Marin County Grand Jury
• 2016-2017
Care of Mentally Ill Inmates in Marin County Jail Report Date: June 8, 2017
⚠️ Translation Notice: This content has been automatically translated. The original English text is the official version. Translation may contain errors.
⚠️ Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.
Findings and Recommendations 14 findings
F1
A significant number of inmates in the Marin County Jail have severe mental illness.
Related Recommendations (1)
R1
Mentally ill inmates should not be kept in a safety cell longer than 24 consecutive hours unless the jail psychiatrist certifies that no other remedy is available to prevent the inmate from harming themselves or others.
F2
The Jail’s clinical and custodial staff are highly professional, dedicated, and competent.
Related Recommendations (1)
R2
Safety cells should never be used for mentally ill inmates as a substitute for adequate medication and/or other psychiatric treatment.
F3
Due to deficiencies in policies, organization, management, and staffing levels, mental health care in Marin County Jail is inadequate.
Related Recommendations (1)
R3
Any inmate placed in a safety cell should be evaluated by mental health staff within one hour for the appropriateness of the placement and the evaluation of possible alternative placements.
F4
No mental health staff are on site for large parts of every day.
Related Recommendations (1)
R4
The Jail should, , establish or contract with a local facility where involuntary administration of psychiatric medication can take place.
F5
The Jail experiences a high level of turnover in the mental health staff.
Related Recommendations (1)
R5
The Jail should identify and adopt, , policies that ensure mentally ill inmates are provided a minimum of one hour per day outside their cell, with a minimum of seven hours per week, while meeting adequate clinical and custodial standards of care.
F6
Inmates with severe mental health issues are placed in isolation, being allowed outside of their cells for only 30 minutes per day or a minimum of 3 hours per week.
Related Recommendations (1)
R6
A psychiatrist should be available at the jail 8 hours per day, 5 days per week, and be available by telephone 24 hours per day, 7 days per week.
F7
Mentally ill inmates are often placed in safety cells (commonly known as padded cells) for periods longer than 24 hours, a practice that has been described by the courts as cruel and unusual punishment.
Related Recommendations (1)
R7
A Mental Health Crisis Specialist or a Psychiatric Nurse should be available at the jail 24 hours per day, 7 days per week.
F8
The mental health status of inmates at the time of booking is often performed by deputies rather than mental health staff.
Related Recommendations (1)
R8
The Jail should immediately institute programs to provide appropriate professional mental health (non-medication) therapy to all mentally ill inmates, particularly those incarcerated for longer than 7 days.
F9
In the case of emergency psychotic events, inmates who refuse medication are often placed in safety cells rather than being treated by involuntary administration of medication, which is allowed by California law and is the common community standard.
Related Recommendations (1)
R9
Booking of inmates should at all times include screening for mental illness by a nurse using an accepted mental health screening tool.
F10
Since the termination of the County’s contract with Santa Clara in 2015, the Jail and the Department of Health and Human Services have not yet established adequate processes to provide involuntary psychiatric medication in an emergency situation.
Related Recommendations (1)
R10
Classification of inmates as mentally ill should be reviewed by a member of the mental health staff within one hour of booking.
F11
Neither individual nor group psychotherapy is provided by professional mental health staff.
Related Recommendations (1)
R11
All policies and procedures in the Sheriff’s Manual related to the care of inmates should be reviewed and updated and following that, as necessary, at least biennially.
F12
The Jail’s clinical quality assurance process does not adequately address mental health issues in the Jail.
Related Recommendations (1)
R12
The Jail should develop, implement, and enforce a quality improvement procedure and establish a quality improvement plan for mental health services.
F13
The County’s use of state funds associated with AB 109 does not adequately address the increased mental health care burden on the Jail of longer term inmates that resulted from the enactment of AB 109.
Related Recommendations (1)
R13
The County should provide adequate funding to implement these recommendations.
F14
Multiple documents in the Marin County Sheriff’s Department Custody Division Policy and Procedures Manual have not been reviewed or updated for up to 12 years.
No recommendations for this finding
Conclusions 1
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CL1Although identifying and committing adequate resources to provide appropriate mental health care in Marin County Jail may be difficult for the County, there are important reasons that a significant enhancement of mental health care in the Jail should be a high priority. Current staffing and organization of mental health care in the Jail is inadequate, and appears not to conform to California law and code nor to court rulings regarding the care that should be provided to incarcerated persons. In particular, delays in assessment and treatment of recently booked mentally ill inmates, lack of adequate local processes to address emergency mental health crises, inadequate 24/7 clinical coverage, and the use of safety cells for acute mental illness episodes need to be addressed as soon as possible. There appear to be clear violations of the rights of inmates to adequate care based on, and equivalent to, “community standard” care. Marin is one of the richest counties in the nation. Surely the County can find adequate resources to provide humane mental health care to inmates in Marin County Jail that meets the requirements of the law and accepted clinical practices. June 8, 2017 Marin County Civil Grand Jury Page 23 of 31 Care of Mentally Ill Inmates in Marin County Jail