San Diego County Grand Jury • 2022-2023

Crisis in Treatment Access for Incompetent to Stand Trial Incarcerated Persons in the County Jails

Published: May 10, 2023 12 pages
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Findings 12 findings

F01
Most IST IPs in the San Diego County jails spend a lengthy jail time awaiting DSH treatment and thus have an increased risk of harm to self or others.
F02
IST IPs in the San Diego County jails have an increased risk of being written up for rules violations or charged with assault the longer they stay in jail. Jail rules violations and additional charges can result in a lengthier incarceration. Fact: As of November 1, 2022, there were 130 IST IPs in the San Diego County jails. 20 https://cops.usdoj.gov/ric/Publications/cops-w0869-pub.pdf 21 https://www.chhs.ca.gov/wp-content/uploads/2021/12/IST_Solutions_Report_Final_v2.pdf 22 https://www.nri-inc.org/media/1500/jbcr_website-format_oct2018.pdf 7 Fact: The Sheriff’s Department receives funding from DSH to operate a 30 bed JBCT program which began operations in March 2017.
F03
The JBCT program decreases the San Diego County jail DSH transfer waitlist by providing competency restoration treatment for 23% of San Diego County jail IST IPs. Fact: Psychiatric medication is available to all IST IPs. Fact: The First District Court of Appeal found that baseline medical services provided by county jails do not constitute substantive services for IST defendants. Fact: No group counseling or multifaceted mental health programming is available for those IST IPs not in the JBCT program or on the PSU unit. Fact: No competency restoration treatment is provided for IST IPs not selected for the JBCT program.
F04
There is no competency restoration treatment and limited general mental health programming provided to IST IPs housed in the San Diego County jails who are not selected for the JBCT program.
F05
Implementation of competency tutoring/support as a stop-gap measure may increase likelihood of IST IPs, at time of 60-day re-evaluation, being found ready to proceed with court proceedings.
F06
Untreated or inadequately treated individuals with a serious mental illness, especially in a jail setting, have increased risk of self-harm, being written up for rules violations, or being charged with assault while in jail. Fact: The JBCT program only accommodates male IST IPs to participate in the program. Females are not offered a JBCT program. Fact: As of November 2, 2022, there were 19 female IST IPs in the San Diego County jail.
F07
There is a gender inequity as female IPs are not provided equal access to treatment. Fact: Unless selected for the JBCT program, there is no dedicated housing for IST IPs. Fact: IST IPs are housed at any of the following jail facilities: Central jail, Vista Detention, Las Colinas, George Bailey. Fact: IST IPs are housed in all types of housing units including administrative separation units which are solitary confinement housing. Fact: No group counseling or other multifaceted mental health programming is available for those IST IPs not in the JBCT program or on the PSU unit.
F08
IST IPs would have better access to mental health services in housing units which are staffed with assigned mental health professionals.
F09
Dedicated housing for all IST IPs will create more opportunities for therapy. Fact: The Sheriff’s Department employs approximately 27 mental health clinicians who provide non-medication mental health services to a jail population of approximately 4,000 IPs. Fact: NaphCare employs an additional ten mental health clinicians who provide non-medication mental health services to the jail population. Fact: BSCC collected data which shows that in 2019, approximately 50% of San Diego County jail IPs had an active mental health case. Fact: BSCC collected data which shows that in 2019, approximately 22% of IPs in San Diego County jails were prescribed psychiatric medication.
F10
There is an insufficient number of mental health clinicians to provide appropriate basic on-site mental health services, as defined by NCCHC accreditation standards, to San Diego County jail IPs, including IST IPs.
F11
An increase in general mental health services will increase likelihood of IST IPs, at time of the 60-day re-evaluation, being found ready to proceed with court proceedings. Fact: The cost of housing an IST IP is 2 to 3 times the amount for housing an IP without a mental illness. Fact: The State of California does not contribute to the cost of treatment and housing of IST IPs who are not selected for the JBCT program.
F12
Costs of increased County funding for competency restoration treatment and/or general mental health services to IST IPs may be offset by cost savings from shorter IST IPs jail stay.

Recommendations 8