The Mental Illness Revolving Door: a Problem for Police, Hospitals, and the Health Care Agency

Recommendations 14

• R1

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  All law enforcement officers should receive at least 40 hours of comprehensive REPORT Crisis Intervention Training on how to handle and evaluate the mentally ill in the 11 field with periodic refresher training. (F.1.)
• R2

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  All law enforcement officers should receive mandatory and specific training REPORT regarding Laura’s Law. (F.2.) 12
• R3

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  Orange County’s Centralized Assessment Team’s response time should be improved significantly with a goal of eventually reducing its maximum response REPORT time to less than 20 minutes. (F.3.) 13
• R4

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  The Orange County Health Care Agency should adopt field screening protocols REPORT to allow (a) medical clearance in the field by law enforcement personnel and/or 14 paramedics; and (b) transport by paramedics rather than police officers. (F.4.)
• R5

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  All law enforcement agencies should either have a psychiatric triage desk to REPORT advise and assist officers in the field or a psychiatric crisis mobile response team. 15 (F.5.) REPORT 16 2014-2015 Orange County Grand Jury REPORT 1 The Mental Illness Revolving Door: A Problem for Police, Hospitals, and the Health Care Agency REPORT
• R6

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  The Orange County Psychiatric Evaluation and Response Team staff should be 2 increased significantly so that an embedded clinician can be placed with each law enforcement agency and can provide service 24/7 if requested. (F.6.) REPORT 3 R.7. Orange County’s Evaluation and Treatment Services facilities should be expanded to easily accommodate all 5150 walk-ins and all 5150s dropped off by REPORT police, paramedic, or ambulance. (F.7.) 4
• R8

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  Orange County Evaluation and Treatment Services should acquire the capability of conducting limited medical screening for minor health problems and cease REPORT from directing police officers to obtain medical screening for 5150s with minor 5 health conditions that could easily be treated at Evaluation and Treatment Services facilities. (F.8.) REPORT 6 R.9. Orange County’s Evaluation and Treatment Services facilities should acquire the capability of handling 5150s who may have ingested alcohol or drugs, but who are not under the influence to such an extent that it inhibits stabilization or REPORT requires medical clearance at a hospital. (F.9.) 7
• R10

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  The Orange County Health Care Agency’s crisis intervention system should be REPORT expanded so as to provide a minimum of four Psychiatric Emergency Service 8 facilities—one in South County, one in Central County, one in West County, and one in North County. (F.10.) REPORT
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  The County’s Health Care Agency should provide strategically located, stand- 9 alone, drop-off psychiatric emergency stabilization facilities with medical treatment capability at convenient locations throughout the County. (F.11.) REPORT 10 R.12. The County’s Health Care Agency should provide a real-time, empty-bed registry to enable officers and clinicians in the field to determine immediately and accurately the current bed availability at Evaluation and Treatment Services REPORT facilities and at designated hospitals. (F.12.) 11
• R13

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  The County’s Health Care Agency should create and maintain a 5150, case REPORT management, and conservatorship database in place to assist officers and 12 clinicians in the field to triage the mentally ill in the field who do not qualify for a 5150 hold, but who may qualify for Laura’s Law. (F.13.) REPORT
• R14

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  The Health Care Agency should establish benchmarks and a complete 13 performance-measurement system with which to track the success and cost effectiveness of Laura’s law, as directed by the Board of Supervisors in May REPORT 2014. REQUIRED RESPONSES REPORT The California Penal Code section 933 requires the governing body of any public 15 agency which the Grand Jury has reviewed, and about which it has issued a final report, to comment to the Presiding Judge of the Superior Court on the findings and REPORT recommendations pertaining to matters under the control of the governing body. Such 16 2014-2015 Orange County Grand Jury REPORT 1 The Mental Illness Revolving Door: A Problem for Police, Hospitals, and the Health Care Agency REPORT comment shall be made no later than 90 days after the Grand Jury publishes its report 2 (filed with the Clerk of the Court). Additionally, in the case of a report containing findings and recommendations pertaining to a department or agency headed by an elected REPORT County official (e.g. District Attorney, Sheriff, etc.), such elected official shall comment 3 on the findings and recommendations pertaining to the matters under that elected official’s control to the Presiding Judge with an information copy sent to the Board of Supervisors. REPORT 4 Furthermore, California Penal Code section 933.05, subdivisions (a), (b), and (c), provides as follows, the manner in which such comment(s) are to be made: REPORT 5 (a) As to each Grand Jury finding, the responding person or entity shall indicate one of the following: REPORT (1) The respondent agrees with the finding 6 (2) The respondent disagrees wholly or partially with the finding, in which case REPORT the response shall specify the portion of the finding that is disputed and shall include an 7 explanation of the reasons therefore. (b) As to each Grand Jury recommendation, the responding person or entity shall report REPORT one of the following actions: 8 (1) The recommendation has been implemented, with a summary regarding the implemented action. REPORT 9 (2) The recommendation has not yet been implemented, but will be implemented in the future, with a time frame for implementation. REPORT 10 (3) The recommendation requires further analysis, with an explanation and the scope and parameters of an analysis or study, and a time frame for the matter to be prepared for discussion by the officer or head of the agency or department being REPORT investigated or reviewed, including the governing body of the public agency when 11 applicable. This time frame shall not exceed six months from the date of publication of the Grand Jury report. REPORT 12 (4) The recommendation will not be implemented because it is not warranted or is not reasonable, with an explanation therefore. REPORT (c) If a finding or recommendation of the Grand Jury addresses budgetary or personnel 13 matters of a county agency or department headed by an elected officer, both the agency or department head and the Board of Supervisors shall respond if requested by REPORT the Grand Jury, but the response of the Board of Supervisors shall address only those 14 budgetary /or personnel matters over which it has some decision making authority. The response of the elected agency or department head shall address all aspects of the REPORT findings or recommendations affecting his or her agency or department. REPORT 16 2014-2015 Orange County Grand Jury REPORT 1 The Mental Illness Revolving Door: A Problem for Police, Hospitals, and the Health Care Agency REPORT Comments to the Presiding Judge of the Superior Court in compliance with Penal Code 2 section 933.05 are required from: REPORT Responses are required for Findings F.3 through F.14. and for 3 Recommendations R.3 through R.14. from the Orange County Board of Supervisors. REPORT Responses are required for Findings F.1 and F.2. and for Recommendations R.1. 4 and R.2.from the Orange County Sheriff-Coroner. REPORT Comments to the Presiding Judge of the Superior Court in compliance with Penal Code 5 section 933.05 are requested from: Responses are requested for Findings F.3 through F.14. and for REPORT Recommendations R.3. through R.14.from the OC Health Care Agency. Responses are requested for Findings F.1 and F.2. and for Recommendations REPORT R.1. and R.2.from the Police Chiefs of the following cities: 7 1. Anaheim 2. Brea REPORT 3. Buena Park 8 4. Costa Mesa 5. Cypress REPORT 6. Fountain Valley 9 7. Fullerton 8. Garden Grove REPORT 9. Huntington Bch 10 10. Irvine 11. La Habra 12. La Palma REPORT 13. Laguna Beach 11 14. Los Alamitos 15. Newport Beach REPORT 16. Orange 12 17. Placentia 18. Santa Ana REPORT 19. Seal Beach 13 20. Tustin 21. Westminster REPORT 14 REPORT 15 REPORT 16 2014-2015 Orange County Grand Jury REPORT 1 The Mental Illness Revolving Door: A Problem for Police, Hospitals, and the Health Care Agency REPORT COMMENDATIONS 2 The Grand Jury commends the Police Department of the City of Orange, the Santa Ana Police Department, the Hospital Association of Southern California, and St. REPORT Joseph Hospital for collaborating on and producing a set of training videos for use by 3 police officers and deputy sheriffs in CIT training. The Grand Jury commends the Director of the John George Psychiatric Hospital in San Leandro, California and the REPORT Director of Behavioral Health for Alameda County for their valuable assistance. The 4 Grand Jury also commends Golden West College for developing and expanding its CIT course to 24 hours. REPORT 5 REPORT 6 REPORT 7 REPORT 8 REPORT 9 REPORT 10 REPORT 11 REPORT 12 REPORT 13 REPORT 14 REPORT 15 REPORT 16 2014-2015 Orange County Grand Jury REPORT 1 The Mental Illness Revolving Door: A Problem for Police, Hospitals, and the Health Care Agency REPORT END NOTES 2 1. The Memphis Model REPORT The first CIT was established in Memphis in 1988 after the tragic shooting by a 3 police officer of a man with a serious mental illness. This tragedy stimulated a collaboration between the police, the Memphis chapter of the National Alliance on REPORT Mental Illness, the University of Tennessee Medical School, and the University of 4 Memphis to improve police training and procedures in response to mental illness. The so-called Memphis model has achieved remarkable success, having been adopted by REPORT more than 2000 communities in more than 40 states and having been implemented 5 statewide in several states. The Memphis Model of CIT has several key components: REPORT 6  A community collaboration between mental health providers, law enforcement, and family/consumer advocates, which determines the best REPORT way to transfer the mentally ill into the mental health system 7  A community coalition to ensure that there are adequate facilities for mental health triage REPORT  A curriculum of specialized training to teach police officers how to interact 8 with persons experiencing a psychiatric crisis  Special training to respond safely and quickly to people with serious mental illness in crisis REPORT  Focused training on how to recognize the signs of psychiatric distress and 9 how to de-escalate a crisis  Materials on how to link people with appropriate treatment, which has a REPORT positive impact on fostering recovery and reducing recidivism 10 The benefits of the Memphis Model of CIT are as follows: REPORT 11  Helps keep the severely mentally ill out of jail and gets them into treatment  Reduces stigma and prejudice toward the severely mentally ill  Reduces officer injuries and SWAT team emergencies REPORT  Reduces the amount of time officers spend on the disposition of mental 12 disturbance calls REPORT 2. Defense of Laura’s Law 13 On January 3, 1999, Kendra Webdale was pushed to her death before an oncoming subway train beneath the streets of Manhattan by a man diagnosed with REPORT paranoid schizophrenia and with a history of mental illness and hospitalizations who had 14 neglected to take his prescribed medication. Responding to this tragedy, the Legislature enacted Mental Hygiene Law § 9.60 (Kendra’s Law) (L. 1999, ch. 408), thereby joining REPORT nearly 40 other states in adopting a system of assisted outpatient treatment (AOT) 15 pursuant to which psychiatric patients unlikely to survive safely in the community without supervision may avoid hospitalization by complying with court-ordered mental health REPORT treatment. In enacting the law, the Legislature found that there are mentally ill persons 16 2014-2015 Orange County Grand Jury REPORT 1 The Mental Illness Revolving Door: A Problem for Police, Hospitals, and the Health Care Agency REPORT who are capable of living in the community with the help of family, friends, and mental 2 health professionals, but who, without routine care and treatment, may relapse and become violent or suicidal, or require hospitalization. (L 1999, ch. 408, § 2.) In addition, REPORT in mandating that certain patients comply with essential treatment pursuant to a court- 3 ordered written treatment plan, the Legislature further found that some mentally ill persons, because of their illness, have great difficulty taking responsibility for their own care and often reject the outpatient treatment offered to them on a voluntary basis. (Id.) REPORT 4 It did not take long for the law’s constitutionality to be challenged. The question was whether the law achieved its goal of creating a mechanism to ensure that REPORT individuals who met the criteria remained treatment-compliant while in the community, in 5 a way that was consistent with the Constitutional rights of those individuals. In the Matter of K.L., 500748/00 (Sp. Ct., Queens County, 2000), the Mental Hygiene Legal REPORT Service (MHLS) moved for dismissal of a petition, arguing that the statute was 6 unconstitutional on two grounds: that it unconstitutionally deprived patients of the fundamental right to determine their own course of treatment, and that the statutory provisions concerning removal for observation following non-compliance with the AOT REPORT order are facially unconstitutional. The Attorney General of the State of New York 7 intervened to support the constitutionality of the statute. REPORT The Supreme Court rejected each of the arguments advanced by the MHLS, 8 upheld the constitutionality of Kendra’s Law, and found that it comported with due process, noting that Kendra’s Law does not permit forced medication or treatment . The REPORT Court reasoned that the restriction on a patient’s freedom affected by a court order 9 authorizing AOT is minimal, inasmuch as the coercive force of the order lies solely in the compulsion generally felt by law-abiding citizens to comply with court directives. The Court observed that although the existence of such an order and its attendant REPORT supervision increases the likelihood of voluntary compliance with necessary treatment, 10 a violation of the order, standing alone, ultimately carries no sanction. REPORT 3. The Sequential Intercept Model 11 The Sequential Intercept Model provides a conceptual framework for communities to use when considering the interface between the criminal justice and REPORT mental health systems as they address concerns about criminalization of people with 12 mental illness. The model envisions a series of points of interception at which an intervention can be made to prevent individuals from entering or penetrating deeper into REPORT the criminal justice system. The concept is that most people will be intercepted at early 13 points, with decreasing numbers at each subsequent point. The interception points are law enforcement and emergency services; initial detention and initial hearings; jail, REPORT courts, forensic evaluations, and forensic commitments; reentry from jails, state prisons, 14 and forensic hospitalization; and community corrections and community support. The model provides an organizing tool for a discussion of diversion and linkage alternatives and for systematically addressing criminalization. Using the model, a community can REPORT develop targeted strategies that evolve over time to increase diversion of people with 15 mental illness from the criminal justice system and to link them with community mental health treatment. (Munetz & Griffin, 2006) REPORT 16 2014-2015 Orange County Grand Jury REPORT 1 The Mental Illness Revolving Door: A Problem for Police, Hospitals, and the Health Care Agency REPORT Although many communities are interested in addressing the overrepresentation of 2 people with mental illness in local courts and jails, the task can seem daunting and the various program options confusing. The Sequential Intercept Model provides a workable REPORT framework for collaboration between criminal justice and treatment systems to 3 systematically address and reduce the criminalization of people with mental illness in their community REPORT 4 REPORT 5 REPORT 6 REPORT 7 REPORT 8 REPORT 9 REPORT 10 REPORT 11 REPORT 12 REPORT 13 REPORT 14 REPORT 15 REPORT 16 2014-2015 Orange County Grand Jury REPORT 1 The Mental Illness Revolving Door: A Problem for Police, Hospitals, and the Health Care Agency REPORT REFERENCES 2 About Laura’s Law. (n.d.). In Ten years after murders: law meant to prevent tragedies remains overlooked and unused. Retrieved from REPORT http://www.lauraslawoc.org./about.html 3 Assisted Outpatient Treatment (2014, June 13). The Nevada County Experience. REPORT Retrieved from: http://www.mynevadacounty.com/nc/hhsa/bh/Pages/Assisted- 4 Outpatient-Treatment.aspx Bekiempis, V. (2014, February 28). New study on mental illness. Newsweek. REPORT 5 Carpinello, S. (2005, March) Kendra’s Law: Report on the Status of Assisted Outpatient Treatment. New York State, Office of Mental Health. Albany, New REPORT York. Cost Savings for AOT (2012, June 12). Mental Illness Policy Organization, found at http://lauras-law.org. REPORT 7 Dupont, R. Cochran, S, & Pillsbury, S. (2007, September). Crisis Intervention Team Core Elements. University of Memphis. Memphis TN. REPORT Emmanuel, A. & McBride, S. (2015, April 30). Police face choice of handcuffs or 8 helping hand for mentally ill. Chicago Reporter. Chicago, Ill. REPORT Exodus Recovery, Inc. (2015). Mental Health Urgent Care Center at MLK Medical 9 Center by Exodus, found at www.exodusrecoveryinc.com/MLK_UCC.html. Gerda, N. (2014, May 14). Orange County adopts Laura’s Law. Voice of OC. Retrieved REPORT from http:// voiceofoc.org. Holt, W., & Adams, A. (2013). Mental health in California: Painting a picture. California REPORT Healthcare Foundation. Oakland, CA. Retrieved from 11 http://www.chcf.org/publicaations/2013/07/mental-health-california. King, S. (2015, April 5) American tragedy: A staggering percentage of police shooting REPORT victims struggled with mental illness Daily KOS. Retrieved from: 12 http://www.dailykos.com/story/2015/04/05/1375335 Miller, J. (2013, March 5) Patients as prisoners, jails new mental health institutions, REPORT CBS News.. Retrieved from: http://www.cbsnews.com/news/patients-as- 13 prisoners-jails-new-mental-health-institutions/. REPORT Munetz, M. & Griffin, P. (2006, April). Use of the sequential intercept model as an 14 approach to decriminalization of people with serious mental illness. Psychiatric Services. Retrieved from http://www.dbhds.virginia.gov/library/document- REPORT library/ofo%20%20sim%20article%20munetz%20%20griffin%202006.pdf. National Alliance on Mental Illness (n.d.). CIT toolkit; CIT facts. Retrieved from http://www2.nami.org/Content/ContentGroups/Policy/CIT/CIT_Facts_4.11.12.pdf REPORT . 16 2014-2015 Orange County Grand Jury REPORT 1 The Mental Illness Revolving Door: A Problem for Police, Hospitals, and the Health Care Agency REPORT Orange County Board of Supervisors. (2015, May 19). Adoption of stepping up 2 initiative resolution (Agenda Staff Report). Santa Ana, CA. REPORT Orange County Health Care Agency and Hospital Association of Southern California. . 3 (2013, December 17). Triage grant application, Vol XII (27).Santa Ana, Ca. Orange County Health Info. (n.d.). Full Service Partnership Homepage. Retrieved from REPORT http//www.ocgov.com/gov/health/bhs. Santa Ana, CA. Pelley, S. (2014, September 14). The shortcomings of mental health care. CBS 60 REPORT Minutes (Television news program). New York, NY. Quanbeck, T, Tsai, G, & Szabo K. (n.d.) Cost-effectiveness analysis of assisted outpatient treatment implementation in California’s civil sector. Retrieved from: REPORT http://dhmh.maryland.gov/bhd/Documents/ 6 Sewell, A. (2014, July 15,). D.A. Jackie Lacey calls jailing of mentally ill a moral REPORT question. Los Angeles Times. Los Angeles, CA. Sewell, A. (2014, November 12). In push to keep mentally ill out of jail, county to expand crisis centers, Los Angeles Times. Los Angeles, CA. REPORT 8 Shabo, H. (2014, August 20). Governor Davis signs Laura’s Law: AB1421 will help those with severe mental illnesses who are too sick to help themselves. REPORT Retrieved from: http://oceanpark.com/notes/ab1421_background.html. Simon, R. (2015, January 25). Crisis Stabilization of the Mentally Ill. CBS 60 Minutes (Television news program). New York, NY. REPORT 10 Superior Court of Orange County (2014). Annual Report, Collaborative Courts, p. 23, Santa Ana, CA. REPORT Swartz, M., Steadman, H. & Monahan, J (June 30, 2009). Program Evaluation: New 11 York State Assisted Outpatient Treatment Program Evaluation, Duke University School of Medicine, Durham, NC. REPORT 12 Wolfson, B. J. (2014, October 25,). Psychiatric treatment in Orange County. Orange County Register. Santa Ana, CA. REPORT Zeller, S. (2013, September 16). Psychiatric boarding: Averting long waits in 13 emergency rooms. Psychiatric Times. Retrieved from: http://www.psychiatrictimes.com. REPORT 14 REPORT 15 REPORT 16 2014-2015 Orange County Grand Jury REPORT 1 The Mental Illness Revolving Door: A Problem for Police, Hospitals, and the Health Care Agency REPORT APPENDIX: ACRONYM LIST 2 AAOAPOD Adult and Older Adult Performance Outcome Department REPORT AOT Assisted Outpatient Treatment 3 BHS Behavioral Health Services REPORT CAT Centralized Assessment Team 4 CIT Crisis Intervention Training REPORT COPS Community Oriented Policing Services 5 CRT Crisis Response Team REPORT EPU Emergency Psychiatric Unit 6 ETS Evaluation and Treatment Services REPORT 7 FSP Full Service Partnership HCA Health Care Agency REPORT 8 LPS Lanterman-Petris-Short Act NAMI National Alliance on Mental Illness REPORT 9 PERT Psychiatric Evaluation and Response Team PES Psychiatric Emergency Services REPORT 10 PET Psychiatric Evaluation Team REPORT POST Peace Officers Standards and Training 11 TACT Time, Atmosphere, Communication, and Tone: A method of talking to the mentally ill REPORT 12 REPORT 13 REPORT 14 REPORT 15 REPORT 16 2014-2015 Orange County Grand Jury
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  Newport Beach REPORT
• R18

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  Santa Ana REPORT 19. Seal Beach 13 20. Tustin
• R21

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  Westminster REPORT 14 REPORT 15 REPORT 16 2014-2015 Orange County Grand Jury REPORT 1 The Mental Illness Revolving Door: A Problem for Police, Hospitals, and the Health Care Agency REPORT