I worked for Santa Barbara County’s Alcohol, Drug & Mental Health Services (ADMHS) at the County Jail in the 1990s. I recall one very sad case of a mentally ill inmate who spent a month in a “safety cell” — a bare padded cell with a drain in a corner, lights on 24 hours a day, and nothing else. No access to water except when fed, no bed — a bare floor. This particular man was very large and imposing, and he appeared aggressive. He had been arrested for causing a disturbance in public, as I recall.
In spite of many requests to send him to the Psychiatric Health Services, he remained in this awful confinement for about a month. I finally tracked down his mother in Chicago, who was relieved to know where he was. Eventually he was released from the safety cell and the jail. As he was leaving, he came up to me and apologized for his aggressive behavior when I tried to interview him in the safety cell. He was clearly (in retrospect) aware of what was happening during his incarceration, but his mental health problems prevented him from behaving appropriately. Another social worker at ADMHS lent him train fare to return to his mother in Chicago. Getting the appropriate treatment for the mentally ill in jail was often a struggle.
Though medical services at the jail have been farmed out to a private company, which favors the bottom line rather than patient care, ADMHS had a very caring psychiatrist, Leon Marder, who was wonderful with the mentally ill inmates. After he retired services were given to doctors who did not appear to want to be there.