Medical Treatment of inmates with mental illness in counties throughout California dramatically improved in late September as Gov. Jerry Brown signed into law AB 720 (Eggman, D-Stockton) sponsored by The California Psychiatric Association and the Los Angeles County Sheriff’s Department. The measure that will ensure that inmates with a history of mental illness who are dangerous or gravely disabled have access to necessary medications as they await trial and sentencing, will become law on January 1, 2018.
Under existing statute, inmates with a serious mental illness can be booked into jail and if they refuse to take medications that could stabilize or lessen the symptoms of their illness there is no recourse even if they are dangerous. It can be weeks, months or even a year or more before sentencing. There are procedures for sentenced inmates that allow them to be medicated, but not for pre-trial detainees. This circumstance causes inmates with mental illness to spiral downward into more acute states that can deprive them of meaningful participation in their own defense and lengthen the time they spend in jail while unreasonably burdening jail personnel and the courts.
A current workaround exists in a few jails that are designated by the state. These apply community standards to pre-sentenced inmates with mental disorders who become dangerous to themselves or violent while awaiting trial by allowing them to be placed on Welfare and Institutions Code Section 5150, 5250 or 5270 holds. Once placed on one of these holds, a medication hearing can follow that allows a judge to order appropriate medications. These holds, however, expire after 14 or 30 days, sending the ill inmate into another cycle of on-again and off-again use of medications that help them better navigate daily life in jail. Many psychiatrists believe this cycle of sporadic medication may lead to progressive brain damage in individuals who already suffer from a brain disease.
According to Captane Thomson, MD, a forensic psychiatrist who serves as a consultant to jails in the Sacramento and Yolo County region, the need for a change in the care of inmates with acute mental health conditions became obvious when he offered to help a colleague whose son had been charged with a misdemeanor and sent to a jail in Yolo County. The young man had been diagnosed with bipolar disease and was exhibiting severe symptoms. “He was just carrying on terribly in the jail,” Dr. Thompson remembers. “He was taking his clothes off, shouting so loud they had to remove him from the cell, and smearing feces on the window. It made me sick to see the condition he was in.”
Having previously treated the young man, Dr. Thompson talked to him and urged him to accept treatment. He refused. After trying (and failing) to get the resident jail psychiatrist to see the man, Dr. Thompson tried to get him into the care of the hospital in Woodland where he’d been treated in the past. Again, he failed. “There was no question he would qualify as a gravely disabled person who could not take care of himself without treatment,” Dr. Thompson said. “Yet, since he wasn’t assaulting anyone and wasn’t dangerous or suicidal, he didn’t qualify for the 5150, ‘dangerous to self or others’ designation.”
The inability of a veteran psychiatrist to get the jail system to respond to an urgent need for intervention inspired Dr. Thompson to seek a solution. “I thought, we have to do something. We know that people who are mentally ill further deteriorate if treatment is delayed. It’s not good to allow a man to wallow in his own filth,” he explains. “We are putting mentally ill, homeless people into our jails and we need to be able to treat them…”
Leveraging his contacts with public officials he worked with his elected representative Assembly Member Aguilar-Curry. Eventually, Assembly Member Susan Eggman agreed to carry a bill. Dr. Thompson also contacted the California Psychiatric Association which agreed to sponsor and drafted AB 720. Prospects for the bill strengthened when representatives of Los Angeles County Sheriff Jim MacDonald contacted CPA Director of Government Affairs, Randall Hagar, and threw that department’s support behind the bill as co-sponsor. Other law enforcement agencies and advocacy groups joined in the effort to pass AB 720.
Elements of AB 720 already exist for the State Prison system, and for inmates in jail who have been sentenced. Those procedures will be leveraged as counties opt to implement the bill that is garnering additional support throughout California, and promising to help jail mental health and corrections personnel manage a population that’s seriously challenged their capacity and resources.
But most importantly, Dr. Thompson believes the greatest benefit will be experienced by pre-sentenced jail inmates with chronic and severe mental illness. “The idea of languishing untreated in a jail is not the way that any of us want to be treated or to have our children treated,” he says. “Yes, AB 720 is optional, but fortunately sheriffs throughout the state are on board.”
For more information about AB 720 contact Randall Hagar at firstname.lastname@example.org or at (916) 442-5196.