DOJ finds mental health care, overuse of isolation at Santa Rita Jail unconstitutional

DUBLIN, Calif. - The U.S. Department of Justice Civil Rights Division issued a damning report on Thursday saying that the mental health care system in Alameda County, and in particular, Santa Rita Jail, violate parts of the Constitution.

The report, which federal investigators began at the tail end of the Obama administration, also found that the overuse of housing incarcerated people in isolation, or what's called Administrative Segregation, is unconstitutional.

The Constitution forbids cruel and unusual punishment and requires jails to provide incarcerated people with adequate mental health care. People's rights are denied when jail officials "remain deliberately indifferent to their serious medical needs," the report authors found. 

And the DOJ signaled what might come next: In the next 49 days, Attorney General Merrick Garland may sue the jail in order to correct deficiencies if county officials have not satisfactorily addressed the concerns. 

Kara Janssen, whose firm sued Alameda County Sheriff in 2018 over these very issues of "cruel" forms of mental health care and isolation, said the 45-page report from the federal government is a "really big deal."

Her team has been meeting with lawyers from Alameda County regularly to try to correct some of the issues and avoid a trial. She said more might come out at the next federal court hearing later this month. 

Sgt. Ray Kelly, a spokesman for the sheriff, said: "it's very stale information. The DOJ was here in 2019. We have made massive strides to address these issues."

He added that the jail is under federal monitoring because of Janssen's lawsuit, "so we are actively working through and addressing these issues and cooperating with the DOJ."

Kelly also noted how costly it is to care for those with mental health issues. 

"At the end of the day, this boils down to millions and millions of dollars in staffing ... in clinicians and facilities," he said. "We need a proper criminal justice mental health facility that’s connected to the (overall) mental health system. We’re working on all of that."

READ: A closer look at the 50 inmates who have died at Santa Rita Jail 

The federal civil rights prosecutors began looking into the county and the jail in January 2017. 

Specifically, the DOJ wanted to see whether Alameda County unnecessarily uses psychiatric institutional settings to provide services to adults with mental health disabilities and whether the conditions of confinement in John George Psychiatric Hospital and Santa Rita Jail subject people to "unlawful harm."

And as a result of the investigation, Pamela S. Karlan, the Principal Deputy Assistant Attorney in the General Civil Rights Division, said her office found that the jail has essentially become the largest provider of mental health services in Alameda County because the political leaders have not invested in the proper community services. 

People with mental health disabilities "find themselves unnecessarily cycling in and out of psychiatric institutions and jails because they lack access to proven services that would allow them to recover and participate in community life," Karlan wrote. 

The civil rights prosecutors found that: 

• Alameda County violates the Americans with Disabilities Act by failing to provide services to those with mental health disabilities in the most integrated setting appropriate to their needs by unnecessarily institutionalizing them at John George Psychiatric Hospital.
• Santa Rita Jail fails to provide constitutionally adequate mental health care to those with serious mental health needs, including those at risk of suicide.
• Santa Rita Jail’s use of "prolonged restrictive housing" violates the 8th and 14th Amendment rights of those with serious mental illness.
• Santa Rita Jail violates the ADA by denying those with mental health disabilities access to services, programs and activities because of their disabilities.

Santa Rita Jail typically houses 2,400 people. According to the sheriff, 40% of the population is on the mental health caseload, and about 20 to 25% of the population has a serious mental illness.

For example, the DOJ investigators noted that Housing Unit for male inmates with mental health needs is supposed to act as a therapeutic setting but instead, in reality, it is a restrictive housing unit, because incarcerated people are confined to their cells for the vast majority of the day, either by themselves or one other person. 

Jail records show that, depending on their pod, people in this unit get less than three hours out of their cells each day.

And most of the other incarcerated people received yard time outdoors for as little as one hour per week, with many receiving no yard time. 

Those housed in what's called Ad-Seg are allowed a maximum of only five hours outside of their cells per week. But a review of sample records revealed that many people only received only one or two hours outside of their cells, the DOJ found. When they are allowed to leave their cells, they do so alone—with no opportunity to interact with others—and are still confined to the common indoor pod space. They may not go outdoors.

The DOJ report noted that Sheriff Greg Ahern took the federal visits and briefings seriously. And the civil rights prosecutors noted that by August 2019, the "county had taken some positive steps."

But ultimately, the DOJ investigators said they "remain concerned that there has been little actual progress to resolve the discrimination that is occurring in the County’s mental health system and the unconstitutional conditions and discrimination in the Santa Rita Jail."

For example, jail officials also told the investigators that those in Ad-Seg are violent, or need protection, among other reasons.

But the DOJ review of classification records showed many cases where people were put in isolation that "seemed directly related to their serious mental illness and not due to jail officials’ stated reasons." 

In 74% of the involuntary holds, also known as 5150 holds, conducted by Alameda County Sheriff’s Office, the person was neither threatening nor violent, according to the DOJ review. 

In 2019, a KTVU investigation found that Santa Rita Jail had the highest death rate of any jail in Northern California and that there is a direct correlation between those who die by suicide and those housed in isolation. This death-rate analysis was cited as a footnote in the DOJ review. 

During an interview at the time, Ahern said he was well aware of the issues and he was working on fixing them. 

"We know we’re getting criticized," he told KTVU on a tour of the jail. "If you were an athlete, and if you got criticized for the speed you ran, you’d go out and improve your speed, right?" 

Ahern added somberly: "We strive for zero deaths here." 

Two years ago, nearly 80% of those who died by suicide were also housed in some type of isolated confinement, KTVU found. 

When the Department of Justice investigators visited the jail, the report cited there were 75 people in isolation who had been there for over 90 days.

Eleven of the 14 people who died by suicide between 2015 and 2019 were held in restrictive housing at some point, and half of the other instances of self-harm that the DOJ reviewed occurred while people were in restrictive housing.

Fourteen suicides are more than twice the national average, the report noted.

KTVU's independent reporting shows that 19 of the 50 people who have died in Santa Rita have died by suicide since 2014. 

The DOJ specifically highlighted the 2017 case of Edwin Villalta of Hayward, a 29-year-old former Marine, who had previously spent time at both the jail and John George, and who hanged himself in Ad-Seg 18 days after entering the jail.

He also suffered from mental illness and his sister, Jenny Villata, said that he "was punished for his PTSD."

After being told about the DOJ findings on Thursday evening, Villalta said: "I wish this was done sooner, so my brother, who served this country, and needed help, could have gotten it when he needed it."

Still, she said she was glad these issues are being addressed now.

"Other families shouldn't have to go through what we went through," she said. 

The civil rights prosecutors also called out what happened to Christian Madrigal, 20, of Fremont whom police brought to Santa Rita Jail in 2019 while he was experiencing a mental health crisis.

His parents, Gabriela Covarrubias, and stepfather, Jose Jaime, told police that he was not a danger and was in need of mental health treatment.

His parents also said deputies ignored their requests when they begged for their son to get a mental health evaluation.

Instead, a now-ousted lieutenant ordered Madrigal chained to a cell door, in violation of the sheriff’s office restraint policy, while he was still experiencing severe symptoms. He was left unattended and strangled himself with the chains and later died. 

WARNING GRAPHIC VIDEO: Body cam shows 20-year-old chained to cell door

Santa Rita Jail does offer a lot of programming and transition services to those in the general population, the report found. But incarcerated people with mental health disabilities who are held in the segregated "mental health unit" or in Ad-Seg are denied access to these programs.

"Together, these alleged violations result in a system where people with mental health disabilities in Alameda County find themselves unnecessarily cycling in and out of psychiatric institutions, lacking access to proven, evidence-based practices that would allow them to recover and participate in community life," according to the authors of the report. 

A forensic psychiatrist with more than 20 years of experience and a community psychiatrist with experience as a medical director of a statewide community services provider and as a bureau chief for a state mental health authority helped the federal investigators come to their conclusions. 

There are possible solutions. 

The DOJ said that the sheriff could do more than simply transport people for psychiatric care at John George in San Leandro. Instead, the DOJ suggested that the jail could do more to find community-based services and bridge medications for people upon their release.

At two points during the investigation, a national expert of community-based treatment to people with serious mental illness found that nearly all of the people there would have avoided hospitalization or spent less time in the hospital if they had been given appropriate community-based treatment and received professionally adequate discharge planning to connect with those services.

The sheriff and deputies could change their approach and provide more holistic care and discharge methods, the DOJ suggested, which provides a "multidisciplinary team" intended to help people stay in treatment, manage medication, address crises, secure and maintain housing and employment, and engage in their communities.

Teams should be available 24 hours a day and be able to respond to crises and other needs on a flexible basis, according to the DOJ. 

The DOJ report did not say how much money this would cost.

However, in May 2020, the Alameda County Board of Supervisors approved the sheriff’s request for an additional $318 million over the next three years. And the DOJ said that the current methods at Santa Rita are quite expensive, indicating that community-based therapy would be cheaper. 

Bay Area civil rights activists cheered the report's findings.

And now, many community members are urging the Alameda County supervisors to adopt a more integrated approach to mental health care. 

 "The US DOJ report spells out what we have been tirelessly raising to the county for years, we cannot incarcerate our way out of our problems," said Tash Nguyen, of Restore Oakland and a member of Decarcerate Alameda County. "Whether that be mental illness, addiction, or poverty. I sincerely hope that this report doesn't land on deaf ears, but instead creates the political will and creativity from the Board of Supervisors to rebuild a mental health care system that serves everyone, centering prevention and early intervention."

Lisa Fernandez is a reporter for KTVU. Email Lisa at lisa.fernandez@foxtv.com or call her at 510-874-0139. Or follow her on Twitter @ljfernandez