committee Chairman Graham Filler, a Republican from DeWitt. 

Pending House bills would raise the age when juveniles can be sentenced as adults and allow for the release of medically fragile prisoners who are not dangerous. Another legislative package would expunge the records of some former offenders so they can obtain employment. 

Asked about potentially costly reforms to improve life for inmates, there were no clear-cut answers at a time when Michigan spends $2 billion annually on prisons. 

"The conversation I’ve heard is not how can we spend more on prison, but how can we get more people out of prison, or keep more people out of prison and stop them from reoffending," Filler said.

"...I think that’s where the focus has been: trying to keep people from reoffending, trying to keep people out in the first place. I don’t think that just throwing money at the bad guys is a smart way of spending money."

Many inmates probably don't belong in prison, said Senate Judiciary Committee Chairman Pete Lucido, a Shelby Township Republican and former probation officer and criminal defense attorney. 

The lack of community-based mental health services increases incarceration and contributes to recidivism when parolees don't have access to mental health care or life skills training after release, he said.

"We’re not helping our pocket books and we’re not helping society when people are going to jail for crimes that they probably wouldn’t have committed if they had mental health counseling," Lucido said. 

"...They’re going to fail. They’re going to fail because they don’t have life skills."

“Healing Justice” is a Detroit News project made possible through a fellowship with the Association of Health Care Journalists, funded by the Commonwealth Fund, a nonprofit foundation focused on health.

kbouffard@detroitnews.com

Twitter: @kbouffardDN

NEXT ARTICLE: Autistic teen's fatal assault case reflects Michigan's lack of psychiatric beds

Correction: This story has been updated to reflect that Michigan does not keep a record of how many inmates are released directly from maximum security prisons.