Santa Clara County reports 50% of its jail inmates have mental health issues (see Augmentation of Behavioral Health Services to Inmates in County Jail, p. 2). The news reveals that Santa Clara County has a major problem effectively and humanely handling these individuals. This begs the question: how exactly are mentally ill individuals treated in the Santa Clara criminal justice system? This post attempts to point out specific areas during pretrial detention where the system in our county fails mentally ill inmates, effectively punishing them before conviction and thereby exacerbating their mental illnesses and increasing their chances of re-entering the criminal justice system after release.
It is worth noting that in 2015 Santa Clara County established The Blue Ribbon Commission on Improving Custody. Part of this commission is specifically focused on improving mental health treatment in jails and possibly implementing diversion programs in the county. These types of diversion programs would allow non-dangerous mentally ill individuals to receive treatment and assistance instead of being placed in jail.
Presently in Santa Clara, mentally ill pretrial detainees have the odds stacked against them. Let’s first explore what happens during the initial booking process. When an individual is arrested, they are booked into the jail. This process takes about five hours. Detainees are assessed for mental disabilities approximately five different times during this process by the booking officer, the classification officer, the pretrial services officer, and two nurses, though there is no evaluation by a practicing mental health specialist. A 2016 lawsuit filed against Santa Clara County alleged that it is common practice during the booking process for people who are experiencing severe mental health symptoms to be chained to chairs for hours in the booking area (see PDF, first amended complaint page 19).
If at any time during the five-hour booking process it is determined that the individual may have a mental illness they are referred to the mental health staff in the jail. According to the National Alliance on Mental Health, if an individual is referred to the mental health unit, “they will be seen in as timely a fashion as possible.” These individuals are still processed and housed with the general jail population, unless the classification officer places them in special housing.
Once an inmate is booked into jail they can make a request to see a jail psychiatrist. In the same recent lawsuit mentioned above, it claims that an inmate requested to see a clinician on May 16, 2015 and as of January 20, 2016 still had yet to be seen by a psychiatrist. It further alleges this is a common occurrence; inmates can wait several months just for an acknowledgement of their request (see PDF, first amended complaint page 20).
This delay may be due to the understaffed mental health unit. The mental health unit has seven psychiatrists on staff for approximately 1,500 inmates. If a detainee is believed to be a danger to themselves, to others, or is gravely disabled (5150 hold) they can be placed in the 139-bed acute psychiatric care unit in the jail. It seems to be the goal of the psychiatric care unit to stabilize the detainee by providing, “short-term emergency psychiatric treatment.” The average stay in this facility is 6-8 days. It has been alleged that in the psychiatric care unit, psychiatrists meet with patients briefly and infrequently through cell doors, or in the dayroom, without any confidentiality (see PDF, first amended complaint page 19). The only form of treatment is medication. According to local judge Stephen Manley in the Mercury News, “[W]e know, the research is clear, that jail and prison do nothing to change [the] behavior at issue, and those with mental illness are never going to get better unless they are in treatment.” So the question becomes: is medication the best treatment? According to Stanford University law lecturer Michael Romano, it is not. “Medication by itself will not solve the problem, particularly when you’re dealing with people who are both mentally ill and chemically addicted.”
Inmates in the psychiatric care unit are allegedly housed alone, in solitary confinement (see PDF, first amended complaint page 19). Solitary confinement is known to have extremely negative effects on mental health such as suicidal tendencies, hallucinations, and delusions. Housing mentally ill prisoners in solitary confinement seems to cause more harm than good. But the only alternative is housing the individual with the general jail population (and remember: a return to general population seems to be the ultimate goal of the jail psychiatric unit). This is known to create tension and violence between prisoners. As a former Santa Clara correctional officer described, “[mentally ill inmates] kick the doors – in some cases all night- disrupting a dorm of 60 to 90 people. So when you open the doors you’ll find violence because these people will attack this person.”
Not only is there tension between inmates, there is also tension between inmates and jail officers. A recent KQED article highlighted the struggle specifically between Santa Clara Jail officers and mentally ill inmates. The article reported that Santa Clara Jail deputies beat mentally ill inmates to show what behavior they will and will not tolerate. Also highlighted in the article was the case of 32 year-old Walter Roches. He was a mentally ill detainee in the Santa Clara Main Jail when he died from untreated mental illness (elevated heart rate and blood pressure), exacerbated by the jail guards’ extreme use of force to remove him from his cell. The force used against the non-resisting Mr. Roches included pepper spray, tear gas, and a non-lethal firearm through his cell food-slot.
These incidents between mentally ill detainees and jail deputies may be due to the lack of education and training the jail staff receives. Santa Clara judge Stephen Manley explained, “[t]he [jail] culture has to change to understand that mentally ill offenders are very difficult to work with. They are not easy to work with and they take a lot of time, a lot of patience, and they take some compassion. And these are all things that can be taught and can be learned. But you have to be willing to do it.”
Adding to the strain between inmates and guards are the undiagnosed and untreated detainees. There are a number of mental health disorders that do not have overt symptoms, like depression, PTSD, and anxiety. This means that unless the detainee self-reports their mental illness, it may be overlooked, and thus, untreated. If a detainee is forthcoming with their illness and discloses the current medication they are on, they will be denied access to this medication for an unspecified amount of time. This is because until they are evaluated and prescribed the medication by the understaffed mental health unit, pretrial detainees have no other means of procuring it. This is true even if a family member or friend attempts to bring the detainee’s prescribed medication to the jail. A local judge revealed that defendants in his courtroom have waited up to eight weeks to receive their prescribed medication from the jail psychiatrist. One doesn’t have to be a mental health professional to know that disrupting treatment for a few hours, let alone 56 days, can have ever lasting, detrimental effects on an individual’s mental and physical health and has even caused death. Furthermore, the jail psychiatrist may not even prescribe the same medication the inmate was on before being arrested. As the Santa Clara Department of Corrections website states, “the Jail Mental Health staff must conduct its own assessment of your relative/friend’s condition and may not necessarily prescribe exactly the same medications.”
This brings up a few additional problems: fees for prescribed medication and the type of medication being prescribed. California allows its jails to charge for medical care and actively discourages treatment for this reason. It is unclear if Santa Clara follows this practice. One can imagine the ramifications for inmates in need of care but unable to afford it. There is a silver lining regarding this issue with the passage of the Affordable Care Act (ACA). California recently signed into law Assembly Bill 720 that allows jail inmates to enroll in Medicaid. There is a disproportionate need for medical care in jails because inmates tend to have relatively low access to health services outside of custody compared to the general population. Although there is limited data about the healthcare costs in jails, the Legislative Analyst’s Office estimates that 25% of a prison inmate’s total expenses are healthcare related. It has been suggested that jails can cut spending on medical care by enrolling inmates in health insurance because these same individuals continue to have access to medical and mental healthcare once released. This may lower barriers to successful re-entry, thus reducing the jail population and medical care costs. This is also believed to increase public safety because people will be getting the medical and mental treatment they need outside of jail.
Another problem is the types of medication jail psychiatrists prescribe. Many jails administer older, out of date medication, which leads to a lower quality of life. Newer medications tend to improve the life of the inmate. Additionally, newer medications reduce the overall health care costs because they lower long-term hospitalization and emergency admission to psychiatric units. According to the Massachusetts Biotechnology Council White Paper Executive Summary on drug costs: “[G]iven that prescription drug costs (10%) are a fraction of health care spending in the U.S. (compared with hospital and physician care: 32 v. 22% respectively), targeting pharmaceuticals to restrain health care cost is questionable as a significant saving mechanism and may in fact cost the health care system dollars if it involves restricting access.”
Santa Clara is attempting to improve the treatment of mentally ill individuals in our county by spending millions of dollars on the mental health unit in the jail. But is increasing the budget the best solution to the ever-expanding number of mentally ill inmates entering the Santa Clara criminal justice system? Many people believe that it is not. According to our local mental health court judge the answer is not to continuously increase the budget, thereby perpetuating the transformation of jails into mental health facilities: rather, “[t]he answer is how to keep people out and how to keep them from going back.” He has also argued that, “Jails are for punishment. After punishment you have to look at rehabilitation and treatment. When mentally ill offenders have served their punishment time and there is no treatment for them, they simply recycle back through the jail. So we are not doing anything to promote public safety and we are not doing anything to improve the mental health of those individuals who are incarcerated.”
My next post will focus on alternative solutions other counties and states have implemented to improve the treatment of mentally ill community members in their criminal justice system.