Santa Barbara County’s mental health system for jail inmates will soon be under the purview of a private Tennessee-based prison health company.

About three weeks after Sheriff Bill Brown announced the proposal to shift mental health services from county Mental Health to Prison Health Services, Inc. (PHS), the Board of Supervisors on Tuesday gave its stamp of approval.

The proposal was included in a request to extend PHS’s two-year contract as a provider of correctional medicine services to the probation and sheriff’s departments. Oversight of inmate mental health services will be handed over by the county’s Alcohol, Drug and Mental Health Service Department, which has supported the transition.

Brown told the board that the private company would improve the jail’s system while saving the county about $660,000, mostly by providing essential services that mental health services does not.

He added that the 38-year-old jail is rated to house 898 inmates but has an average daily population of 950. He said 29 percent of the jail’s population uses mental health services, a number he chalked up to the closure of various mental health institutions over the years.

James C. Peterson, chief deputy of custody operations for the Sheriff’s department, outlined the bare bones of the proposal, which he said would provide 24/7 coverage at the jail for mental health assessments and care by bringing in two, on-site licensed social workers and providing more training for custody deputies.

“It’s a unique opportunity to add more coverage at a lower cost,” Peterson said. “This is a win-win situation for everybody.”

Brown said one of the key elements of the contract was the addition of a “discharge planner,” someone who will coordinate the necessary community services when inmates are released from custody. This service will diminish recidivism rates, he said.

Critics charge that while the county’s jail system will save money by contracting with PHS, it will be forced to stretch medical and mental health employees too thin. Part of the savings will come from cross-training employees, many of whom will inevitably be on double-duty.

 

 

Reluctant approval

Supervisors debated the contract for more than an hour, and though the contract was approved by a 4-1 vote, with 2nd District Janet Wolf, vice chair, dissenting, two of the “ayes” were lukewarm.

Third District Supervisor Doreen Farr raised some concerns expressed by some in the mental health advocacy community about the level of service PHS has been providing to the county.

“I’ve had a lot of correspondence on this issue from both sides,” Farr said. “And the summation repeated so often is that there is concern that PHS is more concerned with bottom line than about adequate medical attention.

And in the staff report, it says they’ve been ‘satisfactorily’ rendering medical services, so I don’t know,” she continued, measuring her words. “It’s not exactly a glowing word to us.

Brown said the jail’s inmates are a “difficult population to deliver services to,” and reminded the board that PHS’s two-year contract would be up for review upon renewal and that if performance measures were not met, the contract would be reconsidered.

“We will certainly hold PHS’ feet to the fire, but we will also want to make sure they’ll have a fair shake to provide this service,” Brown said. “I’ve been very satisfied with the level of service. We wouldn’t be here today asking for this contract, if we didn’t have that level of confidence in them.”

Farr asked county Public Defender Greg Paraskou if he had reservations about PHS.

“I have some concerns,” he said. “I’m familiar with some of the past history of PHS. Some of the reports and articles go back a few years. But certainly, as a public defender, one of things that we constantly tell the judges is to not always look at the past about making a decision about today, that people can face redemption to some extent.”

A 2005 article by the New York Times said the company had “repeated instances of medical care that has been flawed and sometimes lethal” and that “the company has paid millions of dollars in fines and settlements.”

In that story, PHS countered that “any lapses that have occurred are far outnumbered by its successes, and that many cities and states have been pleased with its work.”

 

Checkered past

Farr also asked county staff if there had been discussions with SEIU Local 620, a union representing jail mental health workers, about the proposal. Staff said though the unions are opposed to it, they had not responded to notices about the change and therefore “waived their ability to meet and confer on the issue.”

First District Supervisor Salud Carbajal said though he is leery of privatization, he was pleased to hear that there would be no displaced employees — whom ADMHS Director Ann Detrick said would be shuffled into vacant positions — and that the contract included an indemnification clause that would hold PHS legally accountable.

“That reminds us, the taxpayers and PHS that they’re going to get multiple whammies if they’re not following proper procedure,” Carbajal said.

Wolf did not support the motion because she has “a philosophical problem with privatizing services that we’re already providing in our county, unless I’m totally convinced we’re going to see a benefit in the services that are already provided. And unfortunately, I have not been convinced of that.”

Wolf said the salient problem in the jail system was poor communication, and she wondered out loud why the county couldn’t provide the 24-hour care and cross-training that PHS was offering.

Centeno said conversations with Detrick had reassured him that there would not be any problems with what was being proposed.

“Looking at that figure and looking at what we’ve been through during the last week during the budget hearings, if we can come up with savings without reducing services to the constituents and clients that we serve, that’s a win-win,” he said.

Public concern

A handful of public speakers were not convinced. Suzanne Riordan, a coordinator for the nonprofit Families ACT!, which advocates for dually diagnosed mental health patients, gave the board a tongue-lashing.

“Why are we bringing in a private national corporation to contract with our jail?” she asked. “Where is our mental health department? Where is our Cottage Hospital? If our mentally ill are sitting in the jail, why aren’t we having community meetings to figure out why? “It is my understanding that (PHS) has a disturbing record of neglect and abuse. What makes us think it’s going to be any different? And even if they did change their ways, it doesn’t take a rocket scientist to figure out that there’s a handsome profit to be made in offering health and medical services in jails and prisons, and it’s going to have to be squeezed out at the expense of quality, humanity and compassion.

“Because where is the economy of scale in services? This is not a matter of manufacturing widgets so that the more you make the cheaper you can make them. We’re talking about hiring real life human beings to work under less-than-pleasant conditions serving real, live human beings in distress …”

Kate Smith also had sharp words for the board. “The most difficult healthcare in America (Mike Brown) said, is mental health in the jails,” she said. “Right. He also said that those people should not be in the jails. What system has set it up so that our children and those with great problems in their lives get thrown into a cage under the watch of people with guns and tasers?”

Sheriff’s Department officials stressed that the change was not a result of any performance shortcomings by mental health services.

“This is not about ADMHS and about the quality of service they’ve provide,” said Sheriff Brown. “Their people have done an extraordinary job under difficult circumstances …”

PHS will take the helm from ADMHS July 1. County supervisors requested a report on the company’s performance be conducted at the end of the first year.

Reach Jeremy Foster at jfoster@syvjournal.com.