By Richard Halstead
The Marin Independent Journal
MARIN COUNTY, Calif. — The county of Marin has joined a national campaign to do something about the inordinately large number of mentally ill people who are being incarcerated in local jails.
At last count more than 300 counties had signed on to the “Stepping Up Initiative,” which is being spearheaded by the Council of State Governments Justice Center, the National Association of Counties and the American Psychiatric Association Foundation.
A group of Marin County officials that included Supervisor Damon Connolly; Marin County sheriff’s Capt. Rick Navarro; Suzanne Tavano, the county’s director of mental health and substance use services; Michael Daly, the county’s chief probation officer; and D.J. Pierce, chief of the county’s division of Alcohol, Drug and Tobacco Programs, attended a California summit on the initiative held in Sacramento in January. Fifty-three of California’s 58 counties sent representatives to the meeting.
On Tuesday, the Board of Supervisors voted unanimously to sign on to the call to action.
“I expect this year to see some focused planning on how our Marin Department of Health and Human Services works with jail detention services to address the unique challenges of people with mental illness in the criminal justice system,” said Connolly, who is heading up the committee to address this issue.
Connolly said he anticipated further discussion on the issue next week when supervisors are scheduled to consider adoption of Assembly Bill 1421, also known as Laura’s Law, which gives local judges the authority to order severely mentally ill individuals to undergo outpatient treatment. The proposal is for a two-year pilot program to assess the effectiveness of Laura’s Law in Marin.
Need for change
On Tuesday, Marin Superior Court Judge Kelly Simmons, who presides over Marin’s mental health court, spoke passionately about need for change in the way that the mentally ill are processed through the legal system.
“If people came to the court and saw how long the mentally ill sit in jail because we can’t provide the appropriate services for them, I think they’d be shocked,” Simmons said.
During an interview after the meeting, Simmons explained the problem in more detail. Once someone with a mental illness is booked into county jail, often due to behavior caused by their illness, they typically remain there until their case is resolved in the courts.
“Because they’re mentally ill, they’re really unable to cooperate with their lawyer,” Simmons said, “so it is harder to get their case through the system quickly.”
County Public Defender Jose Varela said when a person’s mental health status is at issue in a legal case, their mental health has to be investigated by numerous agents.
“The prosecutor has to look into it, the probation department and the court,” Varela said. “That often takes weeks and sadly in some cases months before cases can be resolved.”
Posting bail
Daly, Marin’s chief probation officer, said that while the mentally ill have the same legal rights to post bail as other inmates they generally lack the resources to do so.
“So they do end up spending an inordinate amount of time inside the jail, where treatment in the community could be a much better option,” Daly said.
Daly said if the inmate with a mental illness is judged to be a threat to other inmates they may be locked in a solitary cell.
Navarro, who oversees the jail, said that typically mentally ill inmates are housed in a cell by themselves. Navarro said that on Thursday, 33 of the 308 inmates in the county jail, about 10 percent, had been assessed as suffering from a mental illness. It’s estimated that each year in the United States there are 2 million people with serious mental illnesses admitted to jails.
Judge Simmons said, “So now they’re in a jail cell with no services, no social interaction, and they sit there for long periods of time.”
Suicide concerns
Tavano, the county’s mental health director, said county health workers help the jail determine which inmates are dealing with mental illness and need to be housed in the jail’s mental health housing section. Tavano said county health workers, which include a psychiatrist who works about 24 hours a week, monitor mentally ill inmates for “suicidality.”
Tavano said only patients with the “highest need” receive any ongoing treatment while in jail. She said patients who were taking medication before they were incarcerated are prescribed medications by the county’s psychiatrist, if the patient requests medication.
Daly said often mentally ill inmates don’t realize they’re ill so they choose not to take medications, and their condition worsens as they languish isolated in a jail cell.
Tavano said more medical services aren’t provided to jail inmates “because there is no funding stream to support the system.”
“We at behavioral health can claim Medi-Cal before and after a person is in custody, but because of federal rules we cannot claim Medi-Cal while a person is in custody,” Tavano said. “It really is the county providing the funding for those services. That is the real tension point.”
Treatment plan
Once an inmate’s mental health status has been determined, they are eligible to apply for the Support and Treatment After Release court. By agreeing to abide by a treatment plan developed by a STAR court team, an inmate can sometimes have their case retroactively dismissed or a felony reduced to a misdemeanor. But only inmates with serious mental illnesses, which require medication, treatment and other services are eligible for this diversion program.
“There is only so much room,” Daly said. “You couldn’t possibly have every single mentally ill person in the (STAR) courtroom; you’d have hundreds of people. So they try to pick the best candidates that they can and serve them.”
Judge Simmons said what is needed is a Marin facility where mentally ill inmates can be temporarily housed, treated and their condition hopefully stabilized so they can better navigate the legal system.
She said, “That’s what I’m pushing for.”
At their Tuesday meeting, county supervisors are scheduled to discuss exploring a shared psychiatric health facility with Sonoma County, together with adopting Laura’s Law.
———
©2017 The Marin Independent Journal (Novato, Calif.)