(Mendocino) Grand jury: Law enforcement should not be mental health system

Ukiah Daily Journal Staff
Updated: 05/21/2013 10:10:57 PM PDT

While the Mendocino County Board of Supervisors debated the contract it will issue to a private company to provide mental health services in the county, the Mendocino County grand jury issued a report which says more needs to be done to relieve local law enforcement from its role as the de facto mental health responders.

In its report titled "Cut Backs In Mental Health Services Impacting Law Enforcement" the grand jury said that in its look at law enforcement facilities this year, "There was one issue that came up repeatedly, the impact of 5150 arrests on departmental resources and public safety."

A "5150" is the section of California law which addresses individuals displaying high risk behavior posing an imminent safety risk to themselves or others. "Every 5150 arrest takes an officer away from patrol duty for hours at a time as they wait for a crisis worker to arrive or until preliminary procedures are complete," the grand jury report states. "The severe cuts to the County's Mental Health budget have resulted in less staff and resources. As a result, there is one crisis worker on duty for the entire county after hours and on weekends. Crisis workers have the authority to release patients over the objections of police, hospital staff, and psychiatrists. The lack of mental health workers is costly to law enforcement and local hospitals as well as to the safety of all citizens. Additionally, there are conflicting opinions on how this County's Health and Human Services Agency treats dual diagnoses."

The grand jury is recommending that the county mental health department administration continue and expand the search for a county psychiatrist for the jail, provide additional crisis workers after hours, and re-examine the 5150 hospitalization and release procedures.

"Mental Health needs to make funds available to implement a discharge plan to aid the mentally ill released from jail," the report states. "The medical provider at the jail is currently using a doc-in-a-box (telepsychiatry) in the absence of a psychiatrist. There is a psychiatric nurse on site. The GJ observed and determined the position of the camera was inadequate. Jail administration needs to move the camera closer to achieve personal contact. Telepsychiatry provides prescription service only, no counseling."

During a visit to the county jail, the grand jury was told that close to 20 percent of all inmates have mental health issues. "Due to the lack of mental health services and facilities in this County, people arrested for behavioral issues end up in jail," the report states. "There are people in jail who are not accepted by mental health facilities, not deemed competent to stand trial, or are waiting for conservatorship status."

At the time of the grand jury visit, it was reported there were 254 inmates, of which 46 had mental health issues. "One third of these are women," the report states. "Twelve inmates are acutely mentally ill (half men, half women) and should be hospitalized. This includes one inmate with a misdemeanor waiting months for a mental health bed."

Patient inmates are often placed in solitary confinement for their own safety, as well as the safety of others. Jail staff quoted, "solitary confinement in jail is the worst thing we can do to someone ... safety cells are a horrible, horrible necessity. There is no other way."

According to the grand jury, a senior jail official told them, "We provide more mental health services than the Mental Health Department. We are the end recipient for the people the Mental Health Department no longer serves."

The grand jury's findings include that:

The Mental Health Department scheduling one crisis worker after hours and weekends is insufficient for Mendocino County.

Crisis workers have conflicting responsibility and authority.

Health and Human Services Agency and Ukiah Valley Medical Center have conflicting views on the procedures for treatment of patients with dual diagnoses.

Mendocino County Jail enlisted the help of MH staff to begin a follow-up program for released patients deemed mentally ill.

The current method of providing psychiatric services needs improvement.

Telepsychiatry (doc-in-the-box) is an expensive/poor substitute for the "real thing."

HIPAA regulations prevent mental health communication between law enforcement and medical staff. Hospital staff may only transmit patient information to the medical staff at the jail.

They recommend:

Mental Health provide an additional crisis worker after 6 p.m. and on weekends. (F1)

The Health and Human Services Agency re-examine its policies regarding crisis workers making the determination for releasing 5150s when a supervisor's authorization is required to hospitalize a patient.

Health and Human Services Agency clarify the procedures for treatment of patients with dual diagnoses.

Mental Health funds be used to implement a discharge /follow-up program for mentally ill inmates released from the jail.

The doc-in-the-box camera be repositioned for improved personal interaction.

http://www.ukiahdailyjournal.com/news/ci_23295982/grand-jury-law-enforcement-should-not-be-mental