The Twin Towers Correctional Center is seen in Los Angeles on Wednesday, April 1, 2020. (AP Photo/Damian Dovarganes)
On May 16, the Los Angeles County Board of Supervisors voted to create a unit at Twin Towers Correctional Center to treat inmates with severe mental illness. The new Prison Internment Unit, also called the Acute Intervention Module, will have beds for inmates who represent a danger to themselves or to others.
According to the board-approved motion, introduced by supervisors Kathryn Barger and Janice Hahn, “The number of inmates needing acute emergency mental health services is increasing. On average, 40 or more acutely mentally ill inmates are booked daily.”
Forty or more. Daily. Remember that number.
These are inmates whose mental illness is too severe to be treated in an outpatient setting, supervisors explained in their motion. Other mentally ill inmates “live in a jail housing unit and receive regular mental health treatment, but do not require 24-hour care.”
How many? According to the supervisors’ motion, “approximately 6,800 inmates housed in county correctional facilities participate in jailhouse mental health programs with varying levels of care and treatment.”
That makes the Twin Towers Correctional Center in Los Angeles “the largest de facto mental health institution in the United States.”
This is scary.
California may be building and staffing large hospitals and residential facilities for the treatment of mental illness. Instead, he clings to the outdated belief that “institutions” are always bad and that it is somehow better to leave seriously ill people to fend for themselves in the community and fund “services” for those who wish to take advantage of them.
We still have institutions. Once a person with a mental illness harms another person, that lost soul can be thrown into the criminal justice system and locked up in a cell.
Is it better to treat the mentally ill in a prison than in a large psychiatric hospital?
Some people think so. Apparently Gov. Gavin Newsom is one of them, and politics may be the reason.
The closure of large psychiatric hospitals decades ago was a consequence of the Medicare and Medicaid Act of 1965, signed by President Lyndon Johnson. The law denied federal reimbursement for care in “Institutions for Mental Illness” that had more than 16 beds. As a result, indigent adults up to age 64 who had Medicaid couldn’t get treatment in large residential facilities, because if they were, counties wouldn’t get federal money for their care.
At the time, it was fashionable to believe that new prescription drugs for mental illness held such promise that no one would need to be institutionalized, and community clinics were the modern way.
It has been clear for quite some time that this model did not work for everyone. Where are the people today who would have been receiving treatment in a large hospital in that earlier era? Many are in jails and prisons, or on the streets, or bicycling between them.
In November 2019, the Kaiser Family Foundation issued a report titled “State Options for Medicaid Coverage of Inpatient Behavioral Health Services.” In the first sentence, the report states: “Since the inception of Medicaid, federal law has generally prohibited states from using Medicaid funds for services provided to non-elderly adults in ‘institutions for mental illness’ (IMD).” . It then goes on to explain that “in recent years, the federal government has provided new mechanisms for states to fund IMD services for non-elderly adults through Medicaid in certain situations.”
“In recent years” means during the Trump administration. States can now get a waiver of the IMD exclusion and receive federal funds to pay for mental health services in large institutions. The limitation of “16 beds” would be eliminated.
Why hasn’t Governor Newsom asked for a waiver of the IMD exclusion for mental health services? Is it because this was an initiative of the Trump administration?
California does not have enough mental health beds to adequately care for people with severely disabling mental illness, people dying from a substance use disorder, and people who are a threat to themselves and others.
On average, “40 or more acutely mentally ill inmates” are booked into Los Angeles County every day. The new Jail Inpatient Unit at the Twin Towers facility will have 16 beds.
This is crazy.
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