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.
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.