Jail Mental Health

Psychotropic Retention in Jailed Inpatients
PI: Kory Combs (PPF)
Collaborators: Melanie Thomas, Christina Mangurian, James Dilley, Nicholas Riano
Health Delivery System Partner: San Francisco Health Network
Funding: UCSF Public Psychiatry Fellowship via SFHN-BHS MHSA funds

The large numbers of newly incarcerated individuals with mental illness present a complex challenge for providers in the county jail systems. Many patients have serious mental illness and a majority are dual-diagnosed, having a co-occurring substance use disorder that can obfuscate their diagnoses, especially if acutely intoxicated when received into jail. Current practice at San Francisco County jail for individuals with mental illness is to wait several days after reception before starting psychotropic medications. There are multiple reasons for this delay, once such being that 65% of patients are released within 7 days, and sometimes sooner, before a psychiatrist can perform a full-evaluation. There is strong evidence that abruptly discontinuing psychotropic medication can have a deleterious effect, both acutely and in the long term. The purpose of our quality improvement study is to first develop an algorithm to help guide mental health staff on how to best continue verified psychiatric medications upon arrival to prison, and then second, to see if there is an improvement in specified outcomes when these algorithms are implemented compared to current practice.