Mental Health Mental Illness

Supervisors Want a Plan To Stop LA County From Unnecessarily Criminalizing Its Mentally Ill

Inside LA County's Twin Towers Correctional Facility
Celeste Fremon
Written by Celeste Fremon

On Tuesday, August 14, the Los Angeles County Board of Supervisors will vote on a motion that, if passed, would trigger the creation of an ambitious new “road map” to help LA County keep more of its mentally ill population out of lock-up.  The hoped for plan would also examine which inmates now in jail could be diverted,  and what kind of help is needed to keep those who do wind up in the justice system from repeatedly returning when they get out.

The motion, titled “Scaling Up Diversion and Reentry for People with Serious Clinical Needs,” is authored by Supervisors Mark Ridley Thomas and Kathryn Barger, and has strong support among a broad array of justice and mental health advocates, including the ACLU of Southern California, the Youth Justice Coalition, Disability Rights California, Mental Health America, and the USC Gould School of Law.

“If implemented appropriately and consistent with best practices, expanded diversion in Los Angeles County can reduce the incarceration of individuals with mental disabilities while promoting public health and safety,”  the ACLU’s Peter Eliasberg wrote in a letter he sent to the supervisors on Monday, together with 19 other organizations.

And expanded mental health diversion program, Elias pointed out, “may also make it possible to reduce the bed capacity needed in existing and planned correctional facilities.”

In other words, with a larger diversion strategy, the county’s long-planned and ginormous new jail construction project might not have to be quite so large and costly.

The numbers

It is hardly novel news to say that the U.S. has a problem with criminalizing its mentally ill, and that nowhere in the nation is that problem larger than in Los Angeles County.

According to the most recent report from the Office of the Inspector General (which is also scheduled be presented to the supervisors at Tuesday’s meeting), as of May 2018, the LA County jail system housed 5,046 men and women who suffer from mental health conditions.

Even this high number is likely an undercount, according to Eliasberg, and the Bureau of Justice Statistics, which estimates that 64 percent of the jail population nationwide has a mental health problem.

It doesn’t help that, according to several prominent studies. people with mental illness are more likely to be arrested than those without it, even when their conduct is the same, or in some cases, less serious.

It is also well documented that those with serious mental illness do not stabilize or improve while jailed. Instead, they typically become much worse, simply because of the nature of the jail environment.

Inmates with mental illness, wrote Eliasberg, “spend more time in restrictive housing and are disproportionately confined in solitary.”  They are also likely to encounter “additional physical or emotional trauma,” particularly when their conditions clash with jail life, as they often do.

Wrong environment for healing

Here are some of the practical facts about LA County’s inmates who suffer from mental illnesss, according to the OIG’s  report.

Of those 5,046 who were considered mentally ill at last count, 991 male inmates had severe enough conditions to be housed in what is called High Observation Housing (HOH) in the jails, and 282 female inmates shared that same HOH designation.

But the HOH sections of the Twin Towers Correctional Facility do not provide housing for the inmates with the most severe conditions.

Twin Towers also has a Forensic In-Patient Unit (FIP), which is a 32-bed state-licensed facility that houses the system’s most acute mental health patients.

With 991 male HOH inmates in the jails, beds at the FIP beds are in high demand.

On June 18, 2018, according to the OIG report, there were 79 patients on the FIP waitlist, hoping for admission.

Meanwhile, any pre-admission FIP patients, including the 79 waitlisted patients, are housed in HOH.

“HOH, while generally considered safe,” wrote the OIG, “is clinically inappropriate and grossly insufficient for the housing of these severely ill and vulnerable patients.”

As a consequence, these inmates reportedly often decompensate further while housed in HOH.

Patients requiring FIP level of care sometimes display symptoms such as “smearing or throwing feces,” banging their heads against the cell door, “not eating or drinking, severe self-mutilation, and suicidal and/or homicidal behaviors,” according to the OIG.

The high demand for these grossly limited FIP beds, combined with the needs of many of the HOH inmates, also places enormous pressure on staff, no matter how compassionate, trained, and level-headed.

Deputies “cannot reasonably be expected to manage a jail full of patients whose acuity level would warrant multi-point restraints and involuntary medication in a licensed care setting,” observes the OIG’s report.

And yet many are required to do just that.

Diversion and reentry

In August 2015, the Los Angeles County Board of Supervisors created the Office of Diversion and Reentry within the Department of Health Services (DHS), to begin to address some of these issues.

Although its mission has since expanded, the original purpose of the Diversion and Reentry office (ODR) was, as it’s name suggests, to help individuals with serious mental health problems or substance use disorders who were involved in the criminal justice system.

Since its establishment, the ODR, which is led by retired Superior Court Judge Peter Espinoza, has diverted 1,972 people with mental health issues away from the jails and into community facilities.

Yet, according to the OIR report,  in order to determine which inmates are eligible for diversion, Espinoza and his staff need better cooperation and input than they are getting from the sheriff’s and probation departments, the DA’s office, the offices of the Public Defender, and Alternate Public Defender, and the LA County Superior Court.

The ODR is also hampered in its diversion efforts by a serious shortage of appropriate community placements.

Which brings us back to Tuesday’s motion.

A road map

The motion, among other things, directs the acting director of the Department of Health Services to work with the county CEO, and the various other relevant county agencies—like LA County Probation, DCFS, the LASD, the DA’s office and more—to “create a detailed 5- to 10-year Diversion and Reentry Road Map” for those with serious clinical needs.

The road map is to include, among other elements, an outline of the community facilities and programs needed, which would include programs to provide help with employment, legal relief, and other case management services, plus it would lay out the kind of staffing and budget would be needed to make it all happen.

Yet before the road map can be created, the motion directs the DHS director to conduct a study of the existing county jail population to identify who would likely be eligible for diversion and reentry programs—based on their clinical conditions and existing criminal charges.

The study will also include a look at what the Office of Diversion and Reentry is already doing, and what it needs to maximize its effectiveness.

In short, the purposes outlined in Barger and Ridley-Thomas’s motion are important and ambitious. But, if passed, the real challenge will occur months from now, after the study, the report, and the road map are delivered.

At that time, the larger challenge will likely be to make sure that if a smart and worthy road map is delivered and approved, it has the support from the board that will inevitably be needed to blast through the county’s often deadly entropy in order move from map to concrete reality.


  • I would love for Celeste or any from the left put on a deputy sheriff uniform as a disguise and truly watch these inmates in “mental health” housing. Your experiences probably limited and probably planned. Which means the modules and deputies were also notified. So a fake presentation is probably likely.

    Go in on a random day, unannounced, under disguise, and truly experience the shenanigans.

    70% malingering and manipulation is what you’ll see in “mental health” housing. Full blown gang members from all races wanting better housing and more freedom to do there savagery. You’ll also find long time drug abusers, who don’t want to be clean and still abuse dope, in these modules. Shanks, Pruno, and plenty of contraband found in regular general population! How is it these folks can’t care for themselves but make a shank, LoL!


  • Hmm….”Deputies “cannot reasonably be expected to manage a jail full of patients whose acuity level would warrant multi-point restraints and involuntary medication in a licensed care setting,” observes the OIG’s report.”

    This is an interesting assertion, when Sheriff’s line personnel are put in harms way, made the scape-goats and blamed by medical, mental health, ACLU, monitors, Department higher ups and others for mistreating the inmates. These same line personnel are routinely charged with policy violations, brought under internal investigations and disciplined by the Department everyday in this setting, even though they’re apparently working in an environment they can’t “reasonably be expected to manage”.

    Talk about a did-connect and speaking with a forced them blue.

    Been stated for many years on this site and continues to be the “ginormous”, neon covered pink elephant in the room. It’s not about how law enforcement treats the mentally unfairly, which is a crazy statement since a crime is a crime and the courts are there as the ultimate check and balance in deciding who is or is not guilty. It’s about not having enough bed space in state and county run mental health facilities to house the criminally mental ill. No politicians has the balls to propose building more mental health facilities since its not deemed “politically palatable” in the world of ultra-progressive/super-liberal politics. The answer is staring everybody in the face, always has been but no one in power wants the real solution and are afraid to touch it with the proverbial ten-foot pool.

    Just keep forcing the same old square peg in that good old round hole.

  • Nice word’s…but who is typically the point of first contact, public whipping boy and villain when a “mentally ill person” does something for the “…County’s Unnecessarily Criminalizing wheels to start turning…”?

    Answer: The Police….

  • never been there but i find this in a “consent ” docu,emt and wonder how the—- gangstas get into this rare housing as easily as you say. I get the “religion” declarations to evade the garbage in general pop meals. but unless the hoh in reality is far different than intended, I just am not convinced your claims. Mostly on past experience of these claims about the wiley thugs, I would take your word. II cant believe it is so laxly passed out as a prefered placement, shanks made with the constant supervision, isolation rooms? convince me please. convince me your not a guard with good reason to be piiiiidoff generally, “Code 1 M”

    “Mental Health Housing” refers to prisoner housing areas in the Jails
    that include only the Forensic In-Patient (PIP), High Observation
    Housing (HOH), and Moderate Observation Housing (MOH) areas.
    (i) “Correctional Treatment Center” or “CTC” refers to the
    licensed health facility with a specified number of beds within
    the Jails designated to provide health care to that portion ofthe
    prisoner population that does not require a general acute care
    level ofservices, but which is in need ofprofessionally
    supervised health care beyond that normally provided in the
    community on an outpatient basis.
    (ii) “Forensic In-Patient” or “PIP” can be used interchangeably
    with Mental Health Unit ofthe Correctional Treatment Center
    (MHU CTC). The PIP is located in the CTC and houses
    prisoners who present an acute danger to self or others or are
    gravely disabled due to a mental illness and require inpatient
    (iii) “High Observation Housing” or “HOH” refers to designated
    areas for prisoners with mental illness who require an intensive
    level of observation and care and/or safety precautions.
    (iv) “Moderate Observation Housing” or “MOH” refers to
    designated areas for prisoners with a broad range ofmental
    health diagnoses and functioning whose mental health needs
    can be cared for in a less intensive and more open setting than
    the HOH areas, but preclude general population housing.

  • And so it will continue, but hopefully in concert with highly trained interventionists who have mental expertise and proven skills for the specialty work. it will require some sort of hybrid team. need for a police function will NEVER disappear. This and overseeing the mental population is far above the paygrade of the average police officer. It is a recipe for disaster all around, I agree. bad for those who create the need for call out, bad for those called out, bad for the holding facility, the court, the community who thinks all cops jusst want to be savages and then refuse to help them in any police work even if its in their best interests to do so..

  • A real solution is well aware of this. Police one is working to make life better and reduce PTSD/ suicide and charges among the staff. There is resistance there just as mental advocates have their own resistance even within the “advocate” community. slowly, so slowly it will sort out. how many decades has it took? dont complain- educate and stand up for your interests. and check the macho- its deadly. be ballanced calm warriors, not mad, emotional brawlers

  • talking of how long will this insane clueless situation remain and how to make a better system. This is a Frontline from 2005. An inmate gives the most obvious clue i have ever heard about the recycling. we know how a few take up jail space in and out, how many are mentally ill, and as well as jail are in and out the hospitals for 5150 and back out. catch and release and any other fix and send back to get sick again is the most expensive way to never get anywhere .

  • WS….great post and summary of the real problems. Thank you for the information regarding the Frontline documentary.

    If society continues to not want to call a spade a spade and house the mentally ill in jails, one solution would be to make a legislative change on how jails/prisons, that are predominately used as mental institutions, are classified/regulated.

    Having law enforcement care for and physically handle mentally patients is a recipe for policy violations and the use of constitutional provisions such as deliberate indifference, abuse under the color of authority and cruel and unusual punishment to be weaponized against untrained guards by manipulative prisoners, their families and greedy opportunistic lawyer’s.

    If these institutions were re-classified as health care facilities and those prison/jail employees were either given an exemption from being judged under the lens of law enforcement when working in these rolls or removing them all together, it would address many of the problems that exist.

  • What do all the above entity’s expect? LEOs on the street, deal with a 918 (crazy person) and know if they take them to County USC for a 5150 hold, there either won’t be room or will have to wait hours on end waiting just to be seen. Most logical solution? Take them in on a chicken shit charge (like possession of a stolen shopping cart or 314 PC). It’s not right, but neither is the system. Majority of these people don’t want help on the street and all they do is pester normal people by setting up encampments in front of peoples houses and businesses.

  • Well, I’ve seen both sides. The new side is the “mentally ill” is the new General Population (which I’ve been told by the inmates themselves”, ie Malingering and individual’s faking mental illness to avoid prosecution and getting a reduced sentence. Secondly, I saw an individual who was so medicated he had no reason being in court, doing the psych med shuffle and drooling on himself. Please come in and see the people we deal with everyday. I’ve been doing this too long, I treat each individual with respect, I have nothing to prove.

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