When the court finds a defendant incompetent to stand trial due to a mental disorder, the defendant cannot be tried or convicted. Accordingly, the court must suspend the trial or judgment until the defendant regains competence. The court must order a mental evaluation of the defendant, and must also order that the defendant be confined to an available public or private treatment facility that will promote the defendant's speedy restoration to competency, be placed on outpatient status or, if the defendant is charged with a felony, be confined to a state hospital for competency training. Additionally, the court must determine whether the defendant, with advice of counsel, consents to the administration of psychotropic medication. If the defendant does not consent, the court must conduct a hearing and, if appropriate, may authorize the treatment facility to involuntarily administer antipsychotic medication to the defendant when and as prescribed by the defendant's treating psychiatrist. The County provides competency training for defendants accused of a misdemeanor. The State is responsible for providing competency training to accused felons. These defendants must wait in the county jail until they are transferred to the state hospital or other available treatment program. Under the Penal Code, the court may order the Sheriff to deliver felony defendants found incompetent to stand trial to the state hospital. However, due to the state hospital’s bed shortage, defendants may remain in jail for an extended period of time. Most defendants voluntarily take their psychotropic medications but some refuse, and they have that right, despite the fact that their need for medication as well as the court order to administer medication were addressed as part of the court process. Individuals who have been restored to competence are returned to county jail to await trial. Upon their return to county jail, they can again refuse medication, leading to decompensation. This sometimes results in a return to their incompetence to stand trial, thus repeating the cycle.  
  
The California Penal Code was amended in 2007 (SB 568), adding section 1369.1, attached, to enable counties to designate county jails as treatment facilities for the purpose of administering antipsychotic medication to defendants that have been found incompetent to stand trial due to a mental disorder and are unable to provide informed consent to medication. Prior to the 2007 amendment, it was not clear that antipsychotic medication could be administered to these defendants involuntarily in the county jail, even pursuant to a court order, because the law specified that these individuals were to be committed for competency restoration to the state hospital or to any other available public or private treatment facility, or placed on outpatient status. Without the necessary medication, numerous defendants waiting to transfer out of the county jail were not making progress toward competency.  
  
The 2007 amendment clarified that upon the concurrence of the county board of supervisors, the county mental health director, and the county sheriff, a county jail may be designated as a treatment facility under the law for the sole purpose of administering antipsychotic medication, pursuant to a court order, to defendants adjudged incompetent to stand trial. The law limits treatment in these facilities to a maximum of six months.  
  
The Board of Supervisors on December 5 designated, at the Sheriff-Coroner's and the Health Services Director's joint recommendation, the Martinez Detention Facility as a mental health treatment facility pursuant the Penal Code section 1369.1 as a humanitarian, practical resolution to a dilemma that prevented individuals with serious mental disorders from receiving appropriate medication while in jail. Without medication, symptoms such as increased aggression, self-destructive acts, and severe behavioral outbursts can jeopardize the safety of the inmate-patient, the other inmates, and the detention facility staff. The Health Services Department and the Office of the Sheriff remain committed to transferring individuals to treatment facilities in a timely manner. These facilities, however, are crowded and have long waiting lists. The recommended extension of this designation to the West County detention facilities can help the county cope with the effect of delays beyond the county’s control.  
  
Board approval of the recommended action will ensure that psychotropic medications are administered, as necessary, to misdemeanor defendants and to felony defendants awaiting transfer to the state hospital. Should the Board concur with this recommendation, the Health Services Department and the Office of the Sheriff, in consultation with the County Counsel’s Office, will develop policies and procedures for the involuntary administration of psychotropic medication at the West County detention facilities, pursuant to statute.

Should the Board decline to approve the recommendation, the status quo at these facilities will be maintained. In-custody defendants adjudged incompetent to stand trial may continue to refuse court-ordered psychotropic medication, which can hinder speedy restoration to competency.