SLO County has highest percentage of medicated jail inmates in the state

No county in California has a higher percentage of jail inmates receiving psychotropic medication than San Luis Obispo, state jail data reviewed by The Tribune and The Sacramento Bee shows.

The county also ranked highest and second-highest in the state, respectively, for the percentage of inmates waiting for mental health treatment and the percentage of open mental health cases at the jail in the eight-year period from Jan. 1, 2010, through Dec. 31, 2017, according to data submitted by the county to the Board of State and Community Corrections.

But SLO County officials dispute the significance of those findings, telling The Tribune that they've misreported their own data for decades in one of those categories and that differing interpretations of the agency's survey questions from county to county may skew their results in the other two.

In response to questions about the reports last week, County Behavioral Health Department Director Anne Robin said that The Tribune's questions revealed that the department has been incorrectly reporting data on the number of people awaiting beds in a mental health facility, and possibly over-reporting other things that other survey participants don't count.

The Sheriff's Office did not respond to requests for comment for this article.

The Board of State and Community Corrections, which is responsible for inspecting and collecting population and other data from local detention facilities, surveys county agencies across the state monthly and publishes its findings in monthly and quarterly jail profile reports.

Jail medications

In comparing statewide trends in county jails, The Tribune and The Sacramento Bee analyzed survey data from January 2010 through December 2017.

Notably, the newspapers found that San Luis Obispo County had the highest per capita rate of inmates receiving psychotropic medications in California during the entire eight-year period, according to the latest survey data.

During that time, about 37 of every 100 SLO County Jail inmates received the medications, more than double the statewide rate of 17 per 100 inmates.

By comparison, Santa Barbara County had a rate of roughly 14 medicated inmates per 100 over the eight-year period.

Tracie Cone, spokeswoman for the Board of State Community Corrections, said those SLO County figures are not inflated by patients at Atascadero State Hospital, which lies within county limits. However, should an Atascadero State Hospital patient be arrested on suspicion of a crime, Cone said, the patient would be booked in SLO County Jail to face charges, and would thus be counted in a jail survey.

Asked about the high local rate of medicated jail inmates, Robin said that she doesn't see it as a negative thing, but rather a sign that inmates are getting medications they need. Still, she said a lack of a standard definition of "psychotropic medication" likely produces discrepancies in the survey.

Robin said that SLO County officials report psychotropic medications as those ranging from sleep aids to medicines used to treat symptoms related to serious mental illness.

"SLO County reports any medication classed as psychotropic," Robin wrote. "As there is no standardized definition, it is possible that other jail settings limit their reports to medications related to the treatment of serious mental illness."

Asked why SLO County would still be an outlier from 57 other California counties in the reports, Robin said she can't speak to how other counties report their data.

Asked if the jail is over-prescribing medication, Robin said: "I don't believe so."

Mental health cases

SLO County also showed the second-highest per capita rate of open mental health cases in California jails from 2010 through 2017, a rate second only to San Francisco County.

During that period, there were about 55 open mental health cases per 100 San Luis Obispo County jail inmates, more than double the statewide rate of 23 cases per 100 inmates.

Similar to the medication issue, Robin said differences between counties' interpretations of "mental health" likely led to SLO County reporting a higher rate than other counties.

Robin participated in a statewide work group last year for the Stepping Up Initiative to develop guidance around the definition of serious mental illness and said, "It was evident in that process that there was no clear, single definition among sheriff or probation representatives."

She said the SLO County Jail's adoption of an electronic records system and an aggressive screening protocol for all inmates during the booking process has lead to more "open" mental health cases, though an inmate may not be actively receiving mental health treatment. Some counties do not share the same protocols, she said.

"Data can be tricky. You have to put it in context," she said. "We screen everybody (at the jail), and we keep cases open longer. That shows up in statistics."

Awaiting mental health treatment

While it may be difficult to fully explain the county's high ranking in some areas, Robin said it has definitely misreported one category for decades.

According to the surveys, SLO County had the highest per capita rate of "inmates assigned needing, or actually assigned to, mental health beds" in California jails from 2010 through 2017.

During that period, there were about 14 SLO County Jail inmates inmates assigned or needing assignment to mental health beds per 100, nearly triple the statewide rate of 5 per 100.

But the county has incorrectly been reporting to the BSCC the classification of the inmates, Robin said, rather than the number of occupied specialized or protective beds, which the survey appears to actually ask for.

For example, the jail has a housing unit that contains cells for inmates in protective custody, or those requiring single-person cells due to mental health or other issues. The county should have been reporting those such beds when occupied.

Instead, they've been reporting inmates classified as assigned to mental health beds outside the jail, such as incompetent-to-stand-trial inmates awaiting a bed at a state hospital or other inpatient facility. The jail routinely houses inmates waiting to go to those facilities to restore competency, driving up the county's numbers.

The agency's instructions read: "Mental health beds should be those specifically used for the special housing of inmates, outside of general population, requiring inpatient mental health care. Do not include those inmates who require mental health treatment but are not in a special mental health housing unit."

"It is now our understanding reviewing the (state survey) definition that the data we were reporting for these criteria was partially incorrect," Robin said. "Using this BSCC interpretation ... we are anticipating our reported number (will) be less than previously reported."

She said the county has sought clarification from the Board of State and Community Corrections and will resubmit corrected information if the agency seeks it.

Andrew Holland's death

Treatment of mentally ill inmates at the jail has become a controversial issue in San Luis Obispo County since the death of 36-year-old Atascadero resident Andrew Holland. Holland, who was diagnosed with schizophrenia, was deemed mentally incompetent to stand trial and was ordered by a SLO Superior Court judge in January 2017 to be transferred to the county's 16-bed psychiatric facility for treatment.

Despite the order, jail officials held Holland in a solitary cell for 10 more days and ultimately strapped him to a full-body restraint chair for another 46 hours after he began hitting himself in his cell. He died of an embolism caused by a blood clot roughly an hour after being released from the chair.

Holland's death led to a $5 million county settlement with his family and an ongoing FBI civil rights investigation.

Over the last year, the county says it has made significant gains in expanding its services for the mentally ill both in and outside of the criminal justice system.

Matt Fountain 805-781-7909, @mattfountain1
Phillip Reese 916-321-1137, @philliphreese
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