Findings and Recommendations Group 1: State Standards (Title 15) Compliance Issues F1. The failure of Wellpath, the

Additional Recommendations 1

These recommendations are not explicitly linked to specific findings.

• R16-20
  hours a day. According to answers given by Wellpath on 02/13/2024 in a Request for Proposal - Vendor Report to the County, many staffing positions are currently vacant including:[26] ● One Mental Health Coordinator ● Two full time Mental Health Clinicians ● Three full time Registered Nurses ● Four full time Licensed Vocational Nurses Some notable numbers from the report: ● Average daily # of detox patients - 12 ● Average daily # of combined segregation inmates - 25-30 ● Percentage of inmate population on medication - 65 ● Percentage of inmate population on psych medication - 68 ● Percentage of inmate population who are Severely Mentally Ill - 12 The Grand Jury is concerned with these crisis-level numbers. The workload appears to be a problem, given the vacancies of medical and mental health staff. Reducing staffing level caseloads is not the whole answer, but it is a crucial element to the question of whether inmates with mental illness are being provided with the required level of care. We Can Do Better With Our Jails! published June 11, 2024 A recent Santa Cruz Criminal Justice report, as well as statements by jail staff and the Health Inspector, have all expressed concerns about Wellpath‘s high turnover of staff and the fact that they only provide coverage for eighteen hours a day.[27] [31] While someone is always a call away, the overall effectiveness of mental health services by Wellpath is inadequate to the needs of inmates. This adversely affects inmates’ mental health treatment.[3] [31] While medical staff are away, the mental health needs of the inmates are in the care of correctional staff. Because they have very limited medical training it could lead to inappropriate mental health care decisions.[32] Solitary Confinement and Use of a Safety Cell ● Formerly known as Solitary confinement, “Administrative Separation” (AD-Sep) or Modified Schedule is the physical separation of an incarcerated person from the general jail population.[33] ● The Main Jail has three Safety Cells that are video monitored 24 hours a day with 15-minute visual checks by the correctional staff - not Wellpath. There are an average of 36 inmate/patients placed on suicide watch per month.[34] ● Incarcerated individuals in and out of AD-Sep are provided a minimum of three hours of exercise and seven hours of recreation time per week.[35] ● Safety Cells are used in the Main Jail if a risk assessment deems the inmate is a danger to themselves or others, is making suicidal statements, as punishment for not following the rules, or is having a mental health crisis requiring a 5150 hold while waiting to transfer to a mental health facility.[22] [36] [37] [38] [39] [40] [41] [42] [43] [44] [45] [46] [47] [48] ● On February 28, 2024 there were forty-three (43) inmates on a Modified Schedule and for all of 2022, 321 were separated from the rest of the inmate population.[49] [50] Medical and Mental Health Treatment in the Jail People in the criminal legal system often have a background of trauma and poverty as well as acute health needs. One-quarter have serious mental illness, many have multiple physical health conditions, and 60% of California incarcerated people have substance use disorders.[51] Through jail tours and interviews with staff, the Grand Jury learned that the Main Jail, while not a certified mental healthcare facility, houses many mentally ill inmates. The Grand Jury reviewed two years of reports that review medical health care in the Jail. The reports are conducted annually and are from the County Public Health officer to the Sheriff’s office. The inspections were conducted by an expert with over twenty (20) years experience in reviewing and assessing Title 15 state-mandated medical conditions within county jails.[52] The inspector noted that the jails were in good compliance with regulations except for several significant deficiencies identified in this report.[37] [38] [53] [54] [55] We Can Do Better With Our Jails! published June 11, 2024 Among the deficiencies noted were: ● Failure to prepare Health Service Audits ● Improper use of Safety Cells ● Lack of Mental Health Services and Transfer to Treatment Facilities ● Insufficient Informed Consent ● Over-prescription of Psychotropic Medications The following sections expand on the deficiencies noted above. Health Service Audits According to Title 15 the health authority shall develop and implement a written plan for annual statistical summaries of healthcare and pharmaceutical services that are provided by the Jail.[56] Based on information from these audits, the health authority shall provide the facility administrator with an annual written report on healthcare and pharmaceutical services delivered.[53] [57] Wellpath has not prepared Health Service Audits for several years. The absence of these reports, with essential data concerning the quality of care, is an obstacle to developing steps to increase inmate safety. It also hinders efforts to improve inmate health. The Jail Quality Improvement committee needs these audits to conduct valuable data analysis for data-driven medical care improvements. Also, when all jail medical staff are involved with data gathering, they can provide input and suggestions which in turn promote good morale.[54] Ad-Sep and the Improper Use of a Safety Cell Being incarcerated, even for those in good mental health, is associated with subsequent depression and bipolar disorder and has been documented that it can worsen mental health.[58] An incarcerated person may be isolated from the rest of the inmates in their own cell, or in some cases in a Safety Cell. Generally, Ad-Sep means spending 22 to 23 hours per day in a single cell, usually about the size of an elevator, and are only required to be provided a minimum of three hours of exercise and seven hours of recreation time per week. We Can Do Better With Our Jails! published June 11, 2024 Figure 6: A sobering cell on the left and a safety cell on the right. Photo courtesy of Ashley Keehn.[59] [60] According to The health Inspection Report citing California Title 15 section 1209 regulations governing jails, as well as the Sheriff’s own policies and procedures state, “in no case shall the safety cell be used for punishment or as a substitute for Mental Health treatment.”[40] [61] The Grand Jury has learned through reviewing relevant reports and conducting interviews that inmates are put in Safety Cells for numerous reasons including, but not limited to: ● Breaking the rules[41] [43] ● Threatening to hurt themselves and others[38] [41] [62] ● Having a Mental Health Crisis[41] Documented evidence provided to the Grand Jury revealed that inmates were held in Safety Cells for days.[37] [38] [39] [39] [40] Do we really think it makes sense to lock so many people alone in tiny cells for 23 hours a day, sometimes for months or even years at a time? That is not going to make us safer. That’s not going to make us stronger. And if those individuals are ultimately released, how are they ever going to adapt? It’s not smart. Barack Obama, 2015[63] The number 5150 is the section of the California Welfare and Institutions Code that evaluates adults who are deemed to be a danger to others, himself or herself, or are gravely disabled. A 5150 hold allows an adult to be involuntarily detained for 72 hours in We Can Do Better With Our Jails! published June 11, 2024 a psychiatric hospital or clinic.[36] Santa Cruz has one (1) psychiatric clinic. Patients do not have to be treated in a psychiatric hospital, a clinic is sufficient. They also could be treated at the Emergency department at Dominican until transferred to an LPS facility. To meet a 5150 hold criteria in the jail, the inmate must display suicidal thoughts as determined by a jail medical provider or, absent that, by the correctional officer in charge. However, it has been the practice in our jails to only initiate a 5150 hold immediately prior to release from the jail. Once a 5150 hold is issued you must transfer the inmate to a mental health facility for care. Waiting until discharge to initiate a 5150 hold means inmates may be held in Safety Cells for long periods of time. Use of a 5150 hold by the Sheriff's office numbered more than twenty-six (26) per month in 2022 and there were 321 such holds in 2022, according to the Sheriff’s statistics.[50] In the report, the Health Inspector’s main concern was the use of Safety Cells, and they spoke directly to the mental health professional in charge to determine if correct Title 15 procedures were being followed. According to the report, medical and jail staff were not using correct procedures.[64] This deficiency is closely related to the misuse of giving required mental health care services. It also is related to the proper procedures for transferring inmates to a mental health facility. Mental health care is provided in what are called LPS treatment facilities and are explained below.[44] To read more Safety Cell information see