Current staffing and organization of mental health care in the Marin County Jail is inadequate and does not appear to conform with state law or court rulings, according to a new grand jury report.

“In particular, delays in assessment and treatment of recently booked mentally ill inmates, lack of adequate local processes to address emergency mental health crises, inadequate 24/7 clinical coverage, and the use of safety cells for acute mental illness episodes need to be addressed as soon as possible,” the grand jury states in its report, “Care of Mentally Ill Inmates in Marin County Jail.”

“I think there is a lot in the report that is worth taking a close look at as we move forward with our initiatives,” Supervisor Damon Connolly told Grant Colfax, county director of Health and Human Services, during county budget hearings Monday.

The grand jury recommends a psychiatrist be available at the jail eight hours per day, five days per week, and be available by telephone 24 hours per day, seven days per week.

In addition, the grand jury says a mental health crisis specialist or psychiatric nurse should be available at the jail 24 hours per day, seven days per week.

It’s also recommended that safety cells never be used as a substitute for adequate medication or other psychiatric treatment and that limits should be placed on how long an inmate may be kept in a safety cell under any circumstances and that classification of inmates as mentally ill should be reviewed by a member of the mental health staff within one hour of booking and that the jail immediately institute programs to provide appropriate non-medication mental health therapy to all mentally ill inmates.

“The report is well-researched and identifies several critical issues that the county is tackling,” Connolly said. “I’m gratified that the budget we are voting on reflects the county’s commitment to move forward with the ‘Stepping Up Initiative.’”

In March, the county of Marin signed on to the “Stepping Up Initiative.” More than 300 counties have joined the effort to divert people with mental illness from jails and into treatment. Connolly is heading the local committee tackling the issue.

Suzanne Tavano, the county’s director of Mental Health and Substance Use Services, said, “I found the grand jury to be very thorough and very diligent.”

“We were identifying areas that we would like to see strengthened through the Stepping Up Initiative. I think there will be some good convergence there,” she said.

According to the grand jury report, there are nearly 10 times as many mentally ill people in prisons and jails than there are in mental hospitals. Beginning in the late 1950s, many of the state’s mental hospitals were closed to treat the mentally ill in the communities in which they live rather than institutionalize them. The grand jury notes that California has just five state mental hospitals compared with 14 in the late 1950s.

The grand jury states that it is estimated that between 10 and 15 percent of jail inmates are severely mentally ill and over half may have some type of mental illness.

Marin County commissioned reports on mental health care in the county jail in 2010 and 2015. The grand jury found that even though both these reports cite insufficient staffing of mental health professionals, staffing at the jail today remains inadequate.

The grand jury reports that no mental health staff are on site for large parts of every day. This has a number of consequences.

“If no mental health professional is available for evaluation, a deputy is charged with making critical decisions,” the grand jury states. This includes screening inmates as they’re booked into jail to determine if they are mentally ill or suicidal.

The lack of personnel also means that drugs are the only form of treatment used in the jail, and then only if the inmate is willing to take them. No individual or group psychotherapy is provided by mental health professionals.

The grand jury says that psychotic inmates who refuse medication are often placed in padded safety cells rather than being treated by involuntary administration of medication, which is allowed by California law and is the common community standard.

The grand jury states that mentally ill inmates are often confined in these padded cells for periods longer than 24 hours. In 2016, mentally ill inmates in Marin County Jail were confined 143 times in safety cells, with each confinement averaging more than 23 hours.

Mental health professionals say that keeping anyone in solitary confinement for 23 hours per day for even a small number of days is likely to cause significant mental health damage.

The grand jury states that Marin County had a three-year contract that made it possible for any severely mentally ill inmate in crisis who refused medications to be transferred to Santa Clara County Jail for involuntary administration of medication. That contract, however, expired in 2015.

Tavano said the Santa Clara jail has a specialized forensic mental health unit that makes it easier to meet the legal requirements for administering medications involuntarily. Tavano said disability rights groups have objected to involuntary administration of medications in other jails.

“There is somewhat of a controversy about it,” she said.

The county recently entered into a similar agreement with California Psychiatric Transitions. The grand jury says even though this contract costs the county $1.45 million a year, the arrangement is inadequate since the facility is located 125 miles away in the Central Valley and is not designed to care for convicted inmates.

In his report to county supervisors on the proposed 2017-18 budget, County Administrator Matthew Hymel said current efforts are focused on increasing the number of behavioral health counselors working in the jail, stabilizing the workforce with permanent staff and expanding discharge planning services. He noted that funding for these positions will not be eligible for Medi-Cal reimbursements.