Detention Mental Health Services

In July, 2011, DMH was advised in a 2010-2011 Grand Jury report and was notified by the Institute of Medical Quality that the medical/mental health staffing levels in county jails needed to be restored to 2007 levels, in order to be in compliance with Title 15, Chapter 4, Article 9. As of this writing, the Grand Jury learned through sworn testimony that during the eight months following the 2010- 2011 Grand Jury report, DMH staffing levels were allowed to decrease even further. This was a result of transferring experienced, mental-health, registered nurses out of the jails before licensed clinician replacements were available. The 2012 RCDMH organizational chart reflects currently there are 21 vacant positions out of 40 positions funded with adult detention facilities and three vacant positions out of nine funded in the juvenile facilities. The same chart shows staffing in adult non-detention mental health facilities as having only one vacant position. The Grand Jury learned from sworn testimony that all have the same credentials, but non-detention clinicians have not completed the required background investigation as required by Title 15. The same issues exist in juvenile facilities, which also experienced staff reductions in 2009. The current 2011-2012 budget has not restored the juvenile facilities staffing of 2007. The Grand Jury learned from sworn testimony that filling vacant positions in DMH has been made even more difficult due to the non-competitive salary structure. Annual Performance Evaluations

Through sworn testimony, the Grand Jury learned that up to 60 percent of DMH staff working in detention facilities have not received annual performance evaluations as required by Riverside County Board of Supervisors Policy C-21. Communication within Detention Mental Health

The Grand Jury learned that some detention mental health workers are fearful of communicating with supervisors and/or managers about urgent work-related issues for fear of retaliation. Testimony also revealed that a number of Juvenile DMH clinicians have had onsite visits by their supervisors as few as three times a year. Temporary Replacement of Mental Health Workers

There is an insufficient number of qualified RCDMH personnel to fill vacancies that may arise in DMH. The requirement for level-one security in the jails makes a temporary assignment impossible when the appropriate level-one background investigation required is not completed. (Currently, juvenile facilities do not require a level-one security background check.) The requirements for a background check are the responsibility of the employing departments (i.e., RCDMH, Riverside County Regional Medical Center, and Riverside County Office of Education.) The background check consists of a fingerprint check for possible criminal background, physical exam, drug/alcohol screening, and education and licensure verification. Probation has the authority, through Title 15, Section 1400, to deny any person permission to work with juveniles; however, Probation is not provided with any background or security information obtained in the investigation. Juvenile Detention Administration Consolidation

Current organizational charts of RCDMH show that the administration of the five juvenile detention facilities in Riverside County are under three administrators based on their geographical location. The staffing of DMH workers under these three administrators represents approximately two to five percent of their staffing, as they are also responsible for over 100 other employees. This situation does not allow effective personnel management among facilities as needed or free communication with Probation or within DMH. Memorandum of Agreement for Juvenile Facilities

Sworn testimony from various sources in the RCDMH, DMH and Probation revealed mental-health-care services for in-custody juveniles lacks an adequate number of therapists and clerical assistants. This prevents provide mental-health services from being effective, as required by Title 15. The Probation director is responsible for the security of everyone in a juvenile facility per Title 15, but is not authorized access to the results of the findings of pre-employment investigation conducted by another agency for their employees. Pre-employment background checks for RCDMH, Riverside County Regional Medical Center, and Riverside County Department of Education employees that work in juvenile custody areas are being conducted by the person’s employing department without the Probation’s involvement. In addition, it was brought to the attention of the Grand Jury, through sworn testimony, that in some juvenile facilities mental-health records are not being completed in a timely manner as directed by Title 15, Section 1406, which states that the examination and paper work must be completed in 96 hours. Referral Process in Adult Detention

Sworn testimony by mental health workers and correctional staff indicate procedures for generating and tracking mental health referrals in the adult detention facilities as being insufficient in their compliance with Title 15, Division 1, Chapter 1, Subchapter 4. Current problems are: • delays in notifying DMH of problems, concerns and requests for service, • significant backlogs of adult referrals, particularly with the new AB109 transfers, • no visual tracking or status reporting of referrals, and • collected data does not separate critical requests from routine, thereby making the severity of a problem difficult to ascertain. Gaps in Coverage

The Grand Jury learned, through sworn testimony, that mental-health crisis management has been reported by DMH to have gaps in its mental-health coverage. Outlying juvenile detention facilities often do not have mental-health coverage in the after-hours. Transportation of an individual requires by law, at least two officers. This takes the officers away from the facility for up to six hours. This may require outside assistance such as, but not limited to, fire department paramedics and ambulance services. 5