Outside Alameda County's Santa Rita Jail. Credit: Pete Rosos

Alameda County has agreed to a massive reform program that will remake how mental health care is provided in Santa Rita Jail in order to settle a class action lawsuit filed three years ago on behalf of jail detainees.

The terms of the 110-page proposed settlement were made public in court filings last week. Under the settlement, the Alameda County Sheriff’s Office will be required to revamp its policies and procedures, hire new staff at the jail, build a new “therapeutic housing unit,” and put new oversight structures in place. The draft agreement still must be approved by U.S. Magistrate Judge Nathanael Cousins, who is scheduled to hear the motion on Sept. 22. 

If approved, the settlement could address many of the problems identified by the U.S. Department of Justice Civil Rights Division in a report released in April that showed Alameda County’s system of mental health care violates the 8th and 14th Amendments to the Constitution and the Americans with Disabilities Act. While the Department of Justice’s investigation of the county’s mental health care system is separate from the jail lawsuit, the DOJ has been monitoring negotiations in the case. The DOJ will attempt to reach a separate settlement with the county before filing its own lawsuit. Having such extensive reforms in place already will likely contribute to such a settlement. But the DOJ’s investigation faulted the county’s entire system of mental health care, and the proposed class action settlement only covers issues in the jail.

Throughout the country, jails and prisons have become the de facto largest provider of mental health care as people without adequate treatment suffer psychological breakdowns that can lead to criminal behavior. The DOJ found that the problem was particularly acute in Alameda County, citing a lack of community resources and a much higher rate of involuntary psychiatric emergency holds than elsewhere in California.

Jeffrey Bornstein, a partner at Rosen Bien Galvan & Grunfeld, the firm that brought the class action lawsuit against the sheriff in 2018, said that mental health care in Santa Rita Jail has been essentially nonexistent for years. “There actually needs to be mental health care and treatment because there isn’t any and there hasn’t been for a long time,” Bornstein said. “As long as we’ve got a jail we’ve got to make sure that it’s actually able to take care of people in a constitutionally compliant way.”

Alameda County Sheriff’s Sgt. Ray Kelly, a department spokesperson, acknowledged that the settlement will require substantial changes to the jail’s operations. “It’s been a good process, a difficult process, but it’s going to be of great benefit to the people in our custody,” Kelly said about some of the new policies, procedures, facilities, and programs that would be created under the proposed agreement.

The reforms “will take many years to finish,” Kelly said. “Obviously the more efficiently we do that the better off for everybody because ultimately it is going to be costly to the taxpayers, and at the end of the day we want to make sure we’re providing the treatment and care to the people who need it.”

The agreement will place the county under court supervision, called a consent decree, for up to six years, and potentially longer if the sheriff’s office is found out of compliance after that time. A similar agreement requiring reforms of the Oakland Police Department that was supposed to be completed in five years has gone on for nearly two decades. A similar lawsuit alleging that Sacramento County jails were mistreating prisoners with mental health issues and abusing the use of solitary confinement was settled in 2019, resulting in a consent decree requiring numerous reforms.

The sheriff’s office must remake its intake and discharge procedures

Some of the biggest changes the sheriff’s office will have to  make, if the settlement is approved, involve how people are booked into the jail and what happens when they are released. The new procedures are designed to help place people in appropriate treatment and coordinate better with other county agencies. 

While new inmates are medically screened at intake, they are not routinely screened for mental health issues. The DOJ report cited two cases where failures at intake led to the death of an inmate: Edwin Villalta, a former Marine suffering post-traumatic stress disorder, died by suicide in 2017 18 days after entering the jail and after a doctor found he was not suicidal, and Christian Madrigal, who received no mental health screening despite his family calling police to have him hospitalized during a psychiatric emergency.

The jail will be required to screen anyone brought to it while the arresting officers are still there to determine if it would be more appropriate for them to be taken to a hospital under an involuntary mental health hold. 

The settlement will also make mental health screenings routine at intake, and they must be completed within four hours. Anyone who is determined at that screening to have immediate suicidal behavior must be seen by a mental health professional within the next four hours. Anyone showing delusional behavior or who has been suicidal in the past 30 days must be seen in 24 hours. Anyone else who requests mental health treatment, or is referred by staff, must be seen within 14 days. 

The jail will also be required to change the way it releases detainees. The DOJ investigation found that when people are released from jail they often are given few instructions for how to receive mental health services outside the jail and sometimes leave without any prescribed medication, increasing the chances that they will have a recurring mental health crisis and end up either in the hospital or back in jail.

Under the proposed settlement, once anyone receiving mental health treatment in the jail has been there for more than 72 hours, the staff must create a release plan and continue updating it as long as the person is in custody. Jail staff must coordinate with community service providers, housing providers and the detainee’s friends and family, and if the person authorizes it, provide access to records to help create the release plan. Anyone taking psychiatric medications must have access to a 30-day supply of the medication when they are released. 

The sheriff’s office will build a new therapeutic housing unit

For many years, the jail used spartan “safety cells” to hold detainees in isolation who are suicidal, sometimes for weeks at a time. These cells contain no furniture and have only a hole in the floor for a toilet. The proposed settlement aims to significantly reduce the amount of time inmates spend by themselves in these cells. 

The sheriff’s office must restructure its categories for who needs to be housed securely and take a person’s mental health condition into account when making those decisions. Even the inmates in the most restrictive tier will be entitled to two hours out of their cell per day. And if any behavioral health patients are placed in restrictive housing, they must be evaluated by a mental health professional within 24 hours.

The sheriff’s office has agreed to phase out the use of “safety cells” and to reconfigure new suicide restraint cells in which detainees will be placed for no more than eight hours at a time. They must be re-assessed by a mental health professional and either taken to a different cell or hospitalized after that point.

The sheriff’s office will also be required to create a new therapeutic housing unit where detainees with serious mental health problems would be looked after. While the sheriff’s office currently has a behavioral health unit, the class action lawsuit alleged that often people with mental health issues were housed in “administrative segregation” cells, essentially solitary confinement, and that the behavioral health unit provided no meaningful care.

The DOJ found that care in the behavioral health unit was “generally limited to medication administration, screenings for suicidal ideation, and brief conversations with clinicians.” The lead plaintiff in the class action case, Ashok Babu, who was arrested for domestic violence in 2017, was housed in the behavioral health unit on suicide watch, but the lawsuit alleges he was confined to his cell for 23 to 24 hours per day. 

The new unit would provide more time outside, give people access to educational and mental health programs, and coordinate better with other county mental health providers. 

“It’s supposed to be more therapeutic and treatment-oriented instead of more punitive,” said Bornstein, the attorney in the class action case. “We’re cautiously optimistic that by working together with them by implementing this unit we’ll be able to come up with ways that are genuinely helpful to people compared to what they’ve been in the past.”

The sheriff’s office must have a plan for the new units within three months and be using them within a year.

Jail staff will also be required to conduct mental health care in confidential settings. The DOJ found that many detainees had to talk with mental health care providers in places where other inmates and deputies were present and could overhear. The lack of privacy made detainees reluctant to share sensitive information.

Other new policies adopted by the sheriff’s office will include an updated use of force policy and new rules for when and how restraints can be placed on detainees. Already the sheriff’s office has ended the use of Wrap full-body restraints, which led to the death of Dujuan Armstrong while he was suffering an apparent mental health crisis in 2018.

New oversight positions will be created to ensure compliance

Bornstein said his team wanted to “find a way to have people affected by policies and procedures” to have a role in changing the conditions in the jail “in the hopes that we can make things better by working together instead of imposing it without talking to folks.”

Along these lines, the jail will set up an inmate advisory council and ombudsperson, who will address grievances from inmates about conditions in the jail. The council will strive to have representatives from all housing units and jail classifications.

The jail also must add a new coordinator to ensure compliance with the Americans with Disabilities Act, a landmark civil rights law passed in 1990 that prohibits discrimination based on disability. The DOJ found that Alameda County’s treatment of people with chronic mental health conditions violated the ADA because they were not provided legally-required services in the community and instead were jailed, where their rights were violated further.

The ADA coordinator must meet with anyone admitted to the jail with a psychiatric disability within 14 days to explain the rules of the jail, how to request accommodations for their disability, what accommodations are available, and how to raise a grievance for an issue related to their disability. If they remain in jail for more than 60 days, the ADA coordinator must meet with them again to ensure that their needs are being addressed.

The sheriff’s office is prohibited from considering a psychiatric disability as a factor when determining what restrictions to place on the detainee’s movement. While they can consider whether a detainee’s condition is causing them to be victimized, deputies can’t place more restrictions on them just because they have a psychiatric condition.

Staffing in the jail will increase

One of the reasons conditions in Santa Rita Jail have been so bad is that there isn’t enough staff to look after and serve the roughly 2,000 detainees. The county has agreed, according to the proposed settlement, to boost staffing of both the sheriff’s office and mental health workers. 

“You need to have the right staffing mix so that you can provide them with not only the constitutionally-mandated out of cell time that they’re entitled to but especially with regard to mental health treatment,” Bornstein said. “We would love to see Alameda County use other alternatives such as not putting people in jail and finding community-based programs and we are hoping that is something they will consider.”

Mike Brady of Sabot Consulting, a former assistant secretary of the California Department of Corrections and Rehabilitation who is an expert on jails and prisons, recommended in an April 2020 report that Alameda County hire 259 additional deputies and 72 sheriff’s technicians over a three-year period so the jail can operate without mandatory overtime. 

Based in large part on Brady’s report, the Board of Supervisors voted in May 2020 to allocate $318 million over three years to increase staffing in the jail. That also includes funding to hire 107 behavioral health employees. 

The agreement doesn’t settle all the county’s issues with mental health care

While the proposed settlement outlines extensive reforms, implementing them will take years and the county’s problems with mental health care are far from resolved, even if the jail comes into full compliance. The DOJ found civil rights violations in all of Alameda County’s mental health services, including conditions in the public mental health hospital John George Psychiatric Pavilion in San Leandro and the lack of community-based services for treatment.

A separate class action lawsuit brought by Disability Rights California is still pending in federal court alleging inadequate community-based services and harsh conditions in John George hospital. 

Finally, if the county does not reach a settlement with the DOJ based on what its civil rights division investigators found, it could be sued by the federal government as well.

Fixing mental health care will also be costly. As part of the settlement, Alameda County has agreed to pay the attorneys who filed the jail mental health lawsuit $2.15 million. 

But Kelly, the sheriff’s spokesman, said that he expects the changes to be transformative.

“It’s going to ultimately change the way our organization’s run, the way the county jail is run,” Kelly said. “When you look back over the history of law enforcement in the county jail this will be a pivotal moment.”

Scott Morris is an independent journalist in Oakland covering policing, protest, and civil rights.