Sonoma County Jail officials acknowledge mental health shortcomings, defend care

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Read the full Disability Rights California report here


PDF: Report of Sonoma County Jail inmates receiving medications in 2015 & 2016

While acknowledging some of the shortcomings in the mental health unit of the Sonoma County Jail highlighted this week by a statewide disability rights agency’s report, county mental health and jail officials insisted the level of care exceeds that at other California jails or across the country.

The most serious allegations in the 25-page report released by Disability Rights California included illegally medicating some inmates and using excessive solitary confinement and isolation with others.

Michael Kennedy, head of the county behavioral health department that provides the jail’s mental health services, said the problems cited in the report are not unique to Sonoma County. The real problem, he said, is the lack of secure inpatient psychiatric beds not only for jail inmates but also for the general population.

And county mental health and jail officials said while some of the report’s findings were valid, anecdotal accounts obtained during the DRC’s 2015 visit were exaggerated and “over-dramatized.”

But Anne Hadreas, an attorney for DRC, a nonprofit advocacy organization with state and federal authority to inspect and monitor government agencies affecting the disabled, said the people housed in the mental health unit were more acutely mentally ill than in other jails and often were cycled through the facility without ever being sent to an appropriate inpatient psychiatric hospital. Hadreas and other DRC attorneys, along with lawyers with the nonprofit Prison Law Office, toured the jail Aug. 25.

“What it is is a place that’s not set up to provide intensive mental health treatment,” Hadreas said Tuesday in an interview. “Which is a role that it’s taking on and a role that is not appropriate.”

In a planned all-day visit to the jail’s most secure mental health module, she and the attorneys went cell-to-cell and spoke, through door windows, to about a dozen inmates concerned about their treatment. The DRC reviewed the full health records of four inmates.

Of the Sonoma County Jail’s approximate 1,200 inmates, about one-third are taking medications for mental health conditions such as depression or anxiety, according to county statistics. Of those, just over a third were taking anti-psychotic drugs in 2015.

About 71 percent of inmates are accused or convicted of felony crimes, and the rest for less serious misdemeanor crimes, said Assistant Sheriff Randall Walker, who oversees the county jail system. For mental health inmates, about 67 percent are jailed for felony crimes and 33 percent for misdemeanors.

While the DRC report did recognize positive practices at the jail, particularly efforts to release people more quickly from custody, the majority of the report upbraided the jail for:

Treatment of mental health patients that focused on medication and cell-front interviews with staff through door food slots or between the door and the frame, interviews, the report said, that are ineffective in providing therapy;

The most acute patients receiving a visit from a psychiatrist only two or three times a week;

Illegally administering psychotropic drugs to mental health inmates not on involuntary psychiatric holds;

Illegally administering long-term psychotropic medications known as “decanoates” to unstable inmates who were on short-term psychiatric holds. State health officials, the report said, recommend such medications be used only after mental health patients are stabilized, and not on short-term holds; and

Read the full Disability Rights California report here


PDF: Report of Sonoma County Jail inmates receiving medications in 2015 & 2016

Subjecting inmates to prolonged isolation when even brief periods of extreme isolation could worsen an inmate’s mental health symptoms.

Don Spector, head of the Prison Law Office who also toured Sonoma County’s jail, acknowledged the issues of isolation and the use of medication he observed are “not uncommon with other jails in the state.”

“A lot of counties are in the same boat, but legally it’s a county problem because the county is the one arresting him, the county is the one keeping him in jail, the county is the one not providing the treatment,” he said.

County officials strongly objected to the report’s claim that medication practices in the jail are illegal.

Phyllis Gallagher, deputy county counsel, was confident a court would uphold the jail’s practices around involuntary medication.

She said the county provides mental health inmates with their rights around involuntary medication, including the right to counsel and a hearing where a judge can determine an inmate’s competence. On the use of long-term psychotropic medications, Gallagher said the county has adopted the DRC’s recommendation.

“We no longer use a long-acting injectable medication in the scenarios that DRC found objectionable,” she said. “We have made a change in response to that.”

County officials said the real problem is the decades-long elimination of acute inpatient psychiatric beds and inadequate mental health services in general.

“You’re looking at people who haven’t had any or sufficient mental health treatment ending up in jail,” said Sonoma County Supervisor Shirlee Zane, who has long advocated for more mental health services.

Zane said she welcomed the DRC report but insisted the county is in many way on the vanguard of mental health services. She cited such programs as the pretrial diversion program which reduces the number of mental health inmates, crisis intervention training and a mobile support team.

“Counties are facing this crisis because we’ve had 40 to 50 years of large reduction in acute care treatment,” she said. “We, at the taxpayer expense, are now having to deal with the aftermath of that.”

Kennedy said one of the reasons the local jail houses inmates with such severe mental illness is that no local psychiatric hospitals in Northern California will take them and provide the necessary psychiatric treatment to stabilize them. He said some inmates should be in secure inpatient psychiatric units specially designed for jail inmates. But none exist in the region.

The county is slated to begin construction in 2019 on a $48-million unit for mentally ill inmates that’s designed to be a more therapeutic environment.

There are 153 beds spread among three units at Sonoma County’s main jail in Santa Rosa for mentally ill inmates, who are divided by the severity of their symptoms.

The most acutely ill are housed in what’s called the “mental health module,” a large room shaped like two adjacent trapezoids with a correctional deputy booth in the center. A waist-level wall divides the room into two sections, each with a TV and chairs. Walker said that configuration allows two inmates who can’t interact with other inmates to be out at a time. All inmates in this module are housed alone in cells.

Wednesday, there were 29 inmates, just under the 32-bed capacity of the unit.

You can reach Staff Writer Martin Espinoza at (707) 521-5213 or On Twitter @renofish. You can reach Staff Writer Julie Johnson at 521-5220 or On Twitter @jjpressdem.

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