For decades, jails throughout the state have operated as de facto mental health facilities, a trend that intensified in recent years after California changed its laws to keep some offenders out of the state’s overcrowded prison system.

In San Diego County, where there were 12 inmate suicides in 2014 and 2015, Sheriff Bill Gore and his staff have been working to improve mental health services at the county jails to prevent more deaths.

The department has modified the mental health screening process when inmates arrive at jail, created “enhanced observation housing” for inmates at high-risk of harming themselves and started using video-based “telepsychiatry” to expand the ways in which an inmate can see a doctor.

“It kind of goes to the state of mental health care in this country. It’s, in my opinion, substandard to say the least,” said Gore, adding that the county’s largest mental health provider is the downtown San Diego jail, an observation his predecessor, Bill Kolender, also made frequently.

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