Last week, a Santa Cruz County civil grand jury released a report exploring mental health care in county jails. It alleges that corrections staff abuses the use of solitary confinement intended for people having a mental health crisis and that the private medical contractor used by the jails provides inadequate staffing and over-prescribes medications’ dosages.
County law enforcement and reform advocates agree there is a connection between being mentally ill and being in jail. They agree that the sheriff oversees the largest mental health care facility in the county. They disagree about what happens once inmates are inside.
Sheriff Jim Hart responded that the report is biased, written based on the jury’s preconceived notions and misunderstandings of procedure.
Unique to the California Constitution, each county must convene a civil grand jury. The group of private citizens investigates local matters. In Santa Cruz County, 19 people met over the last year to create reports with the aid of legal fact-finding powers not available to the general public.
“Imagine suffering from a mental health condition, and because of a crisis, you end up in jail. You are in a totally unknown environment. No one explains anything to you that you can understand,” the report reads on its fourth page, saying that instead of being taken to a health care facility “you may be pepper sprayed, tased, tied to a chair, and finally dragged to a safety cell with no water or toilet where you may languish up to 48 hours. That may happen multiple times.”
First: A gray-doored Sobering Cell stands next to a gray-doored Safety Cell at a Santa Cruz County jail, in an undated photo. Last: First: A gray-doored Sobering Cell stands next to a gray-doored Safety Cell at a Santa Cruz County jail, in an undated photo. Last: An interior of a cell Santa Cruz County’s Main Jail, with a white shelf, bench and a stainless steel toilet in an undated photo. (Ashley Keehn, Santa Cruz County Sheriff’s Office via Bay City News)
Roughly 40 percent of Santa Cruz County’s incarcerated population usually receives psychiatric medication, per the Sheriff’s Office and the county’s Criminal Justice Council, an advisory group consisting of law enforcement, elected officials, criminal justice workers and local nonprofits.
A survey from the Centers for Disease Control and Prevention’s National Center for Health Statistics found that 16.5 percent of adult Americans take such medicine.
Santa Cruz County operates four adult jails, where approximately 80 percent of those incarcerated wait for their trial. The jails operate at roughly three-quarter capacity, with its total population about 350 people, according to 2023 reports by the Sheriff’s Office.
Hart said 65 percent of his department’s arrests were people accused of misdemeanors, who his department releases after booking them. Hart added that he currently has a large group of people waiting two to five years for trial, and at least one person waited nine.
Imagine suffering from a mental health condition, and because of a crisis, you end up in jail. You are in a totally unknown environment. No one explains anything to you that you can understand. …
CIVIL GRAND JURY REPORT
Civil rights attorney Jonathan Gettleman responded that law enforcement officials release some people facing misdemeanor offenses. Others, including some of his clients, are held because they miss court dates or are found to be incompetent because of their mental health status.
“It’s particularly challenging in a town like ours, which is a touristy town. There’s a lot of pressure to get people off the streets, right?” said Gettleman. “People that are just out in the streets yelling at street signs. So these are the people that are all winding up in the jail.”
When inmates experience mental health crises, they may be sent to a “Safety Cell.” The grand jury describes the room as “a small white cell where everything is made of concrete.”
Hart said a safety cell “is not used often and it’s used when somebody becomes a danger to themselves or others.”
The civil grand jury reported an average of 36 people per month were put on suicide watch in those cells last year. It found that number in an answer given by the Sheriff’s Office in a 2023 request for health care providers’ proposals. The cells are monitored via video non-stop, with correctional staff checking in-person every 15 minutes.
The report said officers use safety cells in disciplinary matters, in violation of their manual. The jury cited a confidential interview in that assertion.
County Public Defender Heather Rogers has seen surveillance footage of safety cells as part of her work.
“It’s hard to watch,” she said of the video, saying the cells look isolated and uncomfortable.
Hart has worked for the Sheriff’s Office over 30 years. Of mental health care, he said “I think it’s been vastly improved, especially over the last five years or so. We have clinicians that are 18 hours a day. We have 24-hour telemental health available to all incarcerated people. We have mental health screening prior to intake.”
Rogers didn’t blame the Sheriff’s Office, adding she has a good relationship with them. She said they were not supposed to serve as mental health care providers.
“It’s not a pleasant job, and they’re not the best suited to do it. And they know that,” she said. “That is the lot that they’ve been dealt, right?”
Since September 2021, Santa Cruz County used Wellpath to provide inmate mental health care. Hart said they had already been using the private contractor for 12 years to provide medical care in the jail.
Per the jury’s report, the Nashville-based company relies on a single psychiatrist providing treatment and assessments through video conference.
Wellpath did not respond to repeated requests for an interview.
The company staffs mental health workers 16 hours per day and medical workers around the clock. The Sheriff’s Office’s request for proposal listed seven vacancies for nurses and two for mental health clinicians.
The jury’s report states that in the off hours, correctional officers cannot meet the mental health requirements of inmates.
Ashley Keehn, a Sheriff’s Office spokesperson, said they call in mental health liaisons or nurses when there is a need outside of hours staffed by Wellpath. She added that Santa Cruz County correction officers are also trained in crisis intervention.
Wellpath has paid tens of millions to settle wrongful death lawsuits across the country. Their website states they provide medical and mental care for almost 300,000 patients in inpatient, residential, correctional and similar facilities.
Dosing dilemmas
The civil grand jury also reported that Santa Cruz County inmates are overprescribed psychotropic medication, with dose ranges that vary significantly.
“Have I seen people who struggle to assist counsel because they’re too drowsy and out of it? Yes,” said Rogers. “I have also seen people who seem to struggle to assist counsel because they are really suffering.”
She said some clients seemed to need medication, but declined to guess what kind or for what condition. She did add, “Both of those things are hard to see as a human being and also rough on representation.”
Santa Cruz County has not renewed its contract with Wellpath.
“Wellpath has been having a real challenge with staffing,” said Hart. “We weren’t satisfied with their ability to provide us with sufficient staff at times.”
As Wellpath’s contract neared its end, the county put out a request for proposal for other providers. Hart said he heard good reports from several counties that use NaphCare.
NaphCare, a smaller health care provider for jails and prisons, has also settled wrongful death lawsuits in other states. NaphCare also did not respond to requests for comment.
The civil grand jury noted their own lack of discussions with people held in custody. The jury wrote that their handbook recommends conducting interviews with inmates, which they have done in the past. The report outlined that the jury offered to do virtual interviews, which they said were denied.
Keehn, the sheriff’s spokesperson, said “They do have access to inmates, whether that’s through sending them mail or through a subpoena.”
Keehn said the Sheriff’s Office is preparing a line-by-line response to the report, citing other discrepancies.
One omission that Hart found unfair was the department’s nearby sobering center. Hart said some people facing first-time substance abuse-related charges like public intoxication and driving under the influence may go to the sobering center instead of booking. There, they meet with treatment professionals. The program diverts 200 people per month, according to Hart.
“Rather than treat substance use as a criminal matter, we’re trying to treat it more as a health care matter,” said Hart.
The jury commended the county’s juvenile facilities as “exceptional”, achieving a 41 percent reduction in admissions since 2013. Hart and the jury both pointed to the 32-bed women’s facility, which hosts re-entry programs. It houses people awaiting bail or serving sentences of usually a year or less.
The jury, Rogers and Hart commended the correctional staff overall as a caring group with a difficult job.
They agree that mental health and systemic concerns often lead to someone experiencing incarceration.
“Our jail population is made up of primarily people who are experiencing a mental health crisis, people who are addicted, and poverty,” Hart explained. “They’re getting much better services in many situations than they are out on the street.”
