Scrambling for Solutions as Mentally Ill Fill Jails and Prisons 

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• Source: Humboldt County District Attorney's Office
• Incompetent to stand trial in Humboldt County. The number of cases in which defendants have claimed to be incompetent to stand trial, either personally or through their attorney:

The population of mentally ill inmates in the Humboldt County jail has grown so quickly the sheriff has modified plans for an expansion project to include a program designed to treat defendants ruled mentally incompetent to stand trial.

Mirroring a statewide trend, local officials say they have seen a sharp increase in the percentage of local criminal defendants with mental illness, something Humboldt County Public Defender Marek Reavis estimates up to 50 percent of his office's clients suffer from, along with a significant portion who are also struggling with substance abuse issues. The impact on the court, the jail and the state mental hospital system has been significant.

According to Humboldt County District Attorney Maggie Fleming, 80 local defendants claimed they were incompetent to stand trial in 2014, meaning they were unable to understand the nature and consequences of the legal proceeding against them, or to assist properly in their own defense. That number has risen steadily, she said, with 223 defendants making the claim in 2017, the last year for which complete data is available.

And, Humboldt County is hardly alone. Nearly one-third of California's inmates have documented serious mental illnesses, according to the California Department of Corrections and Rehabilitations. (Read more on the state's mental health crisis and its impacts on the criminal justice system in this week's cover story "Breakdown" on page 11.)

Defendants whose claims are upheld by the court need to be sent to a restorative mental health treatment program — either in a state hospital or a county jail. Once they are deemed "competent," meaning they understand the nature and stakes of their court case, and can help their attorney mount a defense, they are returned to Humboldt County to stand trial.

Complicating matters is the fact that there are not enough treatment beds in the state. According to the Humboldt County Sherriff's Office, on the night of Feb. 13, the jail was housing nine people deemed incompetent to stand trial who were awaiting transfer to a treatment program and another four who were in the midst of proceedings to determine their competency. Sheriff William Honsal said there have been times when 20 or more people already deemed incompetent have been in the jail awaiting transfers, noting that it can sometimes take a defendant up to six months to be transferred to a treatment facility due to the lack of beds statewide.

This can have a substantial impact on both the jail, which has a capacity of 417 inmates at any given time, and the defendants, who may have mental conditions that deteriorate in the jail.

Honsal said his office works with the county Department of Health and Human Services, which has three to five mental health clinicians in the facility on weekdays and others available on-call after hours, and is also exploring the possibility of contracting with a private company to provide mental health care in the facility. The bottom line, Honsal said, is the jail as currently constructed isn't an optimal place to provide therapeutic treatment to the mentally ill.

"We cannot treat people with mental health issues the same as someone in custody on a violent charge," he said. "We have to treat them differently from other inmates. ... Our correctional deputies are trained in (crisis intervention training) and they do get components of mental health training, but they are not mental health clinicians."

Honsal said that the majority of defendants deemed incompetent to stand trial are either sent to Napa State Hospital or to the Sacramento County jail, which has its own jail-based competency restoration program that was started because of the long waits to have defendants placed in state hospitals. But that will soon change.

Honsal said the state has recognized that there is such a need in Humboldt County that it has agreed to reimburse the sheriff's office for the cost of running a six-bed competency restoration program in the jail when it is expanded. (The expansion project is slated to begin in May.)

But competency to stand trial is only the tip of the mental health problem in the criminal justice system locally, officials said, adding that there needs to be an increased effort to get people treatment before they reach a crisis point and enter the system.

Reavis said he's been pleased with the strong push by local law enforcement to train frontline personnel in crisis de-escalation techniques and create a crisis intervention team to specifically deal with mental health emergencies, as well as Eureka police's ongoing partnership with DHHS on the Mobile Intervention and Services Team. Plus, he said his office has been working with DHHS to bring social workers in to "assist clients with the tools, information and resources, including mental health guidance, they need" to decrease contacts with law enforcement.

"There's more need, of course, and I can't tell you what the answers are, but the jails and prisons have become the largest providers of mental health treatment in the country and that's a two steps forward and three steps backward solution," Reavis said.

Fleming doesn't disagree, though she says her office has to put public safety first.

"Everyone benefits when someone's improved mental health reduces criminal activity," she said. "Our office pursues mental health treatment for all defendants that experts conclude would benefit from it. However, we also always seek custody of people with a history of violence. People with mental health issues who represent a clear risk to the public should receive treatment in a locked facility, such as as state hospital."

State hospitals triage patient intake, meaning they first admit those with the most dire need or who pose the largest threats to public safety. This leaves lots of non-violent offenders facing lengthy waits for treatment.

Honsal said it's a great frustration for jail staff to see people brought into custody, clearly in the midst of a mental health crisis, who then stabilize while in the facility and on medication, only to deteriorate shortly after being discharged, starting the cycle over again. While Honsal said the jail works with county mental health to facilitate smooth transitions and continuity of treatment, it appears that for some — especially the homeless — finding the stability to maintain medication and treatment regimens is elusive.

"It is heartbreaking," Honsal said. "I really don't know what the answers are in this but I think, as a state and a county, we need to come up with a plan because the need is growing."

The challenges are similar with misdemeanor defendants, who generally aren't held in custody pending trial even when deemed incompetent to stand trial and are discharged to an out-patient treatment program. For many, this is rife with pitfalls as it's difficult for even robust outpatient programs to provide the stability and oversight many defendants need to learn to live with mental illness.

"I think the best outcome for many misdemeanor defendants mentally incompetent to stand trial would be treatment in a state hospital, but the reality is we have a very difficult time even getting mentally incompetent felons into state hospitals because of the shortage of facilities," Fleming said. "Clearly the criminal justice system would benefit from more resources to evaluate and treat people with mental illness."

Ultimately, Reavis said, this is much more than a criminal justice issue.

"The topic is huge and the problem is growing," he said. "It requires that government and citizens recognize that we have to actually do something about it."

Thadeus Greenson is the Journal's