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LA jails face 'significant challenges' improving mental health care

The Twin Towers Correctional Facility in Los Angeles
Robyn Beck/AFP/Getty Images
Most mentally ill inmates in the L.A. County jail system are housed in the downtown Twin Towers facility.

Los Angeles County jails have made substantial progress in improving care for mentally ill inmates, but key reforms mandated under a 2015 agreement with the U.S. Department of Justice have yet to be fully implemented, according to a monitor’s bi-annual report.

The Sheriff’s Department, which operates the jails, and the L.A. County Department of Health Services, which provides mental health care, face "significant challenges" providing better therapeutic services to inmates, getting them out of their cells more often for recreation and planning for care after their release, court-appointed monitor Richard Drooyan said in his report, filed earlier this month with the federal judge overseeing the agreement.

The county has estimated it will be in compliance with most of the agreement in the next 18 months, but Drooyan maintained that it "will likely take considerably more than 18 months" in the challenging areas.

The sheriff's department entered into the agreement after the federal government filed a lawsuit alleging a pattern of mistreatment of mentally ill inmates in county jails. The deal settling the lawsuit also outlined measures to reduce the use of force against all inmates – something the department has done, according to the report.

The agreement includes 69 separate reforms. The sheriff’s department has complied with 22, according to the report. It has partially complied with 27. Its in "non-compliance" regarding 10 others. (Seven others received mixed reviews and three are no longer monitored.)

More than two years after signing the agreement, the department is partially complying with measures to improve suicide prevention training, identify and evaluate suicidal inmates and identify inmates who need to be referred for mental health care.

In one example of how much work the sheriff faces, the agreement called for all mentally ill inmates in high observation housing to receive at least 10 hours of out-of-cell recreation time and 10 hours of structured therapeutic time by Jan. 1 of this year.

Yet by the county’s own assessment, about 73 percent were offered recreation time and just 17 percent were offered out of cell therapeutic time, which could include education or work programs.

"That is a public health crisis," said Mark Anthony Johnson of Dignity and Power Now, which advocates for better care for inmates. "What we are seeing here is that treatment cannot happen in jail."

About 20 percent of the estimated 18,000 people locked up in county jails suffer from a mental illness, according to the sheriff’s department. Many are homeless and arrested for minor crimes – people who should never have been arrested in the first place, Johnson argues.

Sheriff’s officials said aging jails with too little safe recreation space and areas for therapy remain one of their biggest challenges to providing better care.

"The facilities we’re currently working with are jail systems not built to deliver the kind of medical and mental health care that we now strive for," said sheriff’s Chief Stephen Johnson.

The Board of Supervisors has approved a plan to build a 3,885-bed Consolidated Correctional Treatment Facility that would replace Men’s Central Jail, which was built in 1963. The county is in the midst of preparing an environmental impact report and has not set a date to break ground.

The plan has drawn sharp criticism from activists. "Jails should not be functioning as health care facilities," said Johnson. He argues the county should put the money into community mental health programs.

One reform remains in litigation. The American Civil Liberties Union of Southern California has challenged the agreement’s mandate for discharge planning, saying merely referring mentally ill inmates to outside facilities is not enough. A more active handoff that might even include transportation is needed, the ACLU argues.

Among the areas of progress: the county has hired dozens more clinicians to work inside the jails, and the sheriff has developed curriculum for 32 hours of de-escalation and verbal resolution training for deputies inside the jails.

"There has been a great deal of progress," said Robert Bonner, a former federal judge who chaired the 2012 Citizens Commission on Jail Violence. It was that group that prompted some of the reforms. "But there is a ways to go."

In one disturbing report earlier this year, county Inspector General Max Huntsman found "self-directed violence" up substantially from last year. Two hundred thirty-seven inmates engaged in "self-directed violence" through March 24. This category can include everything from a suicide attempt to superficial cutting or head banging. In all of 2016, 649 inmates physically hurt themselves, he said.

It’s likely the result of an increasing number of mentally ill people in jail, said Bonner.

"As a society, we have a system where incarceration for criminal violations is the first and the only option for dealing with people whose fundamental issue is they have a serious mental illness," he said.

"It’s something we need to change," Bonner added.