The Santa Barbara County Jail is a labyrinth of steel and cement. Walking through its dimly lit, stale hallways, it’s difficult to determine your exact location. The letters and numbers spray painted on the jail’s pale blue-gray walls—a blocky E-225 or W-140—offer little navigational help to the untrained eye. The letters, it turns out, stand for directions, like east or west. The numbers stand for cellblocks.
All of the doors in the jail are locked, either manually or remotely. To pass through them, you have to press a button on an intercom, listen for a static-crackled voice to acknowledge you, then mutter a numeric code and wait for the door to click open.
The facility’s cells, with their thick padded doors or narrow metal bars, project a clear message to anyone within its walls: There’s no getting out of this maze without permission from the powers that be.
No one understands this reality better than the men and women who, for whatever reason, currently call the jail home.
Each inmate deals with the loss of his or her freedom differently. Some of them—mostly habitual offenders or troublemakers in solitary confinement—greet sheriff’s deputies with goofy smiles and jokes. Others seem happy just to have a roof over their heads, and they stay hidden under the blankets in their bunks.
During a recent tour of the jail, the inmates seemed subdued, going through the motions of their daily lives with little regard for a passing reporter and photographer. In the barracks-style cells, men sat around in their boxers playing cards or reading. Some walked around clad in white towels, tattooed flesh peeking out, on their way to or returning from the shower.
Occasionally, a group of handcuffed inmates returned from court in Lompoc or Santa Maria. After lining up single file, the inmates quietly stood with their hands spread on the wall and waited as a deputy patted them each down for contraband.
A clearly disturbed man paced back and forth in solitary confinement, alternately eating his sandwich, yelling obscenities, and pounding on his cell door.
Reports and roadblocks
The Sun requested a tour of the jail in response to a report recently released by the Santa Barbara County Grand Jury. The document, titled Homeless Mentally Ill Indigent Recidivism: This Recycling Is Not Good For the Community, delved into the complexities connecting the county’s chronically homeless, mental illness, and incarceration.
The grand jury cites another report compiled in 2006 by the late Roger Heroux, former director of the Santa Barbara County Public Health Department, which says approximately 10 to 15 percent of the county’s chronically homeless suffer from mental illness. Heroux estimated the county spends 50 percent of all funds designated for homeless programs on this vulnerable group, with the majority of the money going toward first-responder services, such as emergency medical services and incarceration.
“For a variety of reasons, it is not unusual for chronic homeless with mental illness to end up in jail,” the grand jury report said. “They may not be immediately diagnosed with mental problems when booked into jail and may not be diagnosed at all unless an event gives cause to have them evaluated.”
Often times, an early diagnosis won’t help anyway, because, according to the grand jury, “there is no long-term case management available upon release from jail.”
Added the jury: “The cost in human suffering is obvious, but there is a monetary cost to the community as well.”
The grand jury estimated the county spent approximately $8.5 million on homeless services in fiscal year 2010-11. The county spent an additional $15.6 million on incarceration, emergency room and hospital visits, and other services, for a grand total of $24 million.
For years, Santa Barbara County, like many other counties throughout the nation, has been struggling to develop methods for treating and providing resources to the seriously mentally ill. Some of these programs are county run, and others are community based.
Despite these efforts, the Santa Barbara County Blue Ribbon Commission on Jail Overcrowding reported in 2008 that an estimated 30 percent of inmates at the main jail are on psychotropic medication. That statistic doesn’t take into account the inmates who refuse treatment or are being treated without medication.
In January of this year, Sheriff Bill Brown told the Board of Supervisors the jail has become “the de facto mental health institution for the county.”
“In an ideal situation, we would have some kind of separate facility [for the mentally ill],” Brown told the supervisors at their Jan. 18 meeting. “We are struggling with a system that forces us to release inmates … and only keep the most serious offenders.”
The grand jury report makes several recommendations to address the chronically homeless and mentally ill population currently flooding the jail, thus adding to the jail-overcrowding problem.
The key to addressing recidivism, the jury wrote in its report, “is to begin a treatment program while the person is in custody.”
However, as the grand jury discovered, there are some significant roadblocks to creating such a program.
A major obstacle, undoubtedly, is the lack of funding available for mental health treatment programs or facilities, both in and outside of jail. Funding is a subject that’s been reported on ad nauseam—and even triggered the creation of several community coalitions, such as Bringing Our Community Home: The 10-year Plan to End Homelessness and Common Ground Santa Barbara.
What hasn’t been reported on nearly as much are the roadblocks inside the jail. According to the grand jury’s report, the problems begin with intake.
The report cites a 2009 briefing paper Jails and the Mentally Ill III: Issues and Analysis, which said, “It is essential for jails to screen incoming inmates for mental illness and to do more comprehensive mental health assessment.” The paper also said jails are encouraged to seek additional mental health training for custody staff.
In 2009, the county contracted with Prison Health Services (PHS)—a private, for-profit company—to provide mental health care at the jail for two years. At that point, PHS had been providing medical care at the jail for more than a decade. Mental health care was provided by the county’s Department of Alcohol, Drug, and Mental Health Services. Sheriff Brown told the Board of Supervisors the change in providers would save the county approximately $500,000, while increasing services for inmates.
PHS’s contract with the county is up for renewal on June 30.
According to various news reports, PHS merged with another private company, Correctional Medical Services, earlier this month and now goes by the name Corizon. However, for the sake of clarity, the Sun will continue to use the name PHS.
In January, the sheriff told the supervisors his department was “very, very satisfied” with the services they’d received from PHS. As of press time, the sheriff wasn’t available to comment further to the Sun on PHS or the grand jury report.
Legally, the Sheriff’s Department has 60 days from the release date, May 26, to respond to the report. The Department of Alcohol, Drug, and Mental Health Services also has 60 days to respond, and the Board of Supervisors has 90 days to respond.
When asked to compare PHS to the county’s services, Sgt. Tim McWilliams, the Sun’s tour guide at the jail, said, “I prefer PHS. … Since they’ve taken over, there’s been more communication between the psych clinician and the jail staff.”
Before, McWilliams said, the doctor would just leave a “slip on the desk” communicating the inmate’s medical needs, but now the doctor takes more time to speak to jail staff.
Not everyone holds PHS in such high esteem.
According to the grand jury report, “The jury found that not only have the promises [made by PHS in its contract] not been achieved, some of the conditions of the contract have apparently not been met.”
Some of these conditions include:
• providing a “seamless continuum of services” from the point of entry into the jail through post-release community based services.
• developing a comprehensive discharge planning program with a full-time licensed clinical social worker responsible for overall discharge planning.
• intake screening conducted by PHS mental health professionals at the time of booking.
• delivering a comprehensive mental health training program for all security staff.
According to Sgt. McWilliams, the intake process is conducted by “whoever is working out [in the jail] that day.” Jail employees have a form they use as a guideline when booking inmates. The employee asks the inmate various medical and mental health questions, such as what medications they’ve been on in the last year and whether they’ve been under the care of a mental health professional.
“The information is only as good as they tell us,” McWilliams said, adding that the jail employee will alert a PHS nurse “if [the prisoner doesn’t] seem right, if they seem like they have a mental illness” or if they answered yes to some of the intake questions.
He said jail staffers receive mental health training every two years, during which mental health workers brief the staff on different conditions and symptoms.
Still, there are some people who feel communication was better under the county’s department of Alcohol, Drugs, and Mental Health Services (ADMHS).
Suzanne Dierenger has served as a social worker for the Santa Barbara County Public Defender’s Office for eight years. She’s currently the department’s only social worker. However, she said she expects to get laid off as a result of the county’s pending round of budget cuts.
“It’s a good position to lay off, with all the concerns about homelessness and mental health being raised,” Dierenger said flatly.
When asked about PHS’s contract with the county, Dierenger said, “In their proposal, PHS promises a lot of different things, and to do those things at a lower cost than the county was able to. And some of those things aren’t getting done, such as the involvement in discharge planning and [issuing of] the medication.
“Things have changed drastically,” Dierenger continued. “There was more communication between the county offices and ADMHS. It seems like there isn’t that line of communication anymore.”
According to Dierenger, ADMHS used to give released inmates 30-day prescriptions to help them transition back into society “so they don’t have to start all over again.”
PHS, Dierenger said, didn’t provide released inmates with any medication until she requested the service multiple times.
“Now they’ll issue prescriptions for one week if the prisoner or a family member pays for it,” she said. “And it seems like the array of medications that the prisoners have is very limited. ADMHS used to prescribe something that wasn’t on the formulary if the prisoner had been doing well on it while they were out in the community. That doesn’t happen anymore.
“It’s hardest for the prisoners who have never been on medication before,” she continued. “The jail doesn’t feel they should have to treat those people, but they’re so symptomatic—they’re hearing voices and hallucinating—that they can’t care for themselves or assist in their cases.”
Again, there’s quite a bit of disagreement over this issue.
Tona Wakefield is the jail’s only discharge planner. Hired in 2009—thanks to money raised by the nonprofit Bringing Our Community Home—Wakefield creates discharge plans inside the jail.
“I think [the grand jury report] was an unfortunate report, because I’m working here with PHS, and I think they’re doing a good job,” Wakefield said. “[Jail] is like anywhere people come in to get medical attention. Nobody gets immediate treatment anywhere. You have to enter the system and go through the process.”
This isn’t the first time PHS has come under fire for its treatment methods—or lack thereof, according to some sources.
In 2005, The New York Times reported the results of a yearlong investigation into PHS, after receiving reports of inmate deaths.
The article referenced numerous instances of “medical care that has been flawed and sometimes lethal,” including several cases in which “[New York] state investigators say they kept discovering the same failings: medical staffs trimmed to the bone, doctors underqualified or out of reach, nurses doing tasks beyond their training, prescription drugs withheld, patient records unread and employee misconduct unpunished.”
The Times also reported PHS has paid millions of dollars in fines and settlements.
The Sun found reports of similar problems in other news sources, such as the Naples Daily News in Florida and The Salt Lake Tribune in Utah.
PHS director Dr. Leigh Ann Bradley declined to comment on the Santa Barbara County grand jury report. She also said she didn’t “feel comfortable” discussing jail medication regimens with a reporter. When asked in previous interviews about reports of inmate neglect by PHS staff in other facilities, Bradley said those reports were blown out of proportion and declined to comment further.
An insider’s story:
To get a better perspective of what life is like behind bars, the Sun contacted people who served time at the jail. The following is a first-person account from John, who asked to be identified by a pseudonym because he’s still on probation and fears retribution.
John has been incarcerated three times for committing nonviolent offenses. He said he also suffers from depression and severe social anxiety, but was responding well to a combination of medications.
In an e-mail to the Sun, John said his first two experiences in custody were bearable because he was eventually able to obtain his various medications.
“The nightmare began on my 3rd time in jail,” John wrote in the e-mail.
John said after he went through the intake process, he put in a request for medication, but the medical personnel indicated he wouldn’t be able to see a doctor for at least a week. Only doctors can prescribe medication at the jail.
“Finally in a last ditch effort I told the guard what was going on and I needed help immediately and he took me out of my cell to see a nurse,” he continued in the e-mail. “When I got there I told her I needed my medication as I was having difficulty sleeping, eating, having panic
attacks, and was disoriented.”
John said the nurse told him his specific brands of medication were no longer available to inmates because of budget cuts.
“I was scared and begged for a doctor and the nurse said I was faking it to the guard and to take me back to my cell,” he said.
John’s mother told the Sun she made repeated attempts to contact PHS to discuss her son’s medical condition, but each time she was told PHS was prevented from divulging medical information under the Health Insurance Portability and Accountability Act (HIPAA).
John said he was eventually offered a low dose of a different medication, but it did little to assuage his symptoms. He said he started hallucinating and lost feeling in his legs.
“And I was not the only one,” John said in the e-mail, explaining he saw others in the cell suffering from not getting their own medications. “I saw people crying and begging for help to no avail … .
“I understand that jail is a place meant to be punishing for those who break the law and agree it should be that way,” John concluded. “What I don’t agree with is that to cut costs or save money, people are not given their prescriptions. This is a matter of life and death, and if cutting costs means people have to … go through what I went through that is sad, and people have to really start looking at what is going on and what is really important in life. We are criminals and broke the law but we are human, no one deserves that, not even [dogs] or other animals go through what I went through.”
The Sun was unable to confirm any of John’s story because of the HIPAA laws.
Contact Managing Editor Amy Asman at aasman@santamariasun.com.
This article appears in Jun 23-30, 2011.