The Santa Barbara County Jail has become “the de facto mental health institution for the county,” Sheriff Bill Brown told the Board of Supervisors Jan. 18 while giving a follow-up presentation about the department’s mental health services.
Brown explained that the jail—like most other jails in the country—has seen an influx of mentally ill inmates since the closure of most mental institutions in the 1970s.
The sheriff said his department is “very, very satisfied with the services we’ve received from Prison Health Services.” Now called PHS Correctional Healthcare, the private company provides mental health and medical services to the county’s jail system. The company’s contract is up for renewal in six months.
However, Brown said several factors—including an aging facility not built to sustain the current inmate population and an increasing dearth of health resources in the county—have turned the jail into a makeshift mental institution.
“The reality is a lot of people [with mental illness] are in jail because there’s no other place for them,” Brown later told the Sun. “I don’t know what else to do. It’s an untenable situation we’re in right now.”
According to a snapshot study conducted by the Sheriff’s Department, approximately 29 percent of the jail population is on psychotropic drugs. Many of the inmates have dual disorders—mental health issues and problems with substance abuse.
“It’s actually more than 30 percent of the jail population, because there are inmates who are refusing treatment or being treated without medication,” Brown said. “Also, the population is boiled down because we’re not confining petty criminals.”
Brown also referenced a study by Dr. Aris Alexander, a former consultant to the Wisconsin state prison system, which essentially found: “Jail is not good for the mentally ill, and the mentally ill are not good for jail.”
“In an ideal situation, we would have some kind of separate facility [for the mentally ill],” Brown said at the meeting. “We are struggling with a system that forces us to release inmates … and only keep the most serious offenders.”
First District Supervisor Salud Carbajal asked Brown if the county and Sheriff’s Department could work with the courts to speed up the sentencing process for inmates, especially those with mental illness.
However, Brown said cases that involve tests for mental competency typically take three times longer to process than cases for people without mental illness who commit the same crime. In response, Carbajal asked if the county would consider addressing the matter in a scientific study.
“It’s such a complicated issue that it may warrant a complicated, serious study,” Carbajal said, “to find a better, more cost effective way to deal with people with mental illness.”
The responsibility, he added, falls on the shoulders of not just the Sheriff’s Department, but the courts and county government.
“If we need to change our system in a dramatic or radical way, so be it,” he said. “But at least we’re being creative and putting our heads together.”
During the public comment period following the sheriff’s presentation, Suzanne Riordan, a representative for the mental health advocacy group Families ACT!, expressed some concerns with PHS Correctional Healthcare. Families ACT! alleges that PHS fails to see inmates with mental health issues in a timely fashion and has at times failed to provide inmates with the necessary medication.
“Communities should not contract with private companies for mental health services in jails,” Riordan said. “It sets a very dangerous precedent.”
She said that unlike the jail’s former mental healthcare provider, Alcohol, Drug, and Mental Health Services (ADMHS), PHS has a financial interest in providing treatment. The county switched its contract to PHS in June 2009 to save approximately $20,000, among other factors.
“It’s like privatizing prisons—the more and more people that go into jail, the more money they make,” Riordan said. “If there’s a savings, it’s at the expense of the poor inmates.”
She said her organization, with help from the Santa Barbara County Housing Authority and ADMHS, is trying to establish more residential treatment centers in the county for people with the dual diagnosis of mental health disorders.
PHS’s Bradley told the Sun she isn’t able to discuss the specifics of patient care because of privacy laws, but she and her organization are “always glad to look into patients’ cases” to ensure they’re receiving the proper care.
In a follow-up interview with the Sun, Supervisor Carbajal said based on little to no opposition to the county’s work with PHS, “the contract seems to be working overall very well.”
He said PHS has addressed some concerns raised by the board, such as service limitations and staff hours.
“We’re in a much better circumstance than we were before,” he said, adding that the board still needs “as much data as we can get to understand any gap or need in services to make the program better.”
But looking at the big picture, he said, it’s a “travesty for us a society” how the mentally ill are cared for.
“We need to find a better way to address the needs of the mentally ill in our community, but the fact of the matter is we don’t have enough resources,” he said.
At the meeting, the board went on to discuss some specifics about the services provided by PHS, including medication and medication funding, treatment timelines, referrals, and more. It was revealed that the cost of all medication for inmates —$600,000 a year— is borne by the Sheriff’s Department’s budget. Inmates are forbidden by law to bring their own medications into the jail.
The board asked county staffers to review some legislative issues with MediCal, including parameters for medication funding, and to return with a report. The board is expected to make a final review of PHS Correctional Healthcare’s contract in June.
Contact Managing Editor Amy Asman at aasman@santamariasun.com.
This article appears in Jan 27 – Feb 3, 2011.
