Butte County Office of the Jerry W. Smith Sheriff - Coroner Superior Court of California County of Butte August 20,*

It is generally agreed among hospital emergency personnel, behavioral health personnel and law enforcement that approximately 50% of those detained under 5150 are released after a mental status evaluation and are never formally admitted to a designated facility for 72-hour treatment and evaluation. The data to verify this general impression should be collected, retained and used to improve policies and procedures of all involved agencies. The respondent agrees with this finding. Although the data is not available to verify the statistic that 50% of the individuals detained are released after evaluation and never admitted to PHF, the respondent agrees that this data should be collected and reviewed. However, it is important to bear in mind that the percentage of individuals released prior to admission does not necessarily reflect a need to improve policies and procedures. Behavioral Health's decision to further detain or release individuals brought in by law enforcement are based upon the individual's mental condition at the time of Behavioral Health's assessment, and not on the earlier assessment conducted by law enforcement. Significant time can pass between the initial law enforcement detention and the subsequent Behavioral Health decision to maintain or release the 5150 W&I hold.

The legal status of person detained under a 5150 hold is often unclear as they move through the system because of the complexity of the various statutes involved. The respondent disagrees in part with this finding. The status of the individual detained pursuant to 5150 W&I by law enforcement is not unclear. The person is detained and their status is explained at the time of the detention. Once the detained person is placed into the custody of ED and/or DBH staff, law enforcement is no longer in a position to ensure continuing clarity as to the status of the detained person.

The mental status evaluation of many of those detained under 5150 by law enforcement does not take place in a timely manner. Frequently those detained during the late evening and early morning hours have to wait in a hospital emergency department for an extended period of time before the mental status evaluation is conducted. Hours after law enforcement personnel deliver a detainee to emergency departments, a large percentage of those detained are found by mental health professionals not to meet the criteria for further involuntary detention. . The respondent agrees with this finding.

There are no procedures in place for law enforcement officers who detain an individual under 5150 to communicate directly with the mental health professional conducting the mental status evaluation. Communication is limited to brief hand-written comments on a poorly designed application-for-detention form (MH-302). The respondent disagrees with this finding. Law enforcement can call the PHF and speak with a mental health professional if there is a question or concern. Additionally, the application for detention document (MH-302) is a state regulated form and although it is handwritten and concise, an accurate communication can occur using this form.

Law enforcement lacks capability to video record behavior displayed by 5150 detainees at time of detention, and has limited audio recording capability. Law enforcement's ability and responsibility to complete a video record of detainee behavior and share it with mental health professionals would contribute to a more complete and accurate mental health evaluation of 5150 detainees. The respondent disagrees with this finding. While handheld video and audio equipment is available to law enforcement, the suggested use of such equipment causes serious concerns. The presence and use of video cameras at a mental health crisis call would tend to escalate the danger of the encounter, both to the individual and law enforcement. Pointing a camera at an individual experiencing a mental health crisis is an affront to their dignity; tantamount to recording an individual suffering a medical crisis, such as a heart attack, stroke or other trauma. Such provocative behavior by law enforcement could further upset or enrage the very individual we are trying to calm, and make it less likely the individual will voluntarily comply with instructions. Even if done surreptitiously, audio or video recording would have little to no value in final assessment of the individual by mental health professionals since Behavioral Health's independent assessment is conducted on the individual at a point in time after medical clearance. As noted, this delay may take several hours and the individual's crisis may have passed.

The lack of a centralized 24-7 designated facility or other 24-hour facility necessitates law enforcement officers having to take detainees to a hospital emergency department. Holding detainees in an emergency department creates many problems for the hospital, the detained individual and DBH. The respondent agrees with this finding.

The lack of coordinated procedures relating to the various statutes involved when a person is detained under 5150 and the other statutes involved creates a continuing state of confusion and results in unnecessarily high costs to county agencies, area hospitals and to the individuals involved. The respondent neither agrees nor disagrees with this finding. These impacts are not seen by law enforcement because they take place after our involvement. <b>Grand Jury Recommendations:</b>

A large percentage of those being released from incarceration, either from the Butte County Jail or from a State prison, have been identified as having behavioral health issues. There is a need to improve the procedure for moving these persons into the existing mental health system and for providing adequate treatment. The respondent agrees with the finding. Current jail statistics show10% of the in- custody jail population receives prescription psychotropic medications. Upon release, not all of these individuals are in immediate need of acute care. Individuals suffering a mental health crisis are not simply released from the Butte County Jail. Those individuals in crisis are taken for evaluation and assistance. Those not in crisis and currently on medication are medicated prior to release and medical staff calls in a 30 day prescription to a local pharmacy so the released individual can continue on their mediations while awaiting further mental health assistance out of custody. The Sheriff's Office employs a release 33 County Center Drive . Oroville, CA 95965 . (530) 538-7321 . Fax (530) 538-2099 planning coordinator to assist released inmates in their reintegration back into the community. We expect our release planning coordinator to work closely with Behavioral Health's new Forensic Clinician to ensure a smooth transition of those persons into the existing mental health system

There are serious issues concerning implementation of policies and procedures pursuant to section 5150. The presently dysfunctional working relationships between DBH and area hospitals, as well as in some cases questionable application of the 5150 provisions by law enforcement, are not serving the best interests of either the community or mental health consumers. The respondent disagrees in part with the finding. The respondent does not agree that there is "questionable application of the 5150 provisions by law enforcement." Deputies make on scene decisions regarding the criteria present to assess an individual in crisis to determine if they are a danger to themselves, a danger to others or gravely disabled. Respondent does not believe that just because an individual displayed ideations of suicide at scene and then does not fit the criteria later when assessed by medical or DBH staff that the detention was questionable. If the noted dysfunctional working relationships between ED staff and DBH staff exists as stated, this could create a delay, allowing time for some consumers to recover from an episode of mental health crisis. If this situation occurred the consumer may no longer meet the criteria for a 72 hour placement, but this situation does not change the validity of the assessment conducted on scene. <b>Grand Jury Recommendations:</b> The Respondent was not asked by the Grand Jury to respond to Recommendations 1-9 or 12-15 and those recommendations pertain to matters that are not under the control Sheriff's Office. Accordingly, no response to those recommendations is being provided.