December 16, 2021 — The Mendocino County Board of Supervisors approved the contract, including a $3 million increase, with the medical provider for inmates at the county jail this week, with the proviso that the contract be amended to include a mental health clinician. Dr Jenine Miller, the head of the county’s Behavioral Health Department, agreed to work with NaphCare, the provider, on those amendments, and report back to the board in 60 days.
Supervisor Ted Williams asked Miller for her assessment of the mental healthcare in the current contract. “Are we completely in compliance, in providing a level of care that meets standards?” he asked.
“Without a mental health clinician and expanding mental health services in the jail, no, we’re not,” she replied. “If we approve this contract, with adding the clinician, we’ll be closer to where we need to be, mental health-wise.” She added that there is a number of ways in which the matter can be investigated, if a patient inmate claims they did not receive services.
However, there has been at least one instance of a former inmate who complained about requesting a mental health assessment and not receiving it. Williams said some of his constituents have told him that they fear retribution if they report problems in the jail.
Miller said that, in addition to a mental health clinician, she would need to take a much closer look at the details of the treatment. “I have made it clear with NaphCare and the jail, for me to really get on board with their contract, we need to do audits,” she insisted. “NaphCare and the jail have agreed, they would be fine with Behavioral Health doing a quarterly audit.”
Dr Jeff Alvarez, the Chief Medical Officer at NaphCare, added that the National Commision on Correctional Healthcare does conduct an independent audit every three years and would be back onsite this year.
The mental healthcare portion comprises 17%, or less than a fifth, of NaphCare’s contract. Another 17% is the jail-based competency treatment program, which is funded by the Department of State Hospitals. A significant percentage of the inmates are receiving some form of mental healthcare. Dr. Amber Simpler, NaphCare’s Chief Psychologist, broke down the numbers as of Tuesday morning: out of 305 patients, 120 were on antidepressants; 111 had had an evaluation outside of the initial intake process; “and we know about 58 of those individuals were on anti-psychotic medication,” which is the first course of treatment for schizophrenia spectrum disorders. About 46% of the people who had been in isolation also had mental health issues, she reported.
Williams pressed to find out how many mentally ill inmates are isolated, often without medication. Simpler said deciding who ends up in what kind of housing is beyond the scope of NaphCare’s responsibilities, but they do inform jail staff if isolation is contra-indicated. Lt. John Bednar, who works in the jail, did not have statistics on how many people have been placed in isolated housing this year, but that their predicament is discussed at regular meetings.
“No one is placed on administrative separation for being mentally ill,” he said, adding that inmates are isolated if they are violent or “because they have been, or potentially could be, victimized in the general population setting.”
With the contract expiring at the end of the year, not approving it wasn’t really an option. Williams moved approval of the amended contract through the end of 2022, “and direct Dr. Miller to coordinate an amendment to provide mental health services at an appropriate level of care and review mental health patient statistics and report back to the board within 60 days,” he specified.
The motion passed unanimously.
Audio version of "BoS approves jail medical contract, with condition that it be amended soon"