by Matt Clarke

On April 22, 2021, the Civil Rights Division (CRD) of the U.S. Department of Justice (DOJ) issued a notice to Alameda County, California and its Santa Rita Jail, finding that both engage in practices which violate the Americans with Disabilities Act (ADA), 42 U.S.C. §§ 12131-12134, and the U.S. Constitution.

The investigation, conducted under the Civil Rights of Institutional Rights Act (CRIPA), found that by unnecessarily institutionalizing people at its John George Psychiatric Hospital (John George), the county fails to provide services to individual with mental disabilities in the most appropriate setting. Other findings included that the jail failed to provide constitutionally adequate mental health care to prisoners with serious mental health needs, including suicidal prisoners; placed prisoners with serious mental illness in prolonged restrictive housing under unconstitutional conditions; and violated the ADA by denying prisoners with mental health disabilities access to programs and services due to their disabilities.

“The ADA protects individuals with mental health disabilities from unnecessary institutionalization, and the Constitution guarantees all prisoners necessary medical care, including mental health care,” noted CRD Principal Deputy Assistant Attorney General Pamela S. Karlan. “Our investigation uncovered evidence of violations that, taken together, result in a system where people with mental health disabilities in Alameda County find themselves unnecessarily cycling in and out of psychiatric institutions and jails because they lack access to proven services that would allow them to recover and participate in community life.”

The CRD found that, on any given day, hundreds of people are locked into closed facilities at one of several large sub-acute psychiatric facilities or John George.

Institutionalization at the sub-acute facilities averages six to 24 months. Some stays at John George last weeks, or even months, at which point, due to a lack of alternatives, patients are sent to other segregated psychiatric facilities. Most of the patients in the county’s closed psychiatric facilities could live in their own homes in the community if provided services such as Assertive Community Treatment and Permanent Supported Housing. But such services are not available in Alameda County.

The CRD found that the jail’s mental health program failed to provide constitutionally adequate mental health treatment. It had inadequate psychotherapy, treatment planning, discharge planning, programming and treatment, and supervision of suicidal prisoners. The jail also subjected prisoners with serious mental illness to prolonged restrictive housing under unconstitutional conditions, including a failure to provide adequate mental health care.

The CRD noted that half of the prisoners in restrictive housing were believed to have serious mental illness, half the instances of self-harm reviewed occurred in restrictive housing, and 11 of the 14 prisoners who committed suicide between 2015 and 2019 were held in restrictive housing at some point. The CRD also found that jail prisoners with mental health disabilities who were held in the “mental health unit” or in administrative segregation were denied access to an array of programming and transition services that were available to prisoners in general population.

“In Olmstead v. L.C., the U.S. Supreme Court held that Title II of the ADA requires public entities to provide community-based services to persons with disabilities when appropriate services can reasonably be provided to individuals who want them. However, on any given day in Alameda County, hundreds of people are institutionalized for lengthy stays at one of several large, locked psychiatric facilities,” wrote Karlan.

The 45-page CRD report elaborates on how those incarcerated in the Santa Rita Jail experience severely deficient mental health treatment, lengthy stays in restrictive housing, and discrimination on the basis of their disabilities, all of which it says can result in serious harm or even death while incarcerated. Such conditions can also place prisoners at serious risk of frequent, unnecessarily lengthy psychiatric institutional stays after release.

The CRD’s investigation began in January of 2017 and included multiple visits to county facilities, the last of which took place in August 2019. After being briefed on the CRD’s preliminary concerns during the visits, county leadership, including the sheriff, promised progress. By the last visit, some changes had been made but there had been “little actual progress.”

John George has 69 beds in three units and a psychiatric emergency room that is used for crisis stabilization. The county also has 200 beds for long-term, sub-acute inpatient services in several “sub-acute” facilities. Many more people are housed at “board and care” facilities providing residential services and minimal daily support.

The jail has a capacity of around 4,000, but only held an average of around 2,400 prisoners during the investigative period. About 40% of jail prisoners are on the mental health caseload. It is estimated that over half of them have serious mental illness. The county’s Behavioral Health Care Services provides mental health care at the jail.

Prisoners in the jail’s restrictive housing can spend months locked in their cells except for a maximum of five hours per week. Those with serious mental illness have little to no access to mental health treatment, therapy, and programming, placing them at substantial risk of serious harm in violation of the Eighth and Fourteenth Amendments, according to the CRD notice.

Although jail officials tried to justify lengthy housing of prisoners with serious mental illness in restrictive housing by claiming they would otherwise be violent or would be harmed by other prisoners, the CRD inspectors’ review of jail classification records showed instances of such prisoners being placed in restrictive housing because of their serious mental illness and not the jail officials’ stated reasons. A review of restrictive housing records showed that prisoners there were actually being permitted only one or two hours outside of their cells per week, not the theoretical five hours. Such isolation can intensify mental illness and lead to self-harm or suicide. Indeed, there were five suicides in restrictive housing between 2015 and 2019.

The notice found that jail prisoners placed in restrictive housing due to their mental health disabilities were being denied access to the programming available to prisoners in general population in violation of the ADA. The programming included academic education, art therapy, culinary arts, computer coding, job readiness, financial literacy, and hospitality. They were also denied access to transition services in education, employment and housing provided by community-based organizations. The jail was found to have no release planning for prisoners with serious mental illness. The result of this lack of support was repeated institutionalization at the jail, John George, and the sub-acute facilities—incarceration by another name.

The usual course of events following a CRD notice is a settlement.

Editor’s Note: Anyone can file a report or complaint to the CRD using this website: civilrights.justice.gov or sending it to: U.S. Department of Justice, Civil Rights Division, 950 Pennsylvania Avenue, NW, Washington, D.C. 20530-0001. 

Source: DOJ Press Release 21-358.

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