The resolution proposed by S.F.’s

SF to officially recognize incarceration as a public health issue

Jailing people has wide-reaching and severe health impacts on those locked up, their families and the communities where they are from — especially for those who are low-income and people of color.

In recognition of this, San Francisco’s Health Commission is slated to vote March 19 on a resolution declaring “incarceration is a public health issue.” It will also commit the Department of Public Health to develop a plan to help prevent incarceration.

“Each experience of being incarcerated is physically and psychologically traumatic with lasting impact on individuals, their families, communities, and especially to pregnant mothers,” the resolution reads.

The proposal, which builds on the work San Francisco has done in recent years to reduce the jail population, comes as The City remains undecided on how to close the jail facility at 850 Bryant St. in the Hall of Justice.

In 2015, the Board of Supervisors rejected a plan denounced by public health and homeless advocates to build a new jail to replace the one at 850 Bryant, a seismically unsound building all city departments are scheduled to move out from. Instead, The City shifted its focus to reducing the total jail population, with the goal of shuttering the jail without adding bed capacity elsewhere.

Those opposed to adding jail beds want The City to focus on improved public health services, more housing and other policies to address factors contributing to incarceration.

“DPH recognizes the adverse childhood experiences and social inequities, such as institutional racism, leads to disproportionate involvement of people of color throughout the justice system,” the resolution states. “Criminalization of homelessness and poverty, substance use disorders, and mental illness may lead to incarceration.”

The resolution notes the stark disparities of those who end up jailed.

About 40 percent are homeless or marginally housed. Transitional age youth, those aged between 18-25, have the highest number of jail bed stays of any age group. Last year, about 22 percent of those in jail at “any given time” were diagnosed as seriously mentally ill and 80 percent of those booked into jail reported substance use. Estimates of the jail population who are black ranged from 38 percent to 48 percent, when the city’s overall black population is about 5 percent.

After rejecting the new jail in 2015, The City established the Work Group to Re-envision the Jail Replacement Project, a multi-department effort that created strategies to reduce the jail population.

While the work resulted in better data, there remains room for improvement.

Dr. Lisa Pratt, who runs DPH’s Jail Health Services, told the Health Commission during its March 5 hearing on the draft resolution, that, for example, “we want to know who in the jail has kids.”

“That seems like a reasonable question. I can’t tell that from the medical record,” Pratt said. “These are questions that we want answered and we have to figure out how to get to them.”

Jail Health Services treated 11,964 different people booked into the jail in fiscal year 2017-2018.

Mayor London Breed’s newly appointed director of the Department of Public Health Dr. Grant Colfax supported the draft resolution.

“One of the true norths of the department is equity,” Colfax said. “This is a key equity issue.”

He noted that one of the challenges with jail health is “figuring out how to finance that system.”

Those incarcerated in California lose their Medi-Cal status and after being released it can take 30 days to re-establish it, posing an obstacle to access services, according to the resolution.

Colfax highlighted how one of the goals is to reduce incarceration “so that people can get the services they need” and pointed to a clause in the resolution that states “community-based treatment should be the first option to address an individual’s severe behavioral health and/or substance use issues.”

“Obviously that’s not fully in the department’s control, but I think it’s important that we philosophically bring that forward in this resolution,” Colfax said.

Dr. Naveena Bobba, DPH’s deputy director of health, who helped draft the resolution, said it is intended to “focus as a department in integrating our services to improve the outcomes of this client population.”

Daniel Madrigal, a health educator with the Public Health Institute, said it sends a clear message “against proposals to reopen, renovate, expand or build new jails in San Francisco.”

The City’s new proposed 10-year capital plan introduced to the Board of Supervisors on March 5 by Breed shows what’s budgeted for facilities for all city departments including the Sheriff’s Department, but leaves the fate of the jail at 850 Bryant St. and its inmates an open-ended question.

The plan notes that the total jail population “remains too high to allow for the permanent closure of County Jail #4” at the Hall of Justice, which holds 350 prisoners.

“A solution that will permanently close the Hall of Justice jails is still needed,” the plan reads. “San Francisco historically has been averse to the construction of new jail facilities. However, given the City’s responsibility for prisoners and staff, it will be necessary to relocate them from the Hall one way or another. The solution may require the construction of a replacement facility and/or operational changes such as out-of-county placements.”

As for the other departments, “to vacate the building as expediently as possible per direction from the City Administrator, staff from the District Attorney, Police and Adult Probation departments will be relocated to leased space by the end of 2020,” the capital plan said.

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