Jails Must Alter Care of Mentally Ill

The U.S. Department of Justice has ordered Los Angeles County to take drastic action to fix what investigators termed “constitutionally inadequate” care for mentally ill inmates in the county jails--or face a federal lawsuit.

In a scathing 32-page letter issued Friday, Acting Assistant Atty. Gen. Isabelle Katz Pinzler said investigators found “deliberate indifference” to the medical needs of mentally ill inmates in the county jail system. She issued a list of 29 recommendations to correct the situation.

“We believe that the jail’s provisions of mental health care is constitutionally inadequate in numerous aspects,” wrote Pinzler, who works in the department’s Civil Rights Division. “The jail fails to identify adequately inmates with serious mental illnesses and does not adequately test those inmates it has identified as mentally ill.”

What’s more, investigators said, the conditions in the jails’ mental wards are so bad that they exacerbate the illnesses of inmates, who are often confined to cramped, dingy cells where they receive little treatment except for medication--if that.

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“The jail has a duty to ensure that inmates receive adequate medical care, including mental heath care,” Pinzler wrote. “Deliberate indifference to inmates’ serious medical needs violates the 8th Amendment because it constitutes the unnecessary and wanton infliction of pain contrary to contemporary standards of decency.”

The Department of Justice--which began its probe last summer as a result of “complaints from individuals and public interest organizations”--has given the county 49 days to make the necessary fixes.

Among them:

* All inmates entering the jail should be individually and privately screened to determine if they suffer from mental illness or have attempted suicide.

* Jail staff must work to ensure that mentally ill inmates receive their psychotropic medications without interruption.

* Mental health staff should make rounds in non-mental health housing modules in all facilities on a regular basis to identify inmates who may have been missed during the initial screening process.

* The county should implement a computerized medical records system that allows prompt, up-to-date information on the condition of each inmate.

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County Mental Health Director Areta Crowell--whose department provides treatment to about 1,600 inmates in the jails--said the county agency has already moved forward with a number of reforms, including increasing its staff to better screen mentally ill inmates entering the jails.

“We have indeed made a lot of improvements,” Crowell said.

Undersheriff Jerry Harper, whose department runs the jails, said: “We are certainly going to work to close the gap--if not make everyone happy, make everyone feel better about this whole situation.”

Both Harper and Crowell said they are hopeful that the county can reach an agreement with the federal government to avoid litigation.

“I would hate to see resources directed into legal action when it could be used to fix the problems,” Crowell said. “It only diverts the attention.”

The Department of Justice commissioned its study in June 1996 amid complaints that the civil rights of mentally ill inmates were being violated. A preliminary report on the matter was issued in February.

Pinzler’s letter reflects much of the findings of the earlier study, in which investigators detailed instances of inmates being locked up almost continuously in dingy cells with little access to exercise yards.

Investigators found that some prisoners languished for weeks without the medication they desperately needed to keep their illnesses under control, while other prisoners were given psychotropic medications to treat conditions from which they might not have suffered.

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The Department of Justice also found that medical records in the county jails are often incomplete and illegible--leading to dangerous lapses in treatment. Even identification of mentally ill inmates during the booking process is deficient. (Investigators reported that county mental health personnel admitted that little or no effort is made to treat the mentally ill inmates who are not “high impact” or actively suicidal.)

Finally, mentally ill inmates--who are dressed in yellow fatigues to identify their condition--are subjected to verbal and physical abuse by inmate trusties, investigators found.

“The reasons for the poor state of mental health care in the jail are manifold,” Pinzler wrote. “The number of inmates in need of mental health care overwhelms available staff.”