In recognition of the fact that we cannot continue to jail individuals with mental illness, Santa Clara County, together with neighboring Alameda, Contra Costa, San Mateo, Santa Cruz, and San Francisco counties and more than 420 counties nationwide, signed on to the Stepping Up Initiative to reduce the number of people with mental illness in our jails. The goal is to divert people suffering from mental illness away from the jail and into treatment.
Historically, institutionalization was the answer. Asylums were overcrowded; abuses were accepted and even became regular fodder for horror movies. The situation today is not much different. Jails, prisons and state hospitals are often the first line of treatment for people with severe mental illness. The Los Angeles County Jail has been described as the largest mental hospital in the world. Public defenders, district attorneys, judges, clinicians, and law enforcement agents have joined the Stepping Up Initiative acknowledging that a punitive model has not reduced crime or incarceration rates for people with mental illness. You cannot jail away a medical disorder.
The elderly suffering from dementia, veterans with traumatic brain injuries and PTSD, adult survivors of child s****l abuse, and patients from psychiatric facilities are sitting in our jails right now as a result of behavior that stems from mental illness.
One jail therapist observes that most women he treats have been sexually abused as children. He reviews reports documenting how these women were removed from their families as children because of abuse, both s****l and physical. Their trust was broken by caregivers and exploitation was normalized. Now homeless, these women pair with predatory men for protection on the street and barter their bodies. It is a forlorn existence that leads to arrests for petty offenses like using drugs, stealing food and trespassing. Isolation cells amplify the torment for these women. These are only a few of the many examples where jails are used to warehouse individuals with mental illness.
The Department of State Hospitals (DSH) increased its bed capacity by more than 600 beds since 2011 in response to higher demand around California. However, the demand has outpaced the state’s ability to provide more beds and hire staff. The state estimates there are now about 1,000 inmates with mental illness awaiting a state hospital bed.
We cannot continue to outsource treatment for those with mental illness to the state. Upon returning, patients have few local options for housing to maintain their psychiatric stability. DSH examined its population and determined 47 percent of the patients were classified as unsheltered homeless. The percentage of patients with 15 or more arrests is increasing. Of those arrests, DSH assessed the majority as public nuisance crimes related to mental illness and homelessness. The revolving door is evident.
Santa Clara County is stepping up to treat residents with mental illness locally. The county is developing more crisis residential housing, building adult residential facilities and hiring clinicians to respond to crisis calls. Re-entry centers help assist the formerly incarcerated transition back home. Rather than free falling upon release from a highly structured hospital and jail setting, a patient may be transitioned into a sub-acute treatment bed and gradually reenter the community under clinical care.
The most expensive treatment bed is a jail bed. Jails compound the trauma experienced by someone in psychiatric distress. And distress is not isolated to the inmate: correctional staff experience compassion fatigue when exposed to someone who is psychotic or manic. This creates a dangerous situation when an inmate decompensates in jail.
The revolving door in our jails is too expensive and too cruel to maintain. Stepping Up provides communities a path to provide real, enduring treatment to our residents with mental illness.
Molly O’Neal is the Santa Clara County Public Defender.
Opinion: Diverting mentally ill from jails into treatment benefits all