Jail mental healthcare contract comes up short

Nov 19, 2021

November 18, 2021 — The Board of Supervisors declined to approve a $3.5 million increase in the healthcare contract at the county jail this week, which would have brought the agreement total up to just over $19.1 million. But supervisors rebuffed a presentation by top management at Naphcare, which has been providing healthcare to inmates since 2017, calling the documents “thin” and asking tough questions about mental healthcare.

NaphCare Chief Psychologist Amber Simpler told the board that about a third of the inmates are on psychiatric medications. But Dr. Jenine MIller, head of the county’s behavioral health department, took a question about what she thinks is missing from the contract.

“We don’t have a clinician in Mendocino County Jail,” she said. “That was not part of the original contract. That is something I asked. How did we go without getting at least one mental health clinician within that contract...I think it is something that’s missing.” She added that when she spoke with the contractor in April, she received a quote that adding one to two mental health clinicians would cost anywhere from $160,000 to $350,000.

Supervisor Glenn McGourty noted that the current budget allocates $570,000 to mental healthcare services in the jail. “What are we getting for that, and why doesn’t it include someone who does mental health assessments?” he asked.

NaphCare COO Susanne Moore told him that money was for the competency restoration program, which trains inmates to understand their legal predicament so they can assist their defense attorneys and stand trial. 

Supervisor Ted Williams asked about reports he’s heard from his constituents about family members being kept in solitary confinement for long stretches of time without proper medication. He wanted to know why a psychotic inmate patient can’t be forced to accept psychiatric medications. “How many solitary confinements have to do with mental health, and what is the average duration in Mendocino County?” he asked.

Simpler had no ready answer to the last two questions, but said the unmedicated solitary confinement was a combination of the physical layout of the jail, much of which is designed for “single cell placement,” patients’ rights, and bureaucratic finagling. “We offer medication, but there are restrictions as to whom we can compel to medication,” she said. “So it’s not that we’re not offering treatment...we have to respect patients’ rights when they say, I’m not going to take this medication,” even if that patient is psychotic. Simpler added that an order to force medication hinges on the jail based competency program.  “In certain situations, we go through the steps to notify the courts. We get individuals who are involved in the jail-based competency restoration program. They will come attached with an involuntary medication order. But by and large, trying to involuntarily medicate someone outside of the framework takes a lot of steps, and we’ve been able to do that in some acute situations, but by and large, it’s not something the courts do easily, readily or willingly.”

According to Miller, another holdup on forced medication is the professional requirements of the people in charge of declaring the patient inmate incompetent. In Mendocino County, the team that attempts to restore competency to an inmate does not include someone who is qualified to prescribe medications. So if the team fails to render the patient inmate fit for a trial, there is no one who can fill out an order for forced medication. This leads to another round of judicial involvement. “We then have to go back and ask NaphCare after the court order to go through the process to determine the forced order to medicate and then go back to court to get that done. And so it is slowed in Mendocino County because of the processes we have in place, and the professionals that we use don’t allow us to fast-track it as we see in other counties,” she explained

In 2017, then-Sheriff Tom Allman recommended NaphCare to the Board of Supervisors because their bid was more than $400,000 lower than their competitor’s, California Forensic Medical Group, which held the contract at the time. And Allman noted that their insurance was better, carrying six million per incident.

The Board voted unanimously to ask Miller to work with the sheriff’s office and NaphCare to craft an amendment to the contract that Miller feels she can endorse, before bringing it back to the Board again. They also requested the option of a psychiatric evaluation at intake.

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