Thousands of people who are mentally ill are locked up in L.A. County jails at any given time. But should they be behind bars? That's the question the Board of Supervisors set to answer when they requested RAND researchers study the mentally ill jail population back in August 2018.
On Tuesday, that report was presented to L.A. County leaders - and largely echoed findings by their own Office of Diversion and Reentry (ODR) in a preliminary study completed 10 months ago.
The answer: A majority -- more than 60% of them -- could instead be safely cared for in the community, if enough housing and community services were made available.
The new report found:
- In a single month (June 2019), 5,544 out of 17,204 inmates were in mental health housing units and/or on psychotropic medication.
- Some 61% of those inmates with mental illness (about 3,368 people) could be appropriately diverted into community-based services or supportive housing.
- Women were more likely to be eligible for diversion than men, even though the majority of mentally ill inmates were male.
Peter Espinoza, who heads the Office of Diversion and Reentry, said the RAND researchers findings "confirms for me what we suspected: that there are a lot of sick and vulnerable people in the jail that don't have to be there."
'CARE FIRST, JAILS LAST'
2019 was a defining year for the county as lawmakers wrestled with how best to address the rising number of inmates who suffer from mental illness, including substance abuse disorders.
Originally, in 2018, the county approved a $2.2 billion contract to replace the dilapidated Men's Central Jail with a new jail that would have a section with tailored treatment for mentally ill inmates.
In February 2019, however, the Board of Supervisors voted to switch course and replace the jail with a mental health hospital to be overseen by the Department of Health Services rather than the Sheriff's Department. Community members and groups like Reform L.A. Jails and the ACLU of Southern California pushed back, arguing that the supposed hospital would still be a jail.
"Housing thousands of [inmates who are mentally ill] in one hospital is not the answer," Patrisse Cullors, chair of Reform L.A. Jails, said. "We are looking for a model of holistic care."
On August 13, in a 4-1 vote, the Board scrapped the multibillion dollar construction contract for the mental health hospital. They acknowledged that the Men's Central Jail needed to be torn down, but instead of replacing it, the Board decided to focus on alternatives to jailing people with mental health issues.
Some of the supervisors called the move a 'care first, jails last' approach that would be a first in the nation. But in the RAND report, authors noted that there simply aren't enough community-based programs to serve this population across the county.
LA HAS A DIVERSION PROGRAM BUT IT'S NOT ENOUGH
The county has a program that diverts eligible offenders who are mentally ill from jail. Currently, ODR operates the county's diversion programs, placing inmates who are homeless, have substance abuse disorder or are severely mentally ill into housing and community treatment.
There are three diversion courts that serve the entire county. ODR staff, such as clinicians and case managers, also provide support and advice on mental health cases in other courtrooms across the county.
The goal of diversion is to keep someone who's severely mentally ill from cycling from streets to hospitals to jail by working to stabilize them in the community.
Since its inception at the end of 2015, ODR has successfully diverted more than 4,400 inmates with mental health problems and placed them into community-based services that are run by ODR.
ODR operates 71 sites with a total of 1,915 beds. Some of the services include permanent supportive housing (housing with onsite services like case management and therapy) and inpatient and outpatient mental health or substance abuse treatment.
Kristen Ochoa, ODR's medical director, told LAist that it costs the county $70 per day per inmate in a diversion program compared to more than $600 per day (not including health costs) to keep an inmate in Twin Towers, the county jail that houses a majority of the most severely mentally ill inmates.
According to the Sheriff's Department, Twin Towers is the largest mental health facility in the nation.
But ODR doesn't have the capacity to divert all of the eligible people in the criminal justice system to community-based services, according to the RAND report.
"If we had even more resources or services," Ochoa said, "we could help even more people."
SO, WHAT'S NEXT?
Stephanie Brooks Holliday, one of the authors of the RAND report, said now the county needs to take a deep dive and "look at what level of care the divertable population needs."
For example, how many would need outpatient treatment, residential treatment or permanent supportive housing? Also, how do these needs align with what is already available?
Still, some percentage of offenders who are mentally ill -- around 32%, according to the RAND study -- will still need to be behind bars.
ODR director Espinoza said he hopes the study will help the county decide on the best facility to replace the Men's Central Jail for people who can't be diverted safely back to the community.
At Tuesday's Board of Supervisors meeting, Supervisor Kathryn Barger said the county needs more access to community services like outpatient care for the inmate population. "Until we do that, diversion is going to fail," she said.
UPDATES:
5:59 p.m.: The top of this article was updated.
This article was originally published at 2:28 p.m.
