In response to mounting pressure from the Marin County Civil Grand Jury, the Board of Supervisors and the Sheriff’s Office have taken steps to improve the care of mentally ill inmates in the county jail.
Last week, supervisors unanimously approved their obligatory response to the jury’s February report that reprimanded the county for not addressing recommendations, first issued last summer, for increased care for the incarcerated. Their response largely mirrors one that the Sheriff’s Office sent in April.
Out of the jury’s 12 recommendations, the board and the Sheriff’s Office declare that three have already been implemented. They promise to address another three recommendations within the next six months, flag two for further analysis and reject the last three because they are “not warranted or reasonable.”
The board also disputed the jury’s ultimate conclusion that Marin’s current practices leave the county vulnerable to litigation. Though Marin is abiding by minimum state requirements, the jury pointed to case law to show higher standards, especially pertaining to the use of safety cells—small, empty rooms with padded walls—for mentally ill inmates.
“While courts have described the use of isolation as cruel and unusual punishment in certain circumstances, this is not the case for the use of safety cells as used in the county jail,” the board responded. “Settlement agreements involving other counties do not alter or negate those existing laws and regulations that govern required services in a jail, with which the county of Marin currently complies.”
Nevertheless, the board and the Sheriff’s Office agreed to make some adjustments to use of the cells and other policies.
First, they agreed to keep mentally ill inmates in safety cells no longer than 24 consecutive hours unless the jail psychiatrist certifies that no other remedy is available to prevent inmates from harming themselves or others. (Last summer, both the board and the Sheriff’s Office resisted the same recommendation, claiming it needed further analysis).
Second, the board and the Sheriff’s Office agreed that “safety cells should never be used for mentally ill inmates as a substitute for adequate medication and/or other psychiatric treatment.” Though they had both already agreed to this policy following the jury’s first report, the jury questioned their compliance this February. Yet neither the board nor the Sheriff’s Office newly addressed the jury’s continued concern that the specified alternative of transferring inmates to the crisis stabilization unit at Marin General Hospital was possible for only some inmates due to security.
Third, to increase collaboration, the Sheriff’s Office also agreed to inform Health and Human Services of any changes that affect that department’s jail procedures.
The board and the Sheriff’s Office’s responses state that a number of other recommendations would be implemented in the next six months. These included having a member of the mental health staff evaluate inmates in safety cells within four hours to determine the appropriateness of the placement and the evaluation of possible alternatives.
In order to do this, the board pledged to hire a licensed crisis specialist within the next six months to increase the number of hours for mental health staff from 15 hours a day to 20 hours a day, seven days a week (the jury recommended 24-hour coverage).
With this additional position, the board’s response states, staff will be able to provide therapeutic groups to discuss psycho-education, symptom identification, coping skills development, medication management and non-violent communication. Possibly, the board’s letter states, the increased staff time will also allow the county to meet the jury’s recommendation for all mentally ill inmates to receive mental health therapy.
The board’s letter also outlined an impending hire for a behavioral health and recovery services unit supervisor to provide clinical supervision and to oversee the program.
In order to fund the two new positions, the board approved its staff’s recommendation to increase ongoing spending by $500,000 a year. The county currently spends around $1.3 million annually on behavioral health measures, along with additional state realignment funds for transitional services to inmates.
Within the next six months, the county agreed to review and update all the policies and procedures in the Sheriff’s manual related to the care of inmates, and on a biennial basis thereafter.
As far as the remaining sticking points, the board and the Sheriff’s Office requested time to further analyze the recommendation to establish a local facility where sentenced inmates can receive involuntary administration of psychiatric medication. Currently, the jail transports inmates outside the county, and others never receive this service.
The county rejected the suggestion that a psychiatrist be available at the jail eight hours a day, five days a week. Instead, a psychiatrist is onsite 28 hours a week, which increased from 20 hours last September, and by phone around the clock.
The county deemed unreasonable a recommendation to adopt a policy of Los Angeles County jails whereby mentally ill inmates have 10 hours of unstructured out-of-cell time as well as 10 hours of structured therapeutic or programmatic time a week. The county defended its current policy of eight hours out of cells and one hour a day of structured therapeutic and socialization time.
This is the second time the county has rejected that recommendation. Last summer, the Sheriff’s Office and supervisors cited obstacles such as the physical layout of the jail and state standards. In February, the jury found their arguments inadequate, and said courts have repeatedly found that prolonged isolation violates the constitutional rights of prisoners.
The 20-member jury, the only independent watchdog investigative body in Marin, included context for its concern about keeping the county’s protocol up to date: Today, there are nearly 10 times as many mentally ill people in prisons and jails as there are in mental hospitals.
The closure of state mental health hospitals and changes in state law in the last 30 years have placed a particular burden on county jails, leading to an increased number of felons in jails rather than prisons, the report said.
The county’s response pointed to its participation since 2017 in the Stepping Up initiative, a campaign that provides assistance for counties nationwide to address lowering the number of mentally ill people incarcerated in local jails.
“Numerous county departments are also now working together to implement the [initiative], which focuses on reducing recidivism, reducing the number of people with mental illness in the jails, reducing the length of incarceration for those who must be in the jails and providing appropriate mental health treatment,” the board wrote.
The jury is still waiting on optional responses from the Marin County Department of Probation and Office of the Public Defender.