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Date: |
November 17, 2026 |
27 |
Title
Sheriff - Request for Authorization to Issue Competitive Solicitations for Mental Health Services at Detention Facilities (Districts: All)
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Overview
The San Diego County Sheriff’s Office (Sheriff’s Office) provides comprehensive medical and behavioral health services to incarcerated individuals as required by Title 15 of the California Code of Regulations. Mental health and psychiatry services, including the Jail-Based Competency Treatment (JBCT) program, are currently provided under the comprehensive consolidated contract with NaphCare. The Sheriff’s Office and NaphCare have mutually agreed not to extend the contract beyond its initial term, which ends May 31, 2027. Competitive solicitations are needed to continue these services after the contract ends. Issuing the solicitations before the current contract expires will allow time to evaluate proposals, seek approval of the resulting contracts, and plan implementation with the selected providers. The Sheriff’s Office will coordinate the transition to support uninterrupted mental health, psychiatry, and JBCT services after May 31, 2027.
The Sheriff’s Office is transitioning away from a fully comprehensive consolidated service model to separate contracts so that contracted vendors may focus on their specialized areas of service in delivering healthcare to the incarcerated population. The Sheriff’s Office is seeking separate procurements for mental health and psychiatry services and for the JBCT program.
The two procurements address distinct service responsibilities. The Mental Health Services solicitation will cover psychiatric evaluations and assessment, medication management, psychiatric treatment, crisis response and stabilization, suicide prevention services, chronic mental health care, Lanterman-Petris-Short (LPS) unit operations for involuntary civil commitment for mental health evaluations and treatment, behavioral health treatment groups, interdisciplinary treatment planning, and on‑site and telepsychiatry coverage across the detention system. The JBCT solicitation will address competency restoration services with the Department of State Hospitals (DSH) and the courts. JBCT is a state-funded program that provides in-jail mental health care to defendants found incompetent to stand trial (IST), aiming to restore their competency without transferring them to a state hospital where possible. The JBCT services include forensic evaluation, competency education, psychiatric care, structured group treatment, interdisciplinary planning, and coordination with DSH. Separate scopes will allow vendors to propose staffing and operations suited to each of these services.
In addition to the psychiatric services provided under the current contract, there will be further resources required to meet the Dunsmore v. County of San Diego Mental Health Settlement Agreement that was signed on February 12, 2026. The Mental Health Settlement Agreement enhances mental health service requirements throughout the San Diego County Jail system. These enhancements include substantial recurring clinical obligations within each level of care that require sufficient qualified mental health personnel. This will result in improvements to direct clinical encounters, improved psychiatric coordination, more treatment teams, more rounding, additional training, and additional staffing to meet 24/7 coverage requirements. Staffing must be based upon the actual clinical needs and service requirements of the jail population.
The Settlement also requires a system-wide mental health services needs assessment with the input of the neutral expert by February 12, 2027. The assessment will review each level of care, including both mental health staffing and custody staffing needs, and will be used to develop a bed and staffing plan. The psychiatry services may require further expansion beyond the current levels, depending on what the assessment finds.
Today’s action requests authorization to issue two separate competitive solicitations, each structured as a five‑year procurement (one initial year and four option years):
Mental Health Services Solicitation
A comprehensive contract covering system‑wide mental health and psychiatric services at all Sheriff’s detention facilities, including psychiatric evaluations, medication management, crisis stabilization, suicide‑prevention services, chronic mental health care, LPS unit operations, behavioral health treatment groups, interdisciplinary treatment planning, and on‑site and telepsychiatry coverage.
Jail‑Based Competency Treatment (JBCT) Services Solicitation
A dedicated contract for operating the JBCT program, which provides competency restoration services for individuals found IST. This includes forensic evaluation, competency education, psychiatric care, structured group treatment, interdisciplinary planning, and coordination with the Department of State Hospitals and the courts.
Issuing these solicitations will provide a procurement path for continued mental health, psychiatry services and JBCT operations after the consolidated contract concludes on May 31, 2027.
Body
Recommendation by Sheriff:
1) In accordance with Section 401, Article XXIII of the County Administrative Code, Authorize the Director of the Department of Purchasing and Contracting to issue a competitive solicitation for comprehensive Mental Health Services for all Sheriff’s detention facilities, and upon successful negotiations and determination of a fair and reasonable price, award a contract for an initial term of one year with four one‑year option periods, and an additional six‑month extension if needed. Authorize the Director of the Department of Purchasing and Contracting to amend the contract as required to reflect changes in services, staffing, or funding allocations, subject to approval by the Sheriff’s Office.
2) In accordance with Section 401, Article XXIII of the County Administrative Code, Authorize the Director of the Department of Purchasing and Contracting to issue a competitive solicitation for a Jail‑Based Competency Treatment (JBCT) Services contractor, and upon successful negotiations and determination of a fair and reasonable price, award a contract for an initial term of one year with four one‑year option periods, and an additional six‑month extension if needed. Authorize the Director of the Department of Purchasing and Contracting to amend the JBCT contract as required to reflect changes in program requirements, clinical standards, or funding allocations, subject to approval by the Sheriff’s Office.
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Equity Impact Statement
The proposed competitive solicitations for Mental Health Services and Jail-Based Competency Treatment (JBCT) are expected to advance equity by improving access to timely, clinically appropriate psychiatric care for all individuals incarcerated in County detention facilities, including those with serious mental illness and high-acuity needs. The separation of services into targeted procurements allows vendors to deliver care that better aligns with the varied needs of these groups. These actions support more equitable health outcomes and promote safer, more therapeutic environments for all individuals in custody.
Sustainability Impact Statement
Today's proposed actions support the County's Sustainability Goals of providing just and equitable access and protecting health and wellbeing. The proposed solicitations expand equitable access to high‑quality psychiatric and competency‑restoration services for individuals with the greatest clinical needs, including those experiencing acute mental illness, complex co‑occurring disorders, or extended lengths of stay. Long‑term service sustainability by transitioning to specialized vendors with the infrastructure and staffing capacity needed to maintain high‑quality psychiatric and competency‑restoration services across all detention facilities. The separation of mental health and Jail-Based Competency Treatment procurements ensures operational continuity during and after the conclusion of the consolidated NaphCare contract.
Fiscal Impact
Funds for this request are included in the Fiscal Year 2026-27 Operational Plan for the San Diego Sheriff’s Office. The current year funding source is General Purpose Revenue in the Sheriff's Office of $9,302,341 for Mental Health services and $2,261,815 for the Jail Based Competency Treatment (JBCT) program. All costs for the JBCT program are reimbursed from the Department of State Hospitals. It is unknown what the competitive solicitation impacts will be, and funding may not be sufficient to support the expanded mental health service model required under the Mental Health Settlement Agreement nor the planned expansion of the JBCT program. Additional funding will be needed in future years to meet increased staffing, treatment, and clinical coverage requirements. Subsequent year costs will be included in future years Operational Plans for the Sheriff's Office. There will be no change in net General Fund costs and no additional staff years.
The expected increases of the Mental Health Services contract support expanded staffing, broader psychiatric and Qualified Mental Health Professional coverage, 24/7 intake requirements, and enhanced suicide-prevention, crisis-response, documentation, and treatment-planning obligations required for Dunsmore compliance. The JBCT contract reflects the expansion of the JBCT program from 30 to 39 beds, as well as increased staffing, competency-restoration services, reporting requirements, and coordination with the Department of State Hospitals.
Business Impact Statement
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Advisory Board Statement
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Background
The San Diego County Sheriff’s Office (Sheriff’s Office) operates seven detention facilities with an average daily population of approximately 4,000 individuals. As a result of Assembly Bill 109 enacted in 2011, County jails now house individuals who previously would have been incarcerated in State prisons. This realignment significantly increased demands on local detention facilities, staffing, and all aspects of health care service delivery. With no statutory limit on the length of local jail sentences, the County’s correctional health system has had to shift from a model oriented toward episodic, short‑term care to one capable of providing long‑term, comprehensive medical and behavioral health services. This shift requires specialized psychiatric care, integrated treatment services, and a holistic approach to the well‑being of incarcerated individuals. Over time, the population’s behavioral health needs have increased significantly due to chronic and complex psychiatric conditions, co‑occurring disorders, acute stabilization needs, and individuals requiring competency‑related treatment. Title 15 of the California Code of Regulations mandates timely access to clinically appropriate medical, mental health, and crisis‑stabilization services. Meeting these requirements depends on adequate on‑site staffing, sufficient clinical infrastructure, and appropriate therapeutic environments, particularly for individuals requiring high‑acuity psychiatric care.
On August 4, 2020 (1), the Board of Supervisors approved the Sheriff’s request to issue a consolidated competitive solicitation for detention health care services, and on April 26, 2022, the County awarded the comprehensive health care delivery contract. Services began on June 1, 2022, with mental health and medical care delivered under a single consolidated model.
Under the current consolidated health care contract, mental health services include intake screening, crisis response, suicide‑prevention measures, chronic mental health care clinics, psychiatric evaluations, on‑site psychiatry clinics, telepsychiatry, and specialized treatment delivered within the Lanterman‑Petris‑Short (LPS) units. The LPS units provide hospital‑level psychiatric care for individuals needing intensive stabilization through interdisciplinary treatment teams. The JBCT program provides competency restoration services for individuals found Incompetent to Stand Trial (IST). The program is included in the current consolidated agreement and includes forensic evaluation, competency education, psychiatric treatment, psychosocial interventions, interdisciplinary planning, and coordination with DSH and the courts. Separate solicitations will provide for continuation of both these services after the consolidated contract ends. These services must continue as the Sheriff’s Office transitions to new contracts.
In preparation for the planned transition from the NaphCare consolidated health care delivery contract at the end of its term on May 31, 2027, the Sheriff’s Office seeks separate procurements for mental health and psychiatry services, and for the JBCT services supporting DSH competency restoration services. The Sheriff’s Office has experienced sustained, ongoing growth in terms of the utilization of mental health and psychiatric services across all detention facilities, emphasizing the need for additional clinical staffing and resources in the future. The system-wide mental health and psychiatric appointments at the Sheriff’s Office increased from 108, 402 in FY 2023-24 to 126,274 in FY 2024-25, and to 157,387 in FY 2025-26. The sustained growth in these services indicates annual increases of 16.5% and 24.6%, respectively. This is representative of a 45.2% increase over two fiscal years and supports the need for additional mental health clinicians, psychiatric providers, and supporting resources to maintain timely access to care to meet the anticipated future demand. The Sheriff's Office will continue to expand key performance metrics to our Continuous Quality Improvement (CQI) process which is shared quarterly with the public via public facing report. Though our capabilities of capturing specific data may be limited, we will continue to work with our contractors to build a system that can access data to promote transparency in performance. The Sheriff's Office and NaphCare will continue to work collaboratively to ensure this transition occurs safely and the care of the incarcerated population remains uninterrupted.
In addition to the psychiatric services under the current contract, there will be further resources required to meet the Mental Health Settlement Agreement in the Dunsmore Settlement. The Settlement Agreement enhances comprehensive mental health service requirements throughout the San Diego County Jail system across multiple levels of care within the healthcare system.
To support long‑term stability and improved service delivery, the Sheriff’s Office seeks approval for two separate competitive solicitations, each structured as a five‑year procurement (one initial year with four option years):
• A comprehensive Mental Health Services contract supporting all detention facilities.
• A stand‑alone JBCT contract supporting competency restoration services.
Together, these solicitations strengthen behavioral health capacity, align service delivery with modern national correctional health standards, and ensure safe, uninterrupted operations during and after the transition away from the consolidated contract.
Linkage To the County of San Diego Strategic Plan
Today’s proposed action to authorize the competitive procurement of Mental Health Services supports the Community Initiative of the County of San Diego 2026-31 Strategic Plan and aligns with the objective by improving the quality of life of incarcerated individuals by providing services that increase their well-being.
Respectfully submitted,
Kelly A. Martinez
Sheriff
Attachment(s)
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