I’ve been saying for quite some time that the largest mental hospital in Orange County is its main central jail (see MOORLACH UPDATE — Largest Mental Hospital — January 17, 2014 january 17, 2014 john moorlach).
The Orange County Grand Jury has reviewed this matter and has issued a rather scholarly report, titled "OUR BROTHERS’ KEEPER: A LOOK AT THE CARE AND TREATMENT OF MENTALLY ILL INMATES IN ORANGE COUNTY JAILS" (see http://www.ocgrandjury.org/pdfs/2015_2016_GJreport/2016-06-09_Website_Report.pdf).
June is usually Grand Jury report month, as these nineteen members conclude their twelve months of service. Their latest report is covered in the OC Register below.
The piece concludes with a mention of one of my bills, SB 1273, which is trying to pick up on a theme that was started with SB 585 (2013). This effort allowed for the implementation of Laura’s Law in Orange County. For this history, seeMOORLACH UPDATE — More Prop. 63 Repurposing — January 6, 2016 january 6, 2016 john moorlach.
For more details regarding SB 1273, which is currently scheduled to be heard by the Assembly Health Committee next Tuesday, June 14th, at 1:30 p.m. (but it could be deferred for a week), go to MOORLACH CAMPAIGN UPDATE — SB 1273, Beaumont & Part Three — May 23, 2016 may 23, 2016 john moorlach, MOORLACH UPDATE — Opposition — April 22, 2016 april 22, 2016 john moorlach, MOORLACH UPDATE — SB 1142 and SB 1273 — April 16, 2016 april 16, 2016 john moorlach, MOORLACH UPDATE — SB 1273 — March 3, 2016 march 3, 2016 john moorlach, and MOORLACH UPDATE — SB 1273 and MCO Tax — February 27, 2016 february 27, 2016 john moorlach.
BONUS: I sit on the Senate Budget and Fiscal Review Committee, which is scheduled to meet Monday afternoon. My thoughts on this month’s top Legislative priority is provided at the bottom.
Grand jury calls jails unfit for mentally ill inmates
Probe: ‘Safety cells’ in O.C. called a weak solution.
Most mentally ill inmates in Orange County jails are kept with the general population, where they are more likely to be victims of assault and more likely to break rules that lead to harsh punishment. Mentally ill inmates in Orange County generally are given medication, but they don’t all have access to therapy.H. LORREN AU JR., REGISTER FILE PHOTO
As early as 1694, the Massachusetts Bay Colony allowed jail confinement for people “so furiously mad as to render it dangerous to the peace or the safety of the good people for such lunatic persons to go at large.”
Unfortunately, it remains disturbingly the same today, according to an Orange County grand jury investigation released this week.
Jail is the “primary treatment facility” for Orange County’s mentally ill, and at any given time one in five county inmates — roughly 1,200 people — suffers from a documented mental health issue, the grand jury found.
Despite improvement over the last several years, the jail system still lacks sufficient manpower, training, facilities and expertise to address the needs of most mentally ill inmates, and can actually make matters worse, the grand jury said.
The jail system’s acute lack of mental health beds – just 120, when 10 times more could be filled on any given day – means severely disturbed inmates can wind up in “safety cells” as a substitute for treatment.
“A safety cell can be described as a small locked cell with padded walls from floor to ceiling, a closed viewing panel, food slot, and a thin, bare mattress on the floor next to a grated hole in the floor, which serves as a toilet,” said the investigation.
The padding in the cell isn’t intended to “prevent self-injury,” according to the report, but it may “lessen the effect depending on how much time is spent trying to self-inflict injury between 15-minute observation periods.”
The report also noted that the cells don’t have sinks for washing hands, but that lights are on at all times and cameras make it possible for inmates to be observed from the nursing station at all times. Also, inmates are allowed to wear only a “safety gown,” which resembles a hospital gown but is made of heavier fabric. This also is a way to prevent suicide.
And, the report continues, other practices also are aimed at preventing people from doing harm to themselves:
“According to Sheriff Safety Cell Policy (2104.3), Correctional Health Services staff may withhold the mattress and/or safety gown if deemed a hazard, which renders the inmate naked on a lightly padded floor … Several staff stated that it is cold inside the cell.
“When the Grand jury inquired as to how an inmate stays warm, one staff member suggested the inmate roll into a ball. Other staff had no answer at all.”
ONE OF FIVE
In what the grand jury called the first in-depth investigation into the plight of mentally ill inmates in Orange County’s jail system, it found that, between January and October 2015:
• 10,586 inmates entered the system with a mental health diagnosis;
• 2,962 other inmates were diagnosed with acute mental illness;
• 13,548 mentally ill inmates were moved through the Orange County jails over a 10-month period.
Most mentally ill inmates – about 89 percent – were housed with the general jail population, where they’re more likely to be be sexually assaulted, attempt suicide, and break rules that lead to harsh disciplinary action, the grand jury said. These inmates might receive medication for psychiatric symptoms, but they don’t receive therapeutic treatment.
During the 10 months tracked for the report there were 77 safety cell admissions, according to Correctional Health Services. Inmates spent from one to five days there, with about 40 percent locked in the cells for more than one day; 30 percent in for two days; and 10 percent for three days or more.
Inmates are often forcibly medicated prior to being taken to a safety cell and usually fall asleep, a Correctional Health Services clinician told the grand jury.
The criteria for removal from a safety cell are vague.
In 2011, mental illness and law enforcement collided in deadly fashion.
Kelly Thomas, a mentally ill man, died after a conflict – then a beating – by Fullerton police. Thomas, a schizophrenic, wasn’t taking his medication, and police weren’t sufficiently schooled in spotting such behavior and de-escalating conflicts.
In the wake of Thomas’s death, Orange County adopted the controversial Laura’s Law. It empowers officials to order severely mentally ill people into court-imposed outpatient treatment, even if that treatment is against the patient’s wishes.
The grand jury commended the county for its rollout of Laura’s Law, as well as for other improvements made after a U.S. Department of Justice probe of O.C. jails in 2014.
The grand jury also made 17 specific recommendations to improve the treatment of mentally ill inmates behind bars, including developing specific therapeutic and educational programs; clearly defining entry and exit criteria for safety cell use; beginning a “debriefing protocol” to reduce safety cell use; hiring more psychiatrists; and collecting and analyzing data on the mentally ill population.
County and jail officials have 90 days to respond in writing to the grand jury, but this week they were digesting the 60-page report.
“There’s a lot in this,” Orange County Sheriff Lt. Mark Stichter said Thursday. “We absolutely adhere to and provide mental health and medical services to those inside the jail, as per the constitution.
“I can tell you personally, having watched the process from the time they come into custody, that it’s absolutely amazing what our mental health and medical services staff do to provide care to a wide variety of inmates with a wide variety of issues.”
There is of course room to improve, Stichter said. The Sheriff’s Department is seeking grants to offer more services, and will be able to do more when the expanded Musick jail facility finally comes online over the next few years.
In the meantime, he said, the department tries to avoid using safety cells, sending inmates there only when they become a danger to themselves or others. “It provides a safe place for them to calm down for a while,” Stichter said. “When they’re in those cells, they’re constantly monitored.”
While the grand jury drew clear parallels between the de-institutionalization of the mentally ill in the 1960s and 1970s and their growing population in jail cells today, “those that are in custody have committed a crime in violation of the penal code,” Stichter said. “They’re in jail waiting to go to court and haven’t been able to bail out.”
The issue is not unique to Orange County. Several bills are pending in Sacramento to help address the problem, and Gov. Jerry Brown got behind $2 billion plan to build housing for mentally ill homeless people throughout the state.
State Sen. John Moorlach, who championed Laura’s Law as a county supervisor, has introduced a bill that would allow “millionaire’s tax” funds from Proposition 63 (a 1 percent levy on those earning more than $1 million, to pay for mental health services) to be used for “crisis stabilization services.”
That, he said, provides counties with the flexibility to fund outpatient care, as well as help ensure emergency department access for patients.
“People seem to understand that we have to do more for the mentally ill homeless, who are often winding up in jail,” Moorlach said. “The question now is, what are the best models?”
The Sheriff’s Department wants to know that, too.
“These are the kinds of questions we talk about constantly,” Stichter said. “Everybody is trying. It’s a conversation that’s taking place in every single police department.”
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