Sacramento County Sheriff's Department Scott R. Jones Sheriff August 20, 2016 Hon. Kevin R. Culhane, Presiding Judge*

Inmates who need mental health services are at an increased risk for re- incarceration and/or psychiatric hospitalization if they are not linked to community mental health services during the critical 24-72 hours after release. The Sheriff's Department concurs with the Grand Jury's finding that inmates who need mental health services are at an increased risk for re-incarceration or psychiatric hospitalization if no mechanism provides a link to community mental health services within the immediate 72 hours after release. At the foundation of the finding is the critical 24-72 hour period directly following the release of an inmate suffering from one or more mental illnesses. The complexity of this situation involves a wide variety of variables, many of which are not directly under the control of the Sacramento Sheriff's Department. However, the Department, and a multitude of multidisciplinary partnering services, work tirelessly to bridge that pivotal period. Through this quest, the Sacramento County Sheriff's Department focuses a significant amount of effort towards three distinct services aimed at stabilizing the inmate in custody, preparing the inmate for integration back into the community, and providing information on where to locate accessible resources. In Custody The Sacramento County Sheriff's Department contracts with the University of California Davis to provide Jail Psychiatric Services (JPS). The focus of the custody centric mental health services includes the detection, diagnosis, and treatment of inmates suffering from psychiatric illnesses. The JPS also provides crisis intervention and manages acute psychiatric patient service designed to stabilize mental health condition while housed within the facility. Pre-Release Before release, mental health professionals identify individuals exhibiting severe mental illnesses and develop individualized discharge plans. The JPS discharge planner and mental health personnel collaborate with a diverse set of groups that offer a wide variety of services. These groups include, but are not limited to, County Behavioral Health Services, Mental Health Court, community providers, and mental health triage navigators. The triage navigators provide services on a daily basis from 8 AM to 2 AM. Release Mental health professionals also provide inmates with information they can take with them after leaving the facility. These products serve as a guidebook for individuals who may elect to seek out community resources. In addition to knowledge based material, Jail Psychiatric Services also provides a free 30-day prescription of medications to help maintain their mental health stability.

Mentally ill inmates released during non-business hours and at night when they cannot access services are also more at risk for recidivism and exacerbation of mental health symptoms. At the foundation of any examination involving the correlation of mentally ill inmates being unable to access services due to the time of release is the Sacramento County Sheriff's Department's statutory obligations. As previously discussed in Grand Jury Finding (F1), the Sacramento County Sheriff's Department actively strives to guide the release of mentally ill inmates towards successful reintegration in the community. As it relates to the time of release, the Sheriff's Department continually seeks to balance an individual's statutory rights with decisions that could promote a more successful integration. Once court personnel schedule an inmate for release, the Sheriff's Department must process the individual within a reasonable amount of time and allow them to exit the facility. The Sheriff's Department cannot arbitrarily keep an individual incarcerated even if the outcome was a guaranteed success. Keeping an individual involuntarily in the facility would violate a person's Constitutional rights and subject the Sheriff's Department and Sacramento County to litigation. In an effort to achieve the same outcome, without incurring civil liability, the Sheriff's Department offers inmates the option to stay in the release area of the jail until the next morning when community services are available. Officers provide information on where to access mental health services and community resources to those inmates that choose not remain in the release area until the next morning The Sheriff's Department supports examining any additional resources that may provide a greater chance of success for the release of mentally ill individuals. Due to the complex human topography associated with mental illness, this effort may require a collaborative solution involving county agencies, city agencies, care providers, and non-profit organizations, who are willing to seek lasting answers.

The Main Jail data system does not flag those inmates who received mental health services during incarceration. The Sheriff's Department respectfully disagrees with the Grand Jury's findings that the Main Jail data system does not flag those inmates who received mental health services during incarceration. While speculative, the data system referred to in this report is likely the Jail Inmate Management System (JIMS). Custody staff primarily utilize this system for documenting inmate incarceration into the facility, movement, housing, classification levels, and incident documentation. Currently, this is only one of three separate systems utilized in corrections. Mental Health workers assigned to corrections do complete Inmate Reports, commonly referred to as a PF-10, with information necessary for Corrections Deputies. However, this system is not designed to "flag" those who are receiving mental health services for two important reasons. First, the custody staff is advised of limited mental health information only as it relates to the safety of the individual, safety of officers, or jail security. This situation is not unique to only psychiatric information but also other medical conditions. Not all custody staff have both the right and the need to know specific mental health information on every inmate. Second, it is the responsibility of JPS staff to interview, assess, and evaluate the needs of an inmate. Once this assessment is complete, the JPS professionals will determine whether or not they are suffering from some form of mental illness. This determination will involve documentation in the Correctional Health Services electronic medical record system. The purpose of this system includes having a central database system that documents and provides tracking of all mental health services given to the inmates during incarceration in the Sacramento County Jail. The triage navigators and JPS utilize this information in the discharge planning process to help coordinate linking the released individual with outside mental health and community services. Although the current JIMS is antiquated, the Sheriff's Department is in final contract negotiations for a modern system. This system will provide a greater chance for integration, while also maintaining a consistent level of granular security.