Marin County to expand involuntary medication of jail inmates

Marin County plans to expand a program that allows medications to be administered to jail inmates against their will.

Last fall, the Board of Supervisors allowed court-ordered medications to be given to inmates who have been deemed incompetent to stand trial — without their consent, if necessary. Prior to the authorization, inmates had to remain in jail for months until a bed became available at a state hospital.

Involuntary medication has been allowed since the passage of Senate Bill 568 in 2007. When Marin supervisors gave their approval, several other Northern California counties — Contra Costa, Sonoma, Solano and Napa — were already making use of the law.

On Tuesday, the supervisors received a report from Behavioral Health and Recovery Services, a division of the Marin County Department of Health and Human Services, on how the first year of implementation has gone. Michelle Funez Arteaga, a division director, briefed supervisors on plans to expand the program beyond inmates who have been judged incompetent to stand trial.

Arteaga said state law allows the county to give medications to inmates in two additional situations. One is when a psychiatrist or psychologist has determined that the inmate is gravely disabled from a mental disorder or is a danger to self or others. The Marin County Public Defender’s Office represents inmates in legal proceedings when authorities seek a court order for the involuntary administration of medications.

The other instance is when the inmate has been legally “conserved.” A mental health conservatorship gives legal authority to one adult to make certain decisions for a seriously mentally ill person. In these cases, the medication would be given at the request of the patient’s conservator.

“We wanted to start with the incompetent to stand trial,” Arteaga said. “But now that things have been going well, we plan to expand to these other populations when they’re in jail.”

Arteaga said that during the first year of implementation, fewer than 10 inmates were given medications against their will. Arteaga said she could not give the exact number because the Marin County Department of Health and Human Services has a policy of not releasing population numbers under 10 in order to protect the anonymity of members of the group.

Supervisor Katie Rice asked Arteaga how many additional inmates are likely to be medicated involuntarily with the expansion of the program.

Arteaga said that of the three categories, the group deemed incompetent to stand trial was the largest.

“While I don’t have an estimate for those other two populations, they will be even smaller,” she said. “We could go an entire year and not have one person come into jail who will fall under the conservatorship category.”

Arteaga said that since the program began, no inmate or staff member has been injured during the administration of medications.

“When we started the conversation around involuntary medication, some people were concerned that it might lead to injuries,” Arteaga said. “We came to see that it’s actually safer.”

Arteaga said all of the inmates who were initially given medications against their will consented within one to three administrations.

If inmates are deemed competent after receiving medication, they can then stand trial or in some cases qualify for a mental health diversion program.

AB 1810, which was signed into law in July 2018, authorized pre-trial diversion programs for crime suspects with certain mental disorders. To be eligible, however, inmates must have one of three diagnoses: schizophrenia, schizoaffective disorder or bipolar disorder.

Medications are ordered by a licensed psychiatrist or psychiatric nurse practitioner. They are administered by a registered nurse or other licensed medical professional with the aid of jail officers.

“I’m sure it’s traumatic for the individual,” Rice said, “but I’m just wondering about the impact on you as human beings at the staff level.”

Arteaga said, “I think that it was more traumatic to see people incarcerated and untreated for months on end and not having any tools to be able to help them.”

“These were folks that were in a dire psychiatric state, unable to meet their basic needs,” Arteaga said. “There were often problems with eating, hygiene and sleep — just really unable to have any stability. It did not feel humane to see people in that condition for so long.”

Supervisor Stephanie Moulton-Peters said, “I’m aware of one constituent in my district who was languishing in the jail for quite a long time, and his family was quite concerned. He finally was able to get treatment through your program. He’s home now and his family is very happy.”

During the public comment portion of the meeting, Jennifer Carter said, “I’m actually one of those people. I was a person that was in jail with no insight and couldn’t take care of myself and couldn’t take medication. I have always wished that there was a way that somebody had been able to give me medication.”

“I ended up in jail for about a month in psychosis and completely not knowing where I was,” Carter said. “It took me finally saying yes to medication for me to get better.”