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Crisis care: The new mental institutions

Sonoma County has a chronic shortage of psychiatric hospital beds. As as a result, a growing number of mentally ill residents are ending up in local emergency rooms and in the jail system. A four-part series, run on four consecutive Sundays, examines the causes and ramifications of the current state of the county’s mental health system, and the people who are impacted the most.

Aug. 6 — Hospitals: The closure of two psychiatric hospitals in Sonoma County has left a gaping hole.

Today — Jail: The Sonoma County Jail has become the largest psychiatric treatment facility in the county.

Aug. 20 — Solutions: Sonoma County explores ways to improve services to people suffering from severe mental illness.

Aug. 27 — Your response: Readers share their stories about Sonoma County's mental health system.

Ongoing coverage: www.pressdemocrat.com/crisiscare

Share your story

We want to hear about your experience with local psychiatric emergency services. What do you do when you or a loved one faces a mental health crisis? Have you or a loved one sat in a hospital bed waiting to be transferred to an out-of-county psychiatric hospital or other mental health facility? Have you or a loved one received psychiatric services in the Sonoma County Jail’s mental health unit? Please send a brief account of your experience to Martin Espinoza at martin.espinoza@pressdemocrat.com.

When Sonoma County sheriff’s officials publicly revealed their plans last spring to build a $48 million jail wing for the mentally ill, a common question quickly emerged.

Why not build a psychiatric hospital instead in Sonoma County? After all, the only local hospital beds for mental health patients are operated by a for-profit company, while many low-income residents suffering a psychiatric crisis often wait for hours in an emergency room, waiting for a bed to free up in a psychiatric hospital in another county.

“Initially, the pushback was ‘Why are you doing that? You should do it for people in the community,’ ” recalled Assistant Sheriff Randall Walker, who is in charge of county detention facilities.

But “the community,” Walker notes, includes everybody, even those in jail.

“It includes people in custody, and they’re going to go back into the community. Shouldn’t they go back better off than when they came?” he said.

Sonoma County’s existing jail, like many others across the country, was never designed to house so many inmates with mental illness. The new wing, slated for construction beginning next spring, is designed to change that: its primary focus is “treatment in a therapeutic health care environment with a custody overlay,” according to the project design report.

Local officials say the 32,000-square-foot jail wing to house inmates with mental illness could serve as a national model that addresses the realities of mental health services across the country.

“We really believe that we’ve pushed the design envelope into a whole new area,” said Bruce Oveson, senior capital projects manager for the county.

The 72-bed facility, which will be attached to the north side of the existing jail at the county complex, will have four separate single-story units: a 12-bed high-security unit and three standard 20-bed units with ready access to exterior recreation or green-space areas. The three 20-bed units can be divided into two areas of 10 beds each for configurations that increase the amount of time inmates are outside their cells.

In all, the facility will include 48 cells, of which half are double-bunked; nine day rooms; seven multipurpose rooms; and six mental health observation rooms.

The four units surround a central open-air courtyard that designers hope will create a “village” environment. Space for group and individual counseling and basic medical examinations will also be included.

County officials said the new jail facility will allow inmates with mental illness to be stabilized rather than aggravating or worsening their mental health. Walker said the facility will include some of the same treatment programs that are available on the “outside,” allowing inmates to be transitioned to community-based programs without a break in treatment.

“The goal is to do a better job in-custody so someone has a better chance at success when they get into that program out of custody,” Walker said.

Lt. Bryan Cleek, planning and research manager for the detention division of the Sonoma County Sheriff’s Office, said the project has received a lot of buy-in from members of the local mental health community because the county sought their input during the spring of 2016 before the design phase began.

“We didn’t go there with the idea, ‘Here’s what we’re building.’ We went there with the idea, ‘Here’s what we want to build. Do you have any ideas? We’re looking for suggestions,’ ” Cleek said.

Mary-Frances Walsh, executive director of the local chapter of the National Alliance on Mental Illness, said her organization is “very pleased” with the plans for the jail’s new mental health unit. Walsh said inmates should be able to get out of their cells more frequently.

“The unit will offer inmates with mental health conditions access to the out-of-doors, to lawn areas and trees — limited, of course — and more natural lighting inside,” she said. “These are design basics that help to create a sense of dignity and the hope of recovery. These basics aren’t possible in the current facilities.”

If Walsh’s organization can secure the funding, it hopes to provide support groups like NAMI Connection, which helps individuals living with mental illness recognize things that can trigger their illness and learn coping skills to deal with them more effectively.

State funds will cover $40 million of the project’s cost, drawn from state bonds backed by tobacco funds to be used specifically for the construction of local detention facilities. The county will put up the remaining money to build the new wing, nearly $9 million.

The wing, which will be staffed with the equivalent of 38 full-time employees, is expected to cost $5.5 million annually to operate, according to a 2015 forecast. The county is responsible for operating costs.

Last spring, the Sheriff’s Office ended its more than three-decade relationship with the county mental health division, which provided psychiatric services to jail inmates. The jail will now outsource mental health services to the California Forensic Medical Group, or CFMG, a for-profit company that has provided general medical services at the jail since 2000.

CFMG will administer an array of psychiatric services, including mental health evaluations, group and individual psychotherapy, crisis management and psychotropic medication services.

Before CFMG, the Sheriff’s Office paid the county mental health division about $3.2 million annually for jail mental health services, according to data from the Sheriff’s Office.

The new $4.6 million contract includes payment for providing competency restoration services, which is required whenever someone charged with a felony or misdemeanor cannot stand trial after being deemed incompetent. Officials say such services should reduce the amount of time some people with mental illness are kept in jail.

In February, county supervisors approved the schematic design of the new jail wing and authorized the publication of a request for qualifications for the wing’s construction. Officials hope to award a construction contract by December and break ground by next May, a schedule that would allow the facility to open by November 2019.

Sonoma County Supervisor Shirlee Zane said construction of the new mental health wing does not represent an abdication of the county’s responsibility to treat local residents with severe mental illness. Zane pointed to the county’s participation in the Stepping Up initiative, a national campaign aimed at reducing incarceration rates among those with mental illness.

The initiative, headed by the National Association of Counties, the American Psychiatric Association Foundation, and the Council of State Governments’ Justice Center, calls on counties to take incremental steps to address the problem.

These include collecting and reviewing data to better assess the flow in and out of jail for inmates with mental illness; assessing the county’s mental health and substance abuse services; investing in programs that keep mentally ill people out of jail; developing a plan to reduce their numbers in jail; and tracking the plan’s progress.

Zane said the county is already taking some of these steps with its mental health court and diversion programs that mandate treatment through the probation process.

“The way that you reduce the number of people with severe mental illness in our jails is you treat them on the outside,” Zane said. “It’s the early intervention and prevention approach.”

This report was produced as a project for the California Health Journalism Fellowship, a program of the Center for Health Journalism at the USC Annenberg School of Journalism. You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com.

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