California, Kern seek ways to reduce number of incarcerated mentally ill

Apr. 29—The last time Brik McDill ventured to Los Angeles, it was to the Los Angeles International Airport. The Kern County resident sped along Interstate 405 toward arrivals, scooped up his family, and exited on Century Boulevard. As he continued out of the airport thoroughfare that day in 2021, he stared back in disbelief at the line of tents pitched along an underpass.

"It was a righteous city of tents," McDill said. "My heart broke for these people."

In his 50 years as a psychologist — including 20 years as a prison therapist — McDill has watched the issues of homelessness, prisons and mental health become increasingly intertwined. Yet, in recent years, as the state approved a flurry of changes to how it deals with mental health problems, he remains unconvinced anything will improve.

"No person shall be deprived of life, liberty and property without due process of law," McDill said, in reference to habeas corpus. "That's what created a lot of the problems at mental hospitals."

Kern and other counties announced last week they are partnering with California's Department of State Hospitals on another venture: establishment of the Incompetent to Stand Trial Solutions Workgroups. This translates to a committee formed at the local level to develop "local solutions" to remedy the state's mental hospital waitlist and those incarcerated for behaviors related to their mental illness.

As of April 2022, more than 1,700 people are awaiting admission to one of the five state hospitals. The state hospital system only take patients who are mandated for treatment by a criminal or civil court judge.

In the interim, they remain in prison. In Kern County specifically, a 2020 report by California Health Policy Strategies found that roughly 87 percent of jail-incarcerated people had an open mental health case, a 70 percent increase since 2009.

Kern's program, set to start July 1 and continue through June 2028, is funded by $500,000 broken into 20 bimonthly installments.

Stacey Kuwahara, director of Kern Behavioral Health and Recovery Services, said it's too early to give specifics on the workgroup, but expressed optimism for what it could accomplish, such as diverting people into specific, local programs and planning for Community Assistance, Recovery and Empowerment, or CARE Court.

"You don't have enough state hospital bed resources for the people that are being directed to that," Kuwahara said. "So we are looking at community-based resources to help people to ensure people are being connected to the right services and resources at the state level of care."

McDill isn't as optimistic. To him, this is the latest effort by government in a succession of well-intended legislation to treat mental health issues, and part of where, he explains, California can attribute its woes. The problem took root in the 1950s, with "deinstitutionalization," or mass release of patients from mental health institutions — from a peak of 37,000 in 1955 to under 7,000 seven decades later.

Fueled by the Short-Doyle Act in 1959, the expectation was that patients would receive services in community settings, as opposed to a state facility. But funding for that transition never materialized.

"I saw that slow-motion trainwreck happen," McDill said. "It was a good idea, well-intended, but it failed."

Meanwhile prison populations ballooned, as did the prevalence of mental illness among inmates.

"If you look at the number of patients in the mental hospital system and compare it to the population in the prison system, you find that when deinstitutionalization started there was a parallel increase in the population of state prisons," McDill said. "It was a perfect parallel."

All the while, hospitals emptied and prisons filled, which led to concerns in the 2000s and 2010s over mass incarceration and the reality that prisons had become de facto mental health facilities. State prisons proved to violate the cruel and unusual punishment clause of the Constitution for not providing adequate mental health care, largely because of overcrowding.

"As the mentally ill would leave the hospitals, they'd go to the street, they'd get arrested, be brought to jail and they would then reoffend and reoffend and reoffend," McDill said. "After three or four pass-throughs, they'd be sent to prison."

Geared under a 1995 ruling, laws followed — Assembly Bill 109, Proposition 47, Proposition 57, to name a few — that redefined criminality to reduce prison numbers.

McDill, who worked his final post as a prison psychologist at the California Correctional Institution in Tehachapi from 1994 until 2014, once again watched the flux. For a while, he couldn't hire fast enough.

In December 2022, the California Department of Corrections and Rehabilitation announced seven prisons would close or partially close, including some of Tehachapi's facilities.

"What's going to happen to those mentally ill in those yards?" McDill said. "They'll just be sent back to the county of their crime and then back onto the streets."

But others are more optimistic, since a shift in California politics has resulted in adequate funding by the state for these kinds of communal programs.

"We have a lot of supportive housing," Kuwahara said. "And the issue isn't housing, but rather the resources for when people don't have the money to pay for that housing."

While not against their efforts, McDill believes many programs, such as CARE Court, violate constitutional law.

CARE Court, passed in September 2022, allows for an authority figure — a police officer, behavioral health provider or family member — to request a court referral for mandatory treatment for someone believed to be suffering from a mental health crisis, even if that person has not committed a crime.

CARE Court has the support of local and state officials, including Kuwahara, even as it has garnered opposition from advocacy groups like the ACLU, which said in a 2022 letter that it restricts people's right to choose whether they want treatment.

"It harks back to a dark era when forced treatment of people with serious mental health conditions was the norm," co-wrote Eve Garrow, an ACLU homelessness policy analyst and advocate, and Kath Rogers, an ACLU staff attorney. "It would unravel decades of hard-won progress by the disability rights movement to secure self-determination, equality and dignity for people with disabilities."