By Ross Mirkarimi, Sheriff of San Francisco
 Ward 7L/7D located at San Francisco General Hospital is where we house people with serious health or mental health conditions. This group requires specialized care and individualized services. The percentage of individuals in our jails with mental health needs has increased significantly since 2008. Currently, there are far too many inmates with open mental health cases.
Sadly, jail is the landing of last resort for those who fall through all the safety nets, from the severely disoriented, but harmless individuals, to those who pose a danger to themselves or others. From intake, through the criminal justice process, to sentencing, the Sheriff’s Department is responsible for the care and custody of a diverse group of people, each battling very personal demons, and for the safety of these individuals, their fellow inmates and the larger community. Many of these people are arrested simply because their erratic behavior could only be safely contained by the police, thus beginning a journey through the criminal justice system often ill-suited to treat mental illness. When these individuals arrive at the jail, they must be quickly assessed for medical and psychiatric care, and for safe and appropriate confinement. Staff from both the Sheriff’s and Public Health Departments work closely to triage these cases, and our human resources are strong.
As the state shifted responsibility to the counties for services for individuals with mental illness, adequate funding was slow to follow. As state institutions caring for individuals with severe mental illness gradually closed, adequate community care has been slow to materialize. As more individuals with mental illness inhabit the shadows and the streets, our jails become reluctant psychiatric wards. In 2012, 272 Jail Psychiatric Services (JPS) patients were arrested more than three times. 
Here are few snapshots of recent arrestees: In February and March 2013, a 26 year old woman, new to JPS, was arrested for an unprovoked assault on a stranger. In court, she became highly agitated and verbally abusive and had to be removed. A 67 year old male, well known to JPS, entered custody covered in feces, lice and partially naked. A 37 year old male, well known to the criminal justice system, was arrested for murder charges. Since his release from jail five months prior, he has refused medication. 
There is no question that people in this condition require quick and proper evaluation when they are delivered to jail intake, and adequate care and treatment while in custody. Often difficulties functioning in the outside world are exacerbated in confinement. Many people with severe mental illness are quite agitated when they arrive and can be abusive to staff. 
While we recognize the problems, the solutions are elusive. We discuss better diagnosis of mental illness, more effective treatment, and we look for adequate funding. If we are to prevent the incarceration of people with mental illness and eliminate the use of jails as de facto housing of people who are unable to function on the street, we must continue to focus on finding viable alternatives.