2015-16 Civil Grand Jury Report Final Report SF Jails 7-14-16

SANFRANCISCOCOUNTYJAILS
OURLARGESTMENTALHEALTHFACILITYNEEDSATTENTION
June2016
CityandCountyofSanFrancisco
CivilGrandJury,20152016
MembersoftheCivilGrandJury
JayCunningham,Foreperson
AlisonIleenScott,Esq.,ForepersonProTem
ArtiM.Sharma,M.S.,RecordingSecretary
SheldonBachus
RichardBakerLehne
MaryLouBartoletti,M.B.A.
JeanBogiages
CatherineCovey,M.D.
LibbyDodd,M.B.A.
JohnHoskins,Esq.
MargaretKuo,M.S.
DavidLal
AndrewLynch
WassimJ.Nassif
PattiSchock
MichaelSkahill,Ph.D.
DavidStein
CharlesThompson
EricS.Vanderpool,Esq.
SanFranciscoCountyJails
THECIVILGRANDJURY
TheCivilGrandJuryisagovernmentoversightpanelofvolunteerswhoserveforoneyear.
Itmakesfindingsandrecommendationsresultingfromitsinvestigations.
ReportsoftheCivilGrandJurydonotidentifyindividualsbyname.
Disclosureofinformationaboutindividualsinterviewedbythejuryisprohibited.
CaliforniaPenalCode,section929
STATELAWREQUIREMENT
CaliforniaPenalCode,section933.05
Eachpublishedreportincludesalistofthosepublicentitiesthatarerequiredtorespondtothe
PresidingJudgeoftheSuperiorCourtwithin60to90daysasspecified.
AcopymustbesenttotheBoardofSupervisors.Allresponsesaremadeavailabletothepublic.
Foreachfinding,theresponsemust:
1) agreewiththefinding,or
2) disagreewithit,whollyorpartially,andexplainwhy.
Astoeachrecommendationtherespondingpartymustreportthat:
1) therecommendationhasbeenimplemented,withasummaryexplanationor
2) therecommendationhasnotbeenimplementedbutwillbewithinasettimeframeas
providedor
3) therecommendationrequiresfurtheranalysis.Theofficeroragencyheadmustdefine
whatadditionalstudyisneeded.TheGrandJuryexpectsaprogressreportwithinsix
monthsor
4) therecommendationwillnotbeimplementedbecauseitisnotwarrantedor
reasonable,withanexplanation.
TABLEOFCONTENTS
SUMMARY
INTRODUCTION
OBJECTIVES,SCOPEANDMETHODOLOGY
11
BACKGROUND
13
GENERALDISCUSSION
A:JailIntakeandCustodyTransfer
DISCUSSION
FINDINGS
RECOMMENDATIONS
B:Facilities
DISCUSSION
FINDINGS
RECOMMENDATIONS
C:Operations
DISCUSSION
FINDINGS
RECOMMENDATIONS
D:PersonnelandTraining
DISCUSSION
FINDINGS
RECOMMENDATIONS
E:DischargeandReentryPlanningwithOutcomePerformanceMeasures
DISCUSSION
FINDINGS
RECOMMENDATIONS
15
15
17
17
CONCLUSION
41
REQUESTFORRESPONSES
42
BIBLIOGRAPHY
54
GLOSSARY
57
APPENDIX
59
19
21
21
22
30
30
32
35
35
37
39
40
SUMMARY
WhiletheCaliforniaStatePenalCoderequiresthatCivilGrandJuriesvisitandinspectthe
CountyJailseachterm,Juriesarenotrequiredtoissueareportonthem.The201516San
FranciscoCivilGrandJury(Jury)chosetoconductthisinvestigationbecauseitwasespecially
concernedabouttheroleJailsplayasadefaultproviderofpsychiatricandsocialservicesfor
underservedpopulations.
ThisreportfocusesonthecustodyoperationsoftheSanFranciscoSheriffsDepartment
beginningwithintakeofarresteesthroughtheirhousingandcareuntiltheirreleaseandreentry
tosociety.Wearerecommendingthat:
1) Communicationbetweenarrestingofficers,SheriffsDepartmentstaff,andJailmedical
staffbeimprovedbydevelopingandimplementingsignedcustodytransfercards,share
thearrestrecords,andmedicalinformationtrackingprocedures.
2) MentalhealthservicesbeexpandedincludingstaffingJailBehavioralHealthServices
24/7,andtherapybeprovidedinacofacilitatormodel.
3) SheriffsDepartmentexpeditehiringofnewDeputiestoreduceovertime,andnegotiate
withtheChiefofPolicetofindadditionalrotationalopportunitiesforDeputySheriffs.
4) Aparttimepoolofretiredorextrahelpdeputiesshouldbemaintainedforcoverageof
personnelabsentduetoshorttermillness,professionaldevelopment,andvacationtime.
5) Trainingincrisisinterventionandsuicidepreventionbeprovidedandupdatedforall
personnelwhoregularlyinteractwithinmates.
6) Clearcontactinformationshouldbeavailableforfamilyorfriendstoinquireastothe
statusandwellbeingofrecentlyincarceratedlovedonesandtoprovidemedicaland
psychiatrichistorytoimprovecustodialcare.Thisenhancedserviceshouldbepromoted
ontheSheriffsDepartmentwebsiteandotherappropriatevenues.
7) TheSheriffsDepartmentshouldworkwithSFOpenDatatoprovidedataaboutjail
populationdemographicsandoutcomeperformancemeasuresontheSFOpenData
website(
https://data.sfgov.org/
).
8) Awarmhandoffbeprovidedtoallpeoplewithmentalillnesswhentheyarereleased
fromjailsoastomakecontinuityofcareareality.Thismeansintroducingareleased
inmatetoaCaseManagerwhowillbehandlingpostreleasetreatmentandcommunity
services.
INTRODUCTION
InaccordancewithCaliforniaPenalCodeSection919b,the20152016CivilGrandJuryforthe
City/CountyofSanFranciscoinquiredintothefacilities,operations,personnel,andinmatesof
theSanFranciscoCountyJail(CJ).TheJailSystemincludesfivejailspresentlyinserviceand
managedbytheCustodyOperationsDivisionoftheSanFranciscoSheriffsDepartment.Aswe
examinedthejails,ourfocuswasonmentalhealthandreentryservices,suicidepreventionand
generalsafety.
InMay2016,theSanFranciscoBudgetandLegislativeAnalystsOfficereleasedareporton
JailPopulation,Costs,andAlternatives,whichtracedtherecenthistoricalbackgroundforthe
riseinincarcerationofthementallyill:
Nationally,thenumberofindividualswhoarementallyilland
incarceratedinlocaljailshasbeenontherise.Accordingtonational
publichealthofficialsandresearchers,theriseinmentalillnessin
thejailsstartedwiththeclosureofstateandprivatepsychiatric
hospitals.Whiletheclosureofthestatepsychiatrichospitalswas
intendedtoallowpatientstoreturntotheirfamiliesandlive
independently,thefederalgovernmentandstatesfailedtoprovide
sufficientfundingforcommunitybasedmentalhealthprograms.As
aresult,menandwomenoncehousedininstitutionsfound
themselvesarrestedandincarcerated.Thisnationaltrendofa
growingmentalhealthpopulationcyclingthroughthejailsisalso
evidentinSanFrancisco.1
ForbringinguniqueeducationalopportunitiesintotheSanFranciscoJails,HarvardUniversity
recognizedtheFiveKeysCharterSchool,awayforinmatestoearnahighschooldiploma,with
itsInnovationsinAmericanGovernmentAwardanda$100,000granttobuilduponitssuccess.2
Muchofthegrantwasusedforhelpinginmatestobuildandsustainfamilyrelationshipswhile
incarcerated.
However,thepositiveworkoftheSheriffsDepartmentwasovershadowedbyseveralevents
during2015thatdismayedresidentsandraisedconcernsaboutthethenSheriffsjudgment.We
summarizeafewincidentsbelow:
Earlyin2015,thefatherofaninmatereportedtothePublicDefenderthatSheriff
DeputieswereforcinghissonandothersinJail#4locatedintheHallofJusticeto
PolicyAnalysisReportonJailPopulation,Costs,andAlternatives,May25,2016,pg.1011
http://www.sfbos.org/Modules/ShowDocument.aspx?documentid=56029
pg1011[hereaftercitedasPolicy
AnalysisReportonJailPopulation,Costs,andAlternatives]
2
HarvardKennedySchool,AshCenterforDemocraticGovernanceandInnovation,September17,2015newsletter,
http://ash.harvard.edu/news/newyorksanfrancisconamedwinnersharvards2015innovationamericangovernme
ntaward
engageingladiatorstylefights.3InMarch2016,theDistrictAttorneyfiledcharges
againstthreedeputiesaccusedofstagingthefightsandbettingonthem.
OnJuly3,asuspectarrestedforrandomlyshootingandkillingaSanFranciscoresident
hadjustbeenincustodyintheSanFranciscoJailonlyafewhoursbefore.Some
communitymembersquestionedwhetherthe(former)Sheriffshouldhavetakenhim
fromimmigrationcustodyforanoldlocalwarrant.OthersquestionedwhytheSheriff
instructedhisstaffnottohonorrequestsfromImmigrationandCustomsEnforcement
(ICE)todetainhimforviolatingordersofdeportment.Sincethen,thenewSheriff
workedwiththeBoardofSupervisorsonarevisedpolicythatmeetstheCitysgoalof
protectingundocumentedresidents.ItgivesdiscretionfortheSheriff
t
onotify
immigrationagentsiftheinmatehadaviolentorseriousfelonyconvictioninthepast
sevenyearsorthreeormorelesserfeloniesarisingfromdifferenteventsinthepast
fiveyears.
OnJuly28,aninmatearrestedafewdaysearlierforallegedlyviolatingastayaway
ordercommittedsuicideinjail.Hisfamilyhadexpressedthathewassuicidalinfact,he
waspickedupneartheGoldenGateBridge,acommonplaceforsuicideattempts.
Inadditiontotheseevents,wealsonotedtheoverarchingeffectsofrecentlyimplementedlaw,
therapiddeteriorationofSanFranciscoCountyJail#4,andthecrisisinthedeliveryofpublic
healthandsocialservicesoutsideofthejails.
AssemblyBill109(AB109),thestateprisonrealignmentbillsignedin2011,requiresthose
convictedofnonviolent,nonsexualfeloniestoservetheirsentencesinthecountyjailinsteadof
stateprison.Proposition47(Prop47)waspassedin2014andreducedfromfelonyto
misdemeanorseveralclassificationsofpropertycrimeanddrugpossession,largelychangingthe
policeresponsetothesecrimestofieldcitations.ThecombinedeffectofAB109andProp47is
tosignificantlyreducethepopulationoflowleveloffendersandtoincreasethepercentageof
felonyconvictedinmates.InaMay25,2016report4theBudgetandLegislativeAnalystsoffice
reportedthat88%ofunsentencedinmateswerechargedwithfelonies.
ThecrisesinpublichealthandsocialserviceshasmadetheJailanunintendedproviderof
psychiatricandsocialservicesforthementallyillandthehomelessservicesthejailhasneither
thecapacitynorthemandatetoprovide.Thisincreaseofmentallyillandhomelessinmatesin
needofhealth,psychiatric,andreentryservicesfurtherdepletestheresourcesofthedepartment.
SanFranciscoLawEnforcementHasFewOptionsforPeopleinMentalHealth
Crisis
AJune2016conceptpaper,describingaproposedBehavioralHealthCriminalJustice
communityresidentialtreatmentcenterforthementallyillwhointeractwiththecriminaljustice
3
Ho,V.(2016)SanFranciscoChronicle17CountsforAccusedleaderofSanFranciscoJailFightClub.San
FranciscoChronicle.March1,2016.
http://www.sfgate.com/crime/article/17countsforaccusedleaderofSanFrancisco6863736.php
4
PolicyAnalysisReportonJailPopulation,CostsandAlternatives,pg.4
system,notesthattheSanFranciscoPoliceDepartmenthasveryfewoptionsotherthanthejail
forpeopleinmentalhealthcrisis:
InthethreemonthperiodbetweenDecember2015andFebruary
2016,thepolicedepartmentreceivedatotalof5,013callsinvolving
peopleinmentalhealthcrisis.Infact,theSanFranciscoChronicle
hasreportedthat80percentofcallstopoliceinvolveindividuals
withmentalillness.SanFranciscohaslimitedoptionsforlaw
enforcementwhoencounterpersonsinthethroesofamental
healthcrisis.Whenapersoncommitsaminorcrimeandalso
suffersfrommentalillness,officersdonothaveaworkableavenue
oroptionfordivertingpeopleoutofthecriminaljusticesystem.5
Thehomelessandmentallyillareachallengingpopulationforthejailmostarrivewith
multipleissues,arisingfromnoncompliancewithmedicalandpsychiatriccareprovider
appointmentsandmedications,inadequatehousing,theallureandeaseofaccesstoaddictive
streetdrugs,andneglectofchronicmedicalissues.Medicalandpsychiatrictriageattheintake
Jail(CJ#1)refersthemostseverelyafflictedsuspectstomedicalorpsychiatricemergency
servicesatZuckerbergSanFranciscoGeneralHospitalbeforetheyarebookedintojail.Atany
giventimearound6to8percentofinmatesbookedintothejailarehousedinthejailinfirmary
atCJ#2.Mostoftheseinmatesarereceivingtreatmenttostabilizeacutepsychiatricconditions,
suchaspsychosis,bipolarmanicepisodes,clinicaldepression,drugrelatedparanoia,suicidal
ideationandtheeffectsofdetoxificationfromsubstanceabuseandothermedicalissues.Itisnot
ahealthypopulation.
AccordingtotheSheriffsDepartment,thetotaljailpopulationisapproximately1,270inmates.
Averyhighpercentage91.5percentofthedailyinmatepopulationaremaximumormedium
security.Perhapsthemoststrikingstatisticofallisthatlessthan20percentoftheinmateshave
beenconvictedofacrime:83percentoftheinmatesareunsentenced,i.e.awaitingtrial.Inthe
lawseyes,theyarestillinnocentuntilprovenguilty.6
Mostlowleveloffendersbroughttothejailforbookingarecitedandreleasedifeligible
(crimescausingbodilyharmarenoteligible)oraresoonreleasedonbailoronown
recognizance(O.R.).TheSheriffkeepssomeoneinjailuntilajudgedecideswherethatperson
goes.Sometimesajudgewillreferadefendanttopublicagenciesinsteadofjail,butthe
defendantremainsinjailuntilanagencybedbecomesavailable.Personswhoarebeingheldin
jailinSanFranciscocurrentlywaitanaverageof120daysforabedinacommunitybased
residentialtreatmentprogramaftertheyaredeemedclinicallystableandappropriatefor
placement.7
C.Haney,etal.,JusticeThatHeals:PromotingBehavioralHealth,SafeguardingthePublic,andEndingOur
OverrelianceonJails,June2016(hereafterHaney2016)
6
Ibid,pg.1
7
Ibid.pg.2
Weweretoldmostofthepeopledetainedatthejailneedtobeinjailforpublicsafety.Wewere
told,Detentionofthedangerousisareality.
Thepopulationinjailhaschangedovertime.TheSanFranciscoCountyJailwasbuilttohold
prisonersforuptooneyear,yetsomeprisonershavebeeninthejailforuptosixyears.
However,theaveragelengthofstayis37daysforthegeneralinmatepopulationand66daysfor
behavioralhealthserviceinmatesreceivingpsychotropicmedication.8
Facilitiescontributetothesolutionandtheproblem
Overall,ourinvestigationofthejailsfoundthatthenewerfacilityatSanBruno(CJ#5)meets
modernstandardsandaddressesrecidivismthroughrobustprogramsandeducational
opportunities.TheFiveKeysCharterSchoolprovidesapathwayforinmatestoearnahigh
schooldiploma.
Wenotedthatmandatoryovertimeforcustodystaffisanongoingproblem,ostensiblyrequired
tomeetminimumstaffingrequirements.Wealsofoundthatmany,ifnotmost,ofthestaffatthe
jailsareprofessional,dedicated,caring,andpersistentundersustainedduress.Thisincludesthe
teachers,counselors,andhealthcareproviderswhoworkinthejails.Manyofthemchoseto
workwithinmatesbecausetheywishtomakeadifference.Thereisafeelingofcamaraderie
amongthestaff.Theyexpressdisappointmentwheninmatesfinishtheirsentenceonlytobe
releasedwithoutaccesstotheservicesofferedinsidethejail.
UnlikeCJ#5,whenwevisitedCJ#4,wefoundsubstandardconditionsforboththeinmatesand
thestaffexpectedtomonitorthem,feedthem,andofferservices.However,atthetimewewere
anticipatingthatanewjailwouldalleviatetheproblems.WhentheBoardofSupervisorsrejected
an$80milliongranttopartiallyfundconstructionofanewjailfacility,oneoptionforimproving
thesituationwasnolongeravailable.
Accordingtoourinterviews,theBoardofSupervisorsDecember2015decisionnottoprovide
$215millioninfundingforanewfacilitywasahardblowtomoraleintheSheriffsdepartment.
IthadbeeninplanningoverthepreviousfiveyearsandwasexpectedtoreplacethecurrentHall
ofJusticeincludingCJ#4.
AJailReplacementProjectWorkingGroupwiththeSheriffandtheDirectorofHealthas
cochairshasbeenestablishedaftertheBoardofSupervisorspassedaresolutionurgingthe
formationofthisgrouponJanuary12,2016.TherehavebeenfourmeetingsthroughJune2016,
andthegroupexpectstofinalizerecommendationsbytheendoftheyear.9
OneconceptsubmittedtotheWorkingGroupproposesafourtierBehavioralHealthJustice
Centerwhich,amongotherthings,wouldprovideasecure(locked)shorttermtreatmentfacility
Ibid,pg.16
JailReplacementProjectWorkingGroup,https://www.sfdph.org/dph/comupg/knowlcol/jrp/default.asp
forinmateswithmentalillnesswhoaretransitioningtoplacementincommunitybased
residentialtreatmentprograms.10
WebeginthisreportintotheconditionsandoperationofCustodyOperationsoftheSan
FranciscoSheriffsDepartmentwithrespectandadmirationformembersoftheSheriffs
Department,CustodyOperationsdivision,JailHealthServices,andJailBehavioralHealthand
ReentryServicesprovidedbyHealthRight360.Theyaredoingaremarkablejobinspiteofthe
challengestheyface.
10
Haney2016
10
OBJECTIVES,SCOPEandMETHODOLOGY
Objectives
OurobjectivewastoevaluatetheCustodyOperationsandMentalHealth/PsychiatricServicesin
theSanFranciscoJailSysteminrelationshiptosupportinginmateneeds,preventingsuicides,
andassuringthesafetyofinmatesandstaff.
ThisreportfocusesonwhathappensattheSanFranciscoJailsafterpeoplechargedwith
criminalactivityarebroughttotheJailsbypoliceagenciesorsentencedtothejailbythecourts.
WelookintotheinteractionoftheSheriffsDepartmentstaff,theJailHealthServicesandthe
JailBehavioralHealthandReentryServicesastheycooperativelyseektoprovidesafe
conditionsforpeoplebroughttotheJailsforcriminalactivitywhomaybementallyill.
Theprimarygoalofthisreportsrecommendationsissafetyforthecommunity,forthe
inmates,andfortheJailsstaffandvisitors.Inmateswithmentalillnessaretobestabilized,
providedtreatment,andmadereadyforcommunityrelease.
Scope
ThescopeofourinquiryislimitedtotheCustodyOperationsDivisionoftheSheriffs
DepartmentanditsrelationshiptotheJailHealthServicesDivisionoftheDepartmentofPublic
HealthandHealthRight360(HR360),11acontractproviderofbehavioralhealthandreentry
servicesintheSanFranciscoJails.
Wenotethataprevious(20132014)CivilGrandJuryreportfocusedoninjury,illnessand
overtimeintheSheriffsDepartmentandontheFiveKeysCharterSchool,whichwecomment
onbrieflyinthisreport.
WedidnotinquireintoanydivisionsoftheSheriffsDepartmentortheDepartmentofPublic
Healthotherthanthosementionedabove.Inparticular,wedidnotreviewrecentnewsof
unresolvedinternalaffairscases.12Insteadweexploredhowtrainingandrotationofdeputies
mighthelppreventtheirparticipationinegregiousconduct,suchasthatdescribedas
gladiatorfights.
WhilewespendalotoftimediscussinghowtheSanFranciscoJailstreatpeoplewithmental
illness,thisreportdoesnotdealwiththelargerissuesofthementallyillintheoverallcriminal
justicesystem,includingthepoliceandthecourts.
11
https://www.healthright360.org/
http://www.sfexaminer.com/paperbagincompleteinternalaffairscasesdiscoveredsheriffsoffice/
12
11
Methodology
Themethodologyforthisinquiryincludedsitevisitsandinterviewswithcustodystaff,medical
providers,andinmates,performedbetweenJuly2015andJune2016.Ourfirstsitevisitwasa
generalorientationtocustodyoperationsintheJailSystem.Wesubsequentlyreturnedtoeach
facilityformoreextensiveobservationsandinterviewswithinmates,custodypersonnel,
counselors,medicalproviders,andfoodserviceworkers.Additionally,wereviewedcurrent
literatureandmediareportspertainingtocustodyoperationsandmentalhealthandsuicide
preventionincustodialinstitutions.WereliedparticularlyontheUnitedStatesDepartmentof
JusticeMemorandaofUnderstandingwiththeLosAngelesCountySheriffsDepartmentasa
guidetopreferredorbestpracticesinmanagementofjailoperations.Wealsolookedatbest
practicesaroundthecountryandasdescribedinresearch.
12
BACKGROUND
OrganizationalStructureandRolesofPersonnel
TheSanFranciscoCountyJailisanadultdetentionfacilitymanagedbytheCustodyOperations
DivisionoftheSanFranciscoCountySheriffsDepartment.CustodyOperationsreceivesand
booksinmatesintothejailfromarrestsmadebyitsowndeputiesandotherarrestingagencies
including:
SanFranciscoPoliceDepartment
OtherSheriffDepartmentsinthesurroundingcounties
BARTPolice
CaliforniaHighwayPatrol
UniversityofCaliforniaPolice
FederalProtectiveServices
FederalBureauofInvestigations
Whenanindividualisbookedintothejail,custodyistransferredfromthearresting
officer/agencytotheSanFranciscoCountySheriffsDepartment.Inmatesmaybeinthejailfor
onlyashorttimeiftheyarereleasedatarraignment.Iforderedbythecourt,aninmateisheldin
custodyuntiltrialandtocompleteasentence,iffoundguilty.
TheSanFranciscoCountyJailSystem(CJ)includesthesixfacilitiesinTable1belowand
Wards7Dand7LatZuckerbergSanFranciscoGeneralHospital.BecauseCJ#3andCJ#6are
closed,thenumberofavailableratedbedsis1436.CJ#3wasclosedseveralyearsagoasafirst
steptopreparingtheseismicallyunsafeHallofJusticeforteardown.Since2010,CJ#6no
longerhousesinmatesbecauseitisaminimumsecurityfacilitywithoutindividualcellsorsafety
cells.Itwouldrequiremajorrenovationsandincreasedsecuritystaffingtomakeitsuitablefor
enoughofthecurrentinmatepopulationtojustifythecost.Also,thelocation
adverselyimpacts
inmateaccesstolegalcounsel,AdultProbationassessments,andvisitsfromfamilyandfriends.
Table1:SanFranciscoJailFacilities
13
Table2belowshowsthegeneralorganizationofpersonnelinthejailandtherolethattheyhave
injailoperations.Thecustodyoperationsofficersareresponsibleforcontrolandsafety.
Custodyoperationsclassifieseachinmateaslow,medium,orhighrisk,determineswhereinthe
JailSystemtheinmatewillbehoused,andcoordinatestransportationoftheinmatesthroughand
betweenfacilities.JailHealthServicesisadivisionoftheSanFranciscoDepartmentofPublic
Healthwhosepersonnelincludedoctors,nurses,andmedicalassistants.NursesfromJailHealth
ServicesareresponsibleforPillCall,i.e.thedispensingofprescriptionmedicationsto
inmatesattheappropriatetimes.CJ#2andCJ#5havecomprehensiveinfirmarieswherecare
providersseeinmatesforawiderangeofmedicalandwellnessneeds.HR360,alarge
notforprofitsocialandhealthservicesagencycontractedbytheDepartmentofPublicHealth,
providesbehavioralhealthandreentryservicesincludinginterviewinginmatesastheyenterthe
systeminCJ#1,completingtreatmentplansforinmatesidentifiedforrisks,andproviding
individualandgrouptherapy.EducationprogramsintheSanFranciscoJailsareofferedthrough
theFiveKeysCharterSchoolandareoperatedasasubentityoftheSheriffsdepartment.
CustodyOperations
SFSheriffsDepartment
JailHealthServices
SFDept.ofPublicHealth
BehavioralHealth&Reentry
ServicesHR360
Maintainasecurefacility
Inmateclassification,
housing,safety,control
anddiscipline
Coordinatevisitinghours
andattorneymeetings
TriageatCJ#1
Operationofmedical
clinicsinCJ#2.#5,and
7D/7L
Patientcare,health
education,clinicvisits,
andspecialtyvisitsin
SFGeneral
IntakeinterviewandRisk
assessmentatCJ#1
MentalHealthTreatment
Planning
IndividualandGroup
Therapy
Transportationofinmates
withinandbetweenjail
facilitiesandtocourt
PillCall
Reentryplanningand
services
Arrangecontinuityofcare
postrelease
ProvidesProgramsand
Education,
FiveKeysCharter
School
.
Overseesfoodservicesand
othercontractors
Table2:RolesinSanFranciscoCountyJails,compiledbyCivilGrandJury
14
GENERALDISCUSSION
A.JailIntake:TransferofCustody
DISCUSSION
ArrestingagenciesbringanapprehendedpersontoCJ#1forintakeprocessing.Thearresting
officerstayswiththearresteeuntilheismedicallyclearedforbookingintothejail.Arresting
officersandarresteeswaitoutsidethejailuntilitistheirturnforintakeprocessing.Ifthewait
willexceed20minutes,asecondtriagenursestationisopened.
Thefirststopisformedicaltriagebyatriagenurse,employedbytheDepartmentofPublic
Health(DPH).Thisoccursinthepresenceofthearrestingofficer.Weweretoldthemajorityof
arresteeshavemedicalissues.Thetriagenursefirstdeterminesifthepersonatintakeishealthy
enoughtobeinthejail.Ifnot,thearrestingofficermusttakethearresteetothehospitalandlater
returnhimtothejailforbooking(unlessthemedicalproblemissoseriousthatthearresteemust
betransportedbyambulance).
Weweretoldbyahighlevelmedicalofficialoftransportingofficerswarningarresteesnotto
talktothetriagenurseaboutmedicalproblemsbecauseitwillslowthingsdown.Thearrestee
maybetoldIfyoukeepquiet,youwillgetcitedout,andwebothcanleave.Thisconcernsus,
sincemuchofthemedicalinteractionwithaninmatepatientispredicatedonthepatients
selfprovidedmedicalhistory.
Wewerealsotoldofarrestingofficerscitingandreleasingarresteesdeemedmedicallyunstable
bythetriagenurseratherthantakingthearresteetoanemergencyroom.Welearnedofthe
phrasecatchthefish,cleanthefishwhichsummarizestherequirementthatthetransporting
officermaintainresponsibilityforanarrestee,includingsittingatthehospitaluntiladmittanceor
treatmentanduntilthecustodytransferintojail.Policeofficerswespokewithsaidthatifa
supervisorlearnedthatanSFPDofficerhaddroppedoffanarresteearoundthecornerratherthan
goingtoZuckerbergSFGeneralHospital,theofficercouldbefired.Therecurrentlyisnojail
proceduretonotifythearrestingofficerssupervisorofthetriagedecisioninthissituation.
Ifrecommendedbythetriagenurse,therewillbeanindepthmedicalexaminationbyanother
DPHnurse,inasemiprivateroom,oneonone.Thissecondnursewillverifythepatients
medications.IfthearresteehasaDPHmedicalhistoryinSanFrancisco,thenursewillhave
restrictedaccesstohiscomputerizedmedicalrecordonlyJailHealthandJailBehavioral
Healthhaveaccess,notthecustodystaff.ThenursewillaskthearresteetofilloutaReleaseof
Informationformforanyothertreatmentfacilitiesthatprovidedpreviouscare.Thenursewill
alsoaskthearresteeaboutanypsychiatricconditions.Weweretoldthatintakeshouldalsoget
contactinformationaboutanarresteesCaseManager(ifany)andfamilyorfriendswhomay
haveinformationabouttherapeuticmedications.
15
Almosttwothirds(64%)ofjailinmatesacrossthecountryhavementalhealthproblems.
ThirtyfivetofortypercentofindividualsdetainedintheSanFranciscoJailreceivecarefrom
JailBehavioralHealthServices.13
Whiletherearemanywaystoobtainanestimateoftherateofprevalenceofseriousmental
illness(SMI),theFederalSubstanceAbuseandMentalHealthServicesAdministrationestimates
that45percentofthegeneralU.S.populationhasaSMIdiagnosis,while1424percentofthe
individualswithcriminaljusticeinvolvementhaveanSMIdiagnosis.14
Atanypointinthismedicaltriageprocess,ifconcernsarise,anyoneonthecustodyormedical
staffcanreferanarresteetoJailBehavioralHealthforanassessment.IfJailBehavioralHealth
staffareondutyinCJ#1,theinmatewillbeseenrightawayifnot,theinmatewillbeseenthe
nextday.Thepsychiatricstaffdeterminesifaninmateismentallyill.Theseassessmentsare
conductedoneononeandtakeaboutanhour.Weweretoldthatabouthalfofthoseevaluatedat
intakehavenofollowup,eitherbecausenonewasindicatedorthepersonwasreleasedsoon
fromjail.
TheJailcustodystaffwillthenprepareahousingcardindicatingtheinmate'sassignmenttoone
ofthejailpods
,includinganadministrativesegregationpodforthosewhomightcauseproblems
orneedprotectionfromothersinthegeneralpopulation.Ifaninmateisdeemedapotential
dangertohimself,butisnotinapsychiatricemergency,hewillbeassignedtoCPodinCJ#2
forobservation.Someoftheinformationonthehousingcardmaycomefromthearresting
officer,andthearrestingofficermaysharetheinformationwiththetriagenurse.However,at
thetimeofintake,theSheriffsDepartmentstaffdoesnothaveaccesstothearrestingagencys
recordofthecurrentarrest.
WeweretoldthateachpersonbookedintothejailhasanaccompanyingFieldArrestCard.
The
JurylearnedthattheUSDepartmentofJustice(USDOJ)AgreementwiththeLosAngeles
CountySheriffsDepartmentrecommendsacustodytransfercardasabestpractice.The
custodytransfercarddescribesthecircumstancesofarrestandidentifiesanyareasofmedicalor
psychologicaltraumaordistress.Thearrestingofficercompletesandsignsthecardand
providesittothetriagenurse.Thepurposeofthecardistoassistjailstafftoappropriately
assessandclassifytheinmate.
AsnotedintheDepartmentofJusticeGuidelines,thejailentry
screeningprocesscreatessaferfacilitiesforjailstaffandinmates(andalsoprotectstheCounty
fromcostlylitigation).
In2015,adeathincustodyoccurredintheSanFranciscoCountyJail.
Pendinglitigationmay
ascertainwhethertheFieldArrestCardinformed
jailstaffoftheinmatessuicidaldisposition
andthefactthathewasarrestedneartheGoldenGateBridge,acommonlocationforsuicide
attempts.Familymemberspurportedlycalledtowarnthestaffthattheinmatewassuicidal.Even
thoughaninmateisentitledtothreelocaltelephonecalls,hemaynotrealizetheimportanceof
notifyinghisfamilyand/orfriendsofhissituation.Theinmatehandbookdoesnotcurrentlyspell
outtheimportanceofthisorwhatphonenumbertheinmateshouldgivetohisimportant
13
Haney2016.ThisreportnotesthattheSanFranciscoJailisthelargestmentalhealthfacilityinthecounty.
14
16
contacts.AstheNationalAllianceonMentalIllness(NAMI)notes:Itiscriticallyimportantfor
familymemberstoinformcustodyofficialsassoonaspossibleabouttheirfamilymembers
historyofmentalillnessandhisorherspecifictreatment.15
Completeinformationprovidedtothejailaboutaninmatescircumstancesandmedicaland
mentalstateofbeingresultsinasaferenvironmentfortheinmate,otherinmates,anddeputies
andotherjailstaff.Completeinformationhasthepotentialtosavelives.
FINDINGS
F.A.1.
Thereis
currentlynojailprocedurethataccountsfor
thosearresteesreferredfor
hospitalcarebeforebeingbookedintothejail.
F.A.2.
Arresteesandtheirarrestingofficermaynotnotalwaysunderstandtheimportanceof
fulldisclosureofmedicalhistory.
F.A.3.
WhenanarrestingagencybringsanarresteetotheJailforintake,thereisafield
arrestcard.
F.A.4.
AlthoughtheSheriffhasaccesstomultiplecriminaldatabases,thearrestingagencies
donotnecessarilysharearrestrecordswiththeSheriffscustodystaffatthetimeof
custodytransfer.
F.A.5.
TheresultsofapreliminarypsychiatricevaluationconductedbyJailBehavioralHealth
atintakecouldbehelpfultothearresteeslongtermmentalhealthcareifsharedwith
thearresteesCaseManager,ifany.
F.A.6.
Althoughthereareseveralwaysforfamilymembersandfriendstocontactcustodystaff
regardingconcernsabouttheirlovedoneswhoareinjail,modelsforimprovementare
available.
RECOMMENDATIONS
R.A.1a. Jailintakeshoulddevelopasystemtocommunicateandtrackcaseswherethetriage
nursedeterminesthatthearresteemustbetakentoahospitalforemergencymedicalor
psychiatriccarebeforeadmissiontoJail.
R.A.1b. SFPoliceChiefandSheriffshouldrevisittheirMOUregardingtransportandcustody
transfer.
R.A.2.
Intheinterestofobtainingamorecompletemedicalhistory,theSheriffandthe
DirectorofHealthshouldreviewandreviseifnecessarycurrentintakepoliciesand
practicestoencourageIntakestafftoobtaininformationbyappropriatemeans
15
https://www.nami.org/
17
concerningthearresteesCaseManager(ifany),andfamilyorfriendswhomayhave
informationaboutthearresteesmedicalhistoryandtherapeuticmedications.
R.A.3.
TheSheriffshouldreviewcurrentFieldArrestCardcontentandprocedurestoassure
thatbestpracticesareemployed,andinformationnecessaryforthehealthandsafetyof
thearresteeandjailpersonneliscommunicatedinwriting.Informationshouldinclude
circumstancesofarrestandanyobservationsorconcernsthearrestingofficermayhave
aboutthemedicalorpsychiatricconditionofthearrestee.
R.A.4a. Byearly2017,theSheriffshouldimplementapolicyandprocedurerequiringarresting
agenciestoprovideadigitalcopyofthearrestreport,includingchargesanda
descriptionofthearrest,withinsixhoursofthetransferofthearrestee.
R.A.4b. OncethesharethearrestrecordprocessofR.A.4aisinplace,theSheriffshould
requireallarrestingagenciestocomplywiththeprocess.
R.A.5.
TheSheriffandDirectorofPublicHealth,inconsultationwiththeCityAttorneyfor
issuesrelatedtoHIPAA,shoulddevelopandimplementapolicyforsharingwithan
arresteesCaseManager(ifany)theresultsofapreliminarypsychiatricevaluation
conductedatIntake.
R.A.6.
TheSheriffshouldaddtotheinmatehandbookaparagraphabouttheimportanceof
contactingafamilymemberorfriendandshouldprovidea24/7numberthattheinmate
couldgivetothiscontact.
18
B.Facilities
DISCUSSION
th
SanFranciscoCJ#4,locatedonthe7
flooroftheHallofJusticeat850BryantStreet,isthe
Citysmaximumsecurityfacilitywithacapacityof402inmates.CJ#4hasanindustrialsize
th
kitchenwheremealsarepreparedforitsinmatesandalsothoseofCJ#1andCJ#2at4257
Street.Inaddition,CJ#4hasafullscalelaundryfacilitywithcapacitytoserveabout850
inmates.Builtinthe1950s,CJ#4islineardesign(Fig.1upper)andpartoftheHallofJustice
complexthatwasdeclaredseismicallyunsafe12yearsago.Asthemaximumsecurityfacility
withinSanFranciscosJailsystem,itsinmatesandthoseinthemaximumsecuritypsychiatric
sectionalsointhatjailmaybeconsidereddangerousandarisktothepublicssafety.
ContrastthiswiththecircularstyleofhousingatCJ#5inSanBruno(Fig.1lower).There,
guardsinacentralcommandareaatthefocusofthecirclecanmonitormanymoreinmates
withoutmovingfromtheirstation,andinmateshavecommonareasforeating,socializingand
participatinginprogramsdesignedtopreparethemforreleaseandreentry.
TheconditionsinthekitcheninCJ#4causedusgreatalarmduringoursitevisitinDecember
2015.Welearnedthatthreelargeboilerunitsforfoodpreparationwereoutofcommissiondue
toplumbingleaks,whichimpactedlowerfloorsinthebuilding.Thetraydishwasherhadbeen
outofoperationformorethanayear.Hotwaterfaucetsdidnotwork,soinmateswererequired
tocarryhotwaterintothekitcheninlargecontainers.Becauseofthelackofhotwaterand
dishwashingequipment,theriskofillnessarisingfromthe750mealsforinmatesanddeputies
preparedthreetimesadaywashigh.OnourreturnvisittoCJ#4onJune15,2016wefounda
verylargekitcheninthemidstofaremodel,withrepairedtables,patchedfloors,aneatandclean
room,aproperlyworkingdishwasherandmuchbrighterlightingthanbefore.Uponopeningthe
faucet,hotwaterranfreelyfromthespout.Restoringhotwateranddishwashingequipment
reducedourconcernforfoodsafetyatCJ#4,butdidnotaddresstheissuesofseismicsafetyor
thechangesthatwouldneedtobemadetoturnthisintoaplacethatpromotesrehabilitation.
WealsoobservedinDecemberthattheoldkeyedlocktothelaundryroominCJ#4wasno
longerworkingproperly.WesawaDeputySherifftrymanyoldkeysmultipletimesbefore
gettingonetoopenthelock.Sincefiresfrequentlystartinlaundries,thismaintenanceissue
couldhavedisastrousconsequences.AccordingtotheNationalFireProtectionAssociation
website,16inasingleyear,anestimated16,800U.S.nonconfinedorconfinedhomestructure
firesinvolvingclothesdryersorwashingmachinesresultedin51civiliandeaths,380civilian
injuriesand$236millionindirectpropertydamage.AtourreturnvisitinJune,whilethelaundry
roomlockwasworkingproperly,weheardthattherearemanyoldlocksthroughoutthefacility.
Whentheyjam,whichoccursfrequently,anoutsidelocksmithiscalledtofixtheproblem.
16
http://www.nfpa.org/publiceducation/bytopic/safetyinthehome/dryersandwashingmachines
19
Figure1:TwoHousingStylesinSFCountyJailslinear(upper)andpod(lower)design
20
FINDINGS
F.B.1.
InCJ#4,oldlocksjamfrequently,causingsafetyconcerns.Othermaintenanceissues
continuetoarise.
F.B.2.
EndinguseofCJ#4wouldalsorequirefindinganewkitchenandlaundryfacilityfor
CJ#1andCJ#2.
RECOMMENDATIONS
R.B.1a. TheSheriffshouldprepareasupplementalbudgetrequestforfundstoimmediately
addressproblemswitholdlocksatCJ#4andanyotherremainingseriousmaintenance
issues
R.B.1b. TheMayorshouldincludeinasupplementalbudgetrequesttheSheriffsrequestfor
fundstoaddresstheproblemswitholdlocksatJail#4andanyotherremainingserious
maintenanceissuesand
R.B.1c. TheBoardofSupervisorsshouldapprovetheMayorssupplementalbudgetrequestfor
fundstoaddresstheproblemswitholdlocksatCJ#4andanyotherremainingserious
maintenanceissues.
R.B.2. TheSheriffshouldmakeinterimplansforreplacingkitchenandlaundryfacilitiesfor
CJ#1andCJ#2bytheendof2016.
21
C.OperationsHousing,SuicidePrevention,andRelatedInformationSharing
DISCUSSION
Jailsarenotdesignedformentalhealthtreatment:
Correctionalfacilitiesarefundamentallyplacesofpunishmentandcontrol,nottreatment
andrehabilitation.Bynecessity,securitywithinajailorprisonisparamount,makingit
difficulttocreateandmaintainaneffectivesystemofmentalhealthcare.Byvirtueof
theirverynaturefromtheirarchitecturaldesigntothemannerinwhichtheyare
routinelyoperatedjailsandprisonstendtoexacerbatementalillness.17
InreviewingtheoperationsofSanFranciscoCountyJails,wefocusedonhousing,incustody
treatmentofmentalillness,suicideprevention,handlingofmedicines,andhowwebsitescould
assistpatientsandtheirfriendsandfamilytolearnabouttheavailableservices.
Housing
AsmentionedintheBackgroundsection,attemptstoreducethenumberofpeopleinjailandto
givepeopleanotherchancetochangetheirliveshasresultedinminimumsecuritycriminals
beingdivertedtoprogramsoutsideofjail.Thisleavesasinmatesthosechargedorconvictedof
seriouscrimesandincreasinglythosewithmentalillnessthatresultedinviolentbehavior.Asthe
Haneyarticlequotedaboveindicates,expertsdonotrecommendjailforanyonewithmental
illness,butmanytreatmentfacilitieswillnottakethistypeofpatient.Whileanyjailcanbea
destabilizingplace,weweretoldthatinourcity,jailsarerelativelycalmplaces,withoutthe
anguisheddisruptionthatmayoccurinotherlargeurbanjails.
Thechallengeistofindappropriatehousingwhereinmatescanreceivethesupportiveservices
theyneed,includingtherapy.InSanFranciscojailsthereare163bedsforpsychiatricpatients,
usuallywith5070inmatesonthewaitinglist.Thisincludesthreepsychiatricshelterunits
podsdesignedforthementallyillwithrestrictedaccesstosharpsandhangingdevices.At
CJ#2,thereare15bedsandapaddedcellinwhichaninmatecanbeheldupto24hoursfor
temporarypsychiatricevaluation.AtCJ#4,thereare32psychiatricbeds.AtCJ#5,thereare96
bedsdesignatedforthementallyill.JailstaffprefernottohousesuicidalpatientsinJail#4if
alternativesareavailablesincethestaffcannoteasilymonitorthem.Thearchitecturaldesign
ofJail#4withitslinearcellsdoesnotmeetdesignstandardssetbytheNationalInstituteof
Corrections,18astherearenoclearsightlinesandthefurnitureandfixturesdonotpromote
positiveinmatebehavior.
Ineachofthethreelocationswithbedsforpsychiatricpatients,thegoalistostabilizeandmove
themtoregularcells.Whenstabilized,theinmatesgetorangeclothingandgotoregularjail
housing.Forthemostseriouscases,patientsundera5150(namedfortheStatecodethat
17
18
Haney2016
http://nicic.gov/directsupervisionjails
22
addressespatientsofdangertothemselvesorothers),thereareroomsatZuckerbergSan
FranciscoGeneralHospitalWard7.
TreatmentofMentalHealthProblems
Custodystaffseeinmatesdayafterday.Theyareawareofaninmatesmentalconditionandcan
notechangesinaprisonersmentalcondition.Theycanbeaninmatesadvocate.Weweretold
byapersonwithexperienceinjailsandprisonsacrossCaliforniathatSanFranciscosJail
Systemisaveryprogressiveinstitution,withcustodystaffcooperatingwiththeJailmedical
andbehavioralhealthstaff.Thecustodystaffisinstrumentaltotherelativelygoodmentalhealth
conditionsattheSanFranciscoJails.Still,theyfacechallengesinkeepingtheinmatessafefrom
suicideandotherrisks.
AsnotedintheBackgroundsection,HealthRight360providesthebehavioralhealthservicesfor
inmates,soitiscalledJailBehavioralHealthServiceswithinthejailsystem.MostofJail
BehavioralHealthServicessworkinthejailsiscrisismanagement,assessments,andsome
groupsessions.TheJailBehavioralHealthServicesstaffhasongoingcontactwithabout3540%
ofthejailpopulation(approximately450to500inmates)formentalhealthproblemsranging
fromdementia,developmentaldisability,behavioralmanagementissues,selfharmasa
dysfunctionalwayofcoping,andhighriskofsuicide.JailBehavioralHealthServicesseesits
biggestchallengesinthejailsettingasthelargenumberofpeopletheyserveandthecomplexity
oftheissueswhichcanbeacuteorchronicandfrequentlyconcurrentwithsubstanceabuse.
Manyinmateshaveahistoryofpsychosisordepression,alcoholorsubstanceabusedisorders,
medicaldisorders,orsomecombinationofthethree.Inaddition,57percenthavebeenhomeless
atsomepointintheirlives,and31percenthavebeenhomelesswithinthelastyear. 19
JailBehavioralHealthServicesstaffnotedthatthoseinmateswhoarewillingtogettreatment
oftenleavethejailwithimprovedmentalhealth.Forconditionstreatablewithmedications,they
foundthatpillsworkabout25percentofthetime,witheffectivenessincreasingto75percent
whencoupledwiththerapy.Still,theyfindthatabout25percentofthetime,thereisno
effectivemedication,includingincaseswherepatientsswallowdangerousitemsorsubstances.
Unfortunately,thosewhoarenotwillingtoaccepttreatmentincustodymayleavejailinworse
shapethanwhentheyentered.
JailBehavioralHealthServicesstaffalsonotedthatwiththedevelopmentofdiversionprograms
tokeeppeopleoutofjail,peoplewithmentalillnesswhomighthavebeenarrestedandtreatedin
jailsixorseventimesayearforpettypropertycrimesarenowonlyarrestedwhentheir
conditionhasdeterioratedtotheextentthattheycommitamoreseriouscrime(i.e.hurting
somebody).Thiscanmeanthatapersonhasbeenoutofjailforayearorlongerwithout
medications,sowhenheisbackinjail,ittakesmuchlongertostabilizehim.
Thiscreatesabalancingact:
patientswhoareoutofjailtooquicklymaynothavehadtimefor
theirmedicationstotakeeffect,whilepatientswhoareinjailtoolongtendtogetworserather
19
23
thanbetter.
Inmateswithseriousmentalillnessareincarceratedforlongerperiodsoftime(65
days)thanthegeneralinmatepopulation(37days).20
TheJurylearnedthatSanFranciscosJailmanagementandstaffworkwithJailBehavioral
HealthServicestotrytoachievebestpracticesandfollowcommunitystandardsratherthanjust
meetingtheminimumTitle15standards.21Inthisregard:
Individualandgrouptreatmentisavailable.
Patientsunderobservationwillbeseenevery15minutes,atstaggeredintervals,rather
thanevery30minutes.
CustodystaffcanmakeinmatereferralstoJailBehavioralHealthServices.
Inmatesmayfilloutamedicalactionrequest.
Whenaninmateissubacute(athighriskofselfharmbutNOTactivelysuicidal),Jail
BehavioralHealthServicesstaffwillseehimfivetimesaday.
Reentryplanninggoesaboveandbeyondtheminimum(seesectionE).
SuicidePrevention
WewereespeciallyinterestedinthechallengeofpreventingsuicideatSFjails.Wenoted
multilanguagesuicideriskflyersineachunitandweretoldthattheInmateSuicidePrevention
instructionsprevent15to20suicidesannually.AccordingtotheUnitedStatedDepartmentof
JusticeBureauofJusticeStatistics,suicidehasbeentheleadingcauseofinmatedeathinjails
nationwidesince2000.Thesuiciderateamongconvictedjailinmates(12per100,000jail
inmates)is
lower
thantherateamongthegeneralpopulationoutsidejails(13per100,000
people).Butthesuiciderateamongunconvictedjailinmatesthosewhoaredeemedinnocent
22
untilprovenguiltyisanastonishing
seventimeshigher
:86per100,000inmates.
Asnotedin
theIntroduction,atleast83percentoftheinmatesinSFJailshavenotyetbeenconvicted.
EachJailhasaCaptainandaNurseManagerwhomeetregularlywithJailBehavioralHealth
staff.Asmanyas200personsinthejailmaybeconsideredatrisk,includingrepeatoffenders
whoarecuttersorhaveingestedforeignobjects.WeweretoldthereisaHIPAAexceptionthat
permitsmedicalinformationsharingwithcustodystaffinthejailsetting.Useofcodesonan
inmatesHousingCardisonemethodofsharinginformation.
Weweretoldthatahighrisktimeforsuicideattemptsisthefirst72hoursinjail.Accordingly,
everyoneinCJ#2custodystaffandmedicalstaffconsiderseverynewinmatetobeon
SuicideWatch24hoursaday.
JailBehavioralHealthandcustodystaffmustcastawidenetwhendealingwithsuiciderisks,
sincepredictiontoolsdomisspeopleatrisk(especiallythequietones).Parasuicidalisaterm
usedbycustodystafftodescribeinmateswhogamethesystembythreateningsuicidetogain
20
Ibid,pg.16
CACodeofRegulationsTitle15Crime&Corrections
http://www.cdcr.ca.gov/regulations/adult_operations/docs/Title152015.pdf
22
BrentStaplesPreventingSuicideinAmericasjails,NewYorkTimes,August10,2015
21
24
attentionortransfertoobservationareas.Thiscancreateamisuseofresourceswhenavailable
observationspaceistakenupbyprisonerswhoaretherebychoiceratherthannecessity.Because
ofthedifficultyofdistinguishingbetweeninmateswhoaretruesuiciderisksandparasuicidal
inmates,allthreatsaretakenseriously.
Ifcustodystafffindsaninmateatrisk,hecouldbeplacedinasafetycell,wherethewallsare
softerthanconcretealthoughweweretoldthatthesafetycellisnotusedmuch.Thecustody
staffcouldalsoimmediatelyplaceaninmatewithacutepsychoticbehavior(e.g.,cutting)ina
restraintchairandgetmedicalstaffclearanceafterthefact.Anotheroptionistowraptheinmate
inaFergusongarment,colloquiallycalledanOvenMitt.
ThebottomlineisdescribedbyDr.TerryKupers,anexpertatUCBerkeleysWrightInstituteof
Psychiatrywhohasspent40yearsinterviewingprisoners.
Theoversubscribedmentalhealthstafftrytofulfilltheirprofessional
duty.Theymaytryfocusingtheirenergiesonthemajormental
illnesses,includingschizophrenia,bipolardisorder,andmajor
depressivedisorder.Orinsomestatesadecisionismadetoprovidea
largercaseloadbyusingpsychotropicmedicationsonly.Orthereis
atendency,advocatedbynooneinparticular,tolockupthemost
seriouslydisturbedprisonersinsomeformofisolativeconfinement,
usuallypunitivesegregationbutoccasionallyprotectivecustody
(whichtoooftenalsohappenstobeanisolativeconfinementunit).23
Toaddressmentalillnessinthejails,Dr.Kupersadvocatescommunitymentalhealthand
substanceabuseprograms,sincehisresearchshowsthatwhenindividualssufferingfrom
seriousmentalillnessareincarcerated,theyhavehigherrecidivismandparoleviolationrates.To
reduceoreveneliminateinmateswithmentalillness,herecommendsacommunitymentalhealth
modelincorrectionsthatrequiresaspectrumoftreatmentmodalitiesatdifferentlevelsof
intensity.Ashesays,Thereneedstobesufficientscreening,assessment,outpatient,inpatient,
crisisintervention,intermediatecare,andcasemanagementforthepopulationbeingserved.
Cliniciansneedtoformtrustingtherapeuticrelationshipswithprisonerssufferingfrom
mentalillness.24
WhiletheSanFranciscoJailSystemappearstobeworkingtowardsthismodel,theJury
recommendsbothimprovementsinthecoordinationofmentalhealthcareinthejailsand
improvementsofreentryplanning(asdescribedinSectionEofthisreport).
Inmatesdocommitsuicidedespitethepreventativeeffortsofstaff.
Inthosecases,thereisan
investigationinvolvingrepresentativesfromtheSheriffsDepartmentInternalAffairs,Jail
Health,JailBehavioralHealth,SFPDHomicideDivision,andtheCoroner.Theinvestigatorsdo
notsharetheirconclusionsuntilallreportsarefinished.Thentheindependentreportsareshared
23
TerryAKupers,ACommunityMentalHealthModelinCorrections,StanfordLaw&PolicyReview,Vol26
Ibid,pg.129
24
25
amonginvestigators.ThereareinterimHotWashinformalreviewsadiscussionamongthe
peopleinvolvedinasuicideevent.
StatelawrequireMortalityandMorbidityreviews,anindepthanalysisofincidents,asan
afteractionreview.TheSFJailCustodystaffandJailBehavioralHealthrecentlybeganusing
aRootCauseAnalysismethod,askingWhatcontributedtothisadverseevent?Weweretold
thegoalistogettothecoreofsystemicproblemsbyfocusingonthehowandwhy,andnotpoint
fingersbyaskingwho?Thereviewtriestoidentifywhatwasmissed,andwhatcouldbedone
better,andthenapplytheselessonsgoingforwardwithrevisedpoliciesandprotocols.The
M&MreportgoestoJailBehavioralHealthsContinuousQualityReview,whichanalyzesfor
anyprogramchangesandmakesimplementationrecommendations.
Weweretoldofseveralchangesmadeinrecentyearsasaresultofthesereviewprocesses:
Eliminationofbaglunchesincertainareas,topreventsuffocation
Provisionofspecialnontearclothingandblanketsandsmalltowels
Provisionofshoeswithoutlaces.
NewcodeDoNotHouseAlonetoensurethatsuicidalriskinmateshaveacellmateat
night(usuallyinmateslookoutforotherinmates).JailBehavioralHealthStaffmustsee
thepatientbeforecustodystaffcanremoveaDoNotHouseAlonecode.
HandlingofMedicines
Anotherriskisthediversionofprescriptionmedicationsfromtheintendeduseforparticular
patientstotheiruseashighvaluecurrencyinthejail.Weweretoldthatnomatterhowhard
staffworktoensurethatinmatesswallowtheirmedicinewhilesomeoneiswatching,theystill
encountercaseswherenarcoticopioidpainmedicationsarehiddenandexchangedlater.Longer
term,medicalstaffaretakingintoaccounttheresearchshowingareductioninprescriptionof
drugswouldbebeneficial,especiallyifmoretherapyisofferedinstead.
Useofwebsitetoimprovecommunicationwithcontactsoutsidethejails
Besideslookingforchallengesandrisks,theJurylookedforwaysthatoutsidersfriends,
family,andvolunteerscouldassistinmates,especiallythosewithmentalhealthneeds.We
foundamodelontheCookCountySheriffsDepartmentwebsiteandcomparedthatmodelwith
theSanFranciscoSheriffsDepartmentwebsiteat
http://www.sfsheriff.com/
.
26
SanFranciscoCountySheriffsDepartmentHomepage
SanFranciscoCountySheriffsDepartmentHomePage.Acontactphonenumberisgiven
butitdoesnotencourageinteractionorofferassistance.
Figure2:SanFranciscoCountySheriffsHomepage.AccessedJune12,2016
AsofJune12,2016,thefirst(andonly)mentionofmentalhealthissuesatthejailwasabouttwo
thirdsofthewaydowntheopeningpage,asthetwelfthlinkunderPROGRAMS:Behavioral
HealthandReentryPrograms.ThatlinkistoafourpagedescriptionoftheJailHealthServices
BehavioralHealthandReentryPrograms,witharevisiondateof6/23/14.Visitorstothissite
findinformationabouttheMissionStatementanddescriptionsofthetwoprograms:Behavioral
HealthProgramandtheReentryServicesProgram.Referralsforservicefromoutsidethejail
maybemadebycallingJailHealthsAdministrativeOffice(4159951700).Noothercontact
phonenumbersarelisted.
TheJurysetoutinJune2016toseehowtheSheriffDepartmentswebsitelinktoBehavioral
Healthconnectspeopletomentalhealthservicesinformationandserviceproviders.Asatest,a
CGJjurorcalled4159951700at6:30pmonaSaturdaynightinJune2016andagainduring
businesshoursat10:45amonaWednesdayinJune2016.Inbothcases,thecallerreacheda
recordedmessagethatwasspokenveryquicklyandwasdifficultforanativeEnglishspeakerto
27
understand,evenaftermultiplereplays.(Themessageshouldbererecordedmuchmoreslowly.)
Thesubstanceoftherecordedmessagewas:
YouhavereachedJailHealthServices
Weareeitheronthephoneorawayfromourdesk
Ifthisisanemergency,hangupanddial911
Ifyouareseekinginformationonapersonincustody,dial4155531430.
Otherwise,leaveamessage,whichwillbeconfidential.
Callingthe4155531430numberledtoarecordedmessagefromtheSanFranciscoSheriffs
DepartmentCountyJails.Thesubstanceofthismessagewas:
Ifthisisanemergency,hangupandcall911
Goto
www.sfsheriff.com
forinformationontheinternet
Enterthenumberforyourpreferredlanguage(messagegiveninEnglish,Spanishand
Chinese)
Pressnumbers1through8forvariousoptionsaboutprisonerassistance(nonerelatedto
mentalhealthservicesinformation).
Abetterapproachwouldbetoprovideafterhourscallerswitha311option.SF311servesasa
portaltoCityservicesandcommunications,Itisstaffed24/7withliveoperators,andalso
providesacompanionwebsiteatSF311.org(aswellasasmartphoneapp).Thelive311
operatorsusescriptsthatarecreatedinpartnershipwiththeagencyinvolved.
AsapossiblemodelfortheSheriffswebsite,theJuryfoundtheCookCounty,IllinoisSheriffs
Departmentwebsite(
http://www.cookcountysheriff.org
)whichtakesaveryinformative
approachbyprominentlydescribingmentalhealthissues,servicesandadviceregarding
detainees.
28
Figure3:CookCountyIllinoisSheriffsDepartmentHomePage,AccessedJune12,2016
Noticethepagehasasignificantfocusonassistinginmates,pastandpresent,whoneedto
receivementalhealthservices.
TheJuryalsonotedthatOpenDataSFisaninitiativeoftheCitytobemoretransparentinits
operations.SincetheSheriffsDepartmentalreadypreparesdataonjailpopulation,daily
bookingsandreleases,demographics,recidivism,inspectionreports,operatingcosts,spending
perinmateandanumberofothervariables,webelievethatthepublicwouldbeservedby
includingthisdataonthewebsite.
29
FINDINGS
F.C.1.
CJ#4lackssuitablespaceforobservationandtreatmentprograms.
F.C.2.
JailshaveJailBehavioralHealthServicesduringdayshiftsbutnotatnight.Without
morebehavioralhealthservicesinthejailstoprepareinmatesforreentry,the
communitymentalhealthmodelrecommendedbyDr.Kupersandotherexpertswillnot
befeasible.
F.C.3.
DrugdiversionisaseriousissueintheJail.
F.C.4.
TheSanFranciscoSheriffswebsiteprovidesminimalinformationaboutmentalhealth
issuesofthosedetainedinthejail.AsseenonFigure2,thelinktoBehavioralHealth
andReentryProgramsleadstoageneraldiscussionoftheseprograms,andprovidesa
phonenumber.Acallercanonlyreachahumanbeingatthatnumberduringregular
businesshours.
F.C.5.
TheSheriffsDepartmentprovidesdatatotheControllerandtheStateDepartmentof
Correctionsbutdoesnotmakethisdataavailabletothepublic.
RECOMMENDATIONS
R.C.1.
TheSheriffandtheDirectorofHealth,throughtheJailReplacementProjectWorking
Group,shouldfindanew/replacementfacilitywhereCJ#4inmatescanbehousedand
receiveappropriatetreatmentprograms.
R.C.2a. TheCityshouldstaffJailBehavioralHealthServices24/7.TheSheriffandthe
DirectorofHealthshoulddeterminetheamounttobeincluded
inthe201718budget
request.
R.C.2b. TheMayorshouldincludetheSheriffsrequestforfundsforthispurposeinhis
proposedbudgetand
R.C.2c. TheBoardofSupervisorsshouldapprovetheamountfor24/7staffingwhenthebudget
reachesthem.
R.C.3. TheDirectorofPublicHealthandtheSheriffneedtodevelopbettermethodsof
informingcustodystaffwhichpatientsarebeingprescribednarcoticmedicationssothat
custodystaffmaypayextraattentiontodiversionriskstoandfromthosegetting
highvaluemedications.
R.C.4a. TheSanFranciscoSheriffshouldupdatetheDepartmentswebsitetoprovideadditional
informationaboutmentalhealthissuesconcerningthosedetainedinjail,usingtheCook
County,IllinoisSheriffsDepartmentwebsite(Figure3)asabestpracticesguideline.
30
R.C.4b. TheSheriffshouldalso,incooperationwiththeDepartmentofAdministrativeServices
andSF311,developamentalhealthinformationscriptforuseby311operatorswhen
theJailHealthsAdministrativeOfficeisclosed.Thescriptshouldinclude
communicationtipsforfamilymembersandsuggesthowtoprovidejailstaffwith
concernsaboutthepotentialofdetaineestoengageinselfharm.
R.C.5.
TheSheriffsDepartmentshouldprovidejaildataforinclusionontheOpenDataSF
website.
31
D.PersonnelandTraining
DISCUSSION
TheSheriffsDepartmenthasacommandstaffincludingtheSheriffandUnderSheriff,Chief
Deputiesinchargeofeachofthefourdivisions,andCaptains.Thereareapproximately70
supervisorswithranksfromSeniorDeputythroughSergeantandLieutenant.Thereare
approximately500DeputiesintheCustodyDivision,whocareforaround1240inmates.The
medicalstaffincludes161employees.AsnotedintheIntroduction,throughouttheJury
investigation,wefoundthateveryoneweinterviewedwasprofessionalandconcernedaboutthe
inmates.Oneexpertcommentedthattypically,thereisabrightlinebetweencustodystaffand
medicalstaff,withlittlesharing.However,inSanFranciscoswornstaffaremoreprogressivein
termsofpatientcareandpatientrights.Custodystaffseestheirjobtokeepboththeprisoners
andthestaffsafe.
WeweretoldthatSanFranciscoCountyJailsarestaffedbyDeputySheriffswhomeetthe
definitionofpeaceofficer,perSection830.1ofthePenalCode,ratherthancorrectional
officerwhoseleveloftrainingandminimumqualificationsarelessdemanding.
Yet,twoseriousincidents,asuicideandreportedgladiatorstylefights,causedtheJuryto
wonderwhethersomepersonnelpoliciescouldbeharmfultotheoverallmissionofthe
Department.Weexaminedthreefactorsaspossibleareasforchange:overtime,jobrotation,and
training.
Overtimecontinuestocontributetofatigueandstress
Consistentwiththefindingsofthe20132014CivilGrandJuryinitsreporttitledInquiryinto
theProgramsandOperationsoftheSanFranciscoJails,thecustodydivisioncontinuestorely
onamandatoryovertimepolicytomeettheneedsofstaffing24hourshiftsatfivejaillocations.
WhileclosureofSanFranciscoCountyJail#3andtheassociatedreassignmentofstafftoother
facilitiesmighthaveeasedtheovertimeproblems,theControllersSixMonthBudgetStatus
ReportforFY201516projectedtotalovertimepayof$17.1millioncomparedwith$14.8
millioninFY201415and$10.5millioninFY201314.Welearnedthatthisisprimarilydueto
thelackoffundingforrequisitionsoverthepastfouryears.SomeCityofficialsobserveditis
lessexpensivetopayforovertimethantofundthe40positionsthathavebeenrequested.
Asnotedthreeyearsago,continuousovertimecontributestofatigueandstress.Thereisa
relationshipbetweenfatigueandstressandanincreasedriskofaccidentalinjuryresultingin
furthertimelossaswellasanincreaseinworkerscompensationexpense.TheControllers
ReportofWorkersCompensationDataindicatesthattheSheriffsDepartmentsclaims
frequencyincreasedfromathreeyearaverageof19.4per100fulltimeequivalentstaffto21.2
inFY201415.
TheJuryunderstandsthatvarioustypesofleave,includingMilitary,FamilyMedical,regularand
jobrelateddisability,aswellasretirementshavedepletedtherosterofSheriffsDeputiesand
madeitdifficulttomeetminimumstaffingrequirements.AsofJune15,2016,therewere19
32
vacanciesatthesupervisoriallevelwithmoreanticipatedduetoimminentretirements.This
affectspersonnelinmanyways,includingovertimefatigueaddressedhereandlackoftimefor
training(addressedinalatersection).
Overtimefatiguecanbeafactorincausingjobrelateddisability.Forthisreason,commandand
supervisorystaffcanandshouldpromoteacultureofsafetybyincludingsafetytopicsin
conversationsandactivelyseekingandrewardingparticipationinsafepracticesandprocedures.
Welookedforsignsofaworkplacesafetyprogramandwelistenedtoprioritiesofsupervisors
andcommandstafftoseewhatemphasistheyplaceonpromotingjobsafetytodepartment
personnel.Wedidnotseeorhearevidencetosupporttheexistenceofaworksafeprogram.
LackofJobRotationlimitsdevelopmentopportunitiesandenablescliques
WhennewhiresjointheSheriffsDepartment,theybeginon18monthprobation.Duringthis
time,theycompletesixmonthsataPoliceAcademyfiveweeksofPeaceOfficer'sStandards
andTraining(POST)andsevenweeksofadditionaltrainingwhichnowincludesthreedaysof
CrisisInterventionTraining.ThentheyareassignedtoaCountyJail.Aslongastheyremaina
DeputySheriff,theycanchoosetokeeptheirfirstassignmentfortheirentirecareer.
Afterfiveyears,aDeputySheriffcanrequestasatelliteassignmentthroughthePersonnel
Department.Satelliteassignmentsincludecourtbailiff,backgroundinvestigator,CityHall
security,andinstitutionalpatrolamongothers.Assignmentisbasedonseniorityontherequest
listanddeputiescanbebumped/reassignedtojailsorothersatelliteoptions.Afterfiveyearsata
requestedsatelliteassignment,aDeputySheriffmustgobacktoajailforoneyearbefore
requestingasatelliteassignmentagain.ThisispartoftheCollectiveBargainingagreement
negotiated30yearsagoandadoptedatatimewhentheSheriffhadfewerfunctionsthantoday.
ItisonlywhenaDeputySheriffispromotedthattheSheriffhastheoptiontoassignthatDeputy
tothesitethatisinthebestinterestoftheDepartmentandlongtermplanning.
Duringsitevisits
tojailfacilities,weaskeddeputieshowlongtheyhadservedatthesameshiftanddutystation.
Eightornineyearswasacommonresponse.Commandstaffconfirmedthisandindicated
furtherthatsomepersonnelinthecustodydivisionhadbeenonthesamedutyassignmentand
shiftformorethan15yearsandthatotherdivisionsalsohadDeputySheriffswithsimilartenure
inthesameposition.
Weverifiedthatadvancementinthedepartmentdependsonexposureanddemonstratedability
toperformmanydifferentdutyassignmentsincludingsupervisionoffunctionalareasthroughout
thedepartment.Weweretoldthatstaffwhoarecomfortableinanassignmentanddontcareto
advancemayremaininonejobformanyyears.
Wewereconcernedbythispracticeforanumberofreasonsincludingtheriskofinjuryrelated
torepetitivemotionorlimitedphysicalactivity,burnoutfromfatigueandboredom,andthe
constraintonthedepartment'sabilitytoprovidetraininganddevelopmentopportunitiesforthose
seekingtoadvanceorincreaseskills.Wewerealsoconcernedfortheeffectoffewerofficers
beingpreparedandcrosstrainedtorespondtoavarietyofrisksinanemergencysituation.One
33
supervisorreportedthatsomelengthydutyassignmentscontributedtocliquesand
insubordinationinafewinstances.
Whilesomeofficersexpressedtheirappreciationforthe
choicestheyhaveinassignments,webelievethattherightincentivescouldmotivatethemtobe
moreflexible.
TheJuryisalsoconcernedthatincidentssuchasthegladiatorfightingreportedatCJ#4couldbe
theresultofpowerdynamicsthatresultwhenafewentrenchedemployeesbecomeaclique
andlookforwaystomaketheirjoblessboring.WhilewefoundthattheSheriffsInternal
AffairsUnitreactedswiftlytodealwiththedeputiesinvolvedwiththegladiatorincidentand
thattheyhavebeenchargedwithseriouscrimes,weremainedconcernedthattheassignment
processdoesnotfacilitatejobrotation.Inthebusinessworld,jobrotationisratedhighlyasan
effectivewaytopreventcrimes.25
TheJuryrecognizesthattheSanFranciscoSheriffsDepartmenthasfeweropportunitiestovary
thetypeofworkfordeputieswhencomparedwithothercountySheriffsDepartments.Insome
jurisdictions,deputiesareallowedtobidonMOUsforhandlingsecurityatcityfacilitiesorto
participatein10Bworkthatpaystimeandahalf,astheircolleaguesintheSFPolice
Departmentdo.IntheSanFranciscoSheriffsDepartment,rotationalopportunitiesoutsideof
jailsinvolveworkingineachofthethreenonCustodyDivisions,especiallyintheField
OperationsDivisionwhichprovidessecurityattheCourts,CityHallandnearbyCityoffices,
andotherfacilitiessuchaselevencityrunhospitalsandclinics,amongotherduties.
Trainingisessential,especiallytoimproveworkwithpeoplewithmentalillness
Trainingisessentialformembersofpublicsafetydepartmentstobeready,prepared,and
professionalinresponsetoeverchangingcircumstances.Inadditiontocompletingthecore
requirementsofaPOSTaccreditedpoliceacademy,allswornpersonnelarerequiredtocomplete
24hoursofcontinuingeducationandinservicetrainingsannuallyandanother24hoursofBoard
ofStateandCommunityCorrections(BSCC)trainingeverytwoyears.26 Thelackof
departmentalfundingtopayyetmoreovertimetoenablestafftoattendtraininghasresultedin
manypersonnelnotincompliancewithtrainingrequirements.WeweretoldthattheStateof
CaliforniaissupposedtoreimbursetheCountyforthistrainingaspartoftheagreementon
realignment,butthishasnothappenedrecently.
Thekeytoanysuicidepreventionprogramisproperlytrainedcorrectionalstaff,whoformthe
backboneofanyprisonfacility.Veryfewsuicidesarepreventedbymentalhealthstaff,medical
orotherprofessionalstaffbecausesuicidesusuallyareattemptedininmatehousingunitsduring
lateeveningsandonweekendswheninmatesareoutsidethepurviewofprogramstaff.27
25
ThreeEasyFixestoHelpReduceFraud,415Group,
http://www.415group.com/threeeasyfixestohelpreducefraud
26
BoardofStateandCommunityCorrections,http://www.bscc.ca.gov/
27
H
ills.H.,Siegfried,C.,Ickowitz,A.(2004)EffectivePrisonMentalHealthServices:Guidelinesto
ExpandandImproveTreatment.US.DepartmentofJustice.NationalInstituteofCorrections.
pg.47
34
TheDepartmentofJusticeGuidelinesrecognizetheimportancethatallstaffbetrainedto
identifysymptomsofmentalillness,andurgesthatformalandinformalmechanismsbeinplace
forstafftoreferthoseidentifiedwithpossiblementalhealthdisorderstotheappropriatehealth
staff.28 SeeAppendixAfordetailsonthetypeoftrainingthatisrecommended.
WhiletheBoardofSupervisorsandtheMayorhaveprovidedfundsforfivedaysofthistypeof
trainingforSFPoliceDepartmentofficersandfortheformationofaCrisisIntervention
ResponseTeam,theyhavenotprovidedforasimilarprogramintheSheriffsDepartment.
AnothertypeoftrainingthatseveralofficialsfeltwouldbewarrantedattheSheriffsDepartment
isimplicitbiasandproceduraljusticetraining.TheDepartmentincludedthisinitsFY201617
planforallofficerswithintheyear.
FINDINGS
F.D.1.
TheSheriffsDepartmentexpenditureforovertimeisincreasing.Increasedovertime
resultsinfatigueandstressonthestaff.
F.D.2.
TheSanFranciscoSheriffsDepartmenthasanassignmentprocessthatenables
deputiestostayinonepositionformanyyears.
F.D.3.
SomeDeputySheriffsappreciatetheopportunitytoworkhoursmorecompatiblewith
familylifeand/orclosertohome.
F.D.4.
ThereisaneedforallDeputiesatCountyJailstobetrainedonsuicidepreventionand
crisisinterventionasapriority,andforadditionaltrainingtomeetannualPOST
requirements.Trainingwillrequireatrainingfloat.
F.D.5.
TheSheriffsDepartmentmanagementconcursthatallstaffneedtrainingincrisis
intervention,incidentdebriefing,andstressmanagement.TheSheriffDepartments
policytoonlysendtwopeoplefortrainingatonetimeduetostaffvacanciesmeansthat
DeputiestrainedinCrisisInterventionwillcontinuetobealimitedgroupforsometime
tocome.
RECOMMENDATIONS
R.D.1a. Toreducetheneedforovertime,
theSheriffshould,incoordinationwiththeCityand
CountyHumanResourcesDepartment,
p
uthighpriorityonfillingexistingvacanciesby
redoublingrecruitingeffortsandexpeditingthehiringprocesswiththeassistanceof
dedicatedSheriffsDepartmentrecruitmentstaff,and
R.D.1b. Identifypositionsthatmightbereclassifiedasadministrativesupport,i.e.civilian,
ratherthanrequiringsworndeputiestohandlethoseduties.
28
ibid,pg.15
35
R.D.2.
TheSheriffsDepartmentshouldhavearotationpolicysimilartopoliciesineffectat
otherlawenforcementagencies:everyfiveyears,onethirdofthestaffgetsrotated.
R.D.3.
TheSheriffshouldnegotiatewiththeSanFranciscoDeputySheriffsAssociationfor
recognitionofthebenefitstobegainedbyrotationandshouldnegotiateincentivesthat
balancethedesireofdeputiesforpreferableassignmentswiththeneedsoftheservice.
R.D.4a. TheSheriffshould
includeinthe201718budgetrequestsufficientfundsforthe
purposeoftrainingallDeputiesatCountyJailsonsuicidepreventionandcrisis
intervention
,includingenoughforatrainingfloat
R.D.4b. TheMayorshouldincludetheSheriffsrequestforfundsforthispurposeinthe
Mayorsproposedbudgetand
R.D.4c.
TheBoardofSupervisorsshouldapprovetheSheriffsrequest
forthepurposeof
trainingallDeputiesatCountyJailsonsuicidepreventionandcrisisintervention.
R.D.5a. NewrecruitsshouldcompletecrisisinterventiontrainingeitherattheAcademyor
withinoneyearofgraduationfromPOSTacademy.
R.D.5b. Allswornofficers,medical,andpsychiatricservicesstaffshouldcompletecrisis
intervention,debriefing,andstressmanagementtrainingwithinthreeyearsof
employment.
R.D.5c. Toaccomplishthegoalsoffastertraining,theSheriffshouldrecruitextrahelpfromthe
rosterofretiredDeputiesandarrangeformoretrainthetrainersessions.
36
E.DischargeandReentryPlanningwithOutcomePerformanceMeasures
DISCUSSION
Atsomepoint,everyinmatereentersthecommunity.Forthoseinmateswhohavefamilyand
friendstohelpthem,acallorabustickethomemaybeallthatisneeded.Forthosewithmental
illnesswhohavealienatedfamilyandfriendsandperhapshavenoplacetocallhome,reentryis
abiggerchallenge.HR360sJailBehavioralHealthServicesReentrystaffischargedwith
preparingpatientsforthisjourneyandhaslinkstocommunityorganizations.Infact,many
organizationssuchasWaldenHouse,AsianAmericanRecoveryServices,HaightAshburyFree
Clinic,andTenderloinHealthServicesareundertheHR360umbrellaofprograms.Thegoalis
topreventrecidivism.
TherecidivismrateforSanFranciscoinmatesmeetingSMIcriteria(47percent)islowerthan
therateforthegeneralinmatepopulation(67.1percent). 29TheJurynotesthisfactand
commendsJailBehavioralHealthServicesfortheirroleinproducingthisresult.
JailBehavioralHealthServicesreceivesadvancenoticefromtheSheriffsAdultProbationoffice
whenapatientisabouttobereleased.JailHealthServicescangetafewdaysofprescription
medicationsforthepatientfromZuckerbergSanFranciscoGeneralHospital.JailBehavioral
HealthServicesseekstodevelopaWellnessRecoveryPlanwiththefollowinggoals:
Stoptakingdrugs
Takeprescribedmedicationstopreventarelapse
Seeatherapist
Knowwhattodowhensymptomsarereturning
Seekhelpformentalhealthproblemsbeforethereisafullblownpsychoticbreak,soas
toreducelongtermbraindamage
TheSheriffsHandbookstates,Community[ReentryProgramssupportpeopleleavingjailby
givingthemtheskillandtoolsneededtomakeapositivereentryintothecommunityandto
returntotheirfamilies.Reentryprogramsincludebuildingrelapsepreventionplans,jobskills
andgeneraleducation,andbattererreeducation(domesticviolence).
Allcommunitybasedservicesarevoluntaryandrequireanindividualprovidingconsentto
participateinbothresidentialandoutpatientservices.30TheBehavioralHealthJusticeCenter
conceptforaLevel4lockedfacilitywouldprovideamuchneededresidentialtreatment
option:
Level4willprovidesecure,shortterm,inpatienttreatmentto
personswithmentalillnesswhoaretransitioningtoplacementin
communitybasedresidentialtreatmentprograms.Movingpatients
withseriousmentalillnessfromthecountyjailtoahospitallike
PolicyAnalysisReportonJailPopulation,CostsandAlternatives,p.15
Id.pg.14
29
30
37
settingwilldecreasetheoveralljailpopulationandcreateasafer
atmospherefordeputiesandjailstaff.Itwillalsoincreasethe
likelihoodofsuccessoncethatpersonistransferredtoaresidential
treatmentbed.Personswhowouldotherwisebewaitinginthe
countyjailwithoutappropriatetreatmentservicesmayvoluntarily
transfertothisunit.Itisexplicitlydesignedandintendedforuseasa
transitionalfacilityforpersonsawaitingtransfertoresidential
treatmentelsewhereortoanotherappropriateplacement.31
Sincealmostallinmateseventuallyreturntothecommunity,theDepartmentofJustice
Guidelinesconsidermoneyspentonreentryservicesasaninvestmentinthecommunityshealth
andsafety.32
Weweretoldthatthereisroomforimprovementinthereentryprocess,especiallyinthecritical
firstfewhoursoutofjailsothatpatientsdontfallthroughthecracks.Welearnedthatcontinuity
ofmentalhealthcareafterjaildischargeisatthetopofmentalhealthproviderswishlist.Itis
criticaltokeepuptherelationshipwithtreatmentproviders.Thishasworkedinasmallplacelike
FranklinCounty,Massachusettssincethe1990s.33
WelearnedthatthisreentrysystemcouldworkinarelativelysmallplacelikeSanFrancisco,
wheremostpatientsuponreleasewillgototheTenderloin,Bayview,orMissionneighborhoods.
TheJailBehavioralHealthServicesstaffareinterestedinmeasuringoutcomessotheycanfocus
andhoneobjectivesoftheprogramsandservicespeoplereceive.Currently,theyhavenogood
waytoknowhowmanyclientstheyarefollowingatatime,althoughtheDepartmentofPublic
HealthandJailBehavioralHealthServicesprepareweeklyupdatesoftheAssistedOutpatient
Treatment(AOT)programfortheSanFranciscoHealthImprovementPartnership.Jail
BehavioralHealthServices
wouldliketoconductareleaseassessmentinordertocomparean
arresteesmentalconditionatintakeandexitfromjail.
TheCityServicesAuditorshouldconductabenchmarkstudyforbestpracticesinjailexit
planningstrategies,includingreleaseassessment.TheCityServicesAuditorcouldstartwith
thespecificrequirementsandprescribedprofessionalstandardsofanindependentreviewing
authorityliketheNationalCommissionforCorrectionalHealthCare(NCCHC).Thebasisof
NCCHCsmentalhealthservicesaccreditationprogramaresetforthinStandardsforMental
HealthServicesinCorrectionalFacilities(2015).34
Whilemanyindividualsreceivecommunitybasedservicesupontheirreleasefromcustody,
currentlytherearenocomparativestudiesontheoutcomesforSMIclientswhoreceive
31
Haney2016
Hills,etal.(2004).pg.8
33
http://www.fcsoma.us/healthservices.html
34
http://www.ncchc.org/
32
38
treatmentinjailpriortoplacementinacommunitybasedprogramcomparedtoindividualswho
aredivertedfromjailtocommunitybasedtreatment.35
Onesuggestedareaofimprovementthatweheardinourinterviewsistotakeadvantageofthe
brainpowerandexpertiseofBayAreauniversitiesincollectionandinterpretationofdata.
Objectiveevaluatorswouldbeavailableforfree.Weweretoldthatgraduateschoolshave
studentswhowouldbeeagertoreviewdataandprovidecomparativerecommendations.TheJail
needssomeonewhocansay:
TheJaildidX
TheCityandCountyspent$Y
Andhereistheresult.
Anothersuggestedareaforimprovementistoinvitereviewofpoliciesandpracticesbyadvocate
organizationsforthementallyill,suchastheSanFranciscochapterofNAMIandtheMental
HealthBoard(MHB)ofSanFrancisco.36
TheControllerhasthenumbersonjailandtreatmentcosts.Servicesareexpensive,resource
intensiveandlaborintensive.Weweretoldspendingthemoneyupfrontonsocialserviceswill
savemoneyinthelongerterm,withanestimatethatforevery$1spentupfront,theCitywill
save$5lateron.Oncepeoplegetreconnectedwithserviceprovidersinthecommunity,the
intensityofservicescanbereduced.
FINDINGS
F.E.1.
TheSheriffandtheDirectorofPublicHealthstaffcoulddomoretoplanforthecritical
firstfewhoursafterdischargeofapersonwithmentalillness.
F.E.2.
JailBehavioralHealthServicesdoesnotcurrentlyconductreleaseassessmentson
patientsdischargedfromtheSanFranciscoJails.
F.E.3.
BayAreauniversitiesrepresentasourceofimpartialdatareviewersofSanFrancisco
Jailsmentalhealthservices.
F.E.4.
BayAreamentalhealthorganizationssuchasNAMIandMHBcouldprovideuseful
recommendationsonmentalhealthservicesinSanFranciscoJails.
RECOMMENDATIONS
R.E.1.
35
36
TheSheriffandtheDirectorofPublicHealthshouldupdatetheSanFranciscoJails
DischargePlanningPoliciesandPracticestoaddWellnessRecoveryPlanProcedures,
including:
PolicyAnalysisReportonJailPopulation,CostsandAlternatives,p.19
MentalHealthBoardofSanFrancisco,http://www.mhbsf.org/
39
ProvideawarmhandofftoaCaseManagerinthecommunitywhowillarrange
forafullcontinuumofcare.(Notethatthisrequiresidentificationofreceiving
handsreadytoacceptthepatient.)
HaveCaseManagerordesigneeaccompanythepatienttofirstcontinuingcare
appointment,andassesspatientneedstoassurefutureappointmentcompliance.
SetupameetingoftheCommunityCaseManagerwiththepatientpriortohis
release,inordertohaveavisualconnection.
R.E.2.
TheSheriffandtheDirectorofPublicHealthshouldrequesttheControllertoconducta
benchmarksurveyofreleaseassessmentandotherperformancemeasuresformental
healthservicesincountyjailsandsuggestbestpracticesforadoptionattheSan
FranciscoJails.
R.E.3.
TheSheriffandtheDirectorofPublicHealthshouldcontactappropriatedepartmentsin
BayAreauniversitiestodeterminepotentialinterestinhavinggraduatestudents
analyzeperformancemetricsandpreparereportsonmentalhealthservicesprovidedin
SanFranciscoJails.
R.E.4.
TheSheriffandtheDirectorofPublicHealthshouldseekoutlocalmentalhealth
organizations,suchasNAMIandMHB,forrecommendationsonmentalhealthservices
providedintheSanFranciscoJailsandrelatedreentryservices.
40
CONCLUSION
SanFranciscoJailshavechallengesduetoboththefacilitiesthatskewtowardsoldandunsafe
andthedifficultyofstaffingenoughtoallowfortrainingandrotationwithoutexcessive
overtime.Todealwiththesechallenges,theJuryrecommendsimprovementsinintake/custody
transfer,facilities,informationsharing,andpersonnelmanagementespeciallytraining.
Mostimportantly,theJuryrecommendsincreasedfocusontreatmentofpeoplewithmental
illnesswhoendupinourjails.Acrossthecountry,therearetentimesasmanyindividualswith
seriousmentalillnessinourjailsandprisonsasthereareinourstatepsychiatrichospitals.37As
longasthejailsinSanFranciscocontinuetoserveastheplacefortreatmentofindividualswho
commitviolentcrimeswhileexperiencingmentalhealthcrises,thereisaneedformore
behavioralhealthservicesinourjailsandfordischargeandreentryplanningthatiscoordinated
withtherequisitecommunitymentalhealthservices.
37
Kupers,ibid,preface
41
REQUESTFORRESPONSE
A.JailIntake:TransferofCustody
FINDING
RECOMMENDATION
RESPONDER
F.A.1. Thereiscurrentlyno
jailprocedurethat
accountsforthose
arresteesreferredfor
hospitalcare.
R.A.1.a. Jailintakeshoulddevelopa
systemtocommunicateand
trackcaseswherethetriage
nursedeterminesthatthe
arresteemustbetakentoa
hospitalforemergencymedical
orpsychiatriccarebefore
admissiontoJail.
ChiefDeputyof
Custody
Operations,
DirectorofJail
HealthServices
Sheriff,Chiefof
Police
R.A.1.b. TheSFPoliceChiefand
Sheriffshouldrevisittheir
MOUregardingtransportand
custodytransfer.
FINDING
RECOMMENDATION
RESPONDER
F.A.2. Arresteesandtheir
R.A.2.
arrestingofficermay
notalwaysunderstand
theimportanceoffull
disclosureofmedical
history.
Intheinterestofobtaininga
morecompletemedicalhistory,
theSheriffandtheDirectorof
JailHealthServicesshould
updateIntakepoliciesand
practicestoseekinformed
consenttocontactandreceive
recordsfromthearrestee's
CaseManager,primary
provider,andfamilyorfriends
whomayhaveinformation
aboutthearresteesmedical
historyandtherapeutic
medications.
ChiefDeputyof
Custody
Operations,
DirectorofJail
HealthServices
42
FINDING
RECOMMENDATION
RESPONDER
F.A.3. Whenanarresting
R.A.3.
agencybringsan
arresteetotheJailfor
intake,thereisafield
arrestcard.
TheSheriffshouldreview
currentFieldArrestCard
contentandproceduresto
assurethatbestpracticesare
employed,andinformation
necessaryforthehealthand
safetyofthearresteeandjail
personneliscommunicatedin
writing.Theinformation
shouldincludecircumstances
ofarrestandanyobservations
orconcernsthearresting
officermayhaveaboutthe
medicalorpsychiatric
conditionofthearrestee.
Sheriff
FINDING
RECOMMENDATION
RESPONDER
F.A.4. AlthoughtheSheriff
R.A.4.a. Byearly2017,theSheriff
hasaccesstomultiple
shouldimplementapolicyand
criminaldatabases,the
procedurerequiringarresting
arrestingagenciesdo
agenciestoprovideadigital
notnecessarilyshare
copyofthearrestreport,
arrestrecordswiththe
includingchargesanda
Sheriffscustodystaff
descriptionofthearrest,within
atthetimeofcustody
sixhoursofthetransferofthe
transfer.
arrestee.
Sheriff
R.A.4.b. Oncethesharethearrest
recordprocessofR.A.4aisin
place,theSheriffshould
requireallarrestingagenciesto
complywiththeprocess.
Sheriff
43
FINDING
RECOMMENDATION
RESPONDER
F.A.5. Theresultsofa
R.A.5.
preliminarypsychiatric
evaluationconducted
byJailBehavioral
Healthatintakecould
behelpfultothe
arresteeslongterm
mentalhealthcareif
sharedwiththe
arresteesCase
Manager,ifany.
TheSheriffandDirectorof
PublicHealth,inconsultation
withtheCityAttorneyfor
issuesrelatedtoHIPAA,
shoulddevelopandimplement
apolicyforsharingwithan
arresteesCaseManager(if
any),theresultsofa
preliminarypsychiatric
evaluationconductedatIntake.
FINDING
RECOMMENDATION
RESPONDER
F.A.6. Althoughthereare
R.A.6
severalwaysforfamily
membersandfriendsto
contactcustodystaff
regardingconcerns
abouttheirlovedones
whoareinjail,models
forimprovementare
available.
Sheriff,Director
ofHealth,City
Attorney
TheSheriffshouldaddtothe
inmatehandbookaparagraph
abouttheimportanceof
contactingafamilymemberor
friendandshouldprovidea
24/7numberthattheinmate
couldgivetothiscontact.
Sheriffand
DirectorofJail
HealthServices
44
B.Facilities
FINDING
RECOMMENDATION
RESPONDER
F.B.1. InJail#4,oldlocks
R.B.1.a.
jamfrequently,causing
safetyconcerns.Other
maintenanceissues
continuetoarise.
TheSheriffshouldpreparea
supplementalbudgetrequest
forfundstoimmediately
addressproblemswithold
locksatJail#4andanyother
remainingseriousmaintenance
issues
Sheriff
Mayor
R.B.1.b. TheMayorshouldincludeina
theSheriffsrequestforfunds
toaddresstheproblemswith
oldlocksatJail#4andany
otherremainingserious
maintenanceissuesand
Boardof
Supervisors
R.B.1.c. TheBoardofSupervisors
shouldapprovetheMayors
forfundstoaddressthe
problemswitholdlocksatJail
#4andanyotherremaining
seriousmaintenanceissues.
FINDING
RECOMMENDATION
RESPONDER
F.B.2. EndinguseofJail#4 R.B.2.

wouldalsorequire
findinganewkitchen
andlaundryfacilityfor
Jails#1and#2
TheSheriffshouldmake
interimplansforreplacing
kitchenandlaundryfacilities
forJails#1and#2bytheend
of2016.
Sheriff
45
C.OperationsHousing,SuicidePrevention,andrelatedInformationSharing
#
FINDING
RECOMMENDATION
RESPONDER
F.C.1. Jail#4lackssuitable
R.C.1.
spaceforobservationand
treatmentprograms.
TheSheriffandtheDirector
ofHealthshouldfindanew
replacementfacilitywhere
Jail#4inmatescanbehoused
andreceiveappropriate
treatmentprograms.
Sheriff,Director
ofHealth
RECOMMENDATION
RESPONDER
FINDING
F.C.2. JailshaveJailBehavioral R.C.2.a. TheCityshouldstaffJail

HealthServicesduring
BehavioralHealthServices
dayshiftsbutnotatnight.
24/7.TheSheriffandthe
Withoutmorebehavioral
DirectorofHealthshould
healthservicesinthejails
determinetheamounttobe
toprepareinmatesfor
includedinthe20172018
reentry,thecommunity
budgetrequest.
mentalhealthmodel
recommendedbyDr.
Kupersandotherexperts
willnotbefeasible.
Sheriff,Director
ofHealth
Mayor
R.C.2.b. TheMayorshouldinclude
theSheriffsrequestforfunds
forthispurposeinhis
proposedbudgetand
Boardof
Supervisors
R.C.2.c. TheBoardofSupervisors
shouldapprovetheamount
for24/7staffingwhenthe
budgetreachesthem.
FINDING
RECOMMENDATION
R.C.3.
TheDirectorofPublicHealth
andtheSheriffneedto
developbettermethodsof
informingcustodystaff
whichpatientsarebeing
prescribednarcotic
medicationssothatcustody
staffmaypayextraattention
todiversionriskstoandfrom
F.C.3. Drugdiversionisa
seriousissueintheJail.
RESPONDER
Sheriff,Director
ofHealth
46
thosegettinghighvalue
medications.
FINDING
RECOMMENDATION
RESPONDER
F.C.4. TheSanFrancisco
R.C.4.a.
Sheriffswebsite
providesminimal
informationabout
mentalhealthissuesof
thosedetainedinthe
jail.AsseenonExhibit
Figure2,thelinkto
BehavioralHealth
andReentryPrograms
leadstoageneral
discussionofthese
programs,andprovides
aphonenumber.A
callercanonlyreacha
humanbeingatthat
numberduringregular
businesshours.
TheSanFranciscoSheriff
shouldupdatethe
Departmentswebsiteto
provideadditionalinformation
aboutmentalhealthissues
concerningthosedetainedin
jail,usingtheCookCounty,
IllinoisSheriffsDepartment
website(Figure3)asabest
practicesguideline.
Sheriff
R.C.4.b. TheSheriffshouldalso,in
cooperationwiththe
DepartmentofEmergency
ServicesandSF311,developa
mentalhealthinformation
scriptforuseby311operators
whentheJailHealths
AdministrativeOfficeis
closed.Thescriptshould
includecommunicationtipsfor
familymembersandsuggest
howtoprovidejailstaffwith
concernsaboutthepotentialof
detaineestoengagein
selfharm.
Sheriff,Director
ofJailHealth
Services,
Departmentof
Administrative
Services,SF311
47
FINDING
RECOMMENDATION
RESPONDER
F.C.5. TheSheriffs
R.C.5.
Departmentprovides
datatotheController
andtheState
Departmentof
Correctionsbutdoes
notmakethisdata
availabletothepublic.
TheSheriffsDepartment
shouldprovidejaildatafor
inclusionontheSFOpenData
website.
SheriffandChief
DataOfficer
D.PersonnelandTraining
FINDING
RECOMMENDATION
RESPONDER
F.D.1. TheSheriffs
R.D.1.a. Toreducetheneedfor
Department
overtime,theSheriffshould,in
expenditurefor
coordinationwiththeCityand
overtimeisincreasing.
CountyHumanResources
Increasedovertime
Department,puthighpriority
resultsinfatigueand
onfillingexistingvacanciesby
stressonthestaff.
redoublingrecruitingefforts
andexpeditingthehiring
process,withtheassistanceof
adedicatedSheriff's
Departmentrecruitmentstaff.
R.D.1.b. Identifypositionsthatmightbe
reclassifiedasadministrative
support,i.e.civilian,rather
thanrequiringsworndeputies
tohandlethoseduties.
Sheriff,Director
ofHuman
Resources
Sheriff
48
FINDING
RECOMMENDATION
RESPONDER
F.D.2. TheSanFrancisco
SheriffsDepartment
hasanassignment
processthatenables
deputiestokeepone
positionformany
years.
R.D.2.
TheSheriffsDepartment
shouldhavearotationpolicy
similartopoliciesineffectat
otherlawenforcement
agencies:everyfiveyears,one
thirdofthestaffgetsrotated.
TheStationTransferUnitand
otheradditionaldutiesto
enrichrotationopportunities
shouldbeimplemented.
Sheriff
FINDING
RECOMMENDATION
RESPONDER
F.D.3. SomeDeputySheriffs R.D.3.

appreciatethe
opportunitytowork
hoursmorecompatible
withfamilylifeand/or
closertohome.
TheSheriffshouldnegotiate
withtheSanFranciscoDeputy
SheriffsAssociationfor
recognitionofthebenefitsto
begainedbyrotationand
shouldnegotiateincentivesthat
balancethedesireofdeputies
forpreferableassignmentswith
theneedsoftheservice.
Sheriff,Deputy
Sheriff's
Association
49
FINDING
RECOMMENDATION
RESPONDER
F.D.4. Thereisaneedforall R.D.4.a. TheSheriffshouldincludein

DeputiesatCounty
the201718budgetrequest
Jailstobetrainedon
sufficientfundsforthepurpose
suicidepreventionand
oftrainingallDeputiesat
crisisinterventionasa
CountyJailsonsuicide
priority,andfor
preventionandcrisis
additionaltrainingto
intervention,includingenough
meetannualPOST
foratrainingfloat
requirements.Training
willrequireatraining
float.
Sheriff
Mayor
R.D.4.b. TheMayorshouldincludethe
Sheriffsrequestforfundsfor
thispurposeintheMayors
proposedbudgetand
Boardof
Supervisors
R.D.4.c. TheBoardofSupervisors
shouldapprovetheSheriffs
requestforthepurposeof
trainingallDeputiesatCounty
Jailsonsuicidepreventionand
crisisintervention.
50
FINDING
RECOMMENDATION
RESPONDER
F.D.5. TheSheriffs
R.D.5.a.
Department
managementconcurs
thatallstaffneed
trainingincrisis
intervention,incident
debriefing,andstress
management.The
SheriffDepartments
policytoonlysendtwo
peoplefortrainingat
onetimeduetostaff
vacanciesmeansthat
Deputiestrainedin
CrisisInterventionwill
continuetobea
limitedgroupforsome
timetocome.
Newrecruitsshouldcomplete
crisisinterventiontraining
eitherattheAcademyorwithin
oneyearofgraduationfrom
POSTacademy.
Sheriff
R.D.5.b Allswornofficers,medical,
andpsychiatricservicesstaff
shouldcompletecrisis
intervention,debriefing,and
stressmanagementtraining
withinthreeyearsof
employment.
Sheriff
R.D.5.c Toaccomplishthis,the
Sheriffshouldrecruitextra
helpfromtherosterofretired
Deputiesandarrangeformore
trainthetrainersessions.
Sheriff
51
E.DischargeandReentryPlanning
FINDING
RECOMMENDATION
RESPONDER
F.E.1. TheSheriffandthe
R.E.1.
DirectorofPublic
Healthstaffcoulddo
moretoplanforthe
criticalfirstfewhours
afterdischargeofa
personwithmental
illness.
TheSheriffandtheDirectorof
PublicHealthshouldupdate
theSanFranciscoJails
DischargePlanningPolicies
andPracticestoaddWellness
RecoveryPlanProcedures,
including:
Provideawarmhandoffto
aCaseManagerinthe
communitywhowillarrange
forafullcontinuumofcare.
(Notethatthisrequires
identificationofreceiving
handsreadytoacceptthe
patient).
Havecasemanageror
designeeaccompanythethe
patienttoatleastthefirst
continuingcareappointment
andassesspatientneedsto
assurefutureappointment
compliance.
Setupameetingofthe
CommunityCaseManager
withthepatientpriortohis
release,inordertohavea
visualconnection.
Sheriff,Director
ofPublicHealth,
DirectorofJail
BehavioralHealth
andReentry
Services
52
FINDING
RECOMMENDATION
RESPONDER
F.E.2. JailBehavioralHealth R.E.2.

Servicesdoesnot
currentlyconduct
releaseassessments
onpatientsdischarged
fromtheSanFrancisco
Jails.
PublicHealthshouldrequest
theControllertoconducta
benchmarksurveyofrelease
assessmentandother
performancemeasuresfor
mentalhealthservicesin
countyjailsandsuggestbest
practicesforadoptionatthe
SanFranciscoJails.
Sheriff,Director
ofPublicHealth
FINDING
RECOMMENDATION
RESPONDER
F.E.3. BayAreauniversities R.E.3.

representasourceof
impartialdata
reviewersofSan
FranciscoJailsmental
healthservices.
PublicHealthshouldcontact
appropriatedepartmentsinBay
Areauniversitiestodetermine
potentialinterestinhaving
graduatestudentsanalyze
performancemetricsand
preparereportsonmental
healthservicesprovidedinSan
FranciscoJails.
Sheriff,Director
ofPublicHealth
FINDING
RECOMMENDATION
RESPONDER
F.E.4. BayAreamental
R.E.4.
healthorganizations
suchasNAMIcould
provideuseful
recommendationson
mentalhealthservices
inSanFranciscoJails.
PublicHealthshouldseekout
localmentalhealth
organizations,suchasNAMI
andMHB,for
recommendationsonmental
healthservicesprovidedinthe
SanFranciscoJailsandrelated
reentryservices.
Sheriff,Director
ofPublicHealth
53
BIBLIOGRAPHY
AmericanAssociationofSuicidology,U.S.ASuicide:2013OfficialFinalData,April2015
http://www.suicidology.org
BoardofStateandCommunityCorrections,
http://www.bscc.ca.gov/
CACodeofRegulationsTitle15Crime&Corrections
http://www.cdcr.ca.gov/regulations/adult_operations/docs/Title152015.pdf
CityandCountyofSanFrancisco,BoardofSupervisorsBudgetandLegislativeAnalyst,
PolicyAnalysisReportre:JailPopulation,Costs,andAlternatives,May25,2016
CityandCountyofSanFrancisco,OfficeoftheControllerCityServicesAuditor,
CityServicesBenchmarkingReport:JailPopulation,February21,2013
http://sfcontroller.org/sites/default/files/FileCenter/Documents/4031Final%20issued%20Jail%2
0Population%202%2021%2013.pdf
CookCounty,Illinois,SheriffsDepartmentHomepage
http://www.cookcountysheriff.org
Ford,Matt,AmericasLargestMentalHospitalIsAJail,TheAtlantic,June8,2015
http://www.theatlantic.com/politics/archive/2015/06/americaslargestmentalhospitalisajail/39
5012/
FranklinCountyMassachusettsSheriffsOffice.HealthServices.
http://www.fcsoma.us/healthservices.html
Haney,CraigJohnson,JenniferLacey,Kathleen,andRomano,Michael,JusticeThatHeals:
PromotingBehavioralHealth,SafeguardingthePublic,andEndingOurOverrelianceonJails
http://sfdistrictattorney.org/sites/default/files/Document/BHJC%20Concept%20Paper_Final_0.pdf
HarvardKennedySchool,AshCenterforDemocraticGovernanceandInnovation,September17,
2015newsletter,
http://ash.harvard.edu/news/newyorksanfrancisconamedwinnersharvards2015innovationa
mericangovernmentaward
Hills.H.,Siegfried,C.,Ickowitz,A.(2004)EffectivePrisonMentalHealthServices:
GuidelinestoExpandandImproveTreatment.US.DepartmentofJustice.NationalInstituteof
Corrections.http://nicic.gov/library/018604
Ho,V.(2016)SanFranciscoChronicle17CountsforAccusedleaderofSanFranciscoJail
FightClub.SanFranciscoChronicle.March1,2016.
http://www.sfgate.com/crime/article/17countsforaccusedleaderofSanFrancisco6863736.php
54
JailReplacementProjectWorkingGroup,
https://www.sfdph.org/dph/comupg/knowlcol/jrp/default.asp
Kupers,TerryA,ACommunityMentalHealthModelinCorrections,StanfordLaw&Police
Review,Vol.26
http://connection.ebscohost.com/c/articles/103421162/communitymentalhealthmodelcorrections
Lacey,Jackie,ProvidingTreatment,PromotingRehabilitationandReducingRecidivism:An
InitiativetoDevelopaComprehensivePlanforLosAngelesCounty,August9,2015
www.scpr.org/news/2015/07/22/53263/ladistrictattorneyreleasesroadmapfordivertin/
MentalHealthBoardofSanFrancisco,
http://www.mhbsf.org/
NationalAllianceonMentalIllness,DepartmentofPolicyandLegalAffairs,
AGuidetoMentalIllnessandtheCriminalJusticeSystem:ASystemsGuideforFamiliesand
Consumers,1993
http://www.pacenterofexcellence.pitt.edu/documents/Guide_to_Mental_Illness_and_the_Crimin
al_Justice_System_NAMI.pdf
NationalCommissiononCorrectionalHealthCare.
http://www.ncchc.org/
NationalFireProtectionAssociation.DryersandWashMachines
http://www.nfpa.org/publiceducation/bytopic/safetyinthehome/dryersandwashingmachines
NationalInstituteofCorrections.(2010)
DirectSupervisionJailsTheRoleoftheAdministrator
http://nicic.gov/directsupervisionjails
PolicyAnalysisReportonJailPopulation,Costs,andAlternatives,May25,2016,
PublicPolicyInstituteofCalifornia,PretrialDetentionandJailCapacityinCalifornia,July2015
http://www.ppic.org/main/publication_quick.asp?i=1154
SanFrancisco,California,SheriffsDepartmentHomepage.
www.sfsheriff.com
SanFranciscoSheriffsDepartment,InmateOrientationHandbook,March2015[Sheriff
Handbook2015]
Staples,Brent,PreventingSuicideinAmericasJails,NewYorkTimes,August10,2015.
http://takingnote.blogs.nytimes.com/2015/08/10/preventingsuicideinamericasjails/?_r=0
ThreeEasyFixestoHelpReduceFraud,415Group.
May29,2014
http://www.415group.com/threeeasyfixestohelpreducefraud
UrbanInstitute,WhatWeKnowAboutJailSuicides,August2015[UrbanInstitute2015]
http://www.urban.org/urbanwire/whatweknowaboutjailsuicides
55
U.S.DepartmentofJustice,EffectivePrisonMentalHealthServices:GuidelinestoExpandand
ImproveTreatment,2004
https://s3.amazonaws.com/static.nicic.gov/Library/018604.pdf
U.S.DepartmentofJustice,NationalInstituteofCorrections,
http://nicic.gov/mentalillness
56
GLOSSARY
AOT
AssistedOutpatientTreatment
Assessment
theprocessofexaminationorevaluationfollowingthescreeningthatascertains
thespecificnatureandseverityofthementalhealthandsubstanceabuseproblemsandtheir
historyandcourse.DOJGuidelines2004
BSCC
BoardofStateandCommunityCorrections
CIT
CrisisInterventionTeam
CSA
CityServicesAuditor
Diversion
ofmedicinesPretendingtotakeprescriptionmedicineswhilefindingawaytosave
themforsaleortouseinasuicideattempt
DOJ
DepartmentofJustice(U.S.Government)
DPH
DepartmentofPublicHealth(SanFranciscoCity&County)
HIPAA
HealthInsurancePortabilityandAccountabilityAct
HR360
HealthRight360
JailBookings
theprocessbywhichthepolicedepartmentregistersandenterschargesagainst
apersonbelievedtohaveviolatedthelaw.Theprocessofbookingtypicallyincludesrecording
oftheinmatespersonalinformationanddescription,photograph(alsoknownasmugshot),
fingerprinting,andaDepartmentofJusticerecordscheck.CSA2013at10
JailDiversion
Aprogramthatallowsapersonchargedwithacrimetoavoidacriminaltrial
andconvictioninexchangefordoingcommunityservice,undergoingpsychiatrictreatment,
payingafine,orotheralternativedispositionorinthecaseofapersonwithamentalillness,
agreementtoparticipateinvoluntarytreatmentinexchangefortheprosecutorsdroppingthe
charges.
MaximumSecurityInmates
Inmateswhotypicallydisplaythehighestrisktothepublic,
staff,andotherinmates.Theymayposehighescaperisksandseriousthreatstothesafeand
orderlyoperationofthejailorhaveahistoryofviolenceincustodytypicallyhousedseparately
fromthegeneralpopulation.Someinmatessuchasthosewithmentalhealthissuesorviolent
tendenciessometimesrequireaddedhousingsecurity.
MediumSecurityInmates
inmateswhomayposeanescaperiskorathreattostafforother
inmates,buttypicallyshowawillingnesstocomplywithjailrulesandregulations.Theyare
typicallyhousedinthegeneralpopulationquarters.
57
MHB
MentalHealthBoardofSanFrancisco,acitizensadvisoryboardthatworkswiththe
BoardofSupervisorsandtheDepartmentofPublicHealthsMentalHealthDirectortoensure
thatmentalhealthprogramsmeettheneedsofthepeopletheyareintendedtoserve.
http://www.mhbsf.org/
M
inimumSecurityInmates
Inmateswhoarenotconsideredaseriousrisktothepublic,other
inmates,orfacilitystaff.Theyarehousedonthegeneralpopulationquarters.
M&Mreport
MortalityandMorbidityreport
MOU
MemorandumofUnderstanding
NAMI
NationalAllianceonMentalIllness
NCCHC
NationalCommissionforCorrectionalHealthCare
NIC
NationalInstituteofCorrections
NonSentencedInmates
Inmateswhohavenotyetbeensentencedandarebeingheldinthe
jailfacilitywhiletheyawaittrial.CSA2013at12.
POST
PeaceOfficerStandardsandTraining
Screening
aprocessofinformationgatheringthatincludesaninterview,areviewofexisting
records,andtheadministrationofspecializedinstrumentsortestswhichseekstoidentifythose
inmateswhomayrequireaparticularinterventionortreatment.DOJGuidelines2004
Sentencedinmates
inmatesthathavebeenconvictedofacrimeandareservinga
courtdeterminedsentence.CSA2013at12
SMISeriousmentalillness
(1)diagnosablemajorpsychiatricdisordersi.e.,schizophrenia,
unipolarandbipolardepressions,andorganicsyndromeswithpsychoticfeatures.
(2)mentaldisorderwithhighdegreeofdiscomfortandimpairmentwithsignificantduration
(3)asubstantialdisorderofthoughtormoodwhichsignificantlyimpairsjudgment,behavior,
capacitytorecognizerealityorcopewiththeordinarydemandsoflifewithintheprison
environment,plusmanifestedbysubstantialpainordisability.[DOJGuidelines2004at2]
WarmHandoff
ThetermforintroducingareleasedinmatetoaCaseManagerwhowillbe
handlingpostreleasetreatmentandcommunityservices.
58
APPENDIX
RecommendedTrainingforCorrectionalOfficersperDepartmentofJusticeGuidelines
Basictrainingforallcorrectionalstaffshouldincludethefollowinginformation:38
Howtorecognizetheearlysignsandsymptomsofseriousmentalillnessandsuicide.
Thenatureandeffectsofpsychotropicmedications.
Thementalhealthservicesavailableintheprison.
Howandwhentomakereferralstomentalhealthservices.
Trainingtomakecustodyofficersmoreeffectiveshouldcoverthesetopics:39
Understandingthatsimplylisteningandtalkingtomentallyillinmatesmayresolve
crises.
Understandthatfrequentcontactbystaff,evenbriefcontacts,canhelpcalmconfused
andanxiousinmates.
Provideaccurateinformationabouttheinstitutionandhowtoaccessmentalhealth
servicestoinmates.
Observeandrecordinmatebehavior.
Receiveandrelayinmaterequestforassistancefrommentalhealthstaff.
Consultwithmentalhealthstaffaboutmentalillness.
Monitorinmateswhotakepsychotropicmedicationsforcomplianceandsideeffects.
Identifytheearlysignsandsymptomsofmentalillnessandimplementsuicide
prevention.
38
Hillsetal.(2004)pg.34
ibidpg.33
39
59

2015-16 Civil Grand Jury Report Final Report SF Jails 7-14-16

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SANFRANCISCOCOUNTYJAILS

F.B.2. EndinguseofJail#4 R.B.2.

F.C.2. JailshaveJailBehavioral R.C.2.a. TheCityshouldstaffJail

F.D.3. SomeDeputySheriffs R.D.3.

F.D.4. Thereisaneedforall R.D.4.a. TheSheriffshouldincludein

F.E.2. JailBehavioralHealth R.E.2.

F.E.3. BayAreauniversities R.E.3.

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