The United States incarcerates more people than any other nation on earth, and within this vast system, a crisis of mental health care is unfolding.

The numbers paint a stark picture.

According to the Prison Policy Initiative, more than 2.3 million people are incarcerated in the United States, with jails holding the vast majority — more than 10.3 million bookings annually.

Despite successful efforts to reduce jail populations, the percentage of incarcerated individuals with mental illness continues to grow.

According to the Bureau of Justice Statistics, approximately 14% of state prisoners, 26% of federal prisoners, and 20% of local jail inmates have a serious mental illness (SMIs), compared to just 2.5% of the general population.

This disproportionate representation reflects the complex interplay of poverty, lack of access to mental health services, and the criminalization of mental illness.

The consequences of this inadequate care are far-reaching.

Without proper treatment, mental illness can fester and worsen within the confines of a jail. Untreated conditions can lead to self-harm, suicide attempts and violent outbursts.

A 2016 study by the Treatment Advocacy Center found that people with mental illness are 14 times more likely to die by suicide in jail than the general population.

Furthermore, the lack of mental health services contributes to recidivism, as individuals are released without the support they need to maintain stability and avoid future criminal activity.

Understanding the rise of mental illness in jails requires examining broader societal shifts.  The deinstitutionalization movement of the 1960s and ’70s led to the closure of many state mental hospitals, often without adequate community-based support systems taking their place.

This left many individuals with mental illness vulnerable and at risk of homelessness, substance abuse, and involvement with the criminal justice system.

In recognition of the crisis, some national efforts are underway. The bipartisan “Justice for All Reauthorization Act,” passed in 2016, allocates funding for jail diversion programs that connect individuals with mental illness to treatment in the community.

The Stepping Up Initiative, a national effort focused on reducing unnecessary incarceration of people with mental illness, provides resources and technical assistance to local jurisdictions.

These efforts are fragmented and underfunded, however. Many jails continue to operate with limited resources and inadequate training for staff in recognizing and responding to mental illness.

Addressing the mental health needs of incarcerated individuals requires more than just medication; it necessitates a comprehensive approach that includes supportive programs and therapies.

Best practices in correctional mental health care emphasize the importance of screening and assessment upon intake, continuity of care throughout incarceration, and collaboration between correctional staff, mental health professionals and community-based organizations.

Discharge planning is particularly crucial for those with mental illness, many of whom are also unhoused and substance users, making them extremely vulnerable and at risk of recidivism.

Santa Barbara County’s jails are a microcosm of this national crisis. According to a report by Assistant County CEO Tanya Heitman, a staggering more than 60% of the incarcerated population struggle with some form of mental illness.

About 125 out of the total jail population of 740 inmates in our Main Jail have serious mental illnesses, such as schizophrenia, bipolar disorder and Post-Traumatic Stress Disorder.

Despite this high prevalence, the system is ill-equipped to address their needs.

A recent grand jury report and a lawsuit settlement expose a dire lack of resources — a shortage of 24/7 mental health professionals, long waitlists for medication-assisted treatment (MAT), and limited services for those in solitary confinement.

The Sheriff’s Department relies on Wellpath, a private health-care provider, to deliver mental health services. However, concerns exist regarding the quality of care delivered by Wellpath, with reports of long waitlists and a lack of qualified personnel.

The jail’s Behavioral Health Units, established to house and treat inmates with mental illness, are often understaffed.

Furthermore, the county’s meager 16-bed Psychiatric Health Facility is insufficient to meet the needs of those requiring involuntary psychiatric evaluation and treatment (5150 holds). 

This lack of capacity results in prolonged stays in jail for individuals who should be receiving specialized care in a hospital setting.

The human cost of this broken system is immeasurable.

Lives are shattered by untreated mental illness, isolation and violence. Families are torn apart, and the potential for rehabilitation is lost amid the bleakness of the jail environment. 

This crisis also carries a hefty financial burden for taxpayers.

Jail incarceration costs the county an estimated $322 per person per day, according to a recent article in the Santa Barbara Independent.

These resources, squandered on an ineffective approach, could be directed toward evidence-based treatment programs that demonstrably lead to positive outcomes.

The time for complacency is over. Santa Barbara County has a moral imperative to address the deplorable conditions at the Main Jail and the systemic failures that trap vulnerable individuals with mental illness in a cycle of despair.

We must prioritize evidence-based approaches that prioritize rehabilitation and reintegration over incarceration.

Here are some critical steps toward reforming mental health services in our jail:

• Increased funding and oversight: Significantly increase funding for mental health services within the Main Jail at 4436 Calle Real.
• Strengthen oversight of Wellpath to ensure contractually obligated staffing and services are delivered.
• Expand mental health services: Hire and train a sufficient number of qualified mental health professionals to provide 24/7 care, including crisis intervention and de-escalation techniques.
• Invest in diversion programs: Develop and implement robust pre-trial diversion programs that channel individuals with mental illness away from incarceration and toward treatment within the community.
• Expand housing options: Collaborate with community organizations to establish supportive housing options specifically for mentally ill individuals exiting the justice system. Stable housing is crucial for long-term recovery.
• Step-up/step-down programs: Implement comprehensive step-up/step-down programs offering varying levels of care within the jail and community-based settings. This ensures individuals receive the support they need throughout their recovery process.
• Increase Psychiatric Health Facility beds: Advocate for a significant increase in the number of Psychiatric Health Facility beds available to those placed on 5150 holds. This will reduce reliance on jail beds for involuntary psychiatric commitments.

The future of our community depends on our ability to treat mental illness with compassion and provide a path toward healing and hope. All people deserve dignity and respect, regardless of their circumstances.

I urge the county Board of Supervisors, Sheriff’s Department and Wellpath to work collaboratively to implement these critical reforms.

Let us create a jail system that fosters healing, not despair, and invests in the well-being of our most vulnerable community members.

Together, we can build a more just system that prioritizes treatment and rehabilitation, breaking the cycle of incarceration and mental illness for generations to come.