In the past few months, Sacramento County’s long-scrutinized jail facilities have commandeered the attention of elected officials, advocates and residents.
In June, a grand jury report found that the county could come under a rare federal receivership, losing control of its detention operations, if it didn’t make immediate improvements to the conditions inside.
In September, a contracted health care worker and three others were arrested for bringing fentanyl and other contraband into the Main Jail downtown. According to the Prison Law Office, Sheriff’s data from February to August 2023 show the opioid-reversal medicine Narcan was administered over 30 times in the Main Jail and at least one person has died from a drug overdose there.
The arrest caused Sacramento County Sheriff Jim Cooper to say he’s “at [his] breaking point” with the way health care in the jails is administered, to call current practitioners “inept” and to ask for health care to again be the responsibility of the Sheriff’s department. It was moved out from under the purview of the Sheriff’s office in 2018, before Cooper was elected.
This all comes as the county is trying to meet the terms of a legal agreement entered into in 2019 related to the poor health care of people at the jails and as officials consider a controversial annex to the Main Jail that could cost almost $1 billion.
To understand how Sacramento County got here and where it has to go to improve the jails, we put together this short guide:
What are the problems with Sacramento County jails?
For a decade, Sacramento County has seen numerous official complaints regarding the safety and well-being of people in its jails (the Main Jail downtown and the Rio Cosumnes Correctional Center in Elk Grove).
In 2018, a legal team including Disability Rights California and the Prison Law Office filed a class action lawsuit on behalf of people incarcerated at the jails. The suit alleged that the county wasn’t providing good enough health care, including mental health care, was overusing solitary confinement and wasn’t doing enough to prevent people from committing suicide.
They argued the county was violating people’s constitutional rights while incarcerated and wasn’t compliant with the Americans with Disabilities Act.
“The Sacramento County Main Jail is a horrific, dangerous, depressing, awful, filthy place that is not accessible for people with disabilities and does not allow for confidential mental health and medical care in ways that anyone who's incarcerated is entitled to,” said Margot Mendelson, legal director of the Prison Law Office. “Some amount of change to that building is essential to meet basic human needs so long as that building continues to incarcerate anyone.”
Based on a 2022 report, almost 63% of people detained in Sacramento County have a mental health diagnosis and receive mental health services.
The rate is a bit higher than the statewide number. A report released last week by the Prison Policy Institute of California finds as of June 2023, more than half of people in California jails have mental health needs. That number was 20% in 2010.
What efforts are underway to improve conditions at the jails?
The class action lawsuit resulted in an agreement called the Mays Consent Decree, which was approved in federal court in Jan 2020. The decree is named after one of the plaintiffs, Lorenzo Mays, a man with intellectual disabilities who spent eight years in solitary confinement pre-trial.
It’s an agreement between Sacramento County and Mays counsel — including Disability Rights California and Prison Law Office — that the county will fix issues with five sectors in the jails: health care, mental health care, disability accessibility, solitary confinement and suicide prevention.
Mays counsel, along with federal court-appointed monitors, issue periodic status reports on how the jails are doing meeting the requirements. The latest assessments show the jails have made some progress, but not a lot.
The county is in “substantial compliance” with a third of medical provisions and only a handful of those dealing with mental health care, restrictive housing and suicide prevention. The current buildings are unable to meet the requirements of the Americans with Disabilities Act.
“We have been working to make the premises of that consent decree real for the people inside for the last several years," said Mendelson. “And there's still a very long way to go.”
Recently, issues like overdoses at the jails, the lack of sufficient mental health care and a lack of privacy during intake appointments have been pressing issues the Prison Law Office has brought to the forefront.
Why is it so hard for Sacramento County to follow this consent decree?
The two biggest difficulties for improving health services are inadequate infrastructure and a healthcare worker shortage according to Tim Lutz, director of Health Services for the county.
Health Services oversees Adult Correctional Health, which runs a “24/7 clinic within the sheriff’s jail,” according to Lutz. At the jails, hundreds of medical and behavioral health staff try to meet the needs of the incarcerated population, the majority of whom have not been to trial for the crime they are charged with.
Lutz said it’s very difficult to meet privacy needs for health care screenings.
“We literally repurpose janitorial closets to turn them into an interview area,” he said. “We’re trying to find ways to create privacy in an environment that wasn't geared toward that.”
We literally repurpose janitorial closets to turn them into an interview area. We’re trying to find ways to create privacy in an environment that wasn't geared toward that
He added that although they’ve more than doubled the number of jobs in physical and behavioral health departments, to 251 clinicians on the physical health side and almost 130 on the behavioral health side, there’s a strain across the healthcare industry.
“There is an acute need across all of our communities, whether it's the hospital setting or community based clinic or jail,” he said. “We just have a shortage in the number of people that can fill these roles.”
The county entered into an agreement in June 2022 with Mays counsel to accelerate their compliance with the decree. They agreed to address the infrastructure issues and try to reduce the jail population. To do this, they renewed a proposal to build a health services annex and drafted jail population reduction plans.
What is the annex project?
The county is moving forward with a plan to build an annex, called the Intake and Health Services facility, directly adjacent to the current Main Jail downtown.
The idea was first explored in April 2020. It was met by serious pushback from community groups like Decarcerate Sacramento, who protested any expansion of the jail. The idea was scrapped in March 2021.
In December of 2022, after the county signed the agreement saying it would improve the physical infrastructure, the proposal returned to the supervisors’ dockets.
Eric Jones, deputy county executive for Sacramento County for Public Safety and Justice, said some physical improvements to the Main Jail are imperative, and the annex will not increase the population of the Main Jail.
“There is one thing we know that absolutely has to be done to get within compliance for both ADA and HIPAA issues in the booking area. That's going to require some sort of new construction,” he said.
County staff issued a report that identified what the uses the annex would have, including “a new booking loop, medical clinic, and medical housing, as well as housing units for patients requiring higher levels of mental health care.”
The December 2022 proposal saw huge amounts of opposition and hours of public comment, but the Board of Supervisors voted to advance the project. At that time it looked like the annex would cost around $464.1 million, with the total amount including two smaller renovation projects within existing buildings.
In August 2023, county staff came back with a design proposal that put the price tag for the work around $654 million. Although many supervisors expressed dismay, the board ultimately approved a resolution that could allow them to take on $1 billion in bond debt to build the annex.
What are the Jail Population Reduction Plans?
Following the agreement between the county and consent decree lawyers in June 2022, the county produced Jail Population Reduction Plans. The document outlines a slate of 33 interventions that are meant to eventually reduce the jail population by about 600 people on any average day. The jail’s population currently hovers around 3,200 people.
The overarching goals are to reduce jail admissions, shorten the average length of time a person stays in jail and lower the chances they’ll come back. They include interventions as big as mental health and drug diversion, and as small as releasing people during the day instead of late at night.
Jail population numbers have remained relatively constant since the plan was approved in 2022, according to the Prison Law Office.
A chart from the Prison Law Office showing the daily population at the Sacramento County Main Jail during 2023.Courtesy Prison Law Office“Many of [the interventions] were just recently funded by the Board of Supervisors,” said Jones. “So they aren't even staffed up or the program expansions haven't even been able to to roll out yet.”
Jones said the population reduction plans were never meant to be a replacement for the jail annex and are happening concurrently with plans to build the annex.
In a letter sent Oct. 6, Mays counsel expressed concern about the county’s “failure to reduce the population over the last ten months despite its apparent commitment to doing so.” They emphasized that the consent decree doesn’t require any particular form of construction, but that all experts who have reviewed the jail have stressed the need for population reduction.
The community group Decarcerate Sacramento has said it would not be necessary to build the annex if the county followed through on meaningful population reduction and made renovations to the current jail.
“Sacramento County needs to urgently shift priorities toward strengthening health and human services to prevent criminalization and harm,” they wrote in a public statement responding to the plans. “We cannot afford to waste hundreds of millions of public dollars on jail expansion.”
The county is required to do a quarterly report on how things are progressing with the reduction plans. They published their second quarterly report in mid-October. It showed jail bookings are increasing over the first quarter of 2023, but the amount of time people are staying at the jail is decreasing.
What are the next steps?
In the next few months, according to Jones, the county Board of Supervisors will convene again to approve the next phase of the annex project. During that meeting, they’ll assess the results of a competitive bid process for a design build for the Intake and Health Services facility.
Jones said if things keep moving at the scheduled pace, the annex won’t be complete until 2028.
“We're very clearly not waiting for that to occur before we're putting all of these other things into place, looking at other possible capital projects we can do to get as quick a relief for the situation as possible,” he said.
One of those options is to bring people with severe mental illness out of the jail into community clinics, an intervention that Mays counsel called for last month. The county has not provided any timeline for that could occur or numbers of people who may be eligible.
“This needs to happen now,” said Mendelson. “It's time to get folks who are waiting for days and weeks for a basic level of care outside of the jail to a place where they can get the care they need.”
Correction: A previous version of this article said the majority of people in the jail have not been charged with a crime. It has been corrected to reflect that the majority of people have not been to trial yet for the crime they are charged with.
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