The Marin County Civil Grand Jury says county officials have not done enough to address its recommendations from a June 2017 report on the care of mentally ill people in Marin County Jail, a fact the jury says leaves Marin vulnerable to litigation.
The jury’s follow-up report, released last month, analyzes responses from the three county departments targeted in the report—the Board of Supervisors, the Department of Health and Human Services and the Sheriff’s Office—to last year’s recommendations, and demands a more timely implementation of those recommendations.
The sheriff’s office has until late April, and the board until late May, to formally respond to that demand. The jury report also requests optional responses from numerous other public agencies, including the Marin County Department of Probation and the Office of the Public Defender.
The 20-member jury, the only independent watchdog investigative body in Marin, reports that there are nearly 10 times as many mentally ill people in prisons and jails as there are in mental hospitals. The closure of state prisons 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.
Last year’s jury report had found that despite the fact that a significant number of Marin inmates have severe mental health issues, care for mental health in the jail is inadequate. The report cited insufficient staffing, a high degree of staff turnover and an overreliance on isolation in so-called safety cells as a substitute for effective treatment.
The report also found that isolation in safety cells—small, empty rooms with padded walls—was being used in a manner that could be characterized by the courts as “cruel and unusual punishment” and in violation of an inmate’s rights under the Eighth Amendment.
In addition, the report identified problems with timely policy and procedure updates both at the jail and within Health and Human Services.
Of the 13 recommendations the jury made to the Board of Supervisors, nine were rejected as needing “further investigation,” two were reported to have been implemented, and two were reported to have been partially implemented.
Of the 12 recommendations made to the Sheriff’s Office, only one has reportedly been implemented. The others were either rejected or deferred to Human and Health Services, but the jury was unsatisfied with that department’s actions as well.
The recommendations
Though both supervisors and the sheriff’s office denied it, the jury said safety cells were being used for mentally ill inmates “as a substitute for adequate medication or other psychiatric treatment.”
The sheriff’s office had explained that, to address urgent psychiatric conditions, they sometimes avoided the cells by instead transferring inmates to the crisis stabilization unit at Marin General Hospital and a state mental health rehabilitation center. But the jury said only some inmates can transfer to those facilities and that alternatives to safety cells were needed for the others.
The grand jury said mentally ill inmates should not be kept in safety cells longer than 24 consecutive hours, at least without the jail psychiatrist certifying that no other remedy is available to prevent the inmates from harming themselves or others. The jury found that the mean time of placement in safety cells is almost 24 hours in the jail and discovered multiple instances of inmates being detained for 72 hours or more, with one kept for more than seven days.
Both supervisors and the sheriff’s office claimed that the jury’s recommendation to limit the time in a safety cell to 24 hours needed “further analysis.”
Currently, the sheriff’s department follows the state law Title 15, which just requires a mental health consultation upon placement in a safety cell, and then again within 12 hours, rather than setting a maximum time limit.
The jury’s counter to that argument recommends that Marin go beyond state regulations and instead follow the rulings of recent cases that have set new precedents. By not paying attention to case law, the jury says, the county is vulnerable to litigation.
The report cited a 1995 California ruling in which the court stated, “Placing [certain mentally ill prisoners] in [solitary confinement] is the mental equivalent of putting an asthmatic in a place with little air to breathe. The risk is high enough, and the consequences severe enough, that we have no hesitancy in finding that the risk is plainly unreasonable.”
In its new report, the jury backed down slightly on a previous recommendation that a qualified mental health provider evaluate inmates placed in confinement within an hour to determine the level of suicide precautions necessary. The jury, acknowledging supervisors’ concern about staffing costs required, suggested such an evaluation take place after no more than four hours.
Regarding another recommendation to allow mentally ill inmates at least one hour a day outside their cells, the jury was insistent. The sheriff’s office and supervisors had rejected the recommendation, citing obstacles such as the physical layout of the jail and state standards.
But the jury found their arguments inadequate, and said courts have repeatedly found that prolonged isolation violates the constitutional rights of prisoners.
The jury pointed to Los Angeles, where under a recent settlement agreement county jails must provide seriously mentally ill prisoners with 10 hours of unstructured out-of-cell time and 10 hours of structured therapeutic or programmatic time each week.
In response to the jury’s recommendation that the jail hire an around-the-clock mental health crisis specialist or psychiatric nurse and immediately institute programs to provide therapy to all mentally ill inmates, and particularly those incarcerated for longer than seven days, Health and Human Services has taken several steps.
The department committed to hiring one and a half positions. The jury said this was a good first stab, but recommended additional positions, including that of a mental health supervisor.
Supervisors and the sheriff’s office rejected the recommendation that all policies and procedures in the sheriff’s manual related to the care of inmates be reviewed and updated within six months and, following that, at least every two years. The jury argued that doing so was necessary under state law.
In response to the jury’s demand that supervisors provide enough funding to implement their recommendations, the board again insisted on the need for further analysis. The county spends around $1.3 million annually on behavioral health measures, along with additional state realignment funds for transitional services to inmates. The board said it asked Health and Human Services to bring a recommendation for expanded services.
But the jury was unimpressed. “As discussed in relation to other recommendations above, the courts have repeatedly found that a failure to provide adequate health care cannot be excused by a lack of facilities, personnel or funding,” it wrote.
The civil grand jury is tasked with monitoring the performance of local government and making recommendations aimed at saving taxpayers’ dollars and improving services. Sparked by complaints, their work primarily consists of investigations of officials suspected of misconduct and potential government inefficiencies. The jurors are selected each year, for one-year terms, by a superior court judge.