County jails hold large numbers of people with serious mental illness. The rules that govern what a jail must do for them are scattered across the Penal Code and Title 15, and families rarely see them written down.

The short answer: yes — and the jail is obliged to provide it. Title 15 requires that "a screening shall be completed on all incarcerated persons at the time of intake," covering "medical and mental health problems, developmental disabilities, and communicable diseases," and "a written plan to provide care for any incarcerated person who appears at this screening to be in need of or who requests medical, mental health, or developmental disability treatment."¹ The jail's health authority "shall establish policies and procedures to provide mental health services," which "shall include but not be limited to" identification and referral, "mental health treatment programs provided by qualified staff, including the use of telehealth," "crisis intervention services," "basic mental health services provided to incarcerated persons as clinically indicated," and "medication support services."² For each person treated, "the responsible mental health care provider shall develop a written treatment plan," which "shall include referral to treatment after release from the facility when recommended by treatment staff."³ If the person "may have a mental health disorder," the jailer or a judge "may cause the prisoner to be taken to a facility for 72-hour treatment and evaluation pursuant to Section 5150."⁴ The person may also apply for treatment voluntarily.⁵ And psychiatric medication cannot be forced without a hearing: "an inmate confined in a county jail shall not be administered any psychiatric medication without their prior informed consent," except in a defined emergency or after a court-supervised process with counsel, notice, and proof "by clear and convincing evidence."⁶

Intake: the screening the jail must do

Every person booked must be screened "at the time of intake," under written procedures, for "medical and mental health problems," by "licensed health personnel or trained facility staff."¹ The regulation then requires "a written plan to provide care for any incarcerated person who appears at this screening to be in need of or who requests medical, mental health, or developmental disability treatment."¹ The jail must have a written plan covering care for anyone who requests treatment at screening; once a person is treated, a separate rule requires an individual written treatment plan.³ If your relative takes psychiatric medication, the intake screening is where that needs to be said — by them, and by you, to the jail's medical unit.

The services the jail must provide

The jail's health authority, "in cooperation with the mental health director and facility administrator, shall establish policies and procedures to provide mental health services," including at minimum:²

  • "Identification and referral of incarcerated persons with mental health needs";
  • "Mental health treatment programs provided by qualified staff, including the use of telehealth";
  • "Crisis intervention services";
  • "Basic mental health services provided to incarcerated persons as clinically indicated";
  • "Medication support services";
  • health services "sufficiently coordinated such that care is appropriately integrated, medical and mental health needs are met, and the impact of any of these conditions on each other is adequately addressed."

For each person treated, there must be a written treatment plan; custody staff "shall be informed of the treatment plan when necessary, to ensure coordination and cooperation," and the plan "shall include referral to treatment after release from the facility when recommended by treatment staff."³ Leaving jail or prison: Medi-Cal and continuity →

When jail is not enough: transfer to a 5150 facility

"If it appears to the person in charge of a county jail … or to any judge of a court in the county … that a person in custody in that jail … may have a mental health disorder, that person or judge may cause the prisoner to be taken to a facility for 72-hour treatment and evaluation pursuant to Section 5150 of the Welfare and Institutions Code."⁴ Title 15 presumptively requires transfer where the person "appears to be a danger to themself or others, or to be gravely disabled": such a person "shall be transferred for further evaluation to a designated Lanterman Petris Short treatment facility … unless the jail contains a designated Lanterman Petris Short treatment facility." Two qualifications: licensed health staff may first assess on site whether the person meets inpatient criteria or whether treatment can be started in the jail; and the rule applies "unless the county has elected to implement the provisions of Penal Code Section 1369.1," in which case the jail may instead run its own involuntary-medication procedures under the regulation.²

Three protections travel with the transfer. Whoever orders it must immediately notify the county mental health director; a jailer must also notify every court where the person has a pending case, and the court must then "immediately notify" the prosecutor and "counsel for the prisoner";⁴ "the time passed in the facility shall count as part of the prisoner's sentence";⁴ and the statute closes a loophole: "the fact that the person has temporary access to food, clothing, shelter, personal safety, and necessary medical care while incarcerated is not a basis to conclude that the person is able to provide for their basic personal needs, which shall be evaluated based upon the person's ability to provide for those needs outside the jail setting."⁴ A person transferred "may convert to voluntary inpatient status without obtaining the consent of the court, the person in charge of the jail … or the local mental health director."⁴ What is a 5150 hold? →

Asking for treatment voluntarily

"A person in custody who has been charged with or convicted of a criminal offense may make voluntary application for inpatient or outpatient mental health services."⁵ If the services "require absence from the jail premises," consent is needed from the jailer or a judge and from the county mental health director; time in voluntary treatment "shall count as part of the prisoner's sentence"; and "a denial of an application for voluntary mental health services shall be reviewable only by mandamus."⁵

Medication: consent, emergencies, and the hearing

Section 2603 is the rule families most need. "Except as provided in subdivision (b), an inmate confined in a county jail shall not be administered any psychiatric medication without their prior informed consent."⁶ "Inmate" includes "a person housed in a county jail during or awaiting trial proceedings, and a person who has been booked into a county jail and is awaiting arraignment."⁶

Involuntary medication on a non-emergency basis requires all of the following:⁶

  1. a psychiatrist or psychologist has determined the inmate "has a serious mental disorder";
  2. a psychiatrist or psychologist has determined that, as a result, the inmate "is gravely disabled and does not have the capacity to refuse treatment with psychiatric medications, or is a danger to self or others";
  3. a psychiatrist has prescribed the medication, "considered the risks, benefits, and treatment alternatives," and "determined that the treatment alternatives to involuntary medication are unlikely to meet the needs of the patient";
  4. the inmate "has been advised of the risks and benefits of, and treatment alternatives to, the psychiatric medication and refuses, or is unable to consent";
  5. the jail "has made a documented attempt to locate an available bed for the inmate in a noncarceral treatment facility in lieu of seeking to administer involuntary medication";
  6. a hearing "before a superior court judge, a court-appointed commissioner or referee, or a court-appointed hearing officer";
  7. counsel "at least 21 days prior to the hearing," or, for a person awaiting arraignment, "within 48 hours of the filing of the notice" unless counsel is already appointed — with expedited access where emergency or interim medication is already being given;
  8. written notice at least 21 days before the hearing, setting out "the diagnosis, the factual basis for the diagnosis, the basis upon which psychiatric medication is recommended, the expected benefits of the medication, any potential side effects and risks," and the alternatives, and advising the inmate of "the right to be present at the hearing, the right to be represented by counsel at all stages of the proceedings, the right to present evidence, and the right to cross-examine witnesses," and of the right to appeal and to habeas corpus;
  9. a finding "by clear and convincing evidence" of the mental illness, of grave disability with incapacity or danger to self or others, "that there is no less intrusive alternative to involuntary medication, and that the medication is in the inmate's best medical interest."

An order "shall be valid for no more than one year"; for a person "awaiting arraignment, trial, or sentencing," the determination "shall be valid for no more than 180 days" and "the court shall review the order at intervals of not more than 60 days"; and it ends when confinement ends.⁶ A sworn declaration is enough to show the "documented attempt" to find a non-carceral bed, so the declaration is what the attorney should scrutinise.⁶ In an emergency — "a sudden and marked change in an inmate's mental condition so that action is immediately necessary for the preservation of life or the prevention of serious bodily harm," where it is "impractical … to first obtain informed consent" — medication may be given, but it "shall only be that which is required to treat the emergency condition and shall be administered for only so long as the emergency continues to exist."⁶ To continue beyond 72 hours pending the full hearing, the county must serve notice and seek an ex parte order within the first 72 hours, the inmate and counsel have two business days to respond, and the full hearing "shall commence within 21 days of the filing and service of the notice."⁶ Can they medicate me against my will? — the hospital rules →

What to do

  • Tell the jail's medical unit, in writing, the diagnosis and every medication and dose. Intake screening must record mental health problems and the jail must plan care for anyone who requests it.¹
  • Ask the defence attorney to request a transfer under section 4011.6 if your relative is deteriorating; a judge, as well as the jailer, may order it.⁴ Danger or grave disability presumptively requires transfer under Title 15, subject to the on-site assessment and the county's section 1369.1 election.²
  • Ask for the written treatment plan and whether it includes referral to treatment after release.³ Mental health diversion →
  • If you learn of involuntary medication, ask the attorney whether the section 2603 notice and hearing happened, and whether the jail documented its search for a non-carceral bed.⁶
  • If the case involves competence to stand trial, that is a separate track. Found incompetent to stand trial →

Worked example

A woman with bipolar disorder is arrested and booked at 2 a.m. At intake, staff must screen her for mental health problems;¹ she says she takes lithium and the screener records it, which triggers the jail's plan to provide care.¹ Two days later, unmedicated and increasingly manic, she stops eating. She appears gravely disabled, so Title 15 presumptively requires transfer to a designated LPS facility unless the jail has one;² the sheriff's medical staff evaluate her first to see whether treatment can begin on site, then the jailer causes her to be taken to the county's designated facility for 72-hour evaluation, and the court is notified and notifies her attorney.⁴ Her days there count toward any sentence.⁴ Back in jail a week later, stable on lithium but refusing it, the county psychiatrist wants to continue it against her will; the jail must document its search for a non-carceral bed, give her counsel and 21 days' notice, and prove its case by clear and convincing evidence at a hearing before a judge or hearing officer — and because she is awaiting trial, any order lasts at most 180 days, reviewed at least every 60 days.⁶

Q&A

Q: The jail says they don't have her medication. Do they have to give it? A: The jail must provide "medication support services" and "basic mental health services … as clinically indicated";² what is prescribed is a clinical decision, but a plan of care must exist for anyone who requests treatment at screening.¹

Q: Can they force antipsychotics on him because he is "disruptive"? A: No. Outside a defined emergency, involuntary medication requires a serious mental disorder, grave disability with incapacity or danger to self or others, a documented search for a non-carceral bed, counsel, notice and a hearing with clear and convincing proof.⁶

Q: Does a 5150 transfer stop the criminal case? A: If the facility's professional in charge "determines that arraignment or trial would be detrimental to the well-being of the prisoner, the time spent in the facility shall not be computed in any statutory time requirements for arraignment or trial."⁴ The case itself continues.

Q: What if the jail refuses a voluntary application for treatment? A: "A denial of an application for voluntary mental health services shall be reviewable only by mandamus"⁵ — a court petition, through the defence attorney.

Our therapist directory: See its current status →

In crisis? Call or text 988 — free, 24/7.

Sources

  1. 15 Cal. Code Regs. §1207, "Medical Receiving Screening" — "A screening shall be completed on all incarcerated persons at the time of intake. This screening shall be completed in accordance with written procedures and shall include but not be limited to medical and mental health problems, developmental disabilities, and communicable diseases. The screening shall be performed by licensed health personnel or trained facility staff …"; "There shall be a written plan to provide care for any incarcerated person who appears at this screening to be in need of or who requests medical, mental health, or developmental disability treatment" — regulations.justia.com.
  2. 15 Cal. Code Regs. §1209, "Mental Health Services and Transfer to Treatment Facility" — (a) "The health authority, in cooperation with the mental health director and facility administrator, shall establish policies and procedures to provide mental health services. These services shall include but not be limited to: (1) Identification and referral of incarcerated persons with mental health needs; (2) Mental health treatment programs provided by qualified staff, including the use of telehealth; (3) Crisis intervention services; (4) Basic mental health services provided to incarcerated persons as clinically indicated; (5) Medication support services; (6) The provision of health services sufficiently coordinated such that care is appropriately integrated, medical and mental health needs are met, and the impact of any of these conditions on each other is adequately addressed"; (b) "Unless the county has elected to implement the provisions of Penal Code Section 1369.1, a mentally disordered incarcerated person who appears to be a danger to themself or others, or to be gravely disabled, shall be transferred for further evaluation to a designated Lanterman Petris Short treatment facility designated by the county and approved by the State Department of Health Care Services for diagnosis and treatment of such apparent mental disorder pursuant to Penal Code section 4011.6 or 4011.8 unless the jail contains a designated Lanterman Petris Short treatment facility. Prior to the transfer, the person may be evaluated by licensed health personnel to determine if treatment can be initiated at the correctional facility" — regulations.justia.com.
  3. 15 Cal. Code Regs. §1210(a), "Individualized Treatment Plans" — "For each person treated by a mental health service in a jail, the responsible mental health care provider shall develop a written treatment plan. The custody staff shall be informed of the treatment plan when necessary, to ensure coordination and cooperation in the ongoing care of the incarcerated person. This treatment plan shall include referral to treatment after release from the facility when recommended by treatment staff" — regulations.justia.com.
  4. Cal. Penal Code §4011.6 — (a)(1) "If it appears to the person in charge of a county jail, city jail, or juvenile detention facility, or to any judge of a court in the county in which the jail or juvenile detention facility is located, that a person in custody in that jail or juvenile detention facility may have a mental health disorder, that person or judge may cause the prisoner to be taken to a facility for 72-hour treatment and evaluation pursuant to Section 5150 of the Welfare and Institutions Code and shall inform the facility in writing, which shall be confidential, of the reasons that the person is being taken to the facility"; (a)(2) the court "shall immediately notify the local mental health director or the director's designee, the prosecuting attorney, and counsel for the prisoner"; (a)(3) as quoted; (c) conversion to voluntary status as quoted; (d) "the time passed in the facility shall count as part of the prisoner's sentence"; (f) "if the person in charge of the facility determines that arraignment or trial would be detrimental to the well-being of the prisoner, the time spent in the facility shall not be computed in any statutory time requirements for arraignment or trial in any pending criminal or juvenile proceedings" — california.public.law.
  5. Cal. Penal Code §4011.8 — "A person in custody who has been charged with or convicted of a criminal offense may make voluntary application for inpatient or outpatient mental health services in accordance with Section 5003 of the Welfare and Institutions Code. If such services require absence from the jail premises, consent from the person in charge of the jail or from any judge of a court in the county in which the jail is located, and from the director of the county mental health program in which services are to be rendered, shall be obtained"; "the time passed therein shall count as part of the prisoner's sentence"; "A denial of an application for voluntary mental health services shall be reviewable only by mandamus" — california.public.law.
  6. Cal. Penal Code §2603 — (a) "Except as provided in subdivision (b), an inmate confined in a county jail shall not be administered any psychiatric medication without their prior informed consent"; (c)(1)–(9) the non-emergency conditions as quoted, including (c)(5) "The jail has made a documented attempt to locate an available bed for the inmate in a noncarceral treatment facility in lieu of seeking to administer involuntary medication," (c)(7)(A)–(B) counsel, (c)(8)(B) the notice contents and rights, and (c)(9)(A) the clear-and-convincing findings; (d)(1)(A) the emergency definition as quoted, and (d)(1)(B) "the medication shall only be that which is required to treat the emergency condition and shall be administered for only so long as the emergency continues to exist"; (d)(2)–(4) the ex parte order within the initial 72 hours, the two-business-day response, and the hearing "within 21 days of the filing and service of the notice"; (e)(1)(A) "An order by the court authorizing involuntary medication of an inmate shall be valid for no more than one year after the date of determination"; (e)(1)(B) "in the case of an inmate who is awaiting arraignment, trial, or sentencing, the determination that an inmate may receive involuntary medication shall be valid for no more than 180 days. The court shall review the order at intervals of not more than 60 days to determine whether the grounds for the order remain"; (e)(2) the determination ends when confinement ends or a court finds the criteria no longer met; (c)(5) also: "Submission of a declaration under penalty of perjury is sufficient for the county to demonstrate a documented attempt to locate an available bed"; (m) the section "shall remain in effect only until January 1, 2030"; (k) "'inmate' means a person confined in the county jail, including, but not limited to, a person sentenced to imprisonment in a county jail, a person housed in a county jail during or awaiting trial proceedings, and a person who has been booked into a county jail and is awaiting arraignment" — california.public.law.

Paid for by participating therapists. Inclusion is computed from availability data — never purchased. No ads, no data sold.