On any given day, the Los Angeles County jail system incarcerates more than 5,000 people living with mental illness. That’s around 30% of the total jail population, and the number continues to grow. Over the years, a range of proposals have sought to address the needs of this population, and change has come in fits and starts.

Now, the Measure R ballot initiative looks to catalyze sweeping change, writing into law the requirement for LA to figure out how reduce its jail population, invest in restorative, care-based solutions rather than incarceration, and ensure citizens can hold the county sheriff accountable for misconduct that in some cases has led to the deaths of mentally ill incarcerated people.

The treatment of incarcerated people with mental illness has long been in need of improvement across California, not just in LA County. In 2011, the Supreme Court ruled that the conditions in California’s notoriously overcrowded prison system violated the Eighth Amendment’s ban on cruel and unusual punishment, particularly for mentally ill people. Access to mental health care was far below the level needed, with a 54% vacancy rate for prison psychiatrists. While large-scale releases of incarcerated people since the decision has alleviated some overcrowding, adequate treatment remains elusive for mentally ill people incarcerated in LA County jails.

According to NPR, the LA County jail known as Twin Towers, which incarcerates approximately 3,000 people with mental illnesses, lacks the kinds of facilities necessary for treatment—there are no private or confidential spaces, no rooms for group sessions. A shortage of psychiatrists persists, and there aren’t enough beds for treatment of acute mental health episodes. 

Aside from the lack of treatment, simply being incarcerated for even a short period of time can aggravate mental illnesses and increase the risk that people will find themselves back in jail sooner or later.

Over the years, various proposals to better serve mentally ill incarcerated people in LA have come and gone. In 2019, the LA County Board of Supervisors floated a plan to build a new mental health-focused facility where the decades-old Men’s Central Jail currently stands. The proposed 4,000-bed Mental Health Treatment Center would still have been a jail, albeit one that combined incarceration with mental health treatment. After protests from advocates speaking out against the construction of yet another jail, the $1.7 billion contract was ultimately scuttled.

Then there are the diversion programs, which are intended to prevent mentally ill people accused of crimes from being incarcerated by instead sending them into community-based treatment. According to separate studies commissioned by both LA County and the Rand Corporation, between 55% and 60% of people within the jail system’s mental health population might be eligible for diversion to community-based mental health programs.

Currently, the Office of Diversion and Reentry within the Los Angeles County Department of Health Services has about 10 programs that represent alternatives to criminalizing mental health issues, substance abuse, and homelessness.

“While that is the most humane option, it also happens to be the most economic[al] option,” said Dr. Kristen Ochoa, medical director of the Office of Diversion and Reentry. The county currently pays about $600 per incarcerated person a day, when it could cover the cost of rehabilitation at about $70 per day. Ochoa says that there is a long way to go, but ensuring supportive housing is the first step.

While diversion programs exist, critics have argued that the county’s existing programs help too few people because they exclude those who have been charged with more severe crimes. But perhaps a larger challenge is the unequal buy-in among key players in LA County’s criminal justice system.

During a January debate in the ongoing race for Los Angeles District Attorney, former public defender Rachel Rossi and former San Francisco District Attorney George Gascón both accused incumbent LA DA Jackie Lacey of ordering her deputies to not pursue diversion programs. Last year, Lacey announced the creation of a mental health division within the prosecutors’ office that would expand treatment options and seek community-based care for those with mental illnesses. However, The Appealreports that as of last summer, the division had few staffers and had not trained prosecutors on how to handle cases involving people with mental illnesses.

Critics have also noted that Lacey has failed to seek justice for people with mental illnesses who are victims of police violence. After the 2014 fatal shooting of Ezell Ford, a mentally ill Black man, Lacey declined to press charges. In another instance, a former staffer of the DA’s office recently wrote about his brother who suffered from schizophrenia and was incarcerated in Twin Towers. He died there, Leon Nyarecha wrote, after suffering neglect and receiving inadequate care.

Deaths in county jails are just one reason organizers are pushing for increased accountability for the LA County Sheriff. If Measure R passes, the existing Sheriff Civilian Oversight Commission stands to be granted direct subpoena power, which will allow increased access to documents and witnesses needed to investigate police misconduct, neglect, and violence against incarcerated people.  

Recently, there have been signs of progress as organizers continue to push for LA County to commit to reducing its jail population and seeking care-centered models of treatment for mentally ill people. In February 2019, LA County Supervisors Hilda Solis and Sheila Kuehl commissioned the Board of Supervisors to allocate time and funds for the Alternatives to Incarceration Work Group, which describes its mission as providing “a road map, with an action-oriented framework and implementation plan, to scale alternatives to incarceration and diversion so care and services are provided first, and jail is a last resort.” The group is comprised of members from the sheriff department’s probation sector, the Office of Diversion and Reentry, organizers from the JusticeLA coalition, and history and public health scholars from both the University of Southern California and University of California Los Angeles, among others. Solis and Kuehl supported organizers in the successful effort to stop the planned mental health jail.

LA County is set to review the Work Group’s final report on March 10. The report details several strategies that would decentralize funds for incarceration, probation and policing away from central locations like the Twin Towers, the Men’s Central Jail, and women’s jails across the county, and instead direct the money to a countywide system of care.

Passing Measure R would ensure that LA County builds upon the efforts of the Work Group and devotes research and resources to developing more ways to provide necessary treatment and care rather than incarcerating people. The measure made its way to the ballot after years of organizing by a coalition of local groups that came together to form Reform L.A. Jails and JusticeLA. Among those groups was Dignity and Power Now, a grassroots organization focused on fighting for incarcerated people and their families. Mark Anthony Johnson, the former director of health and wellness at Dignity and Power Now, situates the push for improved mental health treatment and Measure R within the larger movement for the abolition of prisons.   

“To me, the abolitionist principle is to really think how we understand what Black people deserve in Los Angeles,” he said. The population of incarcerated people in LA County is disproportionately Black, even as Black people continue to be displaced from the area by rising housing costs and other challenges. “We started to demand for care first and an end to jails from the very beginning.”

Measure R is slated for a vote on Tuesday, March 3.

“We have an opportunity now more than ever to get it right,” said Johnson.