A new report released last week provides a rare statistical glimpse into San Francisco’s jail population and has health officials already talking about changes, like advocating for the right for those jailed to receive health insurance benefits.
San Francisco spends millions of dollars annually on jail health services, including HIV testing, methadone treatment and dental work. For many, it is the first time they receive the medical care they have long needed.
The Department of Public Health Jail Health Services treated last year 15,000 patients. Some 36 percent received some form of mental health services, and up to 14 percent of inmates were considered seriously mentally-ill.
That’s in a jail with a daily average population of 1,250.
The report points to the need to better help those who only spend a few days in jail. Last year, 65 percent stayed in jail for an average of less than seven days, the report found. Some 86 percent were in jail awaiting their day in court, for reasons such as not being able to afford bail.
The report comes as The City works on an alternative to an unsuccessful plan to build a new jail in San Francisco, which was shot down last year amid calls for alternatives to incarceration such as greater investments in mental health facilities.
The City’s Work Group to Re-envision the Jail Replacement Project has met since March and is expected to provide recommendations on an alternative to a new jail this fall to the Board of Supervisors and mayor.
“There are many more questions … but right now at least we have some important data to work with, which a year and half ago we did not,” Roma Guy, a former Health Commissioner who co-chairs the work group and helped lead the effort to defeat the new jail, told the Health Commission last week.
The report also found that The City spends about $30 million on Jail Health Services for salaries of 163 employees such as nurses and therapists, including about $2.5 million for pharmaceuticals. There were 194,000 pharmacy fills last year.
Lisa Pratt, director of Jail Health Services, presented the data during last week’s Health Commission meeting. Pratt was hired in January and previously worked as chief physician at San Quentin State Prison.
Both Pratt and Guy estimated that at least 30 percent of the jail population are homeless. “That seems to us on the blush of it to be an underestimate, at least if you include marginally-housed people,” Pratt said.
Such information also comes as The City places a greater emphasis on addressing the homeless population, including with the creation of the new Department of Homelessness.
“The opportunity for integration with homeless services is huge here,” Pratt said, “and also providing care for those patients in other than, ‘Please go to this clinic in this neighborhood on this date,’ which is really what the homeless outreach has been doing.”
With the high percentage of short-term stays, including those who are homeless and housed, Health Commissioner David Pating said, “I can think you can almost be a day hospital model where you are just seeing people, doing these acute triages, a lot of quick tuning up and then linking them.”
He added, “For many of your patients, this is the only opportunity we are going to get.”
Pratt said The City is exploring the best way to ensure “a warm hand-off and not just a ‘We’ve made appointment for you on Tuesday, hope you make it,’ because that historically doesn’t really work for this population. We’re more likely to see them again than they are likely to make the primary care appointment.”
Health coverage reform
San Francisco’s health services for those in jail is funded through taxpayer dollars, not health insurance providers like Medi-Cal, which suspends coverage once a person is jailed.
That’s something that Barbara Garcia, director of Public Health, and Colleen Chawla, deputy director of health and policy, are trying to change.
“Medi-Cal is something that both Colleen and I have been really trying to look at, is can we get individuals covered in Medi-Cal as they continue in jail, particularly since they are there for a few days and it gets really complicated in terms of getting them back into care,” Garcia said. “That’s a policy question we need to continue to advocate for.”
A breakdown by race showed 36 percent of the jail population were black, 34 percent white, 16 percent Latino, 8 percent Asian/Pacific Islander, 1 percent Native American and 5 percent unknown or other, according to the report.
Seventy-eight percent of the jail population were men, 13 percent women and 10 percent declined to answer. There were 61 transgender women and 17 transgender men.