Settlement Targets Jail Mental Health Failures

A federal settlement reached this month is expected to change how people with mental illness are treated inside San Diego County jails, shedding light on significant system failures. The agreement follows years of deaths, complaints, and warnings from clinicians who said people with serious psychiatric needs were often placed in isolation without proper care. The settlement grew out of a class-action lawsuit accusing the county of failing to protect vulnerable incarcerated people.

The lawsuit was shaped by cases such as Lester Daniel Marroquin, who, due to mental health system failures, died by suicide after being moved from a psychiatric observation unit into an isolation cell. The clinician responsible for his care had warned that he needed close monitoring and did not know the transfer occurred. The move happened while the clinician was off duty and without clinical approval. Hours later, Marroquin was dead. The clinician later said the death should never have happened.

These accounts were not rare. Nearly half of the roughly 4,100 people held in county jails take medication for mental health conditions. Former clinicians said custody staff often made housing decisions without consulting mental health professionals, sometimes placing people with severe symptoms into administrative separation, where treatment and monitoring were limited.

The settlement is intended to change those practices. Every person entering custody must now receive a mental health evaluation and be assigned a defined level of care. That level will guide housing placement and services such as therapy, monitoring, and medication. Mental health decisions are no longer meant to be routinely overruled by custody staff.

Isolation cells have been linked to some of the most serious deaths. In 2022, Lonnie Rupard, who had schizophrenia, died in an isolation cell from pneumonia, dehydration, and malnutrition. The medical examiner ruled the death a homicide, stating that although self-neglect played a role, Rupard depended on others for care. Months later, Matthew Settles died by suicide in a similar cell after weeks of minimal contact.

Under the agreement, isolation decisions must be based on a person’s current mental health condition, not past behavior or charges. If custody staff disagree with a clinician, the decision must be documented and reviewed by supervisors. Housing and care changes are expected to happen quickly rather than allowing people to remain in unsafe settings.

Former clinicians also described staffing shortages that made safe care difficult. One clinician reported managing more than 150 patients at once. Others said people who needed structured care were denied access to specialized units, and some patients had no written treatment plans.

The purpose of the settlement is to directly address ongoing system failures, requiring a review of staffing levels, housing capacity, and treatment needs. The Sheriff’s Office must determine how many clinicians, beds, and specialized units are needed. The agreement also expands step-down units that provide structured support for people who need care but not full hospitalization.

As part of addressing internal failures, the settlement also requires written treatment plans and increased access to therapy programs, including for people previously held in isolation. Mental health care is no longer supposed to be delivered mainly through cell doors. Instead, care is expected to be private and based on clinical judgment.

Sheriff’s officials said they intend to follow the agreement and acknowledged past gaps in care. The case follows years of deaths involving people with mental illness, including individuals with schizophrenia and dementia who died after being left alone or after calls for help went unanswered.

Beyond mental health treatment, the broader lawsuit also challenges medical care, disability access, safety conditions, and racial discrimination. A court-appointed expert will monitor compliance and issue public reports.

Former clinicians say the settlement reflects plans proposed years earlier but rejected. Whether the changes prevent future harm will depend on follow-through. Supporters hope the agreement leads to safer treatment and fewer preventable deaths inside county jails. For many families, the agreement cannot undo loss, but it represents a step toward accountability and clearer rules. Advocates believe consistent oversight and documented care decisions may reduce risk and improve safety for people with serious mental illness countywide.