Executive Summary

California’s Department of State Hospitals is enrolling thousands of incarcerated people in a program called Early Access and Stabilization Services (EASS)—a program offering limited treatment services in county jails. The Department of State Hospitals implemented EASS for individuals charged with felonies who have been found incompetent to stand trial (IST) and remain in jail while they wait to receive comprehensive competency restoration and treatment services from the Department of State Hospitals. 

Even though jails are not the recommended treatment setting for individuals deemed IST,1 the Department of State Hospitals has used EASS as a short-term solution to fill the holes in mental health treatment in many county jails across California while high numbers of individuals await transfer to treatment programs. Over the past three years, the Department of State Hospitals has invested over $500 million dollars to implement EASS in nearly every county jail in California.

DRC conducted a year-long investigation into EASS after receiving complaints that EASS was exposing incarcerated individuals to increased risks of harm. DRC found that the dangerous jail conditions to which EASS enrollees are exposed undermine EASS’s goals of psychiatric stabilization and competency restoration. DRC also found that EASS provides fewer services and supports than in other settings that clearly meet constitutional standards for competency restoration. Further, DRC found that EASS does not significantly increase rates of competency restoration or diversion opportunities or decrease chances of recidivism. Based on its investigation to date, DRC finds that it has probable cause to believe that some individuals with serious mental health disabilities who are incarcerated, found incompetent to stand trial, and receiving EASS services have or may have been neglected, as that term is defined in DRC’s authorizing statutes and regulations.

Instead of investing millions of dollars each year in EASS, the Department of State Hospitals, county governments, and the State of California should invest more resources into diversion, community-based restoration programs, and other voluntary community-based mental health programs that are more effective at breaking the cycle of criminalization of individuals with serious mental health disabilities. 

To the extent that the Department of State Hospitals continues EASS, it must ensure that EASS is only a temporary program that does not detract from investment in longer-term solutions. The Department of State Hospitals also must take greater affirmative steps to ensure the safety of EASS participants and the effectiveness of this program. Californians living with serious mental health disabilities have urgent needs and deserve far more than a half-measure solution to stop the cycle of overcriminalization and homelessness. 

 

Table of Contents

Background

California’s Crisis Involving High Numbers of People Charged with Felonies and Deemed Incompetent to Stand Trial

The Legal Framework for Competency Restoration Services

Early Access and Stabilization Services (EASS) as a Short-Term Goal to Increase Diversion and Community-Based Restoration

DRC’s Investigation

Findings

Finding 1: The county jail conditions to which EASS participants are subjected undermine EASS’s goals of enhancing stabilization and competency restoration.

Finding 2: EASS does not appear as robust as the constitutionally adequate competency restoration treatment services and supports provided in other settings and jurisdictions.

Finding 3: EASS does not significantly increase rates of competency restoration or access to diversion opportunities or decrease chances of recidivism. 

Finding 4: DRC has probable cause to believe that some EASS
participants have been subject to neglect.

Recommendations

Recommendation 1: The Department of State Hospitals should prioritize investment in diversion and community-based restoration programs, which better support medium and long-term solutions to the IST crisis, over short-term investments in EASS. 

 

Recommendation 2: The Department of State Hospitals should not present EASS as equivalent to or a replacement of the constitutionally adequate intensive treatment and competency restoration services provided in other contexts, such as in state hospitals or in community-based restoration programs. 

Recommendation 3: To the extent that the Department of State Hospitals continues EASS, the Department of State Hospitals should prohibit EASS participants from languishing in conditions that rise to the level of solitary confinement. 

Recommendation 4: To the extent that the Department of State Hospitals continues EASS in the short term, it should establish sufficient metrics to measure outcomes of the EASS for all jails using EASS services. 

Recommendation 5: To meaningfully address the IST crisis, California counties and the State must invest more funding into voluntary, trauma-informed, community-based mental health services and housing support.

 

Recommendation 6: To the extent that county jails incarcerate people with serious mental health disabilities, counties and the State must ensure that mental health care is adequately resourced for all detainees, especially IST detainees needing competency restoration treatment.

CONCLUSION

 

I. BACKGROUND

California’s Crisis Involving High Numbers of People Charged with Felonies and Deemed Incompetent to Stand Trial

People charged with felonies and deemed Incompetent to Stand Trial (IST) face a long and arduous road in the existing criminal legal system. That road begins with individuals facing felony charges being held in county jails as they wait for their criminal case to proceed. Prior to trial, a court must determine whether the individual is competent to stand trial.2 If a court finds the individual IST, the court typically orders the individual to be committed to the California Department of State Hospitals3 for competency restoration services.4 These services are meant to ensure that individuals have an opportunity to understand their criminal legal proceedings and to assist in their own defense and, as such, play an important role in upholding an individual’s constitutional right to a fair trial.

The challenges that the felony IST population face in the criminal legal system are significant and unique. Incarcerated individuals living with mental health disabilities are disproportionately vulnerable to prolonged detention, harsh discipline, victimization and abuse, solitary confinement, and acts of self-harm and suicide.

Over the past decade, the number of individuals with mental health disabilities who are charged with felony offenses and found IST has grown substantially. The Department of State Hospitals has hypothesized that this substantial growth is largely due to the lack of adequate mental health services available in the community, including general mental health services, crisis services, high intensity wraparound services known as Assertive Community Treatment,5 and inpatient psychiatric beds. The gap in these services has led to more individuals with serious mental health disabilities being left “untreated” and “unsheltered” and at risk of experiencing “increased contact with police and criminal charges.”6 

The felony IST population is likely to grow even larger over the next few years due to state and national policy changes that threaten access to community-based mental health services, among other factors.7 With a growing felony IST population, this group of individuals is likely to experience worsening challenges in county jails while they await trial. Indeed, the waitlist of felony IST individuals reached a record high in January 2022 with 1,953 individuals in jails across California awaiting placement in a Department of State Hospitals facility for competency restoration services, some of whom waited for weeks and months to receive services.8  

The Legal Framework for Competency Restoration Services

Individuals found IST have a constitutional right to timely and adequate competency restoration treatment.9 The contours of what is constitutionally required with regard to the provision of such treatment is set forth in Stiavetti v. Clendenin,10 as well as several key federal court decisions.11  

In Stiavetti, a California trial court found that the Department of State Hospitals violated the substantive due process rights of individuals found IST by failing to provide them with timely competency restoration services, referred to as “substantive services.”12 To remedy these constitutional violations, the Stiavetti court ordered the Department of State Hospitals to commence “substantive services” to restore an IST defendant to competency within 28 days of the time that a judge ordered such services.13 The court defined substantive competency-restoration services as “services and medication reasonably designed to promote the defendant's restoration to mental competence.”14 The court made clear that while the Department of State Hospitals “may provide substantive services through a state hospital, treatment facility, outpatient program, jail based competency program, or other facility or program under their supervision,” the “baseline medical services provided by county jails under Penal Code 6030 and 15 CCR 1200 et seq. are not substantive services.”15  

Several federal courts have similarly found that delays by state hospitals in providing competency restoration services to IST defendants violates their due process rights.16 Collectively, these judicial decisions make clear that there is a certain level of timeliness and quality of competency restoration, including adequate staffing, medication, therapy, and other recovery-oriented services, that must be provided to satisfy constitutional requirements.

Early Access and Stabilization Services (EASS) as a Short-Term Goal to Increase Diversion and Community-Based Restoration

In 2021, California established an IST Solutions Workgroup to identify actionable short-term, medium-term, and long-term solutions to address the felony IST crisis in California.17  

The IST Solutions Workgroup proposed early access and stabilization services in jail as a short-term solution to “maximize re-evaluation, diversion or other community-based treatment opportunities and reduce IST length-of-stay in jails.”18 Part of this short-term solution aimed to “increase[] access to psychiatric care, including stabilizing medications in jail for felony ISTs,” to assist with “faster stabilization of mental health symptoms in jail [and] increase opportunities for individuals to be candidates for Diversion or community-based restoration programs.”19 The IST Workgroup recognized, however, that short-term strategies like early access and stabilization services that are not aligned with long-term goals—such as breaking the cycle of criminalization of individuals with serious mental health disabilities and reducing the number of individuals found incompetent to stand trial on felony charges—should be “time limited, phased out when medium- and long-term solutions are implemented, and not detract from the focus and implementation of the long-term goals.”20    

The Department of State Hospitals initiated the first EASS program on July 18, 2022, in response to the 2019 Stiavetti court order and the 2021 Workgroup recommendations. Over the following two years, the Department of State Hospitals implemented the program in nearly every county jail throughout California. To date, the Department of State Hospitals has invested more than $500 million in EASS.21

 Figure A:  Map of 55 Counties with Active EASS Programs (as of Oct 2024)22 

According to the Department of State Hospitals, the purpose of EASS is to initiate treatment at the earliest point possible once committed to the Department of State Hospitals as IST.23 EASS specifically aims to “[p]rovide stabilization and substantive services to ALL ISTs in county jails while they are waiting admission to a Department of State Hospitals facility, [the jail-based competency treatment program] or other competency restoration program.”24  

The Department of State Hospitals currently contracts with California Health & Recovery Solutions and Liberty Healthcare to establish and operate EASS at county jails throughout California. In addition, there are a small number of counties that have decided to operate their own EASS programs, such as Orange, Marin, and Sacramento. Los Angeles County, which has its own diversion program, is one of the only counties with a local jail that does not currently participate in EASS.

According to the Department of State Hospitals, EASS requires the following:

• Dedicated clinical staff to conduct patient engagement and psychiatric stabilization (funded by the Department of State Hospitals);
• Funding for psychiatric medications, including long-acting injectables;
• Funding for deputy costs to support the program; 
• No exclusionary criteria – all IST patients committed to the Department of State Hospitals are eligible to participate;
• No treatment milieu needed; and
• Legal assistance in obtaining involuntary medication orders.25

EASS has enrolled more than 5,200 individuals statewide.26 Individuals who are not restored to competency following EASS are subsequently transferred to a jail-based competency program, an inpatient facility operated by the Department of State Hospitals, a community inpatient facility, a community-based restoration program, or a diversion program.27

Figure B: The Department of State Hospitals’ Incompetent to Stand Trial Treatment Continuum28 

Disability Rights California’s Investigation

As California’s protection and advocacy system, Disability Rights California (DRC) is authorized under state and federal law to provide protection and advocacy services for those individuals in California who have mental, intellectual, developmental and/or physical disabilities.29 DRC has been investigating EASS across California since early 2024, when it received complaints that EASS was placing participants at risk of harm. 

During this investigation, DRC engaged in extensive fact-finding and retained Tobas Wasser, M.D. and Marcus Patterson, Psy.D.— two nationally recognized experts in forensic psychiatry and competency restoration treatment. DRC submitted to the Department of State Hospitals and every county in California public records act requests for information related to EASS. DRC conducted virtual and in-person monitoring visits with the Department of State Hospitals and a cross-section of county jails from across the state (Solano, Nevada, Madera, Fresno, San Diego, and Monterey). In addition, DRC conducted meetings with county jail representatives from San Mateo, San Francisco, and Los Angeles, as well as public defenders statewide with clients enrolled in EASS. DRC also conducted monitoring visits at Napa State Hospital and the Los Angeles Office of Diversion and Reentry. Finally, DRC conducted interviews with numerous current and former EASS participants. 

FINDINGS

Finding 1: The county jail conditions to which EASS participants are subjected undermine EASS’s goals of enhancing stabilization and competency restoration.

Although the Department of State Hospitals touts that one of the key advantages of EASS is that “[n]o treatment milieu30 [is] needed,”31 DRC found through its investigation that the jail context is antitherapeutic and harmful to many individuals with serious mental health disabilities, thus undercutting the goals of EASS to provide psychiatric stabilization and competency restoration.

County jails across California are not designed to promote rehabilitation and recovery, and in fact subject individuals to harsh, punitive conditions. People who are incarcerated face significant restrictions, including where they can walk, with whom they can speak, what they can eat, when they can shower, how often they can call family, and the amount of time they can spend outside in daylight. Studies show that people with mental health disabilities in jail are also at increased risk of physical and sexual violence and disciplinary sanctions for behaviors that are a manifestation of their disabilities.32  

Figures C: Exercise Yard at Fresno County Jail33

Figure D: Rules for MJ4 Unit at Fresno County Jail34

As but one example, DRC’s investigation revealed that EASS participants in Nevada County Jail faced sanctions for exhibiting symptoms related to their mental health, such as being confined to their cell for 23 hours per day and losing the ability to use the yard for recreation and exercise.35 These sanctions increase isolation and exacerbate mental health symptoms by depriving EASS participants of social interactions, fresh air, and therapeutic activities. Additionally, Nevada County shared complaints from EASS participants of officers failing to follow protocols during cell searches, and entire units placed on lockdowns following medical emergencies.36

DRC also found during its investigation that numerous EASS participants were held in conditions that rise to the level of solitary confinement, which involves confining a person to their cell, alone or with others, for a substantially longer period of time each day than those in general population.37  

Studies demonstrate that solitary confinement is an unusually harmful form of punishment that can inflict permanent damage and exacerbate pre-existing mental health conditions.38 The rates of suicide and instances of self-harm increase in solitary confinement conditions.39 The symptoms that individuals experience while in solitary confinement often persist even after they are released back into the general population or into the community.40  

Figure E: Examples of Housing for EASS Participants at Fresno County Jail.41

Based on information collected through in-person site visits, remote site visits with county jail leadership, and data collected from Public Records Act requests, DRC found that approximately 25% or more of EASS enrollees in the various county jails it monitored were locked in cells by themselves between 22 to 23 hours per day, with limited opportunities to recreate with others and minimal programming.  

Figure F: Percentage of EASS Enrollees in Segregation42

County Jail	Number of EASS Enrollees in Segregation	Percentage of EASS Enrollees in Segregation
Fresno County Jail	2 out of 8 (on the day of our in-person site visit)	25%
San Diego County Jail	5 out of 20 (on the day of our virtual visit)	25%
Tuolumne County Jail	13 of 30 (based on PRA responses)	43%
Monterey County Jail	2 out of 3 (on the day of our virtual visit)	67%
Amador County Jail	8 of 12 (based on PRA responses)	75%
Nevada County Jail	8 out of 12 (overall number, as relayed during virtual visit)	75%
Solano County Jail	1 out of 1 (on the day of our in-person site visit)	100%

While this data presents only a snapshot of where county jails across the state are housing EASS enrollees,43 DRC is concerned that it reflects an ongoing challenge given that the Department of State Hospitals’ contracts, policies, and procedures do not prohibit housing EASS participants in segregated conditions that rise to the level of solitary confinement. 

In contrast, conditions of segregation and isolation do not exist as an option at Department of State Hospitals’ inpatient facilities or in house-like community-based restoration programs. Even the Department of State Hospitals’ Jail-Based Competency Treatment program, which is located in certain county jails across California, provides patients with better conditions, including a housing unit dedicated to the jail-based competency treatment program, greater out-of-cell time, and enhanced programming. By requiring at least 4-5 hours of programming per day, the Department of State Hospitals’ policies and procedures preclude subjecting people in jail-based competency programs to conditions that rise to level of solitary confinement.44

In addition to harsh disciplinary sanctions and segregated housing, DRC observed that mental health treatment within county jails is frequently provided in anti-therapeutic environments. Individual patients may be restrained in locked “treatment modules” – which are essentially single person cages – handcuffed to chairs, and/or receive non-confidential treatment with jail deputies present.  

Figure G: Treatment Areas in Fresno County Jail45

Consistent with DRC’s findings, multiple federal courts have recognized the dangerous conditions that the IST population faces when they spend weeks or months in jail awaiting transfer to a state hospital and other competency restoration settings, including: 

• lack of mental health treatment in county jails;
• increased reluctance of individuals to take medications in jail;
• staffing deficiencies;
• lack of recovery activities such as group and individual therapy, recreational and occupational therapy;
• jail overcrowding;
• a disciplinary system that is at best ineffective for, and at worst harmful to, incapacitated individuals facing criminal charges;
• isolation and decompensation caused by locking individuals in their cells for up to 23 hours per day due to behaviors that are a manifestation of their mental illness; and
• increased risks of suicide for individuals who are deemed IST.46

Unfortunately, despite the Department of State Hospitals’ investment into EASS, the jail conditions to which EASS participants are subjected remain dangerous and anti-therapeutic and therefore appear to undermine the primary goals of the program. As the Independent Mental Health Monitor47 from one county jail recently concluded: “EASS is unlikely to be an adequate solution to the overall need for a higher level of care in all cases whose chronic mental health condition is too severe to treat in the jail.”48 Multiple jail staff and attorneys for various counties have also raised concerns about their ability to adequately treat the needs of EASS patients within the jail context. In the words of one jail staff member: “I don’t think we can provide the service that is commensurate with what is provided in the hospital... We are still a jail. As many plants and aquariums as I bring in here, it’s still a jail.”

FINDING # 2:  EASS does not appear as robust as the constitutionally adequate competency restoration treatment services and supports provided in other settings and jurisdictions.

As set forth above, in Stiavetti, the trial court required the Department of State Hospitals to provide substantive competency-restoration services, which it defined as “services and medication reasonably designed to promote the defendant's restoration to mental competence.”49 The court made clear that while the Department of State Hospitals “may provide substantive services through a state hospital, treatment facility, outpatient program, jail based competency program, or other facility or program under their supervision,” the “baseline medical services provided by county jails under Penal Code 6030 and 15 CCR 1200 et seq. are not substantive services.”50

DRC found through its investigation that EASS provides less mental health staffing and fewer mental health services than competency restoration programs delivered in state hospitals, community-based restoration programs, and other competency restoration programs in other jurisdictions and settings that satisfy constitutional requirements. 

EASS mental health staffing, programming, and
competency restoration services

EASS generally requires the following limited staffing: (1) a psychiatrist or psychiatric nurse practitioner who is available off-site through telehealth and meets with patients once per week; (2) one on-site mental health clinician or competency trainer who is present at least once per week; and (3) an on-site nurse or licensed psychiatric tech.51

Figure H: Minimum requirements of EASS52

Service	Frequency and Duration
Treatment Initiated	Services are initiated within 3 business days of EASS receiving referral
Treatment contacts	At least 3 clinical contacts weekly with any of the following clinical staff: Psychiatric prescriber (one contact each week must be a prescriber) Nurse (med pass does not fulfill requirement) Competency Trainer Mental Health clinician
Initial Psychiatric Evaluation and Report	Within 5 days of enrollment
Psychiatric follow-up/medication management	Weekly individual sessions
Competency education	Minimum of once weekly, as clinically appropriate
Treatment team meetings	Weekly
Nursing services	As clinically indicated
Group treatment	Based on patient stability and facility availability
EASS-PMU consultation	Case consultation to discuss the status of patients and determine appropriate treatment pathway

Figure I: Photograph of treatment area at Fresno County Jail with independent treatment module enclosure53

 While some jails bring individuals out of their cells for EASS services, this decision is made at the sole discretion of the jail and EASS. Services can also be provided at an individual’s cell door, which can compromise confidentiality, reduce the therapeutic value of services, and is often experienced as a dehumanizing encounter.

 Figure J: Teleconferencing station at Fresno County Jail54

Several practitioners and DRC’s experts have also expressed concern about EASS relying on psychiatrists who are only available remotely through telehealth.  

In the words of Dr. Wasser, “the ability of severely ill folks to interact with a telehealth system is quite limited—from refusal to attend the appointment, to paranoia when interacting with a screen.” If a patient refuses to meet virtually when the psychiatric prescriber is not physically present in the jail, the psychiatric prescriber generally cannot shift to an in-person meeting to overcome patient concerns.  This leaves patients without any access to critical psychiatric services. 

One former EASS participant shared her impression of meeting with a telepsychiatrist: “The psychiatrist in EASS was awful. They didn’t care about my health. They just sat behind their computer, did their job description, and nothing more. They gave me certain meds that I wasn’t supposed to have based on an improper diagnosis. I used to cry every night. I was allergic to the medications prescribed to me and they almost killed me.”55

In addition, the content of EASS clinical services appears limited. For example, competency education sessions “may range between 10 minutes and 50 minutes,”56 during which EASS providers attempt to determine individual needs by assessing participants’ ability to understand the court process. Competency education training incorporates games and workbooks, such as flash cards of key court terms and “Court Bingo.”  Another example involves group treatment, which under the Department of State Hospitals’ contract should be provided to EASS participants as needed based on patient stability and access to groups.57 In practice, however, group sessions within EASS are rare, and there is no evidence that group programming participation is even monitored or tracked.58

 Figure K: Competency Restoration Worksheets59

The quality and effectiveness of EASS is at best unclear. Formal patient assessments can be an important source of information to assess program quality and effectiveness because they help monitor progress and outcomes over time. However, while the Department of State Hospitals expects an individualized treatment plan for each EASS patient, the Department of State Hospitals does not require formal assessments. Moreover, the Department of State Hospitals has disclosed very little information about the metrics used to evaluate the quality of EASS contacts. DRC’s experts have expressed concern that the Department of State Hospitals may not be tracking the qualitative and quantitative metrics needed to observe important trends and measure the efficacy of EASS (for example, the actual number of contacts, the number of refusals, the duration of contacts). 

Figure L: Meeting room/classroom at Fresno County Jail with multiple independent therapeutic modules60

As researchers on competency restoration treatment programs have noted, “due to insufficient resources, it is unlikely that jails [can] provide the same level of medication support, classroom-based competency instruction, mock trials, symptom management, and rehabilitative services typically provided in hospitals.”61 As a result, “there may be good reason to think hospitalization would produce better results, particularly for severely psychotic adults.”62  

Department of State Hospitals mental health programming and competency restoration services

In contrast to EASS, DRC’s investigation found that competency restoration programs in state hospital facilities and community-based programs offer more comprehensive programming and humane conditions to support individuals who are being restored to competency.63   

For example, at Department of State Hospitals – Napa (“Napa State Hospital”), every IST patient is placed on an IST-specific admissions unit and has an extensive treatment team, which includes at least six staff members: (1) a psychiatrist/psychologist; (2) a social worker; (3) a rehabilitation therapist (including occupational therapists and recreational therapists, among other types of therapists); (4) a nurse; (5) a unit supervisor; and (6) a senior clinician. Each discipline conducts initial assessments that inform the treatment plan, and the patient and treatment team meet at regularly scheduled intervals.64

Figure M: Photographs from Napa State Hospital grounds and IST units65

The IST units have competency groups every day, frequently facilitated by rehabilitation therapists. For individuals who speak Spanish, there is a Spanish-language competency education group. Because many patients do not like classroom settings, competency restoration education can be provided while taking walks outdoors. 

Figure N: Unit Group Schedule and Spanish Competency Group Schedule at Napa State Hospital66

Individuals participating in competency restoration are also able to enjoy a wide range of individual and group therapies. Napa State Hospital, for example, offers group therapy for symptom management, substance use, recovery, community, and recreation. IST patients can engage in three programming slots per day in addition to competency restoration services. 

Figure O: Treatment Area and Day Lounge at Napa State Hospital67

Many patients also receive individual therapy from psychologists and can meet anytime with treatment professionals.  While some state hospital psychiatrists practice telemedicine, all competency restoration patients at Napa State Hospital also meet in person with psychiatrists in the admissions unit. 

IST individuals also enjoy a more therapeutic environment and greater freedom of movement. They have access to at least four breaks per day, where patients can stroll outdoors and interact with nature.

Figure P: Patient room at Napa State Hospital68

When patients are not involved in programming, they can participate in a wide range of activities like playing basketball, exercising with fitness equipment, watching TV, gardening, and playing games. Napa State Hospital keeps the unit engaging with activities such as talent shows and monthly birthday celebrations.

Because of the significant difference between EASS in county jails and the services provided in the state hospital, one jail employee opined, “If my loved one was IST, I would make sure they were going to a state hospital.”

Figure Q: Competency Restoration Unit at Napa State Hospital with wild peacock69

Staff from Napa State Hospital summarized the key differences between their competency restoration program and those provided in a jail setting as: “We’re therapeutic here. No batons, no pepper spray.”

Community-based restoration services

Certain individuals deemed IST who meet eligibility requirements may participate in community-based restoration or diversion programs, which are community-based IST treatment options provided in residential community settings. Both community-based restoration programs and diversion programs offer intensive mental health treatment services with wraparound support and housing. 

The Department of State Hospitals implemented the first community-based restoration program for felony IST individuals in 2018-19 with the Los Angeles County Office of Diversion and Reentry. The Office of Diversion and Reentry aims to reduce the number of people with serious mental health, physical health and/or substance use disorders in the Los Angeles County Jails, to improve long-term health outcomes, and to reduce recidivism.70

The Office of Diversion and Re-entry operates a Felony Incompetent to Stand Trial program that provides competency restoration services in a community setting. The Office of Diversion and Re-entry accepts clients who it believes can stabilize and step down to open residential settings. Clients with significant violent histories or very serious charges are screened out. 

The Felony Incompetent to Stand Trial program assigns clients to community-based placements tailored to meet their needs. Placements range from inpatient treatment locations to care in open residential settings.

Figure R: Special Service for Groups/Project 180 House for Office of Diversion and Re-entry Felony Incompetent to Stand Trial program participants71

In September 2024, DRC visited a program serving the Office of Diversion and Re-entry’s Felony Incompetent to Stand Trial participants. This program included a broad range of staff, including: 

• a psychiatrist who meets with a patient in-person for at least 30-60 minutes per week initially and at least once per month thereafter;
• a therapist such as a social worker or licensed marriage and family therapist (LMFT);  
• an occupational therapist;
• a Licensed Vocation Nurse (LVN); 
• a site Supervisor (who may or may not be a social worker); and  
• a case manager.

These various staff members work together to create “equitable and appropriate interventions tailored to the varying needs of [their] clients.”72 Collectively, they provide approximately ten hours of structured programming per week (two hours per day, Monday through Friday). This programming combines eight hours of group services per week (such as competency restoration, life skills and Dialectic Behavior Therapy), with weekly individual sessions with a case manager and therapist, and bi-weekly meetings with an occupational therapist. The schedule incorporates a balanced distribution of mental health, life skills, and substance use treatment topics.

In order to enhance client engagement, participants also get to enjoy at least two outings per month, including to amusement parks and museums, as well as special events and activities such as basketball games, walks to the park, crafting, exercising, and cooking. These additional activities are aimed at “enrich[ing] the therapeutic experience, [and] promoting social interaction, physical wellness, and a sense of community among clients.”73

Figure S: Treatment Area and schedule for Office of Diversion and Re-entry Felony Incompetent to Stand Trial Program Participants at SSG/Project 180 House74

Within the home-like community-based restoration programs, participants frequently share a bedroom and bathroom with one other person. Individuals are generally free to leave and return to the residence within certain hours.  

Figure T: Sleeping and bathroom areas in SSG/Project 180 House for Office of Diversion and Re-entry Felony Incompetent to Stand Trial Program Participants75

Figure U: Common recreation areas in Project 180 house for Office of Diversion and Re-entry Felony Incompetent to Stand Trial Program Participants76

One participant in the Office of Diversion and Re-entry Felony Incompetent to Stand Trial program shared how he spent four months in jail on the mental health case load and felt suicidal. He described his move into the community-based restoration program house as “blissful” because he had his own food, his own clothes and shoes, and he could play the guitar. When we met, he was about to leave for a few hours to buy an easel and a paint brush so he could paint.  He eagerly spoke about participating in programs such as Alcoholics Anonymous, Narcotics Anonymous, life group, music class, court competency, and playing the bongo. He said he had many opportunities through the program. Most importantly, he shared — “I feel safe here.”

Competency restoration in other settings 

Competency restoration services in other jurisdictions, including within the Ninth Circuit of Appeals, are also more expansive when compared to EASS. For example, in Washington and Oregon, competency restoration occurs in the community on an outpatient basis77 but not in jail.78

In Washington, hospital-based competency restoration services may consist of: 1) administration of psychiatric medications; 2) group and individual psychotherapy that addresses social skills for working with court staff, managing mental illness, and other therapies to assist patients to overcome barriers to competency to stand trial; 3) educational treatment programs to increase a defendant’s understanding of the legal process or individualized treatment programs that address problems that hinder a defendant’s ability to participate in his or her defense; 4) recreational and psychosocial group activities; 5) medical treatment if necessary; and 6) training is also often a component of competency restoration and may consist of competency education and understanding the legal system; and trauma-informed care.79

Similarly, services provided in Oregon’s hospital-based competency restoration services include: 1) psychiatric and psychological assessment and treatment, including diagnoses, medications and therapy; 2) benefit eligibility and coordination, transition planning for discharge; 3) legal skills teaching basic legal terminology and ideas that will help most people to aid and assist; 4) rehabilitation services to engage people in therapeutic activities aligned with their interests and strengths; 5) occupational therapy to assist with daily living skills such as cooking, personal finance, and public transit; 6) medical and dental services; and 7) GED classes for people ages 18-21.80 

Oregon’s community competency restoration services are defined as “services and treatment necessary to safely allow a defendant to gain or regain fitness to proceed in the community…” which “may include but are not limited to”: behavioral health treatment; case management; incidental supports; legal skills training; linkages to benefits; medical treatment related to capacity; medication management; peer-delivered services; and vocational services.”81

Even California’s Jail-Based Competency Treatment program, which takes place in certain county jails across the state, is more formalized and therapeutic than EASS. In the jail-based competency treatment program, patients are generally housed together separately from other incarcerated individuals.82 The Department of State Hospitals requires a minimum of 4 hours of group treatment daily, Monday through Friday, which includes one competency education group a day at least four days of the week.83 The groups must incorporate competency education, understanding and management of mental illness, and mental and social stimulation. The Department of State Hospitals also requires weekly individual clinical contacts and brief daily check-ins intended to build rapport and ensure patients are not in crisis. Importantly, the jail-based competency treatment program carves out certain categories of individuals from participating in the jail-based program, such as individuals with “[s]erious medical issues that the jail is not equipped to treat,” and individuals with complicated psychiatric presentations who may not be psychiatrically stabilized and/or restored to competency in less than 4 months.”84 In the words of one independent mental health expert, “EASS is so drastically different from the [jail-based competency treatment program] that in my opinion people deemed IST should either have the [jail-based competency treatment program] or restoration outside of the jail completely. I don’t understand why EASS exists at all.”

Given the stark disparities between EASS and the competency restoration programs described above, it remains unclear whether EASS meets the standards that courts have delineated to ensure that competency restoration services satisfy constitutional requirements.  

FINDING #3: EASS does not significantly increase rates of competency restoration or access to diversion opportunities or decrease chances of recidivism.  

In conducting its investigation, DRC heard county jail staff and independent experts express uncertainty about the goals of the program and raise questions about why the Department of State Hospitals did not first initiate EASS as a pilot program to assess its efficacy. DRC also heard concerns from various counties about feeling pressured into participating in EASS—some even going so far as to say that they felt “bullied” into entering into contracts for the program.

Based on DRC’s investigation to date, it remains unclear whether EASS is effective, particularly in terms of increasing rates of competency restoration, increasing access to diversion and competency-based restoration programs, and decreasing recidivism.

Recent data indicates that EASS does not significantly increase competency restoration.

While initial EASS proposals and press releases emphasized EASS as a competency restoration program, The Department of State Hospitals has progressively shifted its characterization of EASS as a first step toward placing individuals “on the continuum of care.”  

EASS’s efficacy in restoring individuals to competency remains unclear. In 2022 and 2023, counties implementing EASS reported restoration rates from 12-20%. Some jail mental health staff have raised questions, however, about whether the initial "success" of EASS may be misleading. Instead, they’ve wondered whether it could be an artifact of the large number of individuals who were simply waiting to receive restoration services and being treated by the local jail mental health teams at the time that the earliest EASS programs were rolled out.

Notably, the competency restoration rates of EASS enrollees dropped sharply as the IST waitlist decreased, and as individuals spent less time in EASS. For the last twelve months of data, it appears that fewer than 1 in 20 EASS participants regained competency while enrolled in the EASS program. Based on the Stiavetti status report that the Department of State Hospitals filed for the period of March 1, 2024, to June 30, 2024, the restoration rate appears to be between 1.6% – 4.4%.  In the first part of FY 25, the restoration rate of EASS participants was 4.8%. The most recent data indicates that the restoration rate of EASS participants is between 1.8 – 4.3%.  Therefore, since March of 2024, the restoration rate has been below 5%.

Figure V: EASS Competency Restoration Rate 

Time Period	EASS Competency Restoration Rate
8/28/22 – 2/27/23	17.7%
3/1/23 – 2/29/24	13.6%
3/1/24 – 6/30/24	1.6% - 4.4%
7/1/24 – 10/31/24	4.8%
11/1/24 – 2/28/25	1.8% – 4.3%

Given the small number of people restored to competency following their enrollment in EASS, DRC has significant concerns regarding the efficacy of EASS for this purpose.

EASS does not appear to increase involvement in diversion and other community-based treatment options.

The Department of State Hospitals originally touted EASS as a way to expand opportunities for diversion and community-based restoration programs. The IST Workgroup reported that “[i]ndividuals who are currently waiting in jail for admittance to treatment programs are more likely to access treatment in existing diversion and community-based restoration programs if their acute mental health symptoms are rapidly stabilized. Lack of symptom stabilization has been identified as the primary barrier to Department of State Hospitals’ IST Diversion Program placement.”  

Based on DRC’s investigation, however, EASS does not appear to have decreased barriers to placement in the Department of State Hospitals IST Diversion Program or increased the number of IST individuals eligible for diversion or other community-based treatment opportunities. 

Based on Stiavetti status reports, it appears that, for the first 31 months of EASS, fewer than 0.6% of EASS participants entered diversion programs. 

Figure W: Number of EASS Participants Entering Diversion Programs  

	8/28/22-2/27/23	3/01/23-2/29/24	3/01/24-6/30/24	7/01/24-10/31/24	11/01/24–2/28/25
Number of EASS participants	710	2,328	952	1,144	1,076
Number of EASS participants who entered a diversion program	0	Between 1 and 10	Between 1 and 10	Between 1 and 10	Between 1 and 10

The Department of State Hospitals has acknowledged that EASS resulted in less diversion than originally intended, but attributed this to a drastically shorter average length of stay in EASS. However, no EASS participants entered diversion programs during the first six months of the program (September 1, 2022, to March 1, 2023), when the EASS average length of stay was longest. 

Notably, the Office of Diversion and Re-entry program in Los Angeles County—which is California’s longest established, and perhaps only, community-based restoration program—does not participate in EASS. Given the Office of Diversion and Re-entry’s evident efficacy, it is not clear whether EASS is necessary for successful involvement in community-based restoration programs.

EASS does not appear to break the cycle of re-incarceration.

One of the greatest concerns of the IST crisis is high rates of re-arrest and re-incarceration. As noted by Napa State Hospital staff, for individuals who cycle in and out of incarceration, there is a concern that “every time they are found incompetent, it gets a little harder to treat them. Every time they are here, they are a little sicker.”  

DRC requested data from the Department of State Hospitals and all California counties about rates of rearrest/reincarceration following participation in EASS. Neither the Department of State Hospitals nor the counties appear to track this information, which hinders a clear assessment of the program’s long-term efficacy. Nevertheless, information gleaned through DRC’s interviews with EASS participants, responses to public records requests, and public data sources reveal disconcerting trends. For instance, data from Madera County indicated that of seven individuals restored to competency while enrolled in EASS, more than half were re-arrested within seven months of being released from the jail. 

In contrast to EASS, data from the LA Office of Diversion and Re-entry’s community-based restoration program indicated that, over a two-year period, the reincarceration rate was consistently less than 0.7%. 

Figure X: Office of Diversion and Re-entry Felony Incompetent to Stand Trial data

The Office of Diversion and Re-entry attributes much of its success in reducing recidivism to its overall focus on shifting people with serious mental health, physical health and/or substance use disorders in the LA County Jails away from the jail context and into housing, with the aim of treating people holistically and improving clients’ long-term health outcomes.  In contrast, the limited, jail-based interventions that EASS provides offer little in terms of addressing IST individuals’ long-term health outcomes or needs.

FINDING #4: DRC Has Probable Cause to Believe that Some EASS Participants Have Been Subject to Neglect.

Based on the investigation to date, DRC finds that it has probable cause to believe that some individuals with serious mental illness who are incarcerated, found incompetent to stand trial, and receiving EASS services have or may have been neglected, as that term is defined in DRC’s authorizing statutes and regulations. 

DRC is particularly concerned about the neglect of EASS participants with severe psychotic disorders. While there is a Psychiatric Acuity Review process to enable expedited admission to a state hospital for EASS participants with acute psychiatric needs, very few jail staff with whom DRC spoke seemed to use this process on a regular basis or even to know about it. DRC is thus concerned about the individuals with severe psychotic disorders who may be decompensating in jail prior to being transferred to a state hospital for higher levels of care.  

DRC likewise remains extremely concerned that some portion of EASS participants are housed in conditions rising to the level of solitary confinement. Subjecting an individual to solitary confinement exacerbates the mental health symptoms of people living with a mental disability. It can also cause individuals without existing mental health needs to develop symptoms, such as depression, anxiety, panic, lack of impulse and emotional control, cognitive dysfunction, hypersensitivity to stimuli, and hallucinations. The agony that holding people in solitary confinement conditions causes puts people at heightened risk of decompensation, self-harm, and suicide. The symptoms that individuals experience while in solitary confinement often persist well after they return to the general jail population or into the community. For these reasons, courts have found that solitary confinement violates the law, especially as applied to people with preexisting mental health disabilities. 

DRC further finds probable cause to believe that other EASS participants are or may be at risk of neglect by virtue of participating in a program that is, at best, a half measure aimed at filling the holes in mental health care within county jails while people wait for spaces in treatment programs.

RECOMMENDATIONS

Based on DRC’s investigation and consultation with two national experts, it appears that EASS fails to address many of the needs of the IST population in jails.

DRC’s experts formed the recommendations set forth below to address the identified deficiencies. The recommendations are based on information obtained from site visits, interviews with the Department of State Hospitals and personnel from various county jails across the state, and conversations with EASS participants and community members. They are informed by evidence-based studies as well as DRC’s experts’ years of psychiatric clinical and administrative experience with competency-based restoration programs across the country.

RECOMMENDATION #1: The Department of State Hospitals should prioritize investment in diversion and community-based restoration programs—which support medium and long-term solutions to the IST crisis—over short-term investments in EASS.  

The Department of State Hospitals appears to have spent more than $500 million on EASS since it began in 2022. According to the Department of State Hospitals’ 2025-2026 Governor’s Budget, several new IST programs such as EASS are now “fully or near fully implemented.” The Department of State Hospitals is now focused on its longer-term IST solutions programs, including the implementation of permanent mental health diversion and other community-based treatment programs.”  

DRC is encouraged that the Department of State Hospitals is shifting its focus to longer-term IST solutions. We understand that the Department of State Hospitals is in the process of transitioning from its Mental Health Diversion pilot program to a permanent Mental Health Diversion and Competency Restoration program and is investing $468.8 million to create up to 5,000 new beds statewide that will further increase the capacity to serve in the community the felony IST population.  DRC strongly supports this development.

Going forward, DRC’s experts recommend that the Department of State Hospitals invest more in expanding this Diversion and Community-Based Restoration Program than in maintaining EASS, particularly to the extent that EASS is taking resources away from more successful medium-term and long-term solutions. As programs are developed, attention should be placed on monitoring and measuring the success of these medium-term and long-term solutions to drive improvements and optimize services.

As the Department of State Hospitals expands its diversion and community-based restoration programs, DRC recommends that the Department of State Hospitals consider ways to replicate the success of the Office of Diversion and Re-entry’s Felony Incompetent to Stand Trial Program, which has focused on connecting IST individuals to mental health care and long-term housing and minimizing reincarceration.

Figure Y: Office of Diversion and Re-entry Felony Incompetent to Stand Trial Program outcomes

The Department of State Hospitals should also consider drawing from other successful models, such as Connecticut’s pilot Enhanced Forensic Respite Bed (EFRB) program that diverts individuals charged with misdemeanors who would have likely been found incompetent to stand trial.  EFRB is a 30-day residential program in which participants may receive clinical stabilization, peer supports, case management, access to benefits, referrals for interim and permanent housing, and employment supports.

ERFB outcome data shows that of 28 individuals enrolled in the program, 26 (92.9 %) were discharged from the program, 21 completed all legal requirements (80.8%) and 24 (92.3%) completed their treatment goals.

Outcome	N	%
Discharged	26	92.9
Completed Legal Requirements	21	80.8
Completed Treatment Goals	24	92.3
Terminated from Program	2	7.1
Left Against Staff Advice	1	3.6
Referred to Higher Level of Care	1	3.6

Because of the program’s success, it was recently expanded to three additional sites. Though this program is focused on misdemeanants, the principles and practices can be applied to the felony IST population in California and may be especially useful in small and medium-sized counties.

RECOMMENDATION #2: The Department of State Hospitals should not present EASS as equivalent to or a replacement of the constitutionally adequate intensive treatment and competency restoration services provided in other contexts, such as in state hospitals or in community-based restoration programs.  

Based on its investigation to date, DRC and its experts caution that EASS should not be treated as equivalent to or a replacement for constitutionally adequate competency restoration programs. The Department of State Hospitals should be careful in how it characterizes the actual goals of this program and not use it in ways that will result in lowering the bar of constitutionally adequate competency restoration services and/or set dangerous precedents for lowering the bar of constitutionally adequate competency restoration services.  

While one trial court described the services provided in EASS as “substantive services,” that trial court’s decision is not binding on other state courts. The nuances of competency restoration treatment were not fully briefed or argued before the court, but it still explicitly found that EASS is not equivalent to other competency restoration programs.  Indeed, given the significant differences between EASS and other treatment programs, multiple jail staff and mental health experts have questioned why EASS exists at all. 

	Office of Diversion and Re-entry Community-based restoration program	Department of State Hospitals’ Inpatient Facility	Jail-based competency treatment program	EASS
Setting	Community	Inpatient State Hospital	Jail, but in its own unit	Jail, frequently in segregated conditions
Mental health treatment offered	Staffing includes: (1) a psychiatrist who meets with patients in-person from 3–60 minutes per week initially and then at least once per month thereafter; (2) a full-time therapist such as a social worker or Marriage and Family therapist; (3) may also include a rehab therapist (umbrella term for some type of therapist. May be OT, rec, etc.); (4) a full-time Licensed Vocational Nurse; (5) a full-time site Supervisor (may or may not be a social worker); (6) a full-time Case Manager.	Staffing includes: (1) a psychiatrist/ psychologist; (2) a social worker; (3) a rehab therapist (umbrella term for some type of therapist. May be OT, rec, etc.); (4) a nurse (CRNs, psych techs, CAN, LVNs); (5) a unit supervisor; and (6) a senior clinician. Each discipline conducts initial assessments that inform the treatment plan, and the patient and treatment team meet at regularly-scheduled intervals.	An interdisciplinary team that includes at a minimum, a psychiatrist, psychologist, and nursing staff. Incentivized medication and program compliance provided through weekly individual clinical contacts and brief daily check-ins by clinicians or paraprofessionals intended to build rapport and ensure patients are not in crisis. Weekly individual sessions range from 10 minutes to 50 minutes depending on patient need and tolerance	A tele-psychiatrist once per week, and two additional contacts with a mental health clinician or nurse.
Group Programming	Approximately 5 hours of groups per week (1 per day), which includes groups like court competency, life skills, and DBT. In addition, the case manager and therapist both have individual sessions with all clients at least once per week. The OT has individual sessions about once every other week.	IST patients are able to participate in three groups per day for symptom management, substance use, recovery, community, recreation.	Four hours of group treatment daily, Monday through Friday	Generally none.
Competency Restoration	Required. At least one competency group per week, approximately 60-90 minutes.	At Napa, the IST units have competency groups every day, which are frequently run by rehab therapists. For individuals who do not speak English, there is a Spanish-language competency education group for men. Because many patients do not like the classroom setting, sometimes competency restoration can include taking a walk to talk about competency or playing competency bingo.	At least four days a week including, lasting from 30 minutes to two hours and involving: The use of semi-structured and standardized measures of trial competency and feigning/malingering; Group and individual competency education and psychosocial treatments. A multimodal and experiential educational experience in which materials are presented in multiple learning formats by multiple staff.	Once a week, between 10 minutes and 50 minutes in duration
Access to long-term housing	Yes, including an open-ended subsidy	No	No	No

RECOMMENDATION #3: To the extent that the Department of State Hospitals continues EASS, it should prohibit EASS participants from languishing in conditions that rise to the level of solitary confinement. 

To the extent that Department of State Hospitals continues EASS, it should amend its contracts with EASS providers to prohibit the placement of EASS enrollees in county jails in conditions that rise to the level of solitary confinement. DRC also strongly recommends the implementation of an enhanced, intensive monitoring program to better understand: the issues leading to participants being placed in such segregated settings; the duration of these restrictive placements; the efforts made to remove participants from these settings; and the efforts to reduce this practice, including the effectiveness of such efforts over time.

EASS enrollees need enhanced mental health care, not isolation and punishment. Placement of EASS participants in segregation due to symptoms of mental illness may be a sign that the jail setting is inappropriate for their conditions. Accordingly, people with mental health disabilities in jails must be placed in the least restrictive setting appropriate to their mental health needs. 

RECOMMENDATION #4: To the extent that Department of State Hospitals continues EASS, it should be time-limited and the Department of State Hospitals must establish sufficient metrics to measure outcomes for all jails using EASS services.  

Based on multiple meetings with the Department of State Hospitals and responses to public records requests, it appears that the Department of State Hospitals does not track many metrics necessary to sufficiently assess the efficacy of EASS. Data is crucial to ensure that EASS meets its goals. As such, DRC recommends that the Department of State Hospitals begin tracking relevant data and information, on a monthly basis, including but not limited to: 

1. The number of individuals enrolled in EASS, by facility; 
2. The length of stay in EASS and disposition (e.g., attainment of competency, determined not likely to be restored to competency, discharged to a higher level of care, etc.);
3. The length of time that EASS participants who need a higher level of care wait to be transferred to such care, and the reasons causing waits for such services;
4. The number of EASS participants placed in solitary confinement while enrolled in EASS, the length of time in such placements, the reasons for such placements, and efforts to move participants from such placements and the outcomes of those efforts;
5. The number of EASS participants placed in safety or isolation cells for exhibiting a danger to themselves or others while enrolled in the program;
6. Information as to where EASS participants are discharged (e.g., diversion, community-based restoration program, other jail-based competency restoration program, state or other hospital setting);
7. The number of EASS participants who decompensate following unenrollment in EASS; and 
8. The number of EASS participants who are reincarcerated following unenrollment in EASS.

It is crucial that these outcomes be measured and reported on a regular basis to ensure that program changes and improvements are data-driven and responsive to the needs that EASS participants are experiencing.

RECOMMENDATION #5: To meaningfully address the IST crisis, California counties and the State must invest more funding into voluntary, trauma-informed, community-based mental health services and housing support.

DRC and its experts recognize that EASS is just one piece of trying to address the IST crisis and that the Department of State Hospitals cannot solve this crisis alone. Consistent with the IST Workgroup’s medium-term and long-term recommendations, a crucial piece of addressing the overall IST crisis is ensuring that there are increased opportunities and dedicated State and county-level funding for voluntary, intensive treatment and support in the community.  The goal should be to both reduce recidivism and divert individuals in need of treatment away from the criminal legal system at the outset.  

Pursuant to Title II of the Americans with Disabilities Act, Section 504 of the Rehabilitation Act, and California Government Code §§ 11135 and 11139, counties are required to provide individuals with mental health services in the most integrated setting appropriate to their needs to prevent disability discrimination. The services that people with serious mental health disabilities need to avoid unnecessary institutionalization and/or incarceration include a range of voluntary community-based programs such as Forensic Assertive Community Treatment, Full Service Partnerships, crisis services, and housing support.  These evidence-based services are effective in enabling people – even those with the highest level of need for mental health services -- to live in their own homes in the community.  

Only through adequate investment in voluntary, trauma-informed, culturally responsive community-based services and supports will California be able to truly move from half-measures to meaningful solutions to address the longstanding IST crisis.

RECOMMENDATION #6: To the extent that county jails incarcerate people with serious mental health disabilities, counties and the State must ensure that mental health care is adequately resourced for all detainees, especially IST detainees needing competency restoration treatment.

Jails have a constitutional duty to provide adequate medical and mental health care. Courts across the state have found that County jails consistently fail to provide constitutionally adequate medical and mental health care to incarcerated individuals, which places individuals with serious mental health disabilities at substantial risk of serious harm. Individuals who have been deemed IST and are awaiting placement in a treatment program are particularly vulnerable to neglect, abuse, violence, isolation, and suicide in county jails.

In 2021, the IST workgroup group adopted multiple guiding principles which recognized that “[w]hile jail is not the appropriate setting for mental health treatment, jails need to be able to provide mental health treatment for individuals who are in jail and require treatment.” This Workgroup also noted that “[j]ails do not receive state funding support for treatment and housing of individuals found IST on felony charges unless they have been admitted to a Department of State Hospitals-funded jail-based competency treatment program.”  As a result, it highlighted the importance of increasing “[f]unding to jails to support the resources and costs to provid[e] these services.”  

DRC’s experts agree that, to the extent that County Jails continue to incarcerate individuals with serious mental health disabilities, the State and local government must ensure that mental health care is appropriately resourced to serve the entire range of incarcerated individuals. Investing in only one sliver of the jail mental health population fails to adequately protect the constitutional rights of all incarcerated individuals with mental health needs and fails to adequately prevent mental health deterioration and decompensation.

CONCLUSION

This report documents how the Department of State Hospitals is enrolling thousands of people in EASS as a stop-gap measure to fill the holes in mental health treatment in many county jails across California while individuals await transfer to comprehensive competency restoration treatment programs. 

Based on DRC’s investigation, it appears that the jail conditions to which EASS enrollees are exposed undermine EASS’s goals of enhancing stabilization and competency restoration. DRC also found that services provided through EASS do not appear as robust as treatment services and supports provided in other settings and jurisdictions that clearly meet constitutional standards for competency restoration. Further, EASS does not significantly increase rates of competency restoration or access to diversion opportunities or decrease chances of recidivism. As a result, DRC has probable cause to believe that some EASS participants have been subject to neglect.

This is a pressing issue because the felony IST population is likely to grow even larger over the next few years due to state and national policy changes that threaten access to community-based mental health services, among other factors. With a growing felony IST population, this group of individuals is likely to experience worsening challenges in county jails while they await trial. 

To address the ongoing IST crisis, DRC’s experts recommend that the Department of State Hospitals prioritize investment in diversion and community-based restoration programs, which better support medium- and long-term solutions to the IST crisis, over short-term investments in EASS. In addition, the Department of State Hospitals should not present EASS as equivalent to or a replacement of the constitutionally adequate intensive treatment and competency restoration services provided in other contexts, such as in state hospitals or in community-based restoration programs.  

To the extent that the Department of State Hospitals continues EASS, the Department of State Hospitals should ensure that the program is temporary, and prohibit EASS participants from languishing in conditions that rise to the level of solitary confinement. Additionally, it should establish sufficient metrics to measure outcomes of EASS for all jails using EASS services.  

Given that the root cause of the IST crisis stems largely from inadequate community-based mental health services and housing supports, California counties and the State must also help to solve this longstanding crisis by investing more funding into voluntary, trauma-informed, community-based mental health services and housing supports. Finally, to the extent that county jails incarcerate people with serious mental health disabilities, California counties and the State must invest more money in ensuring timely adequate mental health care for all detainees, especially IST detainees needing competency restoration treatment.