With 35 to 40 percent of inmates needing treatment, the County Jail system is San Francisco's largest mental health facility. And while the inmate population has decreased by up to 8 percent annually since 2008 through alternatives to incarceration and Proposition 47's restructured sentencing for certain crimes, the city has seen no drop in the number of mentally ill people cycling through its jails — and, in turn, its streets.
“People actually in jail now have more mental illness. That hasn't gone down with the jail population decrease,” said Jennifer K. Johnson, a deputy public defender and co-founder of the Behavioral Health Court, which steers such offenders into treatment instead of incarceration.
And the majority of those folks end up homeless. From November 2014 to November 2015, 57 percent of the nearly 5,000 county inmates seen by the Jail Behavioral Health Services said they'd experienced homelessness.
For Johnson and others, this is a public safety concern and the empathic — if not morally sound — direction criminal justice should go. She was among a group led by the District Attorney's Office that in mid-June quietly released a concept paper for the Behavioral Health Justice Center, modeled after several similar facilities around the nation. Making clear it's not a jail or a replacement for San Francisco's myriad existing services, the concept envisions consolidation and collaboration between mental health care and the law.
The center would offer four tiers of service. Level 1 would create a 24-hour location where law enforcement can admit someone who's in a mental health crisis but does not qualify for a mandatory 72-hour hold. Modeled after a similar approach by Bexar County, Texas, it seems to be needed in San Francisco: Police say they receive 20,000 calls regarding people in mental health crises every year.
“One of the things we hear again and again is police don't have a place to take people” in those situations, Johnson said, adding that this alone would be an important new step for the city to take.
The other levels cover the long process of psychiatric care and substance abuse treatment, leading into residential programs for offenders.
San Francisco already has many services for mentally ill inmates, but the paper says they are fragmented and often difficult to access — which inevitably makes it easier for people to reoffend. The program in Miami-Dade County, Fla., for example, dramatically slashed recidivism: 20 percent for misdemeanants and 6 percent for people accused of felonies.
“There's a giant hole in the safety net between jail and inpatient care,” said Michael Romano, a co-founder of the Stanford Justice Advocacy Project and lecturer at Stanford Law School who also worked on the concept paper. “Hospitals are not equipped for taking care of people in the criminal justice system. And jails make mentally ill people more sick.”
The paper is chock full of numbers to support its position — on March 4, 2015, for instance, 61 percent of those in County Jail charged with misdemeanors had accessed Jail Behavioral Health Services — but the big question is whether anyone will listen. To go from concept to reality, the community and city leaders need to buy in. For now, Johnson said, she and others hope the paper at least starts the debate.
That debate, however, seems to have already started. Last December, the Board of Supervisors rejected $215 million in funding for a new jail, saying the city should invest in things like mental health services instead.