A King County Correctional Facility jail health audit uncovered key issues in how the jail provides behavioral health care, including racial disparities and effects of policies that could increase the chances of reoffending.
On June 10, the King County Auditor released its King County Correctional Facility (KCCF) audit regarding the jail’s health services at 500 5th Ave., Seattle. The majority of people booked into jail in King County are sent to the KCCF, which is also the primary psychiatric housing location.
According to the auditor’s office, the audit’s three key findings were:
• Some people don’t receive their psychiatric medicine for weeks after being admitted.
• Some get medication changed without consultation.
• Less than 20% of released inmates receive a seven-day supply of their medication upon release.
According to the report, the auditor’s office provided recommendations and will check back in 2026, and addressing these gaps could reduce the likelihood of reoffending.
“In addition, these improvements could also have positive impacts on patients’ behavioral health once they are released to the community and reduce the likelihood that they will return to jail,” the report stated.
The audit focused on jail health processes for providing inmates behavioral health care in 2023. According to the report, excluding nursing costs, behavioral health costs made up 10% of the 2023 through 2024 jail health budget. That 10% was about $12 million that was spent on psychiatric staffing, the substance use disorder program and behavioral health medications.
Of the behavioral health medications prescribed to inmates, 41% were substance use treatment medications, 24% were antipsychotics, 19% were antidepressants, 11% were anti-anxiety medications and 5% were mood stabilizers. The report stated that a point-in-time count in April 2025 found that 40 percent of the KCCF population had a prescription for a behavioral health medication.
Waiting for medication
Regarding the first key issue, the report stated that when an inmate needs a prescription, they’re often required to have an appointment at the clinic before receiving medication. However, the jail has limited psychiatric provider resources, and management focuses resources on inmates with the most severe needs. According to the report, the median wait time for clinic appointments was 35 days, longer than the median inmate stay. The report stated that these issues could disproportionately impact Black inmates.
According to the report, Black inmates waited the longest to receive medications, with 61% receiving medication within two days, while 66% of Asian or Pacific Islanders received medication within two days, 71% of Hispanic inmates received medication within two days, 72% of white inmates received medication within two days, and 77% of American Indian or Alaska Native inmates received medication within two days. The report stated that these inequities result in part from jail health policies and practices that perpetuate factors outside of jail, but homelessness is specifically a contributing factor.
Homeless people are less likely to have filled their medications in the last 45 days due to fulfilling other needs first, but jail health policy states that inmates must have filled their prescription within the last 45 days to have their medication filled without a clinic appointment. The report stated that Black people experience homelessness at rates much higher than white people, meaning they’re less likely to have filled a prescription in the past 45 days before entering jail.
The auditor’s office made recommendations regarding inmates receiving medication quicker and the inequity with Black inmates. Recommendations include a review and update of standards for psychiatric appointment wait times, and jail health should complete its equity plan and incorporate a strategy to address disparities in psychiatric appointment wait times.
Consultations
A second key issue was that jail health practices for changing and stopping inmates’ medication provide insufficient opportunities for inmate input. However, according to the report, during the audit, jail health entered into an agreement with the United States Department of Justice that requires an individualized medical assessment before changing or stopping medications.
The report stated that before the agreement, jail health practices did not ensure that all inmates and relevant staff understood medication changes or discontinuation. The report stated that one inmate stated that they learned their medication was discontinued after not receiving several doses and asking a nurse about it.
To address these issues, the auditor’s office recommended that jail health develop a policy to improve the timeliness of communication and give inmates the opportunity to ask questions about changes before taking new medication or missing a dose.
Upon release
The third key issue found in the audit was that 17% of people receiving behavioral health medications received a supply of medicine at release. The report stated that inmates who leave jail without medication face challenges getting a new prescription, so jail health provides inmates with a maximum of a seven-day supply of medication at release. The seven-day supply is likely not enough due to long wait periods to meet with a psychiatric provider in the community.
According to the report, the National Commission on Correctional Health Care requires that jails provide a reasonable supply of medications to last until a person can follow up with a provider in the community. The report cites that multiple studies link adherence to behavioral health medication with a reduced risk of reoffending.
According to the report, the auditor’s office recommended that jail health should update policies to ensure inmates receive a sufficient supply of medications at release.
