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As need skyrockets, Sacramento jail to expand aid to mentally ill

A registered nurse conducts medical assessments in 2009 in the booking area of the Sacramento County Main Jail.
A registered nurse conducts medical assessments in 2009 in the booking area of the Sacramento County Main Jail. The Sacramento Bee file

As the Sacramento County Main Jail handles more inmates with psychiatric problems, the Sheriff’s Department is developing a new section staffed by UC Davis medical professionals, social workers and deputies that can provide intensive mental services without 24-hour care.

The county currently keeps inmates who are suicidal or deemed a threat to others in an 18-bed “acute care” unit, which functions like a residential treatment facility. It also has a unit that provides medication and regular meetings with a psychiatrist for 120 inmates who aren’t ready to be in the general population, but don’t need constant monitoring.

But nothing exists in between, which means the jail has to keep some inmates in the “acute” unit who don’t need that level of care, said Aron Brewer, chief of Correctional Health Services for Sacramento County. Inmates in “crisis” who desperately need psychiatric attention sometimes end up in separate cells until they can be moved into the acute unit. Last year, 460 inmates passed through the acute unit.

Under a plan passed by county supervisors this month, the county within weeks will add 20 new outpatient beds to the section of the jail for inmates with mental health issues.

“That intermediate level of care will allow us to shorten the time frame that inmates will need to be on the (acute) unit,” Brewer said. “It should free up bed space to place inmates that are either a fresh arrest or individuals who are now requiring another level of care.”

In the new unit, inmates would get evaluations by a nurse or doctor, help from a licensed social worker, group therapy sessions and individual meetings with a therapist once a week. They would also get a treatment plan.

From there, patients would transition into the lowest level of care, where inmates are medicated and see a licensed social worker every 30 to 90 days depending on their diagnosis and progress, Brewer said.

In 2013, an inmate typically needed six days of the highest level of care, he said. By 2016, the average length of stay was 10 days. Between 2013 and 2016, the number of inmates needing some level of psychiatric care went up 77 percent.

Two main factors have increased the number of mentally ill inmates, Brewer said – a 2011 state realignment that shifted thousands of inmates from state prisons to county jails and a growing homeless population.

“We do have a number of inmates or citizens that get arrested multiple times and a lot of them are homeless … I think there’s an impact there,” he said.

Dr. Alfred Joshua, who serves on the state Council on Mentally Ill Offenders, said county jails weren’t designed to provide the levels of mental health care needed by the new population of inmates who have been diverted from state prisons.

“(Realignment) really increased the length of stay that a lot of these individuals are in our custody,” he said. Jails “are not set up from an infrastructure standpoint to serve these people... The jail environment is going to be very different for the inmate patient.”

Joshua, also chief medical officer for San Diego County Sheriff’s Department, said part of the challenge is that people with the most serious mental health issues often end up in the criminal justice system. Those people require intense care that is difficult to provide in a jail setting.

“At the end of the day, I think the jails specifically become a catchall for these individuals because of the stretched resources of the outreach workers in many of these communities,” he said.

The subset of the mentally ill population that ends up in jail is not usually receptive to treatment, he said. By the time mentally ill people land in jail, they tend to be off their medications, suffering other health or substance abuse issues and sometimes out of touch with family and friends who can support them.

For Sacramento’s new program, four social workers and a part time psychiatrist or nurse practitioner will come from the University of California, Davis Health System, which provides medical and psychiatric care at the jail. The Sheriff’s department asked for nine new officers – one sergeant and eight deputies – to staff the unit 24/7.

The beds and associated staff will cost about $646,000 for the rest of this fiscal year and $2.5 million the next year.

Ellen Garrison: 916-321-1920, @EllenGarrison

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