CONFRONTING CALIFORNIA’S CONTINUING PRISON CRISIS:

The Prevalence And Severity Of Mental Illness
Among California Prisoners On The Rise
Percent of State Prison Population Receiving Mental Health Treatment, 2000-20161

30
25
20
15
10
5
0

‘00

‘01

‘02

‘03

‘04

‘05

‘06

‘07

Executive Summary
The long-running problem of mental illness in
California’s justice system appears to be getting worse,
according to data recently provided by the California
Department of Corrections and Rehabilitation (CDCR)
and other data presented for the first time in this report.2
Recent reforms to California’s criminal laws have greatly
improved the state’s justice system: prison and jail
crowding have reduced dramatically, sentences are fairer
and more proportionate, recidivism rates among those
freed early under the reforms are far lower than most
released prisoners, and capacity to focus on dangerous
crime has increased. Furthermore, since these reforms
were enacted, overall crime rates in California have
remained on a long-term downward trend.3
Despite these significant legislative and administrative
reforms initiated in part to improve treatment and
conditions for people with mental illness in California’s
justice system, the prevalence and severity of mental illness
among California state prisoners are dramatically on the

‘08

‘09

‘10

‘11

‘12

‘13

‘14

‘15

‘16

‘17

rise. Over 30 percent of California prisoners currently
receive treatment for a “serious mental disorder,” an
increase of 150 percent since 2000.4 CDCR estimates
that the population of prisoners with mental illness will
continue to climb, increasing the need for additional
psychiatric services in the years to come.5 Furthermore,
there is evidence that CDCR’s projections underestimate
the current number of prisoners with mental illness.6
In addition, the severity of psychiatric symptoms of
state prisoners is on the rise. The number of prisoners
diagnosed with the most serious disorders and
transferred to enhanced psychiatric services has increased
dramatically over the past 5 years.7
There is also evidence that criminal defendants in
California with mental illness receive longer prison
sentences than defendants without mental illness. This
disparity exists across all crime categories, from murder to
drug possession. Prisoners sentenced to life terms are also
more likely to be mentally ill.
Finally, despite the substantial criminal justice reforms
responsible for the dramatic reduction of California’s
prison population over the last decade, the population of
inmates with mental illness has not decreased.8 Ironically,

1

these reforms were largely initiated on behalf of inmates with
mental illness suffering under unconstitutional treatment
conditions.9

Among California’s ten largest counties, Alameda
County sends the largest percentage of inmates
with mental illness to state prison (42 percent) and
Orange County sends the smallest (24 percent).12

This report contains new and updated data about the
growing problem of mental illness in California’s justice
system and describes how prisoners with mental illness do
not benefit from some of the most important criminal justice
reforms enacted in the state in recent years.

•	 Recent reforms may inadvertently contribute
to problems facing inmates with mental illness:
Recent sentencing reforms that condition release
on in-prison behavior contribute to the increasing
population of prisoners with mental illness.
Disciplinary rules and access to rehabilitative
programs fail to adequately account for psychiatric
conditions.

KEY FINDINGS
•	 The number of prisoners with mental illness in
California is on the rise: While the overall state
prison population has decreased dramatically, the
number of prisoners with mental illness continues
to climb and is expected to grow in the years ahead.
Over the past decade, the percentage of state
prisoners with mental illness has increased by 77
percent.10

•	 Defendants with mental illness in state hospitals
are deprived of the benefits of recent sentencing
reforms: Hundreds of nonviolent defendants with
mental illness confined in state hospitals are denied
eligibility for early release under sentencing reforms
available to prisoners with the same criminal history
but no mental illness.13
•	 There are insufficient community mental health
treatment services: The total number of hospital
beds in communities throughout California for
individuals who need short-term acute psychiatric
care has decreased 30 percent since 1995.14

•	 The severity of psychiatric symptoms among
California prisoners is also on the rise: Since 2012,
the number of prisoners requiring enhanced mental
health services has increased by over 60 percent.11
•	 Defendants with mental illness receive longer
prison sentences: On average, prisoners with mental
illness in California receive sentences that are 12
percent longer than prisoners convicted of the same
crimes but without mental health diagnoses.

•	 Community mental health treatment is more
effective and less expensive than incarceration:
The annual cost of incarcerating an average state
prisoner in California is over $70,000, not including
mental healthcare costs, while the cost of treating
a person with mental illness in the community is
approximately $22,000.15

•	 Some counties send a disproportionate number
of defendants with mental illness to state prison:

Increase of Prisoners in Enhanced Outpatient (EOP) Care, 2012-201616

7000
6500
6000
5500
5000
4500

MAY
2012

SEPT

JAN
2013

MAY

SEPT

JAN
2014

MAY

SEPT

JAN
2015

MAY

SEPT

JAN

MAY

SEPT

2016

2

Prevalance And Acuity Of Mental Illness Among
State Prisoners On The Rise

Prevalence of Mental Illness
among Latino Prisoners (2017)

Percentage of Overall
Prison Population

%

Percentage of Mental
Health Treatment
Population

50
40

Over the past decade, California’s overall prison population
has decreased by approximately 40,000 inmates, or 25
percent. Over the same period of time, the raw number
of prisoners with mental illness increased by 25 percent.
CDCR anticipates need for additional psychiatric treatment
capacity in the years to come.17 CDCR also reports that
current prison health care services are understaffed.18
In 2000, CDCR identified 12 percent of the state prison
population as mentally ill, diagnosed with serious mental
disorders, including schizophrenia, psychotic, and bi-polar
disorders. Today, that number has grown to over 32 percent
of the state’s prison population. These figures may even
underestimate the overall prevalence of mental illness in
California’s prisons. For example, Latino inmates constitute
the largest group of prisoners by race in California prisons

30
20
10
0

NO. OF PRISONERS
AND % OF TREATMENT
POPULATION

LEVEL
OF CARE

Correctional Clinical
Case Management
System (CCCMS)

• Treatment for “serious mental disorder,” according to certain
DSM Axis I diagnoses (e.g. schizophrenia, psychotic disorder,
bipolar disorder).
• Treatment includes medication, individual and group
therapy.

Enhanced
Outpatient Program
(EOP)

• Segregated housing.
• Treatment for acute onset or significant decompensation,
including delusional thinking, hallucinations, vegetative
affect.
• Global Assessment Score less than 50.
• Treatment includes medication, individual and group
therapy, at least 10 hours per week of structured
therapeutic activities.

Inpatient at Dept. Mental
Health Intermediate and
Acute Care

• Acute exacerbation of a chronic major mental illness,
marked impairment, and dysfunction in most areas.
• Highly structured in-patient psychiatric care with 24-hour
nursing supervision.
• Danger to self or others.
• May require neurological/neuropsychological consultation.
• Anticipated discharge within 30-45 days.

Mental Health Crisis Bed

• In-patient psychiatric care, with 10-day maximum stay.
• Continuous therapeutic assistance to inmate-patients
whose condition requires 24 hours or more to achieve
stabilization.
• Danger to self or others.
• Global Assessment Score less than 30.
• Treatment to control and alleviate symptoms with
emergency medication if necessary.

29,062

77%

7,408

20%

1,093

344

3%

1%

3

yet appear to be significantly underrepresented among the
population of prisoners with mental illness. Latino prisoners
make up over 43 percent of the overall prison population but
only 27 percent of inmates with mental illness.
The severity of inmates’ mental illness is also on the rise.
Since 2012, the number of prisoners referred for intensive
psychiatric treatment as part of CDCR’s Enhanced
Outpatient Services (EOP) has increased by 60 percent.
At the same time, there appears to be a deficit of psychiatric
staffing in CDCR. As of 2015, 32 percent of psychiatrist
positions in CDCR remain unfilled.19 As recently as April
19, 2017 a federal court found ongoing delays in transferring
prisoners who require acute and enhanced mental health
treatment to appropriate psychiatric care services. The court

ordered the CDCR to remedy the situation by May 15, 2017
or face financial penalties.20
Even the United States Supreme Court has acknowledged
that inmates with mental illness in California prisons often
get worse instead of better.21 Administrative penalties
(including placement in secure and segregated confinement)
exacerbate mental illness and lead to a downward spiral
of increased symptoms, noncompliant behavior, and
psychiatric decompensation.22 The Supreme Court noted
that the suicide rate among California prisoners was
nearly 80 percent higher than the national average for
prisoner populations and that over 72 percent of suicides in
California’s state prisons at the time were “most probably
foreseeable and/or preventable.”23

Inmates With Mental Illness Serve Longer
Prison Sentences For The Same Crimes
California defendants with mental illness are sentenced to
longer prison terms than defendants without mental illness
convicted of the same crimes. On average, the sentences
for prisoners with mental illness are 12 percent longer than
other prisoners. This disparity exists across
all crime categories, from murder to simple drug
possession. Prisoners sentenced to life terms are also
more likely to be mentally ill.
Prisoners with Mental Illness Receive Longer Sentences (Feb. 2017)

MENTALLY ILL

NON-MENTALLY ILL

Child Molestation

Kidnapping

Robbery

Burglary

Assault/Battery

Marijuana Sales

Weapon possesion

Petty Theft

0

50

100

150

200

250

The problem is compounded because prisoners with mental illness
are more likely to be denied parole and lose other opportunities
for early release based on good behavior.24
Recent California state court decisions have also contributed to
the problem. For example, a California appellate court recently
ruled that nonviolent defendants confined in mental hospitals are
not entitled to the benefits of voter-enacted reforms. In People v.
Dobson, the Court ruled that defendants with mental illness who
committed nonviolent crimes falling under the Three Strikes law
and were found not guilty by reason of insanity are not eligible to
seek reduction in confinement under the Three Strikes Reform
Act (Proposition 36).25 By contrast, prisoners without mental
illness convicted of the exact same crimes and with the exact
same criminal histories may be released early under the reform.26
Other state courts have ruled that prisoners with mental illness
are ineligible for shorter sentences due to in-prison disciplinary
infractions directly related to mental illness (including prison
rule violations for attempted suicide) despite federal court rulings
questioning CDCR’s prison disciplinary system in its application
to prisoners with mental illness.27
Although the problem of prisoners with mental illness is largely a
statewide issue, disparities appear among California’s 58 counties
in response to crimes committed by defendants with mental
illness. For example, among the ten largest counties in California,
42 percent of defendants convicted and sentenced to prison in
Alameda County have a mental illness, compared to 24 percent of
defendants from Orange County. It is not clear why some counties
send a larger proportion of defendants with mental illness than
others. Even counties with robust behavioral health courts and
diversion programs, like San Francisco, send a higher percentage
of mentally ill defendants to prison compared to the state average.

4

Percentage of Prisoners with Mental Illness, Fifteen Largest Counties (Feb. 2017).

42%
40%
38%
36%
34%
32%
30%
28%

SAN FRANCISCO

ALAMEDA

SACRAMENTO

CONTRA COSTA

SAN DIEGO

FRESNO

KERN

SAN MATEO

LOS ANGELES

SANTA CLARA

RIVERSIDE

VENTURA

20%

ORANGE

22%

SAN MATEO

24%

SAN BERNARDINO

26%

Recent Criminal Justice Reforms
Leave Behind Prisoners With Mental Illness
It is ironic that recent reforms to California’s criminal
justice system have neglected prisoners with mental illness
who, as a group, were largely responsible for initiating the
wave of reform in the first place.
In 1995, prisoners with mental illness won a class action
lawsuit against the California prison system for failing
to provide the most rudimentary level of psychiatric
care.28 After decades of failed settlement negotiations and
attempted remediation by the state, the case ended up in
the United States Supreme Court, which in 2011 affirmed
a dramatic reduction to the state’s prison population.
The explicit purpose of the prison reduction order was
to improve treatment of psychiatrically and medically
vulnerable inmates.29 Since the Supreme Court’s decision,
California’s overall prison population has decreased by over
25 percent while prisoners with mental illness seem to be left
behind.
Coleman and Plata litigation (1991)
In 1991, a plaintiff class including “all inmates with
serious mental disorders who are now or who will in the
future be confined within the California Department of
Corrections” sued then-Governor Pete Wilson and other
state officials in the federal district court for the Eastern
District of California over alleged constitutional violations
within the state prison system. After a 39-day trial,
the court found in Coleman v. Wilson “overwhelming
evidence of the systematic failure to deliver necessary care
to mentally ill inmates.”30

three-judge panel ruled that prison crowding was the
direct cause of unconstitutional conditions for mentally
and physically ill inmates and ordered that the state reduce
its prison population to 137.5 percent of overall design
capacity. In 2011, the United States Supreme Court upheld
the prison downsizing order in a landmark decision,
now titled Brown v. Plata. The Court justified its ruling
by noting that prisoners with mental illness in California
were being denied fundamental rights to human dignity
and directed the state to meet the prison population cap
ordered by the three-judge panel “without further delay.”31
AB 109: Public Safety Realignment (2011)
In response to the Coleman and Plata litigation, the
California legislature enacted Assembly Bill 109, known
as “Public Safety Realignment.” The legislation began
California’s prison downsizing process in earnest by
implementing several reforms designed to reduce the
prison population and improve conditions for inmates
with mental and physical illnesses. The new law provided
that defendants convicted of most nonviolent crimes,
and parolees who violated the terms of their release,
would serve their sentences in county jails rather than
state prison. In addition, the legislature directed that
most inmates released from state prison be supervised by
county probation departments rather than state parole
officers. The legislation also allocated billions of dollars
in new funding to county governments to help absorb
the cost of new criminal justice obligations. Within six
months, the state prison population dropped by more
than 21,000 inmates.32

In 2009, after years of attempted mediation, a special

5

Proposition 36: Three Strikes Reform (2012)
In 2012, California voters enacted Proposition 36, the
Three Strikes Reform Act, amending the state’s recidivist
sentencing law. At the time, most prisoners sentenced
under the Three Strikes law were serving life sentences
for nonviolent crimes. Proposition 36 provided that life
sentences could only be imposed for serious or violent
third strike offenses. The ballot measure also provided a
mechanism for current nonviolent Three Strikes prisoners
to petition for early release if they could demonstrate to
a court that they no longer posed “an unreasonable risk
of danger to public safety.” In making this determination,
courts are instructed to consider the petitioner’s prison
disciplinary record and record of rehabilitation.33 Since
Proposition 36 was enacted, more than 2,200 nonviolent
prisoners sentenced to life under the Three Strikes
law have been released.34 The recidivism rate of those
released under the initiative is more than four times
lower than the average inmate released from prison in
California.35
Proposition 47: Safe Neighborhoods and Schools
Act (2014)
In 2014, voters approved Proposition 47, the Safe
Neighborhoods and Schools Act, further amending
California sentencing laws. Among other things,
Proposition 47 reduced the punishment for six common
nonviolent crimes from potential felonies to mandatory
misdemeanors. Proposition 47 also provided a mechanism
for early release of those serving felony sentences for the
targeted crimes unless a petitioner posed a public safety
risk.36 More than 10,000 inmates convicted of petty
offenses have been released from prison and county jails
under the reform. Again, the recidivism rate of those
released early under this ballot measure is well below the
state’s average recidivism rate.37
Senate Bill 260 and 261: Youth Offender Parole
(2013-15)
In 2013, the California legislature enacted Senate Bill
260 to provide an opportunity for early parole for certain
prisoners who were under the age of 18 when they
committed their crimes. In 2015, the legislature enacted
Senate Bill 261 expanding the new parole opportunity
to prisoners who were under the age of 23 when they
committed their crimes. As of March 2017, over 650
prisoners have been granted parole and released under
these measures.38

Proposition 57: Public Safety and Rehabilitation Act
(2016)
In 2016, voters enacted yet another criminal justice
reform, Proposition 57, the Public Safety and
Rehabilitation Act, which was sponsored by Governor
Jerry Brown. Proposition 57 provides early parole
for certain nonviolent prisoners and instructs CDCR
to expand opportunities for prisoners to earn time
off their sentences by participating in rehabilitative
prison programing. Proposition 57 also amends rules
for charging juveniles in adult court. Proposition 57 is
estimated to reduce the state prison population by 9,500
inmates in the next five years.39

People v. Dobson: Denying Reform
To Inmates With Mental Illness
Last year, in People v. Dobson, the California
Court of Appeal ruled that defendants found
not guilty by reason of insanity are not eligible
for sentence reductions under Proposition 36.40
The case involves Steven Dobson, who in 1998
confessed to the crime of joyriding and pleaded
not guilty by reason of insanity. The Court
committed Mr. Dobson to Patton State Hospital
for the length of his prison sentence—which, in
this case, was 25 years-to-life because Mr.
Dobson was charged under the Three Strikes
law.
Today the maximum sentence for this crime,
taking into account Mr. Dobson’s criminal history,
is six years, and prisoners convicted under the
Three Strikes law may petition for early release
41
under Propositions 36 and 47. Nonetheless, the
Court of Appeal ruled that Mr. Dobson was not
eligible for resentencing consideration, even if he
posed no risk to public safety. The Court
determined that Proposition 36 applied only to
“prisoners” and not to “patients” in state
hospitals—even if the patient committed the
exact same crime as the prisoner.

6

How Prisoners With Mental Illness Are
Left Behind By California’s Reforms
There are several reasons why prisoners with mental illness
are not reaping the benefits of many of the reforms that
have been enacted over the past decade, which were largely
inspired by their poor treatment and groundbreaking 1991
legal action.
First, almost all of the recent reforms enacted in California
emphasize inmates’ in-prison behavior when evaluating
suitability for early release. Reforms that provide early
release and early parole consideration establish that a
prisoner’s suitability for release depends in part on the
presence or absence of prison rule violations committed by
the inmate under review.42 However, as previously discussed,
prison conditions are likely to exacerbate a prisoner’s
existing mental illness and deteriorating behavior. For
example, CDCR regulations provide disciplinary sanctions
for prisoners who attempt suicide.43 This sanction results
in loss of privileges within prison, loss of custody credits
that can reduce the inmate’s sentence, loss of rehabilitative
programing opportunities, and an increase in the prisoner’s
custody security level.
Even prisoners with mental illness who do not commit
rule violations and who diligently comply with psychiatric
treatment may have been disadvantaged. These inmates
were frequently unable to participate in rehabilitative
programming, such as vocational training or educational
classes, because of conflicts with their treatment scheduleand
mental health programs. The recently-approved emergency
regulations implementing Proposition 57 provide that
inmates with mental illness will earn credit for participating
in their structured therapeutic activity, among other
rehabilitative programs.

46

Cost of Mental Health Treatment

CDCR Mental Health
Crisis Bed

$345K

State Mental
Hospital Bed

$218K

Cost of Average
CDCR Inmate

$75.2K

Opportunities For Community Based
Mental Health Services
Research shows that community based psychiatric treatment is frequently more effective and significantly less
expensive than in-prison treatment at preventing crime
and reducing incarceration rates for people with mental illness.44 There are a number of public programs supporting
various community treatment options in California.

Community-Based
Mental Health Bed

$21.9K

Marginal Cost of
Parolee Supervision
w/Mental Health
Treatment

$7.9K

The Affordable Care Act (ACA):
The ACA extended health coverage, including mental
health services, to more than 4.7 million low-income

7

Californians.45 Reducing federal funds, amending the
ACA, or cutting eligibility to Medi-Cal threatens the
mental health care of indigent Californians, and would
likely create new pressures on the criminal justice system.

and out-patient services, while serving as a hub for police
and community based mental health treatment programs
in San Francisco.48

Institute for Mental Disease (IMD) Exclusion:
Federal law has severely restricted the availability of
residential mental health treatment programs. Under the
Institute for Mental Disease (IMD) exclusion in the original 1965 federal Medicaid law, residential mental health
facilities with more than 16 beds are prohibited from
receiving federal funding. The exclusion was intended to
avoid large “Cuckoo’s Nest” mental health hospitals and
place primary responsibility for psychiatric services on
state and county governments. The exclusion has effectively prohibited Medi-Cal-funded residential mental health
treatment.
Proposition 63: Mental Health Services Act:
In 2004, California voters approved Proposition 63, which
levied a one percent tax on personal incomes over $1
million to pay for mental health services. In 2013, state
lawmakers passed Senate Bill 82, distributing income generated by Proposition 63 to counties to improve mental
health treatment services. In 2016, lawmakers enacted Assembly Bill 1618, the No Place Like Home Act, providing
another $2 billion from Proposition 63 to build housing
for those with mental illness.47
Proposed San Francisco Behavioral Health Justice
Center (BHJC):
San Francisco police receive approximately 20,000 emergency calls for people in mental health crises every year.
Over 35 percent of San Francisco jail inmates receive mental health services, and the number of mental health crisis
beds in the county general hospital was cut by two-thirds
in recent years. In January 2016, San Francisco District
Attorney George Gascón proposed a new kind of facility
to help address this problem using city money already set
aside for a new jail building. The program would serve as a
24-hour facility for police to redirect suspects with mental
illness away from traditional jail and provide different levels of services, depending on the criminal charges involved
and the severity of an individual’s psychiatric diagnosis. As
envisioned, the BHJC would include a secure level of care
for the most serious cases, as well as residential treatment,

Cost of Incarceration Compared to
Residential Community Treatment49
30K

25K

Contract rate
for out-of-state
prison bed

20K

15K

Residential
Community
Treatment

10K

5K

0

CONCLUSION
Despite success in reducing prison overcrowding in
California, recent reforms have failed to adequately
address the role of mental illness in the criminal
justice system. The number of prisoners with mental
illness in California is on the rise and the seriousness
of their psychiatric conditions is worsening.
Furthermore, the state prison system remains under
federal court order for insufficient staffing, improper
security procedures for inmates with mental illness, and
failing to provide adequate psychiatric treatment.
Many reforms are needed to address the intersection
between mental illness and criminal justice. This
report is intended to highlight the growing problem
in California, help provide new evidence and context
surrounding the state’s mental health prison crisis, and
encourage policymakers and stakeholders to develop
and embrace new and lasting solutions to one of the
most vexing issues facing California’s justice system.

8

1

“New Challenges Raised by Decarceration: Discrimination in Population
Reduction Tactics,” presented by Michael Bien at Western Society of
Criminology (Feb. 2017) (citing HC-POP Summary of Outpatient
Population (enclosure 6A, Coleman monthly report), CDCR monthly
population report archive).

18

2

20

Unless otherwise noted, all data in this report were provided by CDCR in
February 2017. For purposes of this report, a “prisoner receiving mental
health treatment” or “prisoner with mental illness” means the prisoner was
reported as receiving care in the CDCR Mental Health Delivery System as
of February 6, 2017.
3

See Cal. Dept. of Justice, California Justice Information Division, “Crime
in California, 2015.”
4

Cal. Dept. of Corrections and Rehabilitation and Cal. Correctional Health
Care Services, “Mental Health Bed Need Study,” (Jan. 8, 2016).

Coleman, Doc. No. 5564, “Special Master’s Report on the Status of
Mental Health Staffing and the Implementation of Defendant’s Staffing
Plan,” (filed Feb. 6, 2017).
19

Id.
Coleman, Doc. No. 5610, “Order,” (filed Apr. 19, 2017).

21

See Plata, 563 U.S. 493.

22

See Jeffrey Metzner and Jamie Fellner, “Solitary Confinement and Mental
Illness in U.S. Prisons: A Challenge for Medical Ethics,” in Health and
Human Rights in a Changing World (2013).
23

Plata, 563 U.S. at 504.

24

5

See, e.g., People v. Nolkemper, Los Angeles Sup. Ct. Case No. LA03006001 (Nov. 3, 2016) (finding petitioner unsuitable for release based on prison
rule violations directly related to petitioner’s mental illness).

6

25

Id.

See, e.g., Doris James and Lauren Glaze, “Mental Health Problems of
Prison and Jail Inmates,” U.S. Department of Justice, Bureau of Justice
Statistics (Dec. 2006) (reporting that 56 percent of state prisoners and
64 percent of jail inmates nationwide had a recent history or current
symptoms of a mental health problem).

See, e.g., People v. Dobson, 245 Cal. App. 4th 310 (2016) (holding that
offenders confined in state mental hospitals are ineligible for certain
sentencing reforms).
26

Id; Cal. Penal Code § 1170.126.

7

27

8

28

9

29

“New Challenges Raised by Decarceration,” M. Bien at Western Society of
Criminology (Feb. 2017).
Id.

See generally Brown v. Plata, 563 U.S. 493 (2011); Coleman v. Wilson, 912
F. Supp. 1282 (E.D.CA 1995); see also Jonathan Simon, “Mass Incarceration
on Trial: A Remarkable Court Decision and the Future of Prisons in
America,” (The New Press 2014).
10

See “New Challenges Raised by Decarceration,” M. Bien at Western
Society of Criminology (Feb. 2017).
11

CDCR and CCHCS, “Mental Health Bed Need Study,” (Jan. 8, 2016).

12

This does not account for the fact that the prevalence of mental illness
differs between counties. Among the largest counties in California, Contra
Costa county has the highest percentage of Medi-Cal enrollees receiving
mental health services (7.2%) and Orange county has the lowest (3.4%).
See Behavioral Health Concepts, “Medi-Cal Specialty Mental Health:
External Quality Review, MHP Final Report, 2015-16,” (Jan. 2016).
13

Dobson, 245 Cal. App. 4th 310.

14

Cal. Hospital Association, “Psychiatric Inpatient Bed Data,” (Oct. 1,
2013).
15

Legislative Analyst’s Office, “How Much Does It Cost to Incarcerate
an Inmate?” (Dec. 2016); Judicial Council of California, “Task Force for
Criminal Justice Collaboration on Mental Health Issues: Final Report,”
(Apr. 2011).
16

“New Challenges Raised by Decarceration,” M. Bien at Western Society
of Criminology (Feb. 2017).
17

CDCR and CCHCS, “Mental Health Bed Need Study,” (Jan. 8, 2016).

Brown v. Coleman, 28 F. Supp. 3d 1068 (E.D.CA. 2014); Nolkemper, Los
Angeles Sup. Ct. Case No. LA030060-01.
Coleman v. Wilson, 912 F. Supp. 1282 (E.D.CA. 1995).
Plata, 563 U.S. 493.

30

Coleman, 912 F. Supp. at 1316.

31

Plata, 563 U.S. at 545.

32

Cal. Dept. of Finance, “California Budget Summary 2017-18, Public
Safety,” (Jan. 2017).
33

Cal. Penal Code § 1170.126.

34

Plata, Case No. 2:90-cv-00520, Doc. No. 2931, “Defendants’ March 2017
Status Report in Response to February 10, 2014 order,” (filed Mar. 15,
2017).
35

Erik Eckholm, “Out of Prison and Staying Out After 3rd Strike in
California,” The New York Times (Feb. 26, 2015).
36

Cal. Penal Code § 1170.18.

37

Stanford Law School, “Proposition 47 Progress Report: Year One
Implementation,” (Oct. 2015).
38

Plata, Case No. 2:90-cv-00520, Doc. No. 2931, “Defendants’ March 2017
Status Report in Response to February 10, 2014 order,” (filed Mar. 15,
2017).
39

Cal. Dept. of Finance, “California Budget Summary 2017-18, Public
Safety,” (Jan. 2017).
40

Dobson, 245 Cal. App. 4th 310.

9

41

See Cal. Penal Code §§ 1170.126, 1170.18.

42

Id.

43

See Tit. 15 CCR § 3315(a)(2)(W). CDCR’s disciplinary rules were revised
in 2015 to require mental health assessments and mitigate penalties if the
violation was caused by the inmate’s mental illness. (May 4, 2015 Stipulated
Response and Order, Coleman Docket No. 5305.)
44

Judicial Council of California, “Task Force for Criminal Justice
Collaboration on Mental Health Issues: Final Report,” (Apr. 2011).
45

Cal. Dept. of Health Care Services, “Affordable Care Act,” (2017).

46

According to the LAO, the marginal cost of incarcerating a CDCR
inmate may be calculated in several different ways. The average annual cost
of incarcerating a CDCR inmate is $75,210 (not including mental health
costs); the marginal rate of housing an additional person in a state-owned
prion is approximately $10,000 per year (not including mental health

costs); the average marginal cost of staffing for inmates with mental illness
is approximately an additional $6,800 per inmate annually (not including
medication). In addition, note that according to CDCR regulations inmates
should not be housed in Mental Health Crisis Beds (MHCBs) for more
than 10 days, although in some cases inmates may be housed in these beds
for longer periods of time. Data provided by the Legislative Analyst’s Office
(Apr. 2017).
47

Cal. Assembly Bill 1618, Chapter 43, Statutes of 2016.

48

Craig Haney, et. al., “Justice That Heals: Promoting Behavioral Health,
Safeguarding the Public and Ending Our Overreliance on Jails,” (Jun.
2016).
49

See CDCR, “An Update to the Future of California Corrections,” (Jan.
2016); Judicial Council of California, “Task Force for Criminal Justice
Collaboration on Mental Health Issues: Final Report,” (Apr. 2011).

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