DA Gascón, Supervisors, & Academics Propose New Behavioral Health Center

News from the Office of District Attorney George Gascón


JANUARY 5, 2016


CONTACT:       ALEX BASTIAN-415-553-1931

MAX SZABO-415-553-9089



Evidence-Based Practices Provide Way Forward For San Francisco’s Mental Health Crisis


SAN FRANCISCO — Today, District Attorney George Gascón was joined by Supervisors David Campos, Malia Cohen and Jane Kim, in addition to Professor Craig Haney of University of California at Santa Cruz, and Michael Romano of Stanford University’s Justice Advocacy Project, to propose a new Behavioral Health Center in San Francisco.  The purpose of such facility is to address a fundamental problem and tragic irony: On the one hand, the nation’s jails and prisons have become the default placement for the mentally ill in our society, with a Bureau of Justice Statistics study estimating that approximately two out of every three jail inmates nationwide suffers from a “mental health problem” (i.e., has received a clinical diagnosis or treatment by a mental health professional or experienced DSM symptoms of major depression, mania, or psychosis in the preceding year).  Moreover, there are about 10 times the number of mentally ill persons in jails and prisons in the United States as in mental hospitals.  On the other hand, however, jails and prisons are uniquely ill-suited to serve as therapeutic environments.


“It would be difficult to design an environment more counter-therapeutic than a modern American jail or prison,” said District Attorney George Gascón.  “If we want to address the crisis that is evident on street corners from the Haight to the Tenderloin, we must divert individuals with mental illness and substance abuse to treatment, rather than warehouse them behind concrete and bars.”


"Incarcerating people with mental illness does not lead to better outcomes for anyone—not the public, not the person incarcerated, not their families,” said Supervisor David Campos.  “San Francisco has the opportunity to lead the way and invest in mental health services and residential treatment programs that will keep our communities safer and healthier. Today is an important first step towards achieving this goal.” 


“Historical adversity, exclusion from education health, educational and social resources leads to socioeconomic disparities and subsequently poor mental health outcomes,” said Supervisor Malia Cohen.  “It is no coincidence that there is a long standing systemic disparity that exists within our criminal justice system — we must explore the feasibility of a behavioral health center in San Francisco. “


“With 2 million people with mental illness booked into jails each year, the biggest mental health providers in the country are LA County Jail, Cook County Jail in Chicago, and Rikers Island in New York,” said Supervisor Jane Kim.  “Last month, San Francisco took the principled, just, and compassionate stand that we will not join what we should all consider a list of shame. Jail is simply not going to be the San Francisco answer to mental illness. I’m proud to be standing with DA Gascon, who shares the same belief: that we can be the first City to make the commitment to real public safety which can only come when we acknowledge that we have been relying on our criminal justice system to act as our mental health system.”


The difference between a “mental health jail” and a “behavioral health center” is more than mere semantics; rather than a jail facility where mental health treatment is also provided, a behavioral health center is primarily a treatment facility that also properly ensures the safety of the staff and inmate/patients who are housed there. This core difference can and should extend to the way the facility is constructed, the atmosphere created inside, and the primary mission and mindset of the staff who run it. In addition to this core difference in approach, there are several very broad guiding principles that should govern the creation of such a facility.


          1) A behavioral health center is a critically important component—but only a component—in a well-designed and functioning system of overall behavioral health care in the community. That overall system must provide for: meaningful pre- and post-arrest and arraignment mental health screening; an active and concerted commitment to diversion into sufficient numbers of well-functioning community-based alternatives; rapid referrals and transfers to appropriate levels of care and least intrusive alternatives; ongoing client monitoring; a full range of meaningful and appropriate programming and treatment for out- and in-patient services; transitional services before, during, and after major changes in custody, mental health status, or circumstances; adequate and meaningful patient/inmate follow-up; and comprehensive program evaluation.


          2) A behavioral health center facilitates the overall mission of the community’s more comprehensive system of mental health care by providing a safe and secure, police- and mental health professional-friendly environment in which several critical functions can be performed, services and programs provided, and critical decisions about the care of mentally ill citizens and inmates can be made. It contains separate, dedicated space for initial mental health assessments; separate, dedicated housing and treatment space appropriate for inmate/patients who require different levels of care; separate, dedicated space for transitional planning for referrals to residential or outpatient care in the community. This means it can and should include adequate and distinct spaces and settings where assessment, diversion, crisis and residential treatment, and intensive case management can effectively occur as well as, ideally, a mental health court and training facilities are located.


          3) An overall system of mental health care must acknowledge, safeguard, and promote the legal, constitutional, and human rights of mentally ill citizens and inmates. A behavioral health center can and should further these goals by ensuring that the least intrusive alternatives are pursued whenever feasible, and in as timely a manner as possible, and that the center itself provides maximum feasible access (and is located in close proximity) to the clients’ attorneys, family, and loved ones, as well as ancillary professional mental health staff, community mental health providers, and alternative treatment settings. As much as possible, and consistent with the goal of public safety, mental health care—in the community and in a behavior health center— should be designed to minimize the reach of the criminal justice system into the lives of the mentally ill while enhancing access to services for persons who are temporarily under its jurisdiction or housed within it.


San Francisco is a leader in criminal justice and behavioral health innovation and as such is no stranger to these principles.  It is essential that these principles, coupled with thorough analysis of existing data – to be provided by way of a request to the Budget Legislative Analyst’s Office by Supervisor Campos - guide the development of a behavioral health center. 


In the weeks ahead, Professors Haney and Romano, who are experts in the field of mental health, will be joined by experts in the field of criminal justice, to draft a white paper utilizing these principles and the data provided by the Budget Legislative Analyst.  The white paper will explore the suitability of current options and gaps in service that a behavioral health center can fill — where are folks going now; are they diverted or transferred from custody for in-patient and/or outpatient community treatment; and how adequate and accessible are those options; or should they be expanded?  It will also address some questions related to needs analysis, size, and scope of services provided.  The white paper will serve as the contribution of the District Attorney’s Office to the working group that has been created by the Board of Supervisors. 


With the creation of a Behavioral Health Center, San Francisco has an opportunity to intelligently and innovatively address this critical problem by effectively serving the needs of its mentally ill citizens and simultaneously enhancing public safety for the larger community.