Los Angeles County houses the largest jail system in the country. More than New York, more than Cook County in Illinois. As such, any problem experienced in the 57 other counties of California can easily be magnified tenfold in Los Angeles County, home to more than 9 million people.
Earlier this year, amid allegations of prisoner abuse among the rank and file in Los Angeles County corrections, the woman who used to oversee all of California’s state prisons and parolees was brought in to be Sheriff Lee Baca’s right hand woman. In March of this year, Terri McDonald accepted the position of Assistant Sheriff of Los Angeles County.
California Forward had the opportunity to sit down for a candid one-on-one with Asst. Sheriff McDonald recently and we are presenting a distilled version of this dialogue in hopes that our readers gain an appreciation for both the complexity of public safety realignment and the rigors of implementing it properly and cost-effectively in such a massive county.
Part 3 has her discussing the potential benefits of the upcoming Affordable Care Act (ACA) implementation to Los Angeles County’s jail system and what she sees as the future of AB 109.
I don’t know if you’ve seen some of the preliminary numbers, but the estimates from the group COCHS on how much the Affordable Care Act could mean on an annual basis in terms of the Medi-Cal refunding is pretty astounding. Their high estimate for L.A. County over the lifetime was about $168 million.
I think a lot of times researchers, bureaucrats, they tend to overestimate, over-promise and under deliver. It’s great. I hope that happens but I prefer to wait and just see what happens.
Regardless of where it comes in, maybe $40 million below that, it’s still significant cost savings to the County.
It’s an incredible opportunity for the County. Incredible.
Talk to me about how much of a chunk that would represent to L.A. County, what you could do with that money instead. Talk to me in general about the money and what you have to do on the ground and politically, in terms of making sure that you secure the funding to do everything that you’ve just told me that you’re trying to do right now.
My philosophy is that re-entry begins at intake. It’s the philosophy of the entire team here. Whether it’s mental health, re-entry back into the community, homelessness, veteran issues, substance abuse, or it’s a guy that just needs a job. Re-entry begins at intake.
How do we get people, when they come in the door, and begin the benefit enrollment process to take advantage of the ACA? How do we begin the discharge planning process when they hit the door? Because remember, not everybody here stays for a long period of time. So if you get somebody in that’s got a chronic medical disease or substance abuse problem or mental health problem, those are targeted during the benefit enrollment period. Not only to get them enrolled, but we target them to a discharge planner. That doesn’t come cheap, that’s not free. It requires resources to do that. The other challenge for us would be it’s voluntary.
How do we break through the inmates’ fear and stigmatization of the system? I don’t know today what percentage of inmates will volunteer and what percentage won’t. We’ll just have to see. Then partnerships with nonprofits, partnerships with hospitals to focus on substance abuse treatment centers so that when we get them benefit-enrolled, we’ve targeted placements for them when they get out.
It’s not easy though because a percentage of these offenders are released in the evening, they are released directly from jails. They are released without us knowing. So we are working with the courts to say “How can we make sure we are all aware if inmate Jones is enrolled in Medi Cal? What is our plan for Jones if he is released from custody?” That’s easy to do in a system with 400 inmate Joneses. It’s a little harder with 19,000 inmate Joneses. Easier with the realigned population, right? Because we know when they’re getting out, harder with the pre-released population.
The remaining opportunity for us is the money that was given in the budget by Senator Steinberg. There’s roughly $203 million in grant funding.
That’s specifically earmarked for mental illness?
For mental illness, and for counties to go after grant funding. I think there’s 25 mobile mental health crisis vans statewide. So we would seek a good percentage of those vans and they would have a law enforcement officer and a clinician who are able roll to, on request, to somebody who is mentally ill, engaged in potentially criminal behavior. And some of that criminal behavior can be nuisance behavior, drunk in public, urinating on the streets, homelessness, general vagrancy and loudness. And rather than an officer bring him here because he’s committed a crime, he can be taken somewhere else that’s more appropriate to deal with his mental health issue. Don’t bring him into the jail for a mental health problem.
The other part of the $203 million is that there’s funding for 2,000 residential beds. There’s not enough housing resources here for the mentally ill. Particularly when you’re talking about forensic mental illness, where they’ve got some kind of a criminal history.
It’s hard to get those beds. Nobody wants them in their community. Now, if they’re committing violent crimes, come to jail. Right? There’s a place for them. But the jail isn’t the only one stop shop for the mentally ill and now there’s funding for discharge planning.
So we’ll go after that grant funding. So we go after the Steinberg grant funding and we go after the Affordable Care Act Funding and it’s all designed to put the right inmate or the right potential inmate into the right diversionary bed to address their criminogenic needs. Statistically and allegorically we know that we’ll have better outcomes than just warehousing people in jails. Right?
The good news is I work for a sheriff who doesn’t believe in warehousing people. I work for a sheriff who believes that we’ll get better outcomes if we take advantage of their time in custody to address their criminogenic needs and get them into programs. The bad news is there’s not enough here. There’s not enough space. I know you know the jails weren’t built for programming. So we’re eeking out every little bit. Every little hour we can do but it’s a lot harder than the prisons were from that perspective.
So to finish everything off, one last question: What in your eyes is the state of realignment and AB109 right now, and what would you like to see happen in the next two years?
I think it’s still in its operational infancy stage. Statewide, counties are still adjusting to the population that they have and still adjusting to understanding and managing longer term offenders and understanding how to manage a more sophisticated inmate. I think the courts are just now starting a parole revocation process so it’s too soon to know.
I think what we’ll find in the next couple of years, and I think it could be very powerful, is a bigger and broader understanding of what works in reducing recidivism. I think we’ll get a better understanding of what risk tools work better, based on community dynamics. The most fascinating thing about Realignment is, five years ago 20 people said the word “recidivism.” Other than researchers, 20 people said “recidivism.” I am making up a number, but you get my point.
Now, recidivism as a discussion, is happening across divisions, across agencies and statewide. I think most people are beginning to understand that you can’t just throw everybody in a jail bed or a prison bed. The risk will continue to be those bad outcomes, where people are making decisions to manage people differently and there’s a bad outcome. That’s used as a sharpened tool to say realignment doesn’t work. I’m hopeful that a lot of research comes out to talk about the reality of that and comparing pre and post realignment.
The other challenge has go to be that there still has to be consequence for criminal behavior. With early release as a factor, we have to be aking a hard look at how we use our limited resources, but not just letting people off the hook. Because people won’t change if they get let off the hook. Low risk doesn’t mean no risk. It’s really hard to undo a victim.