U.S. News

For years, the Los Angeles County jail has been known as the United States’ largest mental health institution.

An astonishing 5,901 people – nearly half of its population – struggle with mental health issues. In some parts of the jail, incarcerated individuals in quilted robes are chained to metal tables so they can’t harm themselves or others. For years, the U.S. Department of Justice has been monitoring the jail system – also the nation’s largest – to assess its mental health care.

And yet it’s making progress, particularly with a peer-to-peer program called Forensic Inpatient (FIP) Stepdown that the Monitor reported on four years ago. Since then, the nascent program has grown more than sixfold overall, spreading to the women’s jail. Incarcerated people trained as mental health assistants are helping hundreds of others with severe mental illness who are held at the same facility. The California state prison system – long under federal court orders to improve mental health care – is taking notice. Many familiar with the county program see it as a national model.