During Mental Health Awareness Month, Alameda County Supervisors Have an Opportunity to Affirm #BlackLivesMatter by Adopting Care First, Jail Last Policy

By Natasha Baker, Esq., and Dr. Kelan Thomas, PharmD, MS, BCPS, BCPP; Additional coauthors: Heather Bromfield, Sruthi Veeragandham and Casey McAlduff

In 2018, Daniel Rivers broke into an empty vehicle. A Black man diagnosed with schizophrenia, he had been homeless for years and was searching for refuge. Despite his history of mental illness, he was arrested, charged with felony vandalism, and eventually taken to Santa Rita, Alameda County’s jail.

Once in jail, Daniel (whose name has been changed for confidentiality) received inadequate mental health care, and both his mental and physical health deteriorated. He gained thirty pounds due to poor food quality and lack of access to exercise. Since Daniel was not fully able to understand or trust jail staff who prompted him to sign release forms, his family members struggled to learn about his condition and advocate for him. After 18 months at Santa Rita, Daniel was released. According to Daniel’s mother, his time at Santa Rita left him “traumatized and zombie-like.”

Two weeks ahead of National Mental Health Month, California State Sen. Sydney Kamlager (D-LA) noted that 70% of 911 calls are for mental health crises and chairperson of the California Legislative Black Caucus Sen. Steven Bradford (D-Gardena) said, “No more kneeling and social media posts. We’ve had enough of the performative acts. Real police reform is needed now.”

In California, as across the nation, too many people with mental health challenges are criminalized rather than treated. Santa Rita, which is the largest area jail — larger than many state and national facilities — is a poster child for systemic flaws. The Alameda County Sheriff’s office acknowledges that 44 percent of the people at Santa Rita are in need of mental health services, but a scathing report by the U.S. Department of Justice (DOJ) released in April, found that the system routinely denies mental health treatment, isolates ailing prisoners for prolonged periods in restrictive cells, and fails to provide them programming and transition services prior to release. The Board of Supervisors and District Attorney regularly respond to concerns about mental illness in Santa Rita by pointing to mental health diversion programs, but a recent ACLU report found that in 2017 and 2018 only 5% of people charged with crimes had any charges diverted.

We now have a chance to help Daniel and more than 1,000 others with mental illness incarcerated in Alameda County by passing the Decarcerate Alameda County Coalition’s proposed Care First, Jails Last resolution. The measure, which the County Board of Supervisors will consider on May 25th, follows a model developed in Los Angeles County, creating an inter-departmental committee that includes people with lived experiences of mental illness and incarceration to oversee and implement an Action Plan. To promote accountability and solutions, it also enables data-sharing between the county’s healthcare and criminal legal systems. If adopted, Alameda County would recognize that healthcare should be prioritized over punishment.

Adopting Care First, Jails Last would also help address the racial inequality that pervades both our carceral and health care systems. Like Daniel, a disproportionate number of county residents who are pushed into the criminal legal system because of inadequate community-based mental health support are Black; while they represent only 11% of Alameda County’s population, Black people make up 47% of the county’s homeless population, 48% of the Santa Rita jail population, and 53% of people who cycle in and out of both the criminal legal and hospital systems. Care First, Jails Last would publicly acknowledge that Black lives actually do matter here.

Crucially, Care First, Jails Last advances the two-pronged approach required for success: decriminalization and decarceration of mental illness plus developing and nurturing a robust community-based mental health infrastructure that could keep people like Daniel out of the prison system. Daniel cycled in and out of short-term detox facilities for three years before schizophrenia was even diagnosed; such insufficient, fragmented short-term behavioral health treatment is a pattern that escalates individuals into crises and forces them into institutionalized settings. According to Samira Pingali, Director of Behavioral Health at Alameda County’s Community Health Center Network, “Mental health crises are mitigated by proactive community intervention, well before they require police or justice involvement.”

The county sheriff, among others, argues that a solution is to keep increasing the sheriff’s budget, but despite regular budget increases — — including a $318 million budget increase authorized during the pandemic — — and a steadily declining jail population, the record is deadly. Between 2015 and 2019 there were 14 suicides in Santa Rita, more than twice the national average of in-custody suicide rates. Even though the sheriff’s office insists that conditions in the jail are getting better, two more people at the jail have died by suicide since February.

As a recent expert report on Santa Rita bluntly stated, “Jails simply are not the proper setting to deliver meaningful treatment for these serious health issues,” arguing that outcomes would be far better if those with mental health challenges were moved “from a jail setting to a community-based treatment setting.” Even the DOJ and the National Sheriffs’ Association agree that people like Daniel Rivers should be in community mental health care instead of jail.

For those with mental health needs, investment in community-based supportive housing and mental health services would reduce the likelihood of arrests and create safer conditions to seek help. Investing in services outside of jail would also cut the costs to taxpayers in half. And the costs of incarceration are paid in far more than just dollars: time in jail or prison is traumatic, tearing people away from their families and support systems and plunging them into a culture of neglect and violence.

Care First, Jails Last has broad support, from formerly incarcerated people and family members of the mentally ill to healthcare providers and legal advocates. It offers all of us, elected officials, administrators and constituents the opportunity to forge a better alternative. It’s time for the County Supervisors to act.

About the authors:

Natasha Baker, Esq., is an Oakland-based criminal defense and civil rights attorney specializing in class action lawsuits to end the criminalization of poverty.

Dr. Kelan Thomas, PharmD, MS, BCPS, BCPP is an Associate Professor of Clinical Sciences at Touro University California College of Pharmacy and a board-certified psychiatric pharmacist with outpatient behavioral health practice sites in Oakland and San Francisco.

Natasha, Dr. Kelan, Heather, Sruthi, and Casey are members of Decarcerate Alameda County.

The Ella Baker Center for Human Rights builds the power of black, brown, and poor people to break the cycles of incarceration and poverty.