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Extracted from Consolidated Report

This investigation was originally published as part of a larger consolidated report containing multiple investigations. View the consolidated PDF for the complete document.

Orange County Grand Jury • 2016-2017

Our Brothers’ Keeper: a Look at the Care and Treatment of Mentally Ill Inmates in Orange County Jails assurance

Published: June 08, 2016 23 pages
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Findings 22 findings

F1 Page 41
Mod L, located in the Intake and Release Center, has an insufficient number of beds to accommodate all mentally ill inmates who would benefit from regular interaction with medical, psychiatric, nursing, and case management services. The lack of bed space for the number of mentally ill inmates who need acute services supports the Department of Justice concern that the jail needs to act to prevent mental health crises and provide adequate transition programs, not just to deal with the most immediate urgent needs.
F2 Page 41
Correctional Health Services provides minimal mental health treatment services in the form of therapy groups to less than 1% of the total jail population diagnosed with some type of mental illness, which precludes therapeutic treatment to most mentally ill inmates.
F3 Page 41
The Intake and Release Center has no system for ensuring humane treatment of an inmate in a safety cell. Examples include: the inmates are cold, they sleep next to a grate that is used as a toilet, and no water is available for the inmate to wash hands after the use of the toilet and prior to eating meals.
F4 Page 41
Correctional Health Services uses the safety cell as a substitute for treatment. There are no measurable and observable criteria for moving someone into a safety cell, or immediately removing inmates when they are no longer a threat to themselves or others, which has the potential to result in the use of safety cells for disciplinary purposes.
F5 Page 41
A psychiatrist is the only person authorized to remove an inmate from a safety cell, however, one is not always available to do so, which may result in a longer term of confinement than necessary.
F6 Page 41
Correctional Health Services staff does not hold a debriefing meeting after each use of the safety cell. Therefore, CHS is unable to identify how the treatment failure occurred and to help prevent future occurrences, including suicide attempts. 2015-2016 Orange County Grand Jury Our Brothers’ Keeper: A Look at the Care and Treatment of Mentally Ill Inmates in Orange County Jails
F7 Page 42
Neither Correctional Health Services nor Sheriff’s Department staff collects or analyzes data related to safety cell usage other than how often it is used, and therefore, neither has any quality improvement or risk management activities to assist in reducing safety cell use.
F8 Page 42
The Orange County Jail does not have a Restoration of Competency treatment program, to the detriment of inmates declared incompetent to stand trial by the courts. Wait time for transfer to a state hospital does not meet the directive of the court system to transfer within 30-35 days.
F9 Page 42
Data demonstrates that the Collaborative and Community Courts provide effective treatment services for mentally ill offenders who qualify for the programs.
F10 Page 42
Collaborative Courts save the County a significant amount of money in decreased incarceration and recidivism rates.
F11 Page 42
The current number of jail psychiatrists is not sufficient to meet the needs of the general inmate population diagnosed with mental illness. This shortage has resulted in extended periods of time inmates spend in safety cells, as well as a lack of psychiatric services in all but a very small portion of the Orange County Jails. The Department of Justice findings support the concern that therapeutic treatment may not reach prisoners who may be quite ill, but are not the most obviously in need of mental health care.
F12 Page 42
Orange County has become a model for successful implementation of Laura’s Law in the State of California. Behavioral Health Services keeps comprehensive statistics on all aspects of Laura’s Law and therefore can effectively analyze the program’s strengths and weaknesses.
F13 Page 42
Correctional Health Services does not provide therapeutic treatment services to inmates with a chronic mental health diagnosis in most parts of Mod L or in any of the general jail housing. This small concentration of service supports the Department of Justice concern that the jail does not provide for a cohesive system of therapy and treatment.
F14 Page 42
There is a lack of adequate classroom space to conduct educational classes for inmates who would benefit from participation in inmate services programs.
F15 Page 42
Correctional Health Services has no written guidelines, no formal course of study, and no specific training for case managers or nursing staff who conduct group therapy sessions on Mod L Crisis Stabilization Unit.
F16 Page 42
Sixteen beds in Ward D are insufficient to meet the needs of the large number of inmates with chronic mental health issues outside of Mod L. 2015-2016 Orange County Grand Jury Our Brothers’ Keeper: A Look at the Care and Treatment of Mentally Ill Inmates in Orange County Jails
F17 Page 43
Although the Sheriff’s Department has a Memorandum of Understanding with the Health Care Agency to provide mental health care services to Orange County jail inmates, the two entities do not have a formal system in place for sharing mental health data that affects both entities.
F18 Page 43
The Jail Compliance and Training Team, made up of Sheriff’s Department personnel, does not include anyone with a Quality Assurance background. Although the Jail Compliance and Training Team completes standard reports and provides them to Sheriff’s Command staff, it does not consistently collect and analyze data over time to identify trends.
F19 Page 46
R.17. The Health Care Agency/Correctional Health Services should review its quality management committee structure by December 31, 2016 to ensure issues identified in reports are thoroughly analyzed. Trends should be identified and addressed through quality improvement activities. The minutes of the meeting should reflect committee discussion and decisions regarding trends. Minutes should also reflect follow-up actions taken to ensure resolution of identified issues.
F20 Page 43
The Health Care Agency/Correctional Health Services collects health care related grievance data and presents it to the Quality Management Committee on a regular basis, however, the data is not formally analyzed to identify trends and the Quality Management Committee minutes do not demonstrate discussion on the implementation of quality improvement activities based on the data presented.
F21 Page 43
Neither the Sheriff’s Department or Correctional Health Services has developed and initiated a formal process to address or track lingering issues identified in the 2014 Department of Justice correspondence. Additionally, they do not have a formal system in place to track improvement plans that may have been put into place to correct Department of Justice concerns.
F22 Page 43
The Crisis Stabilization Unit does not have a system in place to collect or analyze data. Additionally, they do not have any formal quality improvement activities specific to Mod L treatment services, and therefore are unable to objectively evaluate the effectiveness of therapy groups. 2015-2016 Orange County Grand Jury Our Brothers’ Keeper: A Look at the Care and Treatment of Mentally Ill Inmates in Orange County Jails RECOMMENDATIONS In accordance with California Penal Code Sections 933 and 933.05, the 2015-2016 Grand Jury requires (or, as noted, requests) responses from each agency affected by the recommendations presented in this section. The responses are to be submitted to the Presiding Judge of the Superior Court. Based on its investigation titled “OUR BROTHERS’ KEEPER: A Look at the Care and Treatment of Mentally Ill Inmates in Orange County Jails,” the 2015-2016 Orange County Grand Jury makes the following 17 recommendations:

Recommendations 17