Santa Clara County Grand Jury
• 2017-2018
• Agency Response
Response to:
2017 Update from the City of Santa Clara
Recommended Action Consider recommendations relating to Final Grand Jury Report, Addressing Mental Illness in Santa
⚠️ Aviso de traducción: Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.
⚠️ Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.
Findings and Recommendations 11 findings
F1
Custody Bureau policies and procedures are out of date
Related Recommendations (1)
R1
The Office of the Sheriff should assign personnel whose sole responsibility is to update and maíntain all Custody Bureau policies and procedures with priority given to the Medical and Health Care Services chapter and the Security and Control ' chapter.
F2
lnterim changes to existing Custody Bureau policies and procedures are not explicitly tied to the policies and procedures they affect.
Related Recommendations (1)
R2
The Office of the Sheriff should use a document control method to ensure any interim changes to existing policies and procedures are explicitly tied to the policies and procedures they affect.
F3
Current staffing levels necessitate that correctional deputies typically work alone in a housing unit. This makes it extremely difficult, if not impossible, for the correctional deputies to fulfill their duties and responsibilities.
Related Recommendations (1)
R3
The Office of the Sherifl should increase staffing levels so that at least two correctional deputies are assigned to each housing unit on all shifts to manage the workload, reduce stress, increase security and safety, and allow correctional deputies more flexibility in dealing with the behavior and needs of all inmates, including those with mental health issues.
F4
Supervision of correctional deputies on the housing floors is inadequate. There are not enough sergeants to provide sufficient coaching, support, and remediation where needed. Watch commanders are not on site at all times.
No recommendations for this finding
F5
The number of mental health clinicians is insufficient to adequately address the needs of mentally ill inmates in the jails.
Related Recommendations (1)
R5
The Santa Clara Valley Health & Hospital System should increase clinician staffing levels in the jails to improve the levelof support counseling, therapy, and advocacy for mentally ill inmates.
F6
There is a need for improvement at all management levels of Custody Health Services.
Related Recommendations (1)
R6
The Santa Clara County Board of Supervisors should commission a thorough independent audit of the Custody Health Services organization to ensure best management practices are identified and employed.
F7
Custody Health Services is unable to facilitate a "warm handoff' of mentally ill inmates to community providers upon release from jail.
Related Recommendations (1)
R7
Custody Health Services should develop a process to ensure discharge planning begins upon incarceration and leads to a "warm handoffl' to community support services at time of release. I
F8
Implementation of multi-disciplinary teams approved by the Board of Supervisors has been poorly executed, and the proposed benefits have not been realized.
Related Recommendations (1)
R8
The Board of Supervisors should appoint a project manager to oversee the implementation of the multi-disciplinary teams to ensure their anticipated benefits are fully realized. Custody Health Response Custody Health Services disagrees with the finding. The recommendation has already been implemented. A Health Care Program Manager II was hired in late May to oversee the implementation and management of the Behavioral Health teams. Five Behavioral Health teams are operational to date, with additional teams to launch in the next few months. The teams consist of a psychiatrist, psychologist, psychiatric nurse, and licensed clinician. The Behavioral Health teams are supported by Multi-Support Deputies who assist with custody-related issues. Additionally, a contract with a community-based agency will be brought to the Board of Supervisors for approval on August 30th to provide the substance use counseling component to the teams. The Behavioral Health teams meet weekly to discuss patients and coordinate care. They also participate in regularly scheduled facility-specific Multi-Disciplinary Team meetings at Elmwood and the Main Jail to discuss inmate-patients who require a more coordinated plan of care by Medical, Mental Health, and Custody. The Behavioral Health teams are in the process of addressing critical gaps in care for seriously mentally ill (SMI) and intellectually disabled (ID) inmate-patients at Elmwood and the Main Jail. SMI and ID inmate-patients in the BHT units are more quickly identified and their conditions stabilized with a team approach that focuses on ongoing, rather than crisis-driven, care. In the last few months, adherence to treatment has improved as evidenced by an overall reduction in mental health clinic refusals across facilities. Specifically, refusals for outpatient psychiatric appointments have decreased from 23% in January 2016 to 12% in June 2016. Coordination and collaboration with Behavioral Health Services, Mental Health/Drug Treatment Court, and community-based agencies has increased, resulting in improved discharge planning, smoother transitions back into the community, and “warm handoffs” to community-based providers. The addition of the substance use counselors (expected in September 2016) will also help to initiate and support a recovery process for those inmate-patients with chronic substance use and/or co- occurring disorders.
F9
There is significant opportunity to enhance the quality and training methods of Custody Academy courses that deal with mentally ill inmates.
No recommendations for this finding
F10
While the Custody Bureau has expanded its curriculum to include Crisis lntervention Team training, some of that training is not relevant to the custody environment.
Related Recommendations (1)
R10
The Office of the Sheriff should develop or select a custody-centric Crisis lntervention Team training program for the Custody Bureau by December 31, 2016, for immediate implementation.
F11
There is no content specific to dealing with mentally ill inmates in the Probationary On-the-Job Training manual. Recornmendation 11 The Office of the Sheriff should add content on dealing with mentally ill inmates to the Probationary On{he-Job Training manual. Evaluation criteria should include interaction with mentally ill inmates and those with developmental disabilities, de- escalation techniques, and appropriate use of force. oÍ 35 Glossary Anxiety disorders: Mental illnesses in which people display excessive distress or uneasiness of mind for months. Bipolar disorder: Also known as manic-depressive illness, a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. Cell extraction: A procedure used by an emergency response team to move an inmate by force from a cell when all attempts to gain voluntary compliance have failed. Clinician: A Licensed Clinical Social Worker or Marriage and Family Therapist. De-escalate: To decrease in intensity or magnitude. Depressive disorders: Disorders characterized by sadness severe enough or persistent enough to interfere with function and often by decreased interest or pleasure in activities. Developmental disabilities: A diverse group of chronic conditions that are due to mental or physical impairments and cause difficulties particularly with language, mobility, learning, self-help, and independent living. Document control: The management of documents through the document life cycle for version control, security, availability, and a reliable audit trail. Exigent: Requiring immediate action or aid; urgent lnpatient: An inmate who is housed in Main Jail BA and is attended by medical profession als 24 hours a day. lntellectual disabilities: Disabilities originating before the age of 1B and characterized by significant limitations in both intellectualfunctioning and adaptive behavior. Licensed Clinical Social Worker (LCSW): A specialist in the principles of psychotherapy and social work who has completed a master's degree in social work and 3,000 hours of direct clinical experience to acquire a license to do psychotherapy. Marriage and Family Therapist (MFT): A specialist who diagnoses and treats disorders related to mental health. Requires a Master's degree and 3,000 hours of direct clinical experience. Mood disorders: A category of mental disorders in which the underlying problem prirnarily affects a person's persistent emotional state (their mood). Nurse Practitioner (NP): An individual with a four-year college degree in nursing and a Master of Science in Nursing or Doctor of Nursing Practice. Practicing under the supervision of a medical doctor, NPs can provide assessment, diagnosis, and prescriptions for medication. Objectively reasonable force: According to Custody Bureau policy, that level of force which is appropriate when analyzed from the perspective of a reasonable correctional deputy in the same situation and possessing the same information as the correctional deputy who actually used force. Perishable skills: Skills that depreciate over time if they are not practiced Polysubstance dependence: A psychological addiction to being in an intoxicated state using any combination of three drugs. Post traumatic stress disorder: A disorder that develops in some people who have seen or lived through a shocking, scary, or dangerous event. Programs/Programming: Activities designed to enhance the safety and order of the jail and improve public safety by making inmates more productive upon release. Often used by Custody Bureau personnel to refer to all out-of-cell time. Psychiatric Nurses: RNs with specialized training in psychiatry and some forms of psychotherapy who typically have 500 hours or more of direct clinical experience. Psychiatrist: A medical doctor who specializes in mental health care and can prescri be m ed ications. Psychologist: A professional who has a Ph.D. degree and per{orms diagnoses, psychological assessments, and a wide variety of psychotherapies. Psychotic disorder: A severe mental disorder that causes abnormal thinking and perceptions. People with psychoses lose touch with reality. Two of the main symptoms are delusions and hallucinations. Role-playing: A simulation in a safe training environment to prepare for unfamiliar or difficult situations. Scenario: Scripted role-playing used as an evaluation tool. Schizoaffective disorder: A condition in which a person experiences both a loss of contact with reality and mood problems. Schizophrenia: A severe brain disorder in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior. Schizophrenia (paranoid type): A subtype of schizophrenia in which persons have delusions that others are plotting against them or members of their family. Warm handoff: Active engagement between jail mental health staff and a community provider to ensure a seamless transition of care upon inmate release. References Bibliography 2011 Public Safety Realignment: The cornerstone of California's solution to reduce prison overcrowding, costs and recidivism. (2013, December 19). California Department of Corrections and Rehabilitation. Retrieved from + (/ l v -l \ - - ^ J ^ i / , - .) _ r - ^ I l ì U -,^ d ^ " il ^ L ^ ¡ r ' ¡l I ¡e¡ iL - ! ¡ ^ L 1^u¡i .-ù-L; tü - d ^ { r .. -J L - ¡ t f ¡ 2011-2012 Santa Clara County Civil Grand Jury. (2012,I,liay 29). AB 109/AB 117 Realignmenf; /s Sanf a Clara County Ready for Prison Reform? Retrieved from http://vwvw.scscourt.orq/court divisions/civil/cqi/2012lCriminalRealiqnment.pdf 2013-2014 Riverside County Civil Grand Jury. (2014, June 17). Report lmpact of AB 109 upon Riverside County Municipal Police Agencies. Retrieved from htto ://cor r ntvofriverside.us/Portal ra nd J u rv/G ra ndJ u rv20 1 3-201 4 I 2O1 3- 2014o/o2jGrando/o2jJurvo/o20Reoorto/o20lmoaclo/o20ofo/o20ABo/o201j9o/o2}uoono/o 20Riversid e%20Countv%20Municipal%20Police%2OAqencies.pdf Adult Custody Mental Health, Santa Clara Valley Health & Hospital System. (2015, August 4). 8A Officer Mental Health Training (Training materials). Adult Custody Mental Health, Santa Clara Valley Health & Hospital System (2415, December 24). lrrlental Health in Custody (Training materials). Adult Custody Mental Health, Santa Clara Valley Health & Hospital System (2015, August 31). SIC Mental Health Update (Training materials). Adult Custody Mental Health. (2015, December 24). Suicide Prevention in Custody (Trai n ing materials). Agreement Between County of Santa Clara and Traditions Behavioral Health. (2015, September 10). Retrieved from https://wt¡¡w.indvbav.orq/uploads/201 5/09/2Siaqreement-traditions-psvcholoqv- orou o-i n c. -d ba-tracl itions-behavioral-he... 1 .odf Auerback, A. (1959, May).The Short-Doyle Act-California Community Mental Health Services Program: Background and Status After One Year. ln US National Library of Medicine, National lnstitutes of Health, Western Journal of Medicine. Retrieved from http:i/wvwv.ncbi.nlm.nih.qov/pmc/articles/PMC1 577700/ Aufderheide, D. (2012, Winter). Crisis lntervention Teams lmproving Outcomes for lnmates With Mental lllness. CorrectCare, 26(1), 10-12. Retrieved from htto ://wvwv. n cch c.oro/fi lebi n/i aqes/Website PDFs 126-1 .odf Barry, M., Tullys, T. (2015, October 14). BHSD and CHS Report on Services for I n mates. Retrieved from htto ://sccoov.i o m 2. com/Ci tizens/Detail LeqiFile.aspx?lD=78539 Beliveau, T. (2015, November 23). Memorandum: Use of Force and Mentally lll lnmates. County of Santa Clara, Office of the Sheriff. Beliveau, T. (2015, December '1). Memorandum: Transfers/Activity Logs. County of Santa Clara, Office of the Sheriff. Beliveau, T. (2015, December 2). Memorandum: CIT Trained Staff. County of Santa Clara, Office of the Sheriff. Cattabriga, G., DepreZ,R., Louie, M., Lumb, R. (2007, December2l). Crisis lntervention Team (CIT) Training for Correctional Officers, An Evaluation of NAMI Maine's 2005-2007 Expansion Program. Center for Health Policy, Planning and Research, University of New England. Crisis lntervention Training, Current Practices and lnformation for California (2015, September). California Institute For Behavioral Health So/ufions. Retrieved from http://www.ci bhs.orq/sites/main/files/fi le- attachments/cit oractices in ca cibhs sept 2015 1.odf Custody Staffing, Department of Correction, January 2005-2A16. (2016, February 24). Santa Clara County Office of the Sheriff, Personnel Division. Denes, A.C.(2011, July). Training U.S. Correctional Officers in Mental'Health Emergency Response Using the Memphis Crisis lntervention ïeam Model. Northcentral University. Retrieved from http://www.meraqe-equitas.orq/wp- content/uoloads/20 1 4/06/Trainino - U S - Co rrecti o n a I -Off i cers-i n - M e n ta I - H ea lth - Response.pdf Diversion Programs in America's Criminal Justice System. (2015, August). Ihe Center for Prison Reform. Retrieved from https://centerforprisonreform.orq/wp- co nten t/u p I oa d s/2 0 1 5/0 9/J a i l - D i ve rsi o n- P roq ra m s- i n -Am e ri ca. pdf Early, P. (2006), Crazy: A Father's Search Through America's Mental Health Madness. New York, NY: Penguin Group (USA) lnc. Elmwood Complex Women's Facility. (2014, June 27). Santa Clara County Sheriff . Retrieved from https:llwww.sccqov.orq/sites/sherifflPages/elmwood- \¡/omen.aspx Elmwood Men's Facility. (2014, June 27). Sanfa Clara County Sheriff . Retrieved frorn h ttps ://www. sccq ov. o rois ites/sh e riff/Paqes/elmwood-men.aspx Felthous, A.R. (2014, August 13). The Treatment of Persons with Mental lllness in Prisons and Jails: An Untimely Report. Psychiatric Times. Retrieved from http:/lwww.psychiatrictimes.com/forensic-psvchiatry/treatmeryl:Qer$ons-mental- ness-prisons-and-iails-u ntimelv-report i ll Final BudgeI: 2005-2016. (2016). Santa Clara County Department of Correction Final Report: Department of Correction Needs AssessmenlFacilities Study. (2014, December). MGT of America, lnc. Retrieved from https://www.sccqov.orq/sites/faflco/mp/nmi/Documents/Santa%20Clara%20FlNA L%20 Repo rt%20 12291 4 pu b. pdf Fiscal/Budget ltem 79301, Consider recommendations related to the provision of behavioral health services to the inmates incarcerated in the County Jails through the development of twelve (12) teams of behavioral health professionals (Santa Clara Valley Health and Hospital System). (2015, December 15). ln The County of Santa Clara. Retrieved from http ://sccoov. io m 2. com/Ci tizen s/D etai I Leqi Fi le.asÞx? Frame=SplitView&Meetinq I D=6069&MediaPosition=1 359.978&l D=79301 &CssClass= 1 Flores E.C. (2005, February 25). Memorandum: FY06 Budget Reduction and lmplementation Plan for the Department of Correclion. County of Santa Clara, Depar-tment of Correcti on, Ford, M. (2015, June 8). America's Largest Mental Hospital ls a Jail. The Atlantic. Retrieved from http ://www.th eatla ntic. com/politics/a rchive/20 1 5/06/a m ericas- larqest-mental-hospital-is-a-iail/3950 2/ 1 Garavaglia Architecture, lnc. (2015, April 1). County of Santa Clara Main Jail South, San Jose, CA. Historic Resource Evaluation - DRAFT. Construction Chronology, p.15. Retrieved from https://www,sccqov.orq/sites/dpcl/DocsForms/Documents/10729 201 50505 Aop endixA.pdf Graves, G.A. (2015, December '15). Memorandum: Summary of Actions Taken to Address lssues ldentified in the County's Correctional System. County of Santa Clara, Office of the County Executive. Retrieved from htipç./lwww,sccqov.org/siteslscclDocr:m ents/ltem 1 ô-79393-Boa rcl-of- Supervisors-Meetinq-20 1 5-1 2-1 5.pclf Graves, G.A. (2016, May'16). Memorandum: Master List of Jail Reform
Related Recommendations (1)
R11
The Office of the Sheriff should add content on dealing with mentally ill inmates to the Probationary On-The-Job Training Manual. Evaluation criteria should include interaction with mentally ill inmates and those with developmental disabilities, de-escalation techniques, and appropriate use of force. Custody Bureau Response The Custody Bureau agrees with this finding. The recommendation is in the process of being implemented. The Probationary On-The-Job training program for newly hired Correctional Deputies entering the jail facilities after completion of the Academy is currently being evaluated and amended to reflect a variety of enhanced philosophical and procedural job criteria that measures essential skills for Correctional Deputies. Some of these included criteria will be in the areas of Use of Force, De- Escalation techniques and identification of mental illness signs and symptoms along with appropriate communication and response to incidents involving mentally ill inmates. The newly created Office of Standards and Inspection Unit within the Custody Bureau will be working closely with the Training Unit to ensure this amended Training Manual and Training Officer Update is completed and implemented. The goal is to ensure that the increased training received in the academy in the areas of mental illness and de-escalation is further supported and emphasized to new Correctional Deputies in real life situations once assigned to the actual jail facilities. 8