Recognizing mental illness before making an arrest in SLO County

Oct 2, 2019

One-third of San Luis Obispo County jail inmates have mental illness, and half the jail population is either homeless or doesn’t have stable housing on the outside. That's according to county health experts, who said the numbers have held steady even as they work to improve jail healthcare. The county board of supervisors got an update on jail health care this week and discussed ways to keep some of the area’s most vulnerable from ending up behind bars. But not all county jurisdictions are embracing preventative methods.

In February, the San Luis Obispo County Jail made a switch: county staff no longer provide jail health services. Now, Wellpath, a private company, does.

Christy Mulkerin is the chief medical officer for the San Luis Obispo County Sheriff’s Office.

"Wellpath utilizes more mid-level practitioners, in addition to physicians,” Mulkerin said. “Which has really enabled us to see more people. It’s a more cost-effective way to deliver primary care.”

Mulkerin said the healthcare services for inmates have almost doubled since the change. They now receive more hours with MDs, psychiatrists and dentists, and all inmates receive a mental health screening. The jail now has the remodeled Behavioral Health Unit, which helps treat inmates with mental health and substance abuse issues. And there’s the new 77-bed Kansas Max Housing Unit, which houses inmates with mental illness, disabilities, and other needs, together, not in isolation.

“[It] has allowed them to have a sense of community and more socialization,” Mulkerin said. “Postivitive behavior is rewarded, such as exercising, keeping a clean cell and taking medication.”

The switch to Wellpath comes two years after the death of Andrew Holland, a mentally ill inmate who died after being tied to a restraint chair for almost two days. Holland wasn’t alone— so many inmates died in custody over the past five years, the county jail was named one of the deadliest in the state. Since Wellpath took charge in early 2019, one inmate has died in custody.

This week, the San Luis Obispo County board of supervisors commended Wellpath’s improvement of county jail health operations.

“But it’s not without great irony that we are now offering much greater services to people with mental illness that sometimes we are in out own community,” said Supervisor Adam Hill.

The board and health officials say they want to holistically change the county’s approach to mental health. The county’s part of the Stepping Up Initiative, aimed at reducing the number of people with mental illness in jail. That means improved health services in the jail as well as giving people support when they get out.

“I think that coordination inside and out is the next frontier,” said Supervisor Bruce Gibson.

Gibson and Hill said they want to see crisis intervention integrated into all county law enforcement training to keep some people with mental illness out of jail in the first place. Crisis Intervention Training (CIT) helps police recognize the signs of mental illness before making an arrest.

Gibson said he’d like to see officials press for crisis intervention training on a county-wide level.

“We have jurisdictions who have not done it,” Gibson said. “Apparently there are jurisdictions who are not enthusiastic about having their personnel do it.”

“We have seven cities,” County Sheriff Ian Parkinson said. “Many of those cities bring inmates into custody every day. If they are not CIT trained or following the guidelines or direction of Stepping Up, we fail county-wide.”

After Tuesday’s meeting Parkison told KCBX News all of his employees take 40 hours of crisis intervention training, compared to the state’s recommended eight hours of training.

“What we have really noticed is the understanding of mental illness has improved,” Parksinson said. “The ability to de-escalate [a situation] has improved.”

But Parkinson said the training can be expensive for some agencies to fill positions while employees get trained, so some cities haven’t done it. However, Parkinson and county officials wouldn’t say which cities haven't done the training

“Some cities are better than others and our push is going to be to get them all on board in the same way we are,” Parkinson said.

The county’s administrative office has been tasked with trying to get all seven cities to do the training. But no one is sure how long that will take.