Replace Jail with Mental Health Care

Chesa Boudin’s Comprehensive Plan to Dramatically Reform Treatment of Individuals with Mental Illness in San Francisco’s Criminal Justice System

San Francisco’s jails have become our largest mental health facility. 75% of people incarcerated suffer from serious mental illness and/or substance use disorders. Yet jails do nothing to treat the root cause of crime. Rather, jails often victimize and destabilize an already vulnerable population, who are then released to the streets with no treatment plan or housing, often leading to more crime. Jails also substantially increase the risk of overdose. Our next District Attorney will play a critical role in ensuring that those who suffer from mental illness or substance use disorders receive the treatment they deserve so that our city becomes more safe and humane for everyone.

As District Attorney, Chesa Boudin will implement a comprehensive transformation of the criminal justice system to decriminalize and treat mental illness, housing instability and substance use as public health issues rather than criminal justice issues. With the passage of Prop C and new proposals for expanded mental health from Supervisors Matt Haney and Hillary Ronen, San Francisco has a chance to finally solve our mental health and homelessness crisis. 

Boudin’s plan includes three major reforms:

  1. Expand and strengthen all levels of mental health diversion programs. Expand all forms of diversion from the criminal justice system to mental health care including pre-arrest, pre-charge, and post-charge diversion programs. 
  2. Close County Jail # 4 and put savings into mental health care.  By treating mental illness, housing instability and substance use as public health issues, Boudin will substantially reduce the county jail population within the first six months in office. This will allow the Sheriff’s department to close down the seismically unsafe County Jail # 4, with a goal of achieving closure within six months, and dedicate savings to expanded mental health program. 
  3. Create a centralized mental health facility run by health professionals. Work with mental health and homelessness advocates, as well as the Board of Supervisors, to create a facility run by health officials that can humanely screen and refer individuals in the criminal justice system who suffer from mental illness to treatment. 

None of these reforms can be enacted without cooperation and consensus among advocates, nonprofit and public health agencies, city government, and the different departments of San Francisco’s criminal justice system. As the top elected law enforcement official in San Francisco, the new District Attorney has a key role to play in outlining a plan of action and advocating for fundamental reform. 

This is Boudin’s comprehensive road map to reform:  

#1 Expand and strengthen all levels of mental health diversion programs.

The District Attorney’s office will provide mental health diversion opportunities on as many levels as possible to divert mental health away from the criminal justice system and into the Department of Public Health. These opportunities will increase the number of times and ways a person can be connected to treatment.

We know diversion programs are a successful way to reduce recidivism and make our communities safe. People who successfully complete diversion treatment programs are far less likely to reoffend, more likely to stay sober/on their prescribed medication, and more likely to find jobs and housing. 

In Miami a similar program resulted in their inmate population dropping from 7,000 people to around 4,000. Harris County, Texas, has a similar program that saved an estimated $9 million while serving more than 1,000 people since the center first opened in September. And Arizona’s program resulted in recidivism rates of approximately 70% dropping to approximately 20%. 

Immediately upon taking office, Chesa Boudin will create and expand the following diversion programs:

Pre-arrest diversion

  1. Create new diversion options for law enforcement. Currently, when law enforcement respond to a crime that is clearly caused by mental illness, their options are to 1) involuntarily commit someone to SFGH on a 51 50 hold, and/or 2) arrest them and take them to jail. SFGH is so limited on bedspace that staff there often release people before the 72 hours expire, so that people in mental health crisis quickly end up back on the streets.  Law enforcement will be trained on a third option: call a DPH clinician who can respond to the scene and take over. Law enforcement can also take the person directly to the mental health facility to receive services, but emphasis will be placed on letting clinicians handle mental health issues as much as possible and limiting law enforcement involvement. 
  2. Expand existing pre-arrest diversion programs. Pre-arrest diversion programs that are already in place (such as LEAD) will be expanded to all parts of San Francisco and include 24 hour, 7 days per week services to allow more people to get treatment and services in lieu of criminal charges. 
  3. Increase staffing and hours for DA rebooking attorneys. When in doubt, law enforcement officers can consult with the rebooking DA’s (rebooking lawyers will be available at all hours for this purpose) to see if the case is appropriate for pre-arrest diversion. Harris county does this and it is effective.

Pre-charge diversion

  1. In custody diversion and mental health screening. Every person in the jail will be screened by a Department of Public Health clinician for mental health or substance use problems. If flagged, rebooking DA’s can make the decision to defer any filing of charges and refer individuals to DPH where a treatment plan will be created.
  2. Out of custody diversion. If a person is arrested and cited to appear in court out of custody, part of that citation will include an opportunity to set up meetings with DPH to get screened. Rebooking DA’s can be notified and make the decision to delay filing charges to see if treatment is successful.

Post-charge diversion

  1. Expand eligibility for diversion. People who are charged with a crime and appear at arraignment may be eligible for diversion at the district attorney’s discretion. 
  2. Expand collaborative courts. Collaborative courts that already exist such as veterans court, young adult court, behavioral health court, etc will be expanded to allow many more people to participate and receive services.

 Ensure that diversion programs are comprehensive:

  • Peer Supporter. A peer supporter will be assigned, many of whom themselves graduated from the program. Spanish speakers must be included. 
  • Harm Reduction Treatment Plans. Treatment plans will focus on harm reduction models rather than abstinence only. We know relapse is a part of recovery and need to stop punishing people when that happens.
  • Part of the treatment plan must include assistance in securing housing (assuming the person wants it) for everyone. Resources must be devoted to this.
  • Job Placement. Assistance with job placement.
  • Mental Health and Physical Health Treatment. Mental health treatment AND physical health treatment needs to be arranged whenever appropriate. Many people end up homeless and in crisis because of a physical health ailment. 
  • Services After Completion. After the diversion program is complete and the criminal case is over, services must continue to remain available to assure continued stability.

# 2 Close down County Jail #4 and dedicate savings to mental health care

The jail located on the seventh floor of 850 Bryant Street, otherwise known as County Jail #4, is hazardous and needs to be shut down. Aside from being old and seismically unsafe, there are frequent raw sewage floods at this jail, where sewage with fecal matter invades people’s living spaces, destroys belongings, and causes injuries. The jail’s untenable living conditions caused it to be the subject of a class action lawsuit against the city of San Francisco.

As District Attorney, Chesa Boudin will immediately begin work to close down County Jail # 4 by substantially reducing the county jail inmate population, and advocate to dedicate savings to mental health diversion programs within the criminal justice system. 

# 3  Create centralized mental health facility run by health professionals, not law enforcement

Although a District Attorney cannot build facilities, Chesa Boudin will partner with community and health care professionals, along with elected officials, to advocate for the city to create a mental health facility for individuals in the criminal justice system who are suffering from mental health illness. This facility will be run by health professionals, such as the Department of Public Health, and not law enforcement. 

This facility will be open to the public - we shouldn’t wait for a crime to occur to offer people treatment and services. This facility will:

  • screen people for mental health illnesses
  • create treatment plans
  • refer people to community based programs for treatment
  • provide job training
  • house individuals needing mental health treatment and awaiting placement in other programs, and 
  • offer drop-in services during the day (for showers, job training, and connections to other services). 

Today, there is no centralized center for people to go to to seek mental health assistance. TAPP exists for out of custody referrals, but it has no bed space and cannot be utilized for in-custody referrals. 

Right now, if a person is in jail and wants to receive treatment in a residential treatment program, they have to wait in jail for several weeks or months for a bed to open up. This is discouraging, inappropriate and harmful. The result is that many people who need it, do not seek or obtain that treatment.

Similarly, if a person is out of custody and wants to receive treatment in a residential treatment program, they first have to check themselves into a detox facility, which are almost always full. So a person in crisis has to return every morning to check if bed space is available at the detox facility until something opens up. This does not provide enough support for people in crisis.

Many of the current treatment programs are abstinence based, so that if a person relapses, they are kicked out of the program. With a very limited number of programs and bed space, people who are genuinely trying to get help often fail out. If they are in a diversion program, they fail out of that, their criminal convictions remain, and they often have to serve time in jail only to repeat the cycle. 

The centralized mental health facility will solve many of the existing problems in the system and reduce the instability, trauma and increased risk of overdose that jails create. It will treat the root cause of crime, thereby reducing recidivism rates and making San Francisco safer and more humane for everyone.