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Chair Nathan Fletcher’s pursuit of developing a better way to provide behavioral and physical health services in the County of San Diego’s seven detention facilities is getting underway now that a Memorandum of Understanding (MOU) between the San Diego County Sheriff’s Department and Health and Human Services Agency (HHSA) Behavioral Health Services division has been completed. 

The development of a new plan to provide improved services in jails took place after an August 2020 vote of the Board of Supervisors where they agreed with a vote of 4-1 to let the Sheriff’s Department explore and obtain information from potential healthcare service provider. Chair Fletcher then worked closely with HHSA Behavioral Health Services Director Luke Bergmann and worked with Sheriff Bill Gore to add enhanced restorative health services. Chair Fletcher first announced there was an agreement in the works during his State of the County Address in February. 

This MOU is just the start of a multi-year commitment to build out better medical and behavioral health services in our detention facilities,” said Chair Fletcher. “With this agreement, we are setting a new direction that will help to create a better, more caring set of services for individuals in our jails and also connect them to the supportive services they need when they leave the County facilities. 

“In the budget approved earlier this year, we made extensive investments to strengthen our jail health capacity by adding 160 new County medical/behavioral health-related employees and nearly $25 million,” Chair Fletcher said. “The MOU is the roadmap to create a better future for restorative health services in San Diego County.”

According to the MOU HHSA and the Sheriff’s Department will work collaboratively to improve in-custody behavioral and physical healthcare services, including the following:

  • Intake and ongoing individual assessments,
  • Medicated Assisted Treatment (MAT),
  • Care Coordination,
  • Additional identified healthcare enhancements,
  • Clinical Quality Oversight through Quality Assurance and Quality Improvement (QA/QI), and
  • Coordinated health record-keeping, including improvement and coordination with jail information management related to behavioral and physical healthcare services, and the sharing of data and management of that data

The MOU also indicates that the County Workforce will be leveraged more effectively for their knowledge and expertise: “ goal of this MOU is to help ensure that employees in existing or future created Sheriff's healthcare staff classifications and future vacancies in those classifications will continue to be filled with County employees…"

As part of their commitment to providing the highest quality health care, the San Diego County Sheriff's Department continues to move toward accreditation with the National Commission on Correctional Healthcare (NCCHC). They are implementing more robust programs such as Medication Assisted Treatment (MAT) and are also in the process of moving toward a new model of nursing they call "primary care."  This will decentralize much of the healthcare out to a more direct access model in the housing units.  These long-planned changes to their system were ultimately approved this fiscal year and multiple positions in various areas of healthcare delivery will be filled as soon as possible.  The people entrusted to the Sheriff's Department have always had access to quality healthcare; however the new model will make the system more efficient and effective.

"The Sheriff’s Department is committed to supporting our communities while enhancing health care for individuals while they are in jail" said Undersheriff Kelly Martinez. "Our partnership with HHSA facilitates a path to long-term recovery. It will expand the Medication Assisted Treatment (MAT) program we have at Las Colinas Detention and Reentry Facility to other county jails. The wrap-around service will meet or exceed national standards for healthcare services in our jails. With continuous treatment in the community, these individuals can get their lives back in order and thrive once no longer in custody."

"Correctional healthcare is a dynamic, engaging environment, and represents nearly the full spectrum of public health.  We provide care for an extremely diverse, medically challenging population.  Partnering with Health and Human Services Agency is a natural progression, as we both serve the same patients, just at different stages in their lives along the continuity of care" said Sheriff's Chief Medical Officer, Dr. Jon Montgomery.

Having the County of San Diego’s Behavioral Health Services Department guiding the direction of healthcare in jails could be life-changing for the incarcerated. Statistics from a recent reentry conference indicated that 70% of incarcerated people are addicted and 25% are addicted to opioids. Seventy-five to 80% of people in San Diego County Jails admit to taking drugs or test positive for drugs, and approximately 30% of those in our jails have had medication prescribed for a serious mental illness.  

"We know that people with behavioral health conditions are more likely to be jailed, and more likely to be jailed repeatedly.  And we know that incarceration deteriorates health, leading to worsening symptoms of mental illness and higher risk of death due to drug overdose,” said Dr. Luke Bergmann, Director of Behavioral Health Services/HHSA.  “The collaborative work that we are beginning with the Sheriff’s Department is designed to reverse these trends by engaging the jail population in care, and by proactively coordinating community-based health and behavioral healthcare for people leaving jail, so that they are more likely to remain in better health, and less likely to return to jail."