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A local victory in California’s East Bay: Care First, Jails Last

Thanks to coalition efforts including AFSC, Alameda County takes steps to stop jailing people with mental illness.

"I was just trying to help my boy,” Jose Jaime Madrigal said about his son Christian, who was suffering a mental health crisis when his parents called police to get him to a psychiatric facility in June 2019. Christian was taken to Santa Rita Jail in Alameda County, California, where he died after deputies chained him to a door, then left him by himself, and found him afterward hung from the chain. The multiple deputies present never called a clinician for support. “Our heart is broken,” Jose Jaime said

Christian’s is one among the numerous, preventable, and highly visible deaths of people with a mental illness during interactions with police—drawing much-needed attention to the country’s punitive, wrong-headed approach to addressing mental health needs. According to recent data from the Washington Post, more than 1 in 5 people fatally shot by police experience a mental illness.

Last month, Alameda County in California took an important step to stop the incarceration of people with mental illness—and start providing them with the care they need. On the anniversary of the police murder of George Floyd, the Board of Supervisors unanimously passed the Care First, Jail Last Resolution, which prioritizes a continuum of care and services for people with mental illness who are at risk of incarceration. AFSC co-authored the policy as part of the Decarcerate Alameda County coalition, which brings together families impacted by incarceration and mental illness, faith communities, mental health service providers, community advocate organizations, and ordinary residents moved to action by the police killings and community mobilizations of the last year. 

The goal of Care First is to address the county’s paucity of community-based mental health resources in Alameda County to prevent more people from being pushed into incarceration. The policy also aims to grapple with racial inequity in the county’s criminal legal system. Black people represent only 11% of Alameda County’s population, but make up 47% of the county’s homeless population, 48% of the Santa Rita jail mental health unit population, and 53% of people who cycle in and out of both the criminal legal and hospital systems.

The Care First policy mandates interagency and public sharing of data on the unmet mental health and substance use treatment needs in the community. Today, families of people with serious mental illness must navigate between uncoordinated, siloed programs to help their loved ones get the care they need. Even public defenders of people with mental illness in the jail don’t know the case managers who could provide information for a client’s defense, housing support, and reentry services. Moreover, without measuring the diverse needs of people with mental illness, the resources that Alameda County budgets for programs and services are just guesses, shots in the dark. The policy seeks to fill that wide gap of information.

Much of the attention for both criminal justice reform and abolition is focused on state prisons, where the number of incarcerated people exceeds those in federal prisons, jails, and immigrant and youth detention facilities combined. Yet there are hundreds of thousands of people who are also locked in local jails, the vast majority of whom haven’t yet been tried and cannot afford bail. In our county, more than 94% of people in jail are unsentenced—they’re legally innocent. Yet even short stays in jail are enormously disruptive—and cause people to lose their jobs and housing and devastate family relationships. The work for decarceration of people with mental illness requires addressing the broader practices and policies that keep so many unsentenced people in jail.

There is extensive evidence that being locked in jail is damaging to mental health, especially for people already experiencing mental illness. Multiple lawsuits have been filed against the county for the awful conditions in Santa Rita Jail, including frequent and widespread solitary confinement and the largest number of in-custody deaths in the region. The Department of Justice announced in April a plan to sue the county for the lack of community-based mental health services, as well. Yet so far, the county government has done little more than appropriate more resources for incarceration—including approval last year of more than 450 additional jail staff, most of them sheriff deputies, at a cost of $106 million more annually. Last month, the county also approved funds to redesign the jail to accommodate the large influx of clinical staff—essentially, a “mental health jail”—despite a growing number of funded jail staff vacancies. All this was supposed to comply with constitutional requirements for mental health care in the jail. Yet it exacerbates the reality that many people with mental illness have to go to jail in order to get treatment. 

Instead of wasting tens of millions of our taxpayer dollars on harmful jails, the county should implement the Care First resolution by moving funds into community-based services and housing that meet people’s needs and help prevent mental health crises and encounters with cops. That money can also leverage matching federal and state funds such as Medicaid (which jail funding cannot do). That’s why Decarcerate Alameda is advocating that the county reallocate at least half of that $106 million in new jail funds to community-based mental health, substance use services, and housing. 

The county’s Behavioral Health Department last year proposed $50 million for mental health services but the county didn’t find the money for it. Now, with new state and federal funds on the way, county leaders have no excuse. In a region with raging gentrification that heavily impacts Black, Indigenous, and people of color (BIPOC) people and an unhoused population that has doubled in the last two years, there is a huge overlap between people who are unhoused and people who are in jail over a given time. Last year, the County Board of Supervisors adopted the Home Together Plan to begin to address that need, with $50 million allocated for 2021. While an important start to implementing the Care First policy, more is needed. 

This month is an intensive time of budget discussions for Alameda County, as it is for many cities and counties with fiscal years beginning July 1. Budgets are moral documents, as many have noted, because they reflect values and the material priorities of our government and communities. 

In Alameda County and across the country, advocacy is needed to make sure community-based resources, not cages, are the priority. It’s time we stop treating mental illness with incarceration, divest from jails and policing—and move public dollars toward the treatment and housing that people with mental illness and substance use disorders desperately need.

About the Author

John Lindsay-Poland co-directs the California Healing Justice program of AFSC and co-authored the "Care First, Jails Last resolution" adopted by Alameda County.