SAN MATEO COUNTY -- The county needs to refine its process for dealing with teens during psychiatric emergencies, according to a report released Tuesday.
The San Mateo County Civil Grand Jury issued the report titled, "Teens in Mental Health Crisis: From 911 to the Emergency Room Door," which found that the county's "lights and sirens" response leads individuals, schools and other public agencies to be "often reluctant to use the 911 dispatch system because of the detrimental effects on adolescents when first-responders arrive on the scene with lights and sirens activated."
One of the grand jury's findings was that the San Mateo County Mental Assessment and Referral Team's (SMART) car program, which approaches psychiatric emergencies in a discreet manner and was launched in 2005, was only available to respond 28 percent of the time in 2015. Reasons it found for the low percentage include vehicles undergoing repairs, personnel absent or reassigned, vehicles responding to other calls, or calls coming in after hours.
The county since April 2014 has had two SMART cars, which are SUV-type vehicles with tinted windows but without lights or sirens, each of which is staffed by "two specially trained emergency medical staff" who can treat the patients in the vehicle or transport them to a hospital. The SMART program assists youths and adults and it is fully funded by the county, meaning it is free of charge to patients.
Though it began as a 24-hour-a-day operation, the SMART program currently operates from 7 a.m. to 10 p.m., with only one car available from 7 p.m. to 8 p.m., the "period when the need for two cars is greatest," the report states. The grand jury recommends that the county make two cars available during the "widely acknowledged critical and high-volume period" of 3 p.m. to 8 p.m.
When psychiatric emergency calls come to the 911 dispatch center that serves East Palo Alto, Half Moon Bay, Millbrae, San Carlos, Portola Valley, Woodside and unincorporated areas of the county, dispatchers can only send police and/or fire and ambulance vehicles to the scene, according to the report. Dispatch centers serving other areas might or might not send a SMART car.
"There is a stigma to riding in the back of a police car," according to an unnamed school official quoted in the report.
The report found that an estimated 743 county residents under age 18 experienced psychiatric emergencies severe enough to require a trip to the emergency room in 2015, adding that when return visits are factored in, the number is almost 1,000. Ninety percent of them are discharged within 24 hours.
"The SMART program includes some of the elements necessary to avoid these short-term emergency hospitalizations altogether," the grand jury wrote.
The grand jury also recommended the Sheriff's Office expand Crisis Intervention Team training, a 40-hour course that "covers specialized techniques on how to handle psychiatric emergencies in a sensitive manner," and includes a 90-minute presentation focusing on minors. It found that only 20 percent of county law-enforcement officers and 35 percent of sheriff's deputies have completed the training. Reasons it found for the lack of participation include the training not being a requirement at local law-enforcement agencies, the need to pay overtime or assign shifts to other officers causes burdens to departments, and "some involved say that the subject area is secondary to the basic police mission of 'arrive quickly and control the situation.'"
New officers are usually not enrolled in the crisis training "because it is thought that on-the-job experience is required to fully absorb the concepts," according to the report. However, the report noted, beginning in August, police academy training in California will increase behavioral health instruction from six to 15 hours, and officers will have to take three hours of additional instruction annually.
Grand jury recommendations are not mandates, the report noted, adding that elected officials are required to respond to a report's findings and recommendations within 60 days, and governing bodies must respond within 90 days.
June 8, 2016
San Jose Mercury News
By Kevin Kelly
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