The central jail on Front Street in downtown San Diego. Photo by Chris Stone

The San Diego County Sheriff’s Department and the Health and Human Services Agency’s Behavioral Health Services division, under an agreement announced Wednesday, will seek to develop a better way to provide behavioral and physical health services in the county’s seven detention facilities.

The memorandum of understanding between the agencies is part of a process which began in August 2020, when the San Diego County Board of Supervisors voted 4-1 to let the sheriff’s department explore and obtain information from potential healthcare service providers.

Board of Supervisors Chair Nathan Fletcher worked with HHSA Behavioral Health Services Director Luke Bergmann and Sheriff Bill Gore to add enhanced restorative health services. Fletcher first announced there was an agreement in the works during his “State of the County” address in February.

“This MOU is just the start of a multi-year commitment to build out better medical and behavioral health services in our detention facilities,” Fletcher said.

“With this agreement, we are setting a new direction that will help to create a better, more caring set of services for individuals in our jails and also connect them to the supportive services they need when they leave the county facilities,” he said. “In the budget approved earlier this year, we made extensive investments to strengthen our jail health capacity by adding 160 new county medical/behavioral health-related employees and nearly $25 million.”

According to the MOU, HHSA and the sheriff’s department will work collaboratively to improve in-custody behavioral and physical healthcare services, including the following:

  • intake and ongoing individual assessments
  • medicated assisted treatment
  • care coordination
  • additional identified healthcare enhancements
  • clinical quality oversight
  • coordinated health record-keeping, including improvement and coordination with jail information management related to behavioral and physical healthcare services, and the sharing of data and management of that data

The sheriff’s department continues to move toward accreditation with the National Commission on Correctional Healthcare. It is implementing programs such as medication-assisted treatment and is also in the process of moving toward a new model of nursing called “primary care,” which is intended to decentralize much of the healthcare to a more direct access model in the housing units.

Those changes were approved this fiscal year, and multiple positions in various areas of healthcare delivery will be filled as soon as possible, officials said.

“Correctional healthcare is a dynamic, engaging environment and represents nearly the full spectrum of public health,” said Dr. Jon Montgomery, chief medical officer of the sheriff’s department.

“We provide care for an extremely diverse, medically challenging population,” he said. “Partnering with Health and Human Services Agency is a natural progression, as we both serve the same patients, just at different stages in their lives along the continuity of care.”

About three-quarters to 80% of people in San Diego County jails admit to taking drugs or test positive for drugs, according to a recent survey, and around 30% of those in county lockups have had medication prescribed for a serious mental illness.

“We know that people with behavioral health conditions are more likely to be jailed, and more likely to be jailed repeatedly. And we know that incarceration deteriorates health, leading to worsening symptoms of mental illness and higher risk of death due to drug overdose,” Bergmann said.

“The collaborative work that we are beginning with the sheriff’s department is designed to reverse these trends by engaging the jail population in care, and by proactively coordinating community-based health and behavioral healthcare for people leaving jail, so that they are more likely to remain in better health, and less likely to return to jail,” he said.

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