By Mark Delucchi, PhD, CCHP-MH
The Acute Stabilization Unit (ASU) at the Maguire Correctional Facility in Redwood City, California, represents a pioneering approach to addressing severe psychiatric illnesses and co-occurring substance use disorders among incarcerated individuals. Operated by Liberty Healthcare Corporation in partnership with San Mateo County Behavioral Health and Recovery Services, Correctional Health Services, and the Sheriff’s Office, the ASU has been a cornerstone of acute psychiatric care since its inception in October 2018, providing high-quality care in a safe environment.
Solving for Better Psychiatric Care
Before the ASU opened, people in custody requiring involuntary psychiatric hospitalization were temporarily transferred to the county hospital. This practice was disruptive to all involved. Patients had to navigate an unfamiliar environment in orange, jail-issued clothing while mingling with civilian psychiatric patients. Deputies had to accompany patients and remain with them, resulting in program disruption at the hospital, safety issues during transport and hospitalization, and potential staff shortfalls at the jail. Hospital staff had to manage the unit milieu with both custody and civilian patients, along with the accompanying sworn staff.
The result was often a short hospital stay with minimal psychiatric stabilization for the patient, while other incarcerated people languished in jail without adequate mental health care because the jail facility lacked the clinical resources to truly address this critical psychiatric need. The ASU was created to ensure that all individuals in custody experiencing acute psychiatric symptoms received necessary and clinically appropriate care within the existing jail system.
Creating a Safe Space
The ASU is a 10-bed unit certified by the State of California Department of Health Care Services as a Jail Inpatient Unit. It serves as the county receiving facility for incarcerated individuals placed on involuntary psychiatric holds, known as 5150s in the State of California. The unit admitted and discharged more than 300 patients in its first five years, maintaining an average daily census of 7.3 and an average length of stay of 50.5 days. This extended length of stay is often due to the need for temporary conservatorship, which helps patients be found competent to stand trial and ultimately address their criminal cases while receiving psychiatric care for their symptoms.
ASU staff perform frequent safety checks and suicide assessments upon patient admission and throughout hospitalization. These assessments are critical for identifying patients at risk and assist staff in implementing appropriate interventions to reduce that risk. The ASU’s focus on safety has contributed to a therapeutic clinical environment in which staff have performed fewer than 50 emergency involuntary medication administrations and experienced only one staff assault incident in more than six years of operation.
Collaborative Care With Results
The ASU provides comprehensive care through a multidisciplinary team approach. The treatment team includes psychiatrists, nurses, mental health workers, a recreational therapist, the program clinical director, and the program director. The team collaborates daily to review patient progress, adjust treatment plans, and address emerging clinical and safety issues, ensuring continuity of care through regular communication. The ASU team provides thorough psychiatric assessments tailored to each patient’s needs, forming the basis of individualized treatment plans aimed at achieving psychiatric stability as quickly as possible. The ASU’s trauma-informed, recovery-oriented approach ensures that patients receive psychotropic medications and treatments in a supportive environment.
The unit offers 24-hour care, with nurses addressing patients’ medical needs, administering medications, collecting blood samples, providing wound care, and offering health education. Mental health workers, similar to psychiatric technicians, monitor patients’ safety throughout the day at least every 15 minutes, and more frequently as necessary, resulting in more than 1.6 million observations since 2018. They also provide recreational activities consistent with patients’ treatment plans.
The program’s board-certified psychiatrist leads the treatment team, meeting with each patient daily, adjusting psychotropic medications, working to stabilize the patient quickly, and providing consistent psychiatric care and monitoring. A board-certified recreational therapist develops clinical activities tailored to each patient’s needs, including individual and group treatment, designed to engage patients and promote their mental health and recovery. The clinical director is a licensed therapist who provides individual and group therapy on the unit and ensures that all patients receive a supportive transition back to the most appropriate jail housing or to community-based care. The ASU director oversees the unit and represents the ASU at most judicial court hearings related to patients’ involuntary psychiatric hospitalization.
The ASU has also provided more than 100 hours of clinical mental health training for sworn staff. With their greater understanding of mental health symptoms and diagnoses, custody staff show patience and commitment to the population and help reduce the need for seclusion, restraint, and other less therapeutic interventions.
Patient satisfaction is a key indicator of the program’s success. Patients complete a satisfaction survey before discharge. This feedback, with scores averaging 4.5 on a 5-point Likert scale, highlights the positive impact of the ASU’s comprehensive care and supportive environment on patient recovery. Patients also have shown a 99.3% compliance rate with psychotropic medications.
The ASU has significantly affected the San Mateo County jail system as a whole. The unit has saved the Sheriff’s Office nearly 34,000 deputy shifts at the hospital that would have been required while patients were admitted on psychiatric holds. The ASU’s presence has also supported the transition of incarcerated individuals with significant mental illness from segregated housing to more supportive environments. In 2018, 100% of ASU admissions came from segregated housing and approximately one-third of discharges returned to segregated housing units. Today, approximately 40% of admissions come from segregated housing, and no discharges to segregated housing have occurred in the past 15 months.
The ASU at Maguire Correctional Facility exemplifies how innovative, collaborative approaches can transform mental health care for those in acute psychiatric crises. The ASU stands as a model for other correctional facilities, demonstrating the profound impact of dedicated psychiatric care on the health of incarcerated individuals and the overall jail system. By providing specialized, in-custody treatment, the ASU not only improves clinical patient outcomes but also alleviates the strain on sworn staff and the broader county health care system. This model offers a promising blueprint for other correctional facilities seeking to enhance their mental health services.
Mark Delucchi, PhD, CCHP-MH, is a clinical psychologist and executive clinical director at the HOPE Program, a California-wide company that provides clinical treatment to registered sex offenders and other parolees. He was formerly executive director of the Acute Stabilization Unit at San Mateo County Jail.
