Jail is largest psychiatric facility in Sonoma County
The Press DemocratAug 13, 2017
It's the jail.
If not by design then by default, jail cells have essentially replaced psychiatric hospital beds for many of
Now, nearly 40 percent of the 1,100 inmates held at the county's main jail and its lower-security
To house them and improve the quality of their care, the county is building a
The new wing, which is slated to open in two years, underscores the magnitude of the sweeping changes that have altered the way America cares for its mentally ill.
"I'm glad a better mental health unit is being built at the jail, but why do we not have a freestanding hospital? Why do we have to wait until people are so sick they have to go to the jail?" said
With so many mentally ill inmates, the
Milbrath, who spoke as an individual and not a representative of NAMI, calls the trend "disgusting" and a violation of the spirit of the landmark 1967 Lanterman-Petris-Short Act, a state law that, among other things, sought to end the process of indefinitely locking up those with mental illness and developmental disabilities.
"It guarantees people will be housed in the least restrictive environment for their level of illness," she said. "But we've just defaulted to jails."
A six-month review by The Press Democrat found that people with mental illness are increasingly winding up in a jail cell or a hospital emergency room -- the two places where society is legally bound to provide mental health treatment.
In jail, the 8th Amendment of the
Some mental health advocates argue that the wide array of outpatient and community-based mental health services in
But for their part, local mental health officials say their treatment model -- which includes temporary crisis housing, long-term supportive housing and a relatively new 24-hour crisis stabilization center -- is working and has already reduced the need for psychiatric hospitalizations.
However, no one is arguing that problems do not exist. Although the county spends about
The Press Democrat review found that:
The number of local jail inmates with some form of mental illness has nearly doubled since 2008, when the county lost its last remaining psychiatric hospital beds for low-income adults. Last year, the
The number of inmates with severe mental illnesses such as bipolar disorder and schizophrenia increased 60 percent to an average of 69 inmates a day last year, up from 43 in 2008.
Inmates with mental illness take longer to process through the criminal justice system, just as they do when they go through a hospital's emergency department. They often end up staying behind bars longer, for the same crime, than those who do not have mental illness.
Inmates found by the court to be "incompetent to stand trial" must be sent to a state psychiatric hospital, such as
The
Some mental health critics see a correlation between the decline in psychiatric beds and the rise of inmates with mental illness as evidence that jails and prisons have simply replaced the most infamous of mental health institutions: the insane asylum.
County officials are not blind to the trend and the criticism. But they say they must immediately deal with today's realities.
"It is a lot of money on a mental health jail that could probably be spent on a hospital," said
"Whether we like it or not, the jails have become the new psychiatric hospitals. Let's get them (mentally ill inmates) out of isolation and provide medication management to the best of our ability and provide the wraparound service they are going to need once they out."
In the spring of 2016, jail became inevitable for Barbara and
During his final weeks at Aurora, her son, who was 27 at the time, became increasingly aggravated and desperately wanted to get out. On
Bozman-Moss asked that her son's name not be used in this report to preserve his privacy. It's a common request among family members whose loved ones are suffering from severe mental illness -- even as they watch their son, daughter or spouse spiral deeper into their illness, there's still a hope that one day they'll recover.
"We knew that they wanted him out of there. We wanted him out of there," said Bozman-Moss. "We wanted him to be moved into a facility where he can get more treatment. An acute hospital doesn't give treatment, all it does is stabilize, supposedly, and he wasn't stabilizing."
The kind of treatment Bozman-Moss envisioned for her son -- a residential therapeutic mental health farm or campus where psychiatric care is regarded the same way as other medical conditions, such as heart disease -- doesn't exist in
One of the country's strongest critics of the American mental health system argues that the bulk of mental health dollars are being spent on mild to moderate forms of mental illness, while those with serious mental illness are left to law enforcement and emergency room staff.
"The mental health system has an exit strategy. It's called jail," said J.D. Jaffe, executive director of Mental Illness Policy Org. and co-founder of the Treatment Advocacy Center in
He and other advocates say that a lack of effective psychiatric treatment leads to decompensation, a deterioration of one's mental health, which often leads to confrontations with law enforcement.
"This is the only illness left that we allow to be criminalized in this way," said Snook.
"The majority of people with mental illness who are incarcerated are not bank robbers or gang members," Snook said. "They're in for quality-of-life crimes -- trespassing, loitering, crimes that are just a result of the illness."
Snook's organization has for years been tracking the loss of inpatient psychiatric hospital beds and the increase of jail and prison inmates with mental illness. Between 2010 and 2016, the nation lost 20 percent of its state hospital beds for the most disabled and dangerous psychiatric patients, according to a report conducted by the Treatment Advocacy Center last year.
The number of mentally ill inmates in jail is now 10 times the number of patients in psychiatric hospitals, the center found in a 2014 study.
Counties across the country face the same dilemma. Every year in
In
What's more, state hospitals, which are operated by the
But because of the shortage of inpatient beds at facilities like
During a visit to the
These inmates require a level of treatment that is not available at the jail.
"There's no beds, which is unfortunate. These guys need treatment," House said.
The county plans to provide restoration treatment in the future after the new mental health jail wing is built. That should reduce the number of people waiting for higher level treatment, House said.
Over the years, county jail officials have made modifications to several units in the main jail to accommodate the growing number of inmates with mental illness. But the jail was never designed to make up for the loss of local psychiatric hospitals.
In May, a statewide disability rights agency alleged serious violations against inmates held in the mental health unit of the local jail, including illegally medicating some inmates and levying excessive solitary confinement and isolation. The allegations were part of a 25-page report issued by
But Walker admits that the existing mental health wing at the local jail is no place for someone with severe mental illness.
"Our treatment is primarily based on medication and that's not the complete treatment process," he said. "That's just one part of it. ... I need to create an environment that allows us to do the complete treatment process."
In early 2008, shortly after
That may have been true at the time but is less so now, said
The county currently has 99 beds in residential housing with supportive services for people with mental illness and 22 such beds for clients facing a short-term crisis. Six peer-run respite beds are expected to come online soon. Kennedy said a 30 to 40 percent increase in community housing for people with mental illness would meet the county's needs and help reduce mental health logjams in local emergency departments, at the jail and the county's new Crisis Stabilization Unit, a sort of emergency department for psychiatric patients in west
The vast majority of the county's mentally ill are living peacefully in the community, never coming into contact with law enforcement, Kennedy said.
"Some of our clients they get psychotic but they don't do anything bad. They're just delusional," he said.
Kennedy said the idea that jails are becoming psychiatric institutions is an exaggeration. Most of the county's mental health clients who become involved with law enforcement are those who use illegal drugs or alcohol, he said. They stop taking their medications and take, for example, methamphetamine, he said. But the same can be said of many others in jail, he said.
"That's how the general population is," he said. "You check and see how many people in the jail got in trouble when they were drunk or on meth or on something -- the majority of them."
Nonetheless, Kennedy is concerned that inmates with severe mental illness, such as schizophrenia, are not getting appropriate treatment in the current jail.
"Anybody with serious mental illness shouldn't even be in that place," he said. "I'm not saying they shouldn't be charged with a crime, that's not what I'm saying. They've got to go some place if they're a public safety risk. What I'm saying is that facility is not suited for those folks. ... It'd be like somebody committing a crime, they had serious cancer, they're in the middle of treatment and you stick them in jail and you don't treat them."
Jail officials say the new mental health unit, which will be adjacent to the existing jail, will allow for more humane treatment of mentally ill inmates. The
But some advocates and family members of those with mental illness say jails are inherently not therapeutic settings and rarely do a good job of being a substitute for clinical treatment.
"Why does the state give them money for that but not give our mental health (agency) the money to build an inpatient facility for people that aren't criminals? What's up with that?" said Jackie Ganiy of
"Why do they throw them in jail when they're not at fault?" she said. "Believe me, they are not at fault, the vast majority of them. Why are they put in jail? That's really a barbaric thing to do, take somebody that's mentally ill, does something while they are mentally ill and put them in jail for it."
In late 2015, Ganiy said her son spent several days isolated in
Snook, of the Treatment Advocacy Center, said many mentally ill inmates would likely have been treated in a psychiatric hospital prior to what has come to be known as deinstitutionalization, the decadeslong process of emptying out the nation's state-run psychiatric hospitals and, subsequently, the ongoing closure of public and private psychiatric facilities.
"The taxpayer is now having to pay through our jails, our homeless services, our crisis behavioral health services, because we have a health care civil rights issue, with years and years of private health care not treating mental illness on an equal basis, discriminating against people with mental illness," Zane said.
The result, she said, is that taxpayers are now providing that service in ways that are more expensive and less effective than they would be on the "outside."
"It is morally and financially advantageous for the system to provide services to that population before they reach the point of needing emergency services," she said.
Jail officials argue they must deal with the realities before them. Walker, the assistant sheriff, said therapeutic programs in the new jail wing will better prepare inmates for release.
"Our goal is if we can move people through the system faster, get them to competency faster, get them the programming so that they are eligible for things out in the community, then they will get out of custody faster," he said. "Then you have more room for those who are severely acute and more resources to focus on those people."
As it is now, he said, those with mental illness can "get stuck in the system."
Earlier this year, the county entered into an agreement with the
Programs aimed at stemming the flow of mental health patients into the local jail include the county's forensic assertive community treatment program, which offers intensive mental health treatment for those who have committed low-level felonies or misdemeanors. Participants are given the option of probation if they agree to mental health treatment.
Booher said treating mental illness in jail "is the most expensive way to treat these people. We'd like to treat them in the community where it's more appropriate."
Other programs include mental health court, crisis intervention training for local law enforcement officers and the mobile support team of mental health workers that help peace officers deescalate encounters. Booher said the county recently obtained a
"We're not planning for future growth in this population in the jail," said Booher.
After his arrest, Bozman-Moss's son waited 4 1/2 months in
"They are on their own, all by themselves, 23 hours a day, no socializing, no place to eat together," she said. "It was set up as a jail. It wasn't set up for people with mental illness."
This report was produced as a project for the California Health Journalism Fellowship, a program of the
___
(c)2017 The Press Democrat (Santa Rosa, Calif.)
Visit The Press Democrat (Santa Rosa, Calif.) at www.pressdemocrat.com
Distributed by Tribune Content Agency, LLC.