Illness, Incarcerated: As Residents with Mental Illnesses Cycle from the Streets to Cells, County Officials Struggle to Create a New System

January 25, 2017

Santa Maria Sun

By Brenna Swanston

The dimly lit hallway seems to grow narrower as I pass through it, trying to ignore the balmy air’s musty stench. I fix my gaze on the grimy-looking floor as I step past a row of metal doors, barring inmates in their isolation cells. They bang on their windows, yelling at me and my escorting officers: “Hey, bitch! Come back here!”

We pause at the end of the hall, and the deputy leading my tour (who asked the Sun not to use his name) tells me where we are: the upper isolation cells, which generally house inmates with mental illnesses. He points out how the cell windows here differ from most of the others—these are just two transparent slits divided by a wide metal pane, to ensure a human body can’t fit through. That’s because in these cells, inmates sometimes try to smash through the glass.

I ask how often that kind of thing happens. The deputy’s answer: “frequently.”

“They’re supposed to be fracture-proof,” he says of the windows, “but I’ve seen people break them before.”

I remember the fourth item listed on the custody tour waiver agreement I signed a few days ago: “In the event I am taken hostage by anyone, no inmate will be released as a condition of my safety, and no consideration for my safety will be given to those who have taken me hostage.”

Suddenly, that stipulation is more frightening than amusing.

As the deputy continues with his spiel, a man in a nearby cell presses against his special window and yells, steadily and loudly, and the yelling intensifies as we turn to proceed back down the hallway. I notice a sign next to one cell door—“Paper tray, paper spoon”—and ask my guiding officers about it. Apparently inmates sometimes break the jail’s usual plastic dinner trays into pieces, trying to use them as weapons.

This is the Santa Barbara County Main Jail.

This—as county Sheriff Bill Brown once told the Board of Supervisors—is our county’s “de facto mental health institution.”

It’s been five years since Brown made that declaration, but not much has changed since then. For this story, the Sun explored the problem of criminalizing people with mental illnesses in Santa Barbara County, as well as efforts to solve it.

The county’s current plan of action for decriminalizing mental illness is the Stepping Up Initiative, which aims to reduce the number of mentally ill inmates nationwide. The initiative brings together leaders in mental health, law enforcement, and criminal justice to help provide nonviolent mentally ill offenders with treatment, not jail time.

The Sun spoke with mental health experts and county representatives who are vying to improve law enforcement’s approach to mentally ill offenders. We toured the county jail, where the Sheriff’s Office blocked us from taking our own photographs, despite having given us permission to do so in 2011. We also analyzed investigative reports of the jail’s mental health services, which have been harshly criticized by third-party agencies, as well as the county’s responses to those critiques.

A broken system

In December 2016, 174 inmates at the Santa Barbara County Jail were taking psychotropic mental health medication, according to the Sheriff’s Office. This accounted for 17 percent of the jail’s total population.

Last year, sheriff’s deputies responded to an average of 29 mental health-related calls each week. Because Santa Barbara County lacks the necessary treatment programs and facilities for its mentally ill residents, responding officers are often left with just one option for these individuals: jail. And when the jail’s mental health resources fail to adequately treat those people, many of them become trapped in a cycle of incarceration.

That’s how it goes in jails across the nation. More than half of inmates suffer from mental health problems, of whom only one out of six say they’ve received treatment while in jail, according to a study from the Urban Institute.

Federal statistics show that jail inmates with mental illnesses are more likely than those without to have three or more prior incarcerations, break facility rules, and get injured in a fight while incarcerated—meaning more jail time and consequences for people who need mental treatment, and more dollars from taxpayers to provide it.

These trends persist in Santa Barbara County, as well, where state statistics say more than 5 percent of the population requires mental health services. And yet, the Santa Barbara County Jail—which has been called actively neglectful of its mentally ill inmates by an investigating agency—acts as the county’s go-to mental treatment facility.

“Too many people slip through the cracks, or they’re not caught until they’ve finally committed that major crime,” Lt. Rob Plastino, assistant to the sheriff, told the Sun. “Had they been caught earlier or gotten into treatment earlier, maybe it would have solved a lifetime of pain and suffering for them and any potential victims they might have.”

He said that when a mentally ill person commits a crime, law enforcement and justice agencies need to recognize that “at the end of the line, there’s a human being,” and they may need treatment.

“If we can help them in some way,” Plastino said, “let’s do that.”

Stepping up

At its Dec. 13 meeting, the Board of Supervisors unanimously green-lighted the Sheriff’s Office’s proposal to pursue the Stepping Up Initiative, which would divert nonviolent mentally ill offenders away from jail and into treatment programs—without criminal charges.

Alice Gleghorn, director of the Department of Behavioral Wellness, said the first course of action in implementing Stepping Up is to assess which mentally ill individuals commit crimes most frequently, where they do it, and what those crimes look like. Then Behavioral Wellness can work with law enforcement to intercept those situations before anyone winds up in jail.

“The community feels confident that the person is getting their needs met and addressed without going the route of legal charges, time in jail, warrants where they don’t appear,” Gleghorn said. “It’s taking a critical look at where we’re coming in contact with those people.”

As good as Stepping Up sounds for Santa Barbara County, there’s currently no money behind it. And on top of that, Behavioral Wellness may face severe budget cuts in the 2017-2018 fiscal year, thanks to a countywide budget deficit of more than $12 million.

“There’s going to be a finite amount of resources that we can push to make this happen,” Gleghorn said. “We have to analyze this very carefully to find out, where is the best use of resources going to be to keep people out of jail, but safe, and keep the community safe.”

Still, Sheriff Brown is determined to make changes with whatever resources are available.

He’s toured the country to see how Stepping Up has been successfully implemented in other places, such as Miami, Florida. According to Plastino, Miami has managed “phenomenal” mental health facilities with funding help from corporate sponsorships and private donations.

Ali Mandelblatt, a Florida-based forensic psychologist who previously worked in the Miami-Dade County Jail, said Stepping Up is showing promise there so far. She said Miami’s law enforcement officers have received “a great deal of training” to recognize symptoms of mental illnesses, and the county has pushed to move mentally ill individuals with minor-level charges outside the jail system.

While the initiative might be effective in keeping nonviolent mentally ill offenders out of jail, it doesn’t address the shortages in treatment for those who do end up incarcerated. Mandelblatt said Florida jails still come up short in their mental health resources, citing staffing issues as a major factor.

“If you’re not compensating people, then well-trained professionals aren’t going to go there,” she told the Sun. “I think it’s a matter of budget, and having the resources developed, and compensating the staff and training the staff in order to run it effectively. We put a lot of money into our jail system, and maybe some of that money can be deflected into the mental health system.”

But for Santa Barbara County, at least, Plastino doesn’t find that option likely. He said government “just doesn’t” have money to sink into mental health programs, including Stepping Up.

Still, he said, the county might follow Miami’s footsteps in seeking funding for the initiative from private stakeholders.

“There are some really neat corporations that are based here in Santa Barbara that could potentially come up with funding like that,” Plastino said. “But whether or not they will, and who’s going to go knock on their doors and ask for it—I don’t know.”

Either way, he said, Stepping Up has to happen.

“We need it to work,” Plastino said, “because our jails are full.”

A lack of resources

Beyond the jail, local residents who need mental health treatment don’t have many options. Where national standards indicate a county of our size should have at least 160 inpatient psychiatric hospital beds, Santa Barbara County only has 16. The county also lacks an institution for mental disease and a mental health rehabilitation center.

One year ago, a crisis stabilization unit opened in South County. Gleghorn said the unit was designed so it could expand and be used more efficiently, but as-is, it might not meet the county’s needs.

Other than that, North County has a residential treatment facility with 12 beds, South County has one with eight beds, and another is slated to be built in Lompoc, most likely also with eight beds.

And as far as publicly funded mental treatment housing goes, that’s it.

Jan Winter, former chair of the Mental Health Commission, said that the county is experiencing severe staffing deficits in the mental health field.

“There’s a shortage also, especially in this county, because it’s very expensive to live here,” Winter told the Sun. “And the [Behavioral Wellness] Department is not very heavily funded, so we really hurt for psychiatrists, and it means that for people who have emerging mental illnesses, it’s hard for them to get seen.”

Winter pointed out that residential treatment options aside from those provided by the county do exist. Some mental health advocacy agencies lease out or purchase motels or apartments to convert into supportive housing for people with mental health problems.

Santa Barbara’s Mental Wellness Center, for example, owns 51 apartments, most under contract for mentally ill people, and the rest are dedicated to low-income residents.

Still, Winter said, the county needs inpatient beds for both adults and children dealing with mental health problems.

“Each individual needs a different level of care, and they need a different level of care throughout his or her life, changing levels of care,” Winter told the Sun. “The least intrusive way for people to manage their mental illness is just housing.”

But without further funding, that housing won’t happen, and the jail will continue to overflow with inmates who might otherwise live in treatment facilities. The Sheriff’s Office contracts with Corizon Health to provide mental treatment services to jail inmates, but according to Gleghorn, it’s still not enough.

“The county jail is not certified as a mental health treatment facility,” Gleghorn said. “Oftentimes, when you have mentally ill people in the environment of the jail, they’re quite traumatized. It’s not a great place for them.”

Inadequate care

Lt. Plastino said that when he thinks of mental health treatment in the jail, all he can do is put himself in the shoes of an inmate with a mental illness, particularly one that involves depression.

“I cannot imagine being in jail with charges pending, that anything’s going to help me get over that depression,” he said. “It’s just going to be made worse.”

For some inmates, that may have been the case. In October 2016, Santa Maria resident Hector Higareda was found dead in his Main Jail cell from apparent suicide. He was scheduled for an early release from his one-year sentence—not even two more months, and Higareda would have been free.

Still, Plastino maintained that the jail provides the bare necessities of mental health treatment—counseling, doctors, medication, even clergy—but the jail setting itself just isn’t ideal for someone trying to heal. But other agencies, such as Disability Rights California, don’t feel the same way about what the jail’s providing to its inmates.

Disability Rights California conducted an investigation of the Santa Barbara County Jail in 2015, concluding in a report released last year that the mental health care provided there was “inadequate.”

The report alleged that the jail excessively used isolation and solitary confinement, where even a short stay “is likely to worsen prisoners’ mental health symptoms.”

Standing inside one of the female isolation cells at the county’s Main Jail, where I can hardly spread my arms, I feel how life here would wear on the mind. The cell’s small bed is crowded by a storage bin, with cookie wrappers and Bible paraphernalia littering the tiny bedside table.

A woman lives here. Every other day she’s placed in a shower, and then returned to this cell. And that is her life.

The safety cell is even more claustrophobia-inducing. These are reserved for inmates who display combative or suicidal behavior, and the jail only has four of them, total. The cell is beige with padded walls and nothing else, except a barred vent in the floor, which functions as a toilet.

The deputy leading my tour acknowledges the cell’s grimness as I step into it: “It’s primitive, but it serves a purpose.” Inmates confined in these cells are given special smocks, since the usual inmate clothing could be fashioned into a noose.

An observation log hangs by the cell door, where guards and mental health professionals record what they see when checking on the confined inmate. Checkups happen every 15 minutes, and inmates can stay there for as long as a few days.

Sgt. Juanita Miranda, one of my tour escorts, tells me the safety cell has previously driven inmates to try clawing out their veins or diving into the toilet: “It’s amazing what the psyche does.”

According to Disability Rights California’s report, inmates kept in solitary confinement apparently had “no access to mental health treatment,” and records and interviews showed that prisoners with mental illness were housed in such cells for three days at a time on a repeated basis.

On top of that, the investigation found that Corizon’s mental health staffers were only available during normal business hours, so if an incident occurred in the evening or on a weekend, custody staff wouldn’t contact the mental health staff to assess inmates before placing them in solitary or isolation.

In response to those allegations, the Sheriff’s Office released a statement claiming that inmates with serious mental illnesses are typically housed in a specialized mental health programming unit and aren’t segregated except in “extraordinary circumstances.”

Still, according to Plastino, many of those seriously mentally ill inmates don’t necessarily belong in jail in the first place.

The reason behind their misplacement traces back to a mid-20th century movement to “deinstitutionalize” mentally ill people, according to the National Institute of Corrections. Between 1959 and the late 1990s, the number of people housed in public psychiatric hospitals dropped from 559,000 to 70,000.

The movement pushed these individuals into local communities, and many of them wound up in the criminal justice system. Stepping Up and similar initiatives aim to reverse this result of the deinstitutionalization movement.

The Sheriff’s Office has attempted to address this issue before. The jail’s North County branch, which is currently under construction, was originally planned to include a rehabilitation center for mentally ill offenders—but the center was, in Plastino’s words, “canned.”

Due to budget restraints, the Board of Supervisors cut the rehabilitation center from the North County branch project before construction began.

“We talk about wanting to do all these things, and we try so hard to make these things reality, and here we would have had a complex that would have done just that,” Plastino said. “It would have been an amazing facility, but you know, government works in ways that are sometimes hard to understand.”

But efforts continue. Gleghorn, of Behavioral Wellness, said that keeping mentally ill individuals out of jail and providing them with an appropriate treatment facility would be better for the county overall, including financially.

“It would end up costing the county a lot less if you’re able to get someone into care, rather than start the cycle of arrest and jail time and court time and fines and more court times, and then get them treatment,” she said. “That’s just a big waste. And it’s obviously a human waste as well.”

What happens now

Ask anyone in the mental health field why resources are so short, and you’ll get the same answer: a lack of government funding. But Winter, of the Mental Health Commission, insists that the county can still work with what it’s got.

“I think it’s important that we not be hung up on a lack of funding, because there will never be as much as we would like to have,” Winter said. “But there’s so much innovative work that is being done and will continue to be done.”

She said the most important improvement the county can make right now, with its current resources, is to the collaborative effort between the Sheriff’s Office and Behavioral Wellness—and with Stepping Up, that’s already underway.

The Sheriff’s Office currently employs deputies who are trained to identify a potentially mentally ill person. Behavioral Wellness currently employs experts who can evaluate that person and recommend a treatment plan. Even with the lack of residential treatment facilities, Plastino said refined teamwork between those government bodies could make a difference.

“There’s a problem with the way we deal with our mentally ill in law enforcement,” he said, “but it’s not necessarily law enforcement’s problem. We’re asked and tasked to do a job. We’re given the tools to do our job. When we’re not given certain tools, they’re either taken away or not provided, then we’re left with a set of tools we have to use. Right now the only set of tools we have is jail.”

Plastino added that no deputy wants to see someone who commits a nonviolent crime, and primarily needs mental treatment, end up in jail. He called the jail a “catch-all” for the mentally ill in Santa Barbara County, and said he wanted that to change.

“We all want to see these people get help,” Plastino said. “It’s just—what tools are you going to give us, public? What will you allow us to do? And will you back that up?”

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