Attachment_3_2nd_Memorandum_of_Agreement_to_Mays.pdf

SECOND MEMORANDUM OF AGREEMENT

Mental Health Care Remedial Measures Implementation Mays v. County of Sacramento (Case No. 2:18-cv-02081-TLN-CSK)

Whereas, Plaintiffs' Class Counsel and Defendant County of Sacramento (the "Parties") reached a settlement agreement in Mays v. County of Sacramento (Case No.

2:18-cv-02081-TLN-KJN), with a Consent Decree approved by the Court on January 13, 2020;and

Whereas, consistent with the Consent Decree, the Mays court-appointed Subject Matter Experts have assessed and continue to assess the County's compliance with remedial plan provisions; and

Whereas, to assist the County in the task of implementation and in light of areas with insufficient progress shown, the court-appointed Subject Matter Experts have identified and specifically assessed in their monitoring reports particular "focus areas" -that is, issues that are urgent to class member well-being, and are of critical importance to broader compliance efforts; and

Whereas, the County is responsible for provision ofa Sacramento County Jail ("Jail") Mental Health Care system consistent with legal and constitutional requirements and the Remedial Plan measures set forth in the Mays Consent Decree, and as such, must ensure appropriate resources, services, oversight, performance expectations, and consequences for deficiencies in the delivery of Mental Health Care services, including services provided by Adult Correctional Mental Health (as delivered by the County's contracted provider, UC Davis Department of Psychiatry & Behavioral Sciences); and

Whereas, Class Counsel sent a Dispute Notice, dated October 29, 2021 (filed at Mays Docket No. 153-1), demanding that the County take immediate, affirmative steps to implement foundational "focus area" remedial provisions regarding Mental Health Care and Suicide Prevention; and

Whereas, consistent with the Dispute Resolution provisions set forth in the Consent Decree (,r,r 32-34), the Parties engaged in Dispute Resolution procedures with the assistance of the Dispute Resolution mediator, the Hon. Nathanael Cousins, and the court-appointed Subject Matter Experts on Mental Health Care and Suicide Prevention;

and

Whereas, following the Parties' good faith attempt to resolve the dispute, the Parties executed a Memorandum of Agreement: Mental Health and Suicide Prevention Remedial Measures Implementation on May 27, 2022 (filed at Docket No. 153-2); and

Whereas, the May 27, 2022 Memorandum ·of Agreement resolved the noticed dispute on certain topics, specifically:

Mental Health Care - Core Remedial Plan Measures

Mays v. County of Sacramento (Case No. 2:18-cv-02081-TLN-CSK)

( l) Reform of the County's mental health levels of care system, including (a) the elimination of the outdated Frequency of Service Study (FOSS) levels system and (b) the implementation of the Enhanced Outpatient Program (BOP) level of care as a supplement to the existing Acute and Intensive.

Outpatient Program (IOP) levels of care;

(2) Revisions to Jail Use of Force policies and practices, particularly as they impact incarcerated people with.mental health and other disabilities;

(3) Revisions to Jail Suicide Prevention policies and practices, with improved staff training;

( 4) Policy and practice changes to address the overuse and unnecessary use of safety smocks;

( 5) Interim improvements to enhance patient confidentiality for suicide risk assessments and mental health clinical encounters;

(6) Policy and practice changes to ensure adequate observation of incarcerated people who are placed on suicide precautions; and .

Whereas, the above aspects of May 27, 2022 Memorandum of Agreement continue to be monitored by the court-appointed Subject Matter Experts, with progress towards implementation shown in several such areas; and

Whereas, the May 27, 2022 Memorandum of Agreement specifically did not resolve the October 29, 2021 Dispute Notice as to four (4) Consent Decree issues (hereinafter "Unresolved Issues"):

(I) Remediation of physical plant deficiencies that prevent delivery of adequate health care services;

(2) Provision of adequate staffing to deliver adequate mental health care services;

(3) Provision of adequate� mental health level-of-care services at the capacitynec-essary tcnneetclass member nffeds; and

( 4) Provision of adequate Intensive Outpatient Program (IOP) mental health level-of care services at the capacity necessary to meet class member needs;

and

Whereas, the May 27, 2022 Memorandum of Agreement provided a structure for the County to develop and present its plan and timeline for addressing the systemic deficiencies underlying these four Unresolved Issues; and

Whereas, with respect to Unresolved Issne #1, in the Mays Consent Decree and Remedial Plan approved by the Court, the County agreed to a 24-month timeline to "develop and fully implement an Accessibility Remedial Plan to address Jail physical

Page 2 ofl0

Mays v. County of Sacramento (Case No. 2:18-cv-02081-TLN-CSK) plant deficiencies that result in access barriers for prisoners with disabilities," Consent Decree Remedial Plan at Section 111.Q.l; arid

Whereas, the May 27, 2022 Memorandum of Agreement required the County to "develop and present its plan and timeline for addressing the systemic deficiencies" for the Sacramento County Jail facilities; and

Whereas, the County thus engaged architectural consultants to develop a design plan for an Intake and Health Services Facility (IHSF), also referred to as the "Main Jail Annex project"; and

Whereas, the County then contracted for a comprehensive peer review of the IHSF design plan, which found that the plan did not adequately address several core Mays Consent Decree requirements, including the provision of sufficient work, clinical, administrative, and treatment programming space for medical/mental health staff, the provision of sufficient outdoor recreation space, and other core facility needs; and

Whereas, based on the comprehensive peer review, it was recommended that the County suspend work on the IHSF project, establish a Jail System Planning/Compliance Oversight Committee, and conduct further analysis through a Jail System Master Planning process, to include Facility Conditions Assessments, Jail Population Analysis, Operational Analysis, and Space Programming Assessment; and

Whereas, on February 26, 2025, the County of Board of Supervisors voted to suspend work on the IHSF project and pursue a new Jail System Master Planning process; and

Whereas, there is therefore at this time no master facilities plan that will fully address physical plant remediation requirements pursuant to the Mays Consent Decree;

and

Whereas, with respect to Unresolved Issues #2, #3, and #4, there remains an undisputed shortage of necessary mental health care staffing, program capacity, and other resources to meet the Jail population's mental health treatment needs; and

Whereas, in September 2024, the court-appointed Subject Matter Expert on mental health care conducted patient assessments during a two-day on-site visit at Sacramento County Jail, reviewed patient records, met with Jail health care and custody staff, and completed a further mental health care monitoring visit on October 8-10, 2024;

and

Whereas, the Subject Matter Expert on mental health care issued a findings letter, dated October 17, 2024 (filed as Docket No. 211-2), concluding: "My assessment is that the mental health program in the Sacramento County Jail system is [] grossly under-resourced and currently incapable of meeting the needs of the patient population" and that "every patient whom I interviewed was placed at an inadequate level of mental health care and was receiving inadequate mental health treatment in the jails"; and

Page 3 ofl0

SECOND MEMORANDUM OF AGREEMENT.

Mays v. County of Sacramento (Case No. 2:18-cv-02081-TLN-CSK)

Whereas, in her Fifth monitoring report on Mental Health Care, dated August 12, 2025 (filed as Docket No. 216-1), the Subject Matter Expert on mental health care further found (at pgs. 13-14):

[T]he Sacramento County Jail system was inadequately resourced and unprepared to provide the level of mental health treatment required by the people in their custody. It also highlighted the lack of reliability (that the numbers of mental health patients at various levels of care were accurate in that they could be reproduced by different evaluators) and validity (that they actually reflected the acuity of patients and their mental health needs) of Defendants' current census information and waitlists. This was not an unexpected finding though the extent of underestimated need was more

• significant than anticipated.

The County musttake immediate steps to secure appropriate inpatient mental . health treatment and a continuum of services for people in their custody with serious mental health needs.

Included in this need for·immediate action, Defendants must quickly undertake a needs assessment to attempt to identifjithetrue or actual need.

and

Whereas, the.County is committed to the development and implementation ofa plan designed to teach compliance on these matters, and the Parties jointly wish to chart a course to this effect;

Now therefore, the Parties enter into this Memorandum of Agreementwith the following terms:

This Memorandum of Agreement does not resolve the October 29, 2021 Dispute .Notice and February 12, 2025 Dispute Notice with respect to the four Unresolved Issues discµssec! aboye._I_his_M�111Qrnnc!_µmofAgr()e111enJi_nst�Ji-JJrovides a further strnct11re __ and timeline for-tlie County fo develop and present its pfanfor addressingthe s)'sfomic •• deficiencies underlying these four issues, and further provides important interim steps towards Mays Consent Decree implementation.

The Parties agree to continue with Dispute Resolution procedures, as set forth in Consent Decree Paragraphs 32-34. Class Counsel retains their right to pursue enforcement proceedings on these issues should Dispute Resolution procedures not lead to a supplemental memorandum of agreement or stipulation resolving any or all of these four issues.

Page 4 ofl0

Mays v. County of Sacramento (Case No. 2:18-cv-0208lsTLN-CSK)

I. Unresolved Disputed Issue #1 re: Remediation of Physical Plant Deficiencies

1. The County shall, by October 30, 2026, complete a Correctional Facility Master Plan, which shall provide a written report that details Jail physical plant remediation options, with associated cost estimates, recommended project delivery methods, project timelines, and other relevant matters.

2. The Correctional Facility Master Plan shall include: (1) the inspection, assessment, inventory, and analysis of existing County facilities, (2) a detailed Jail population analysis that includes assessment of the Jail population's mental health care service, medical care service, and Americans with Disabilities Act (ADA)/Disability-related needs, (3) an operations assessment including compliance with the Mays Consent Decree requirements for ADA/Disability accessibility, mental health care services, and health care services to meet the needs of the Jail population, and (4) space planning and assessment.

3. The Correctional Facility Master Plan will be submitted to the Mays court within seven (7) days of completion.

4. By December 4, 2026, the County will, with input from the Subject Matter Experts and after meet-and-confer with Class Counsel, complete a detailed written recommendation(s) in response to the Correctional Facility Master Plan to be submitted to the Board of Supervisors, with a clear and reasonable timeline, to address physical plant deficiencies that require remediation pursuant to the Mays Consent Decree.

5. Any Correctional Facility Master Plan recommendation(s) adopted by the County through the Board of Supervisors will be submitted to the Mays court for approval.

Class Counsel will have twenty-one (21) days to submit any objections to the plan.

6. The Parties may, at any time, agree to seek the assistance of the designated Dispute Resolution mediator to discuss the adequacy and timeliness of the County's Correctional Facility Master Planas it pertains to Mays Consent Decree requirements.

II. Unresolved Disputed Issues #2, #3, and# 4 re: Mental Health Care Delivery

A. Unresolved Issue #2: Provision of Adequate Staffing to Deliver Adequate Mental Health Care Services.

7. Over the course of the last year, the County identified waitlists of Mays class members who met clinical criteria for Acute Psychiatric Unit (APU), Intensive Outpatient Program (IOP), and Enhanced Outpatient Program (EOP) levels of care. As of August 22, 2025, the point-in-time APU waitlist is 12 patients, the IOP waitlist is 77 patients, and the EOP waitlist is 628 patients. Consistent with the findings of the mental health care Subject Matter Expert, the Parties agree that the

Page 5 of10

Mays v. County of Sacramento (Case No. 2:18-cv-02081-TLN-CSK)

County does not have an accurate assessmentofthe actual APU, IOP, and EOP program need, now and for purposes of future projected need estimates, such that currently identified mental health program needs may be significantly underestimated.

8. Accordingly, the County will include in its Correctional Facility Master Plan process, discussed above, the following necessary components to identify mental health care needs in the Jail system and to develop a plan to meet currently unmet needs through increased programming, capacity, space, and staffing needs at each level of care (EOP, IOP, APU), and to adequately serve the Jail population across all groups (male/fe111ale, all security levels, General Population and Protective Custody, etc.):

a. The mental health care needs assessment process will include face-to-face assessments of patients, individual recordsreview, data analysis, and collaboration with Jail mental health leadership/staff and custody leadership/staff, with input from the Subject Matter Experts and Class Counsel.

b. The mental health care needs assessment process will consider treatment options in the community and barriers that impact the overall need of patients with mental illness in the Jail population.

c. The mental health care needs assessment process will consider and provide options to remediate physical plant deficiencies to facilitate.

delivery of adequate health and mentaJ health care services to the Jail population ( disability accessibility, office space, treatment space, programming space, etc.).

9. The County will ensure completion of a written mental health care needs assessment report by June 1, 2026. Preparation of the report will include the gathering and consideration of input from the Subject Matter Experts and Class Counsel.

10. Any Correctional Facility Master Plan recommendation(s) adopted by the County will include, with input from the Subject Matter Experts and after meet-and-confer with Class Counsel, a detailed plan to implement steps to provide programming, capacity, space, and staffing as necessary to timely meet the mental health care needs of Mays class members, including at each level of care (EOP, IOP, APU).

This plan will be submitted to the Mays court for approval. Class· Counsel will have twenty-one (21) days to submit any objections to the plan.

11. The Parties may, at any time, agree to seek the assistance of the designated Dispute Resolution mediator to discuss the adequacy and timeliness of the County's plan.

Page 6 ofl0

Mays v. County of Sacramento (Case No. 2:18-cv-02081-TLN-CSK)

12. The County will provide staffing plan updates to the Subject Matter Experts and Class Counsel regularly, and upon request.

13. The County will provide notice of any proposed reduction to existing mental health care or medical care staffing positions (i.e., for any discipline or job category) to the Subject Matter Experts and Class Counsel at least twenty-one (21) days before any such reduction is made.

B. Unresolved Issue #3: Provision o(Adequate Acute Mental Health Level of

Care Services at a Capacity to Meet Class Member Needs.

14. The Parties agree that remedial provisions regarding implementation of the Acute Psychiatric Unit (APU) are foundational to Mays Consent Decree implementation, and that the existing 17-bed APU (the 2P unit at Main Jail) does not provide adequate capacity nor physical plant facilities to meet the needs of incarcerated patients requiring an acute (i.e., inpatient) level of mental health care.

15.As an interim measure pending completion of the Master Planning assessment report and the Facilities Master Plan, the County agrees to expand the Acute Psychiatric Unit (APU) level of care program from its current capacity of seventeen (17) patients to forty-one (41) patients with seven (7) APU step-down beds, with the project to be completed by June 12, 2026.

a. Promptly upon completion, the APU program will be staffed with sufficient mental health care staff and custody staff to deliver APU level of care services.

b. Consistent with prior agreements in this case, custody staff will be specifically assigned to the APU, will receive enhanced specialized mental health training, and will not be utilized for other daily operational needs at the Jail, absent exceptional circumstances that are documented and approved by the facility captain.

c. The County will revise its health care and custody policies and procedures to ensure appropriate programming and operations with respect to the expansion of the APU and implementation of the APU step-down level of care.

16. The County will submit to the Mays court an affidavit confirming activation of the forty-one ( 41) patient APU program and seven (7) APU step-down beds, including an APU and APU step-down unit census by July 1, 2026.

17. The County will also modify the Suicidal Inmate Temporary Housing Unit (SITI-IU) to add suicide-resistant features, ADA-compliant facilities, and a safety corridor for health care staff to conduct Constant Observation of SITHU patients when clinically indicated, consistent with the requirements of the Mays Consent

Page 7 ofl0

Mays v. County a/Sacramento (Case No. 2:18-cv-02081-TLN-CSK)

Decree, Suicide Prevention Remedial Plan Section VII.J. This project will be completed by November 15, 2026, and will be evaluated for Mays Consent Decree compliance by the Subject Matter Experts.

C. Unresolved Issue #4: Provision of Adequate Intensive Outpatient Program (IOP) Mental Health Level of Care Services at a Capacity to Meet Class Member Needs.

18. The Parties agree that remedial provisions regarding implementation of the Intensive Outpatient Program (IOP) are foundational to Mays Consent Decree implementation, including as to access to such level of care for class members who have higher security/classification factors, who are women, and across all classification groups, as required by Mays Consent Decree, Mental Health Care Remedial Plan Sections IV.F .4. and VII.F .2. The Parties agree. that the current IOP level of care does not provide adequate capacity nor physical plant facilities to meet the needs of incarcerated patients requiring IOP level of care.

19.As an interim measure pending completion of the Master Planning assessment and Facilities Master Plan, the County agrees to expand the Intensive Outpatient Program (IOP) level of care program from its current capacity ofninety7one (91), with an additional seventy-six (76) spots (for a total capacity of one hundred sixty seven (167) spots), as follows:

a. Twenty-four (24) additional male IOP spots, activated as of the end of July 2025. The CBF 300 housing unit at RCCC completed a renovation project in July 2025 for it to serve as a new IOP unit. !OP patients were integrated into the IOP unit through small groups, and the unit is now operating based on its full capacity of 24 patients.

b. Ten (10) additional female IOP spots, activated as of August 2025.

The County added 10 new female IOP spots in the Main Jail 3 West 100 pod, which are now operating based. on full capacity.

� �c.�ccTliirty-twot3:2Jaaditional mafo'TOPspots'by;FebrU.ary 26, 2026� The County is moving forward with necessary renovations in the CBF 200 housing unit at RCCC to prepare for activation of this unit for IOP level of care.

d. Ten (10) additional female IOP spots by February 76, 2026. The County is moving forward with necessary renovations to further expand IOP capacity, including for higher security classifications, in the Main Jail 3 West 100 pod.

e. The County will submit to the Mays court an affidavit confirming full activation of the IOP units and spots described in subsections (a) and (b), above, by September 15, 2025.

Page 8 ofl0

Mays v. County of Sacramento (Case No. 2: 18-cv-02081-TLN-CSK)

f. The County will submit to the Mays court an affidavit confirming full activation ofIOP units and spots described in subsections (c) and (d), above, by March 5, 2026.

20. The Parties agree that further mental health program capacity will likely be necessary, a matter that will be informed by the forthcoming comprehensive mental health needs assessment and related analyses to be completed through the Master Planning process.

III. Continued Efforts to Safely Reduce the Jail Population to Support Mavs

Consent Decree Implementation

21. The Mays Consent Decree recognizes that "population reduction of thejails will facilitate compliance with this Remedial Plan." Mays Remedial Plan Section II.BJ. The Parties agree that a plan to remediate physical plant deficiencies must be paired with a plan to address population management alternatives, developed with input from relevant community stakeholders, as necessary to facilitate timely, cost-effective implementation of the Mays Consent Decree.

22. The County's Correctional Facility Master Plan process will include a comprehensive Population Analysis of Future Criminal Justice Populations in Sacramento County, providing modeling of several potential outcomes to address future community needs with consideration of at-risk populations, legislative/law changes, current and expected/potential progress with population reduction strategies, and other factors. The Facilities Master Planning process will further assess and report on options for div.ersion, out-of-custody mental health treatment settings, substance use, and other programs as an alternative to incarceration.

23. These components will be included in the Correctional Facility Master Plan report referenced in Section I, above.

IV. CONCLUSION

As the above-referenced processes proceed, the Parties shall meet and confer, with the assistance of the Subject Matter Experts and the designated Dispute Resolution mediator, as appropriate, to discuss the adequacy and timeliness of the plan. The Parties may then enter into a supplemental memorandum of agreement on the matter or, if a dispute remains, may seek further relief from the Mays court as appropriate.

The provisions of this Memorandum of Agreement are designed to ensure compliance with the terms of the Remedial Plan in the Mays Consent Decree. The Parties agree that the relief contained herein is narrowly drawn, extends no further than necessary to ensure the protection of the federal rights of Mays class members, and is the least intrusive means necessary to accomplish those objectives.

Page 9 ofl0

Mays v. County of Sacramento (Case No. 2:18-cv-02081-TLN-CSK)

The te1ms of this Memorandum of Agreement are subject to the monitoring and enforcement provisions set forth in the Mays Consent Decree.

This Agreement shall be deemed fully executed and effective when all Parties have executed it by signature.

Date: September _, 2025

Date: September _, 2025

Date: September _, 2025

Date: September /le,, 2025

Aaron J. Fischer Attorney for Plaintiffs

Margot Mendelson Attorney for Plaintiffs

Monica Robinson Sacramento County Counsel Attorney for Defendant

Eric Jones Deputy County Executive for Public Safety and Justice, Sacramento County