Jail Treatment of Mentally Ill Is Criticized

Although the Los Angeles County Sheriff’s Department is moving forward with plans to patch up its beleaguered jail system, the custody operation remains plagued by lapses in care for mentally ill inmates, a report to the Board of Supervisors concluded Wednesday.

According to the study prepared by attorney Merrick Bobb, retained by the county as a special counsel to track problems in the Sheriff’s Department, custody officials seem “oddly frozen” in their inability to deal with a variety of issues affecting the health and welfare of the mentally ill.

While sheriff’s brass and administrators from the county Mental Health Department have tried recently to remedy the problems--under pressure from the U.S. Justice Department, which has threatened to sue the county--their efforts remain inadequate, Bobb said.

“The sheriff of Los Angeles County has said in unambiguous terms that he will never allow there to be an unconstitutional jail while he is in charge,” Bobb said in his eighth semiannual report on the department. “Although there is no gain saying real improvement in the last six months, Sherman Block will need to continue working hard on custody issues for the foreseeable future.”

The report is the second released in recent months criticizing the care of the mentally ill in the jails. After a yearlong study, federal justice officials this year demanded that county officials fix the situation or face a federal lawsuit.

The Justice Department, in its report last month, found that mentally ill inmates are often housed in cramped, dingy cells with virtually no contact with staff psychiatrists. And because of chaotic record keeping, some inmates are given psychotropic medications that they don’t need, while others go without, federal officials said.

At the root of the problem, according to Bobb, is a long-term struggle over responsibilities within the jail system. While the county Department of Mental Health is assigned the task of diagnosing and treating about 1,600 mentally ill inmates, it is often at “loggerheads” with sheriff’s officials over how much care to provide, Bobb wrote.

“[The department] seems to wall itself off as much as it can from the patients they are supposed to be treating, preferring to deal through intermediaries like custody personnel or the custody medical staff,” Bobb said.

As a result, sheriff’s deputies have had to step in as “lay psychiatric nurses performing off-the-cuff-diagnosis and triage.”

“With all due respect for their intelligence, talent, ability and devotion, sworn and civilian custody staff are not trained psychiatrists,” Bobb said.

Making matters worse, Bobb found, the Sheriff’s Department--which bears the ultimate responsibility for the jail system--appears “unable or unwilling” to demand a better performance from mental health officials.

“At base, the mental health and medical staff seemed to have played--and in our view continue to play--a game of passing the hot potato of responsibility out of concern for additional staffing costs and a fear of legal liability, all at the expense of inmate welfare and the cost of lives that could have and should have been saved,” Bobb wrote.

Sheriff Sherman Block said Wednesday that he agrees that the department must take further steps to rectify the situation. He said he has asked Assistant Sheriff Mike Graham--known as the department’s trouble-shooter--to look into the situation. Graham will try to determine whether the department should hire a private contractor to provide services to mentally ill inmates, Block said.

“It is an issue that must be resolved,” Block said. “There are no other options, except get it done. We are going to do all we can to expedite a resolution to this problem.”

David Meyer, chief of justice programs for the Department of Mental Health, said he has not yet reviewed Bobb’s report. However, he took issue with Bobb’s allegation that the mental health department has failed to assume adequate responsibility.

“We have completely revamped our services in the jails and have done some rather unique and innovative things to address the problems,” Meyer said.

For example, sheriff’s and mental health officials have recently drafted a memorandum of understanding that will lead to a more cooperative effort in treating mentally ill inmates in the jails, he said. Meyer added that the department has nearly doubled its staff in the jail system--to more than 200.

“I’m very proud of what we have done now,” Meyer said. “I’m looking forward to the Department of Justice taking a second look at us.”

Bobb, however, says he is unimpressed by the memorandum, saying that it represents nothing more than “useful dialogue.”

In addition to considering hiring an outside contractor to provide services, the department should look into designating one jail to house all inmates who suffer from mental illness. That way, Bobb said, the department can better coordinate services.

While criticizing the care of the mentally ill in the jails, Bobb praised the custody staff for its efforts in other areas. The department has made significant strides in reducing the number of erroneous releases and over-detentions, he said. Bobb also praised an innovative program that has increased the time hard-core criminals spend in jail by placing low-risk offenders under house arrest.