Marin authorizes involuntary administration of medications to jail inmates

The Marin County Board of Supervisors cleared the way for court ordered medications to be administered to felony inmates at Marin County Jail who have been deemed incompetent to stand trial — without the inmates’ consent if necessary.

The board voted unanimously on Tuesday to authorize the county jail as a facility to administer antipsychotic medications to defendants that have been found mentally incompetent to stand trial and are unable to provide informed consent due to a mental disorder.

The supervisors have had the power to do so since Senate Bill 568 was enacted in 2007.

“I’m glad this is before us. This is a big deal,” board president Katie Rice said. “It’s been a long time coming.”

Three other Northern California counties — Contra Costa, Sonoma, Solano and Napa — already allow the involuntary administration of medications to inmates in their jails under SB 568. San Mateo and Santa Clara counties use a separate facility inside jails to administer medications. San Francisco and Alameda counties have the medications administered in county-operated hospitals.

“Marin is the outlier in this situation,” said Todd Schirmer, who was named interim director of the county’s division of behavioral health and recovery services on Tuesday following the resignation of Jei Africa.

Because Marin supervisors hadn’t previously authorized the involuntary administration of medications, mentally ill inmates have had to wait until a bed at a state hospital, such as Napa State Hospital, became available.

“When somebody is incompetent to stand trial, they are put on a wait list for the Department of State Hospitals,” Schirmer said. “Right now that wait list is anywhere from three to six months.”

Schirmer said in some cases Marin inmates are deemed competent after being administered medications against their will at a state hospital and then stop taking the drugs when they return to Marin County Jail.

“So, they’re again found incompetent,” Schirmer said, “and the cycle repeats.”

Marin County Sheriff Jamie Scardina told supervisors Tuesday, “We have one inmate who has been waiting since March 2022, one since April, three since May, three since June, and two since July. Quite a few.”

Schirmer said for many years the county sent inmates to Santa Clara County for involuntary administration of medications, but Santa Clara stopped offering that option in 2016.

AB 1810, which was signed into law in July 2018, authorized pre-trial diversion programs for people with certain mental disorders alleged to have committed a misdemeanor or felony offense. To be eligible, however, inmates must have one of three diagnoses: schizophrenia, schizoaffective disorder or bipolar disorder.

“And they have to be a low enough risk for violence that it is safe to release them to the community for treatment,” Schirmer said. He said there are fewer than 10 Marin inmates currently in the diversion program.

Sheriff’s Capt. Mark Hale, who oversees Marin County Jail, said since 2016, “We’ve seen a huge increase in mental health cases in our jail. The real severe cases.”

Hale said that severely mentally ill inmates who refuse to take their medications disrupt the housing unit to which they are assigned.

“They get to the point where they’re eating and playing with their feces and throwing that and urine on other inmates and staff,” Hale said. “It is a major, major health concern.”

Some speakers during the public comment period expressed concern about the authorization.

Lisa Bennett of Sausalito, a frequent critic of the Marin County Sheriff’s Office, noted that the Marin County civil grand jury issued reports in 2017 and 2018 that were critical of the mental health services provided to jail inmates.

“Is this request a Band-Aid to respond to a failure of a system?” Bennett asked. “Are we going to tranquilize incarcerated people because we don’t have an adequate system in which to treat them?”

Schirmer, however, said the county has taken several steps to improve mental health services in the jail since joining the Stepping Up Initiative in 2017, a national effort to keep people with mental illness out of jail and on the path to recovery.

“We’ve more than doubled the size of our jail mental health team,” Schirmer said. “We currently have five-and-a-half positions in the jail, including a supervisor.”

The county has mental health staff on duty at the jail 20 hours a day, from 6 a.m. to 2 a.m., seven days a week. In addition, a psychiatrist is on duty at the jail 20 hours a week, and there is on-call psychiatric coverage available at all times.

Everyone who is booked into Marin County Jail is screened for mental health disorders. If a serious mental illness is detected during a screening, the inmate receives a full mental health evaluation, including an examination by a psychiatrist.

“Based on that person’s evaluation that person might be prescribed psychiatric medication for their mental disorder,” Schirmer said.

Prior to Tuesday’s action, however, the county couldn’t force an inmate to take medications, even if a court had ordered the inmate to do so.

Marin County Public Defender David Joseph Sutton said his attorneys represent inmates in legal proceedings when a court order for the involuntary administration of medications is being sought.

“Obviously, we will be vigilant in our defense if we believe involuntary medication is inappropriate,” Sutton said.

But Sutton said keeping a mentally ill person locked in a jail cell for months waiting for a bed in a state hospital “is a cruel situation to say the least.”

“If the litigation has occurred and there is an involuntary order in place,” Sutton said, “in some cases that will actually benefit some of our clients by restoring them to competency.”