Sacramento County Board of Supervisors Propose Taking Out a $925 Million High-Interest Loan to Build a “Mental Health Jail” Despite the Looming Threat of Losing Most of Its State Funding for County Behavioral Health Services
By Corrine McIntosh Sako, Psy.D., LMFT
The majority of funding for mental health services provided by the 58 counties throughout California is provided by revenue generated from Proposition 63, passed by California voters in November 2004. Proposition 63 became known as the Mental Health Services Act (MHSA) and authorized a tax increase on millionaires (1% tax on personal yearly income in excess of $1 million) to develop and expand community-based mental health programs. Of the $674 million Sacramento County’s Behavioral Health Services (BHS) Division received to provide behavioral health services in fiscal year (FY) 2023-24, $154 million came from the Mental Health Services Act (MHSA). These funds are used for mental health treatment services and support for children/youth and their families living with severe emotional disturbance, adults living with a serious mental illness, and housing for these populations. A current Senate Bill—SB 326 (Eggman) Behavioral Health Services Act—threatens to overhaul MHSA in a way that will shift critical funding away from outpatient and crisis services that are foundational pillars in 
Sacramento County.
SB 326 proposes to shift 30% of the total MHSA revenue away from mental health services, while simultaneously adding a new category of clients—those with substance use disorders. With the proposed categorical funding allocations in its current proposal, SB 326 would require Sacramento County to shift $64 million away from important outpatient and crisis services—services that account for 44% of Sacramento County BHS’ MHSA Budget. Because the County’s current use of MHSA funding for mental health services allows the County to draw down federal matching Medicaid revenue, Sacramento County stands to face cuts totaling 65% of its outpatient services budget.
According to data from the Sacramento County Sheriff’s Office (SCSO), people with a mental health diagnosis who receive mental health services during incarceration comprise 70% (2,045) of the population detained in its jails, making the jail one of the largest behavioral health providers in the county. Of the 2,045 patients with a mental health diagnosis, 47% (962) have a Serious Mental Illness (SMI), which includes a diagnosis of a Schizophrenia Spectrum and Other Psychotic Disorders, Borderline Personality Disorder, Post-Traumatic Stress Disorder, and/or Bipolar and Related Disorders. People with mental illness often face challenges to navigating life in a jail. Behaviors related to their symptoms can put them at risk for consequences of violating facility rules, such as solitary confinement or being barred from participating in programming. These challenges are the direct result of the behavior of those who are trusted to provide care for these individuals—namely, the Sacramento Sheriff’s deputies. An additional building with increased programming space will not remediate this dynamic that correctional officers are not licensed mental health professionals and that a jail, by its very definition, can never be a therapeutic milieu.
The Sacramento County Board of Supervisors almost unanimously opposed the proposal to construct a Mental Health Jail Annex in March 2021. At that time, they explicitly expressed their intent to recalibrate their approach to meeting the Mays Consent Decree and explore community-based alternatives to incarceration. And yet in December 2022 in a 3-2 vote, the BOS approved moving forward with constructing a Main Jail Intake and Health Services Facility—a stand-alone tower in the back parking lot of the Sacramento County Main Jail. At the time of the vote, the proposed cost for this construction project was $450 million. The County’s plan to pay for it? Indebtedness. The County will take out a lease-revenue bond, which generally comes with a 20-30 year commitment along with a high interest rate. Also at the time of this vote, the plan for the State to modernize the MHSA had yet to be revealed.
According to the most recent county documents related to this plan, current project costs are now estimated at $654,000,000 and is estimated to take at least five years. When all is said and done, total costs will be near $1 billion.
At the December 2022 meeting, the BOS also directed County staff to move forward with a set of jail reduction and alternative to incarceration plans.. A number of the behavioral health programs included in the County’s Jail Reduction Plans are those that are funded by MHSA dollars, including the Mental Health Urgent Care Clinic (MHUCC), the 11 Community Outreach Recovery Empowerment (CORE) Wellness Centers, and the Mobile Crisis Support Team (MCST). These programs offer community-based behavioral health services for individuals (age 18 and older) being released from acute care settings or who are at risk for entering acute care settings and are not linked to on-going mental health services. Other vital MHSA-funded programs that can provide the benefit of jail diversion include the Adult Psychiatric Support Services (APSS) clinic, Juvenile Justice Diversion and Treatment FSP, Transitional Age Youth FSP, Crisis Residential Programs, and Children’s Community Mental Health Services. Should these programs lose capacity or become depleted, many of our County residents with mental health challenges are at-risk of becoming destabilized. And when our individuals with mental health challenges become destabilized, especially when their symptoms are externalized, they are likely to have interactions with law enforcement and ultimately become incarcerated.
Additionally, moving forward with this construction project directly opposes recommendations set forth by the County’s own Mental Health Board in November 2022. These six recommendations called for the adoption of a “Care First, Jails Last” policy resolution and specifically in recommendation 3c it states: “It has been estimated that $100 million in construction costs is needed to add a psychiatric wing to the main jail and an additional $50 million annually to staff and secure it. Instead of prioritizing funds to construct a treatment space for those individuals with behavioral health needs inside Sacramento County Jails, focus on constructing a freestanding mental health treatment facility that contains beds licensed at the psychiatric health facility (PHF) level and also offers a step-down program that accommodates beds licensed at the mental health rehabilitation center (MHRC) level.”
The construction project’s price tag has increased to $650 million, an additional $200 million from when it was first reported 8 months ago and before a shovel has even touched the ground. Considering that the total financial consequence for this bind will be close to $1 billion, coupled with the looming threat of the County’s behavioral health system being drastically transformed and potentially emaciated by the categorical funding allocations of the MHSA modernization proposal, now is not the time for our County Board of Supervisors to stick its residents with a 20-30 year debt for a capital improvement.
Unless it was their plan all along to continue warehousing our residents with mental illness in its jails.
Let Your Voice Be Heard!
- Call and/or email your County Supervisor and join me in calling on the Board to end this project and commit to alternatives to incarceration that prioritize public health and community safety. Find Your County Supervisor: https://www.saccounty.gov/SupervisorLookUp/Pages/default.aspx
- Join the Coalition of Health Professionals, Community Leaders, Businesses, and Concerned Residents Demanding that Sacramento County Supervisors Cancel the Contract and Stop the Loan for the “Mental Health Jail” Expansion of the Sacramento County Main Jail. Use this toolkit for more information, including talking points and how to submit written public testimony: https://bit.ly/CancelTheContract
Dr. Corrine was born and raised in Sacramento. She is a licensed psychologist and a licensed marriage and family therapist and she has provided mental health services to Sacramento residents in her private practice since 2006. She currently serves as the President of the Sacramento Valley Psychological Association and Chair of the Sacramento County Mental Health Board. She collaborates and consults with a number of local community-based organizations to foster awareness of social injustices, promote community solidarity, and advocate for non-law enforcement and criminal legal system responses to mental health crises. You can find out more about her by visiting her website www.drcorrinemcintosh.com or following her on social media (IG: @drcorrine; Facebook: Dr. Corrine McIntosh). She can be contacted at corrine@drcorrinemcintosh.com
