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The 24-hour Crisis Intervention Training Course has given law enforcement responders additional tools for dealing with people in crisis, resulting in less use of force. X AGREE (*with clarification) PARTIALLY DISAGREE – explain the disputed portion DISAGREE – explain why Response explanation (required for a response other than Agree): We agree that the Crisis Intervention Training Course (CIT) which is modeled after a national Evidence Based model originally developed in Memphis TN has given law enforcement additional tools for dealing with individuals in crisis, we are not able to determine if that training has resulted in less use of force.

Adding more mental health liaisons and increasing their hours of availability would increase the benefit of this program to law enforcement and people in crisis. X AGREE PARTIALLY DISAGREE – explain the disputed portion DISAGREE – explain why Response explanation (required for a response other than Agree): Response Required by August 15, 2018 Mental Health Crisis Santa Cruz County Health Services Agency

The Mobile Emergency Response Team (MERT) is not accessible through 9-1-1, resulting in overuse of law enforcement. X AGREE (*with clarification) PARTIALLY DISAGREE – explain the disputed portion DISAGREE – explain why Response explanation (required for a response other than Agree): We agree that the MERT is not accessible through 9-1-1, but do not consider dispatching law enforcement to a 9-1-1 call to be an overuse of law enforcement. As an organization, we continue to encourage any member of the public who has immediate concerns about a public safety issue to call 9-1-1, even if they are unsure whether or not it rises to the level of an emergency. Although following a response from law enforcement may determine the call did not rise to a level of an imminent threat or an emergency, we would not consider those calls an overuse of public safety resources. We depend on the skills of the law enforcement officer to make an appropriate assessment of the situation in the field, and use their training and experience to determine the appropriate next steps. As we will discuss later, the proposed model of differentiating threats based on a mental health-related 9-1-1 phone call, particularly one from family or loved ones in obvious distress, is very difficult. A law enforcement officer being dispatched to the scene to make a further determination of what is needed is in our opinion an appropriate use of those resources. Response Required by August 15, 2018 Mental Health Crisis Santa Cruz County Health Services Agency

Having a private, for-profit contractor operate the County BHU reduces transparency between the Behavioral Health Department and the people they serve. AGREE PARTIALLY DISAGREE – explain the disputed portion X DISAGREE – explain why Response explanation (required for a response other than Agree): We disagree. The Grand Jury asked for and was provided a copy of the County's contract to operate the Behavioral Health Unit. The County answered multiple rounds of questions from the Grand Jury related to the operation of the Behavioral Health Unit. The Contracts for operation of the Behavioral Health Unit and Crisis Stabilization Program are approved by the Board of Supervisors and available to the general public, and include provisions for state-required disclosures, complaint processes and more. Furthermore, the Behavioral Health Unit is independently accredited by the Joint Commission, which can be accessed by searching the www.qualitycheck.org website. Contracting for medical services is not unusual in Santa Cruz County or in any other County. We believe this provides medical expertise and improved care for clients, as well as reducing costs for taxpayers, including future retirement obligations. Subject to HIPAA and other limitations on the disclosure on protected patient data, these contracts do not reduce transparency. While the Grand Jury was unable to obtain a tour of the facility, we understand that may have been a communication issue rather than a formal denial of access. As noted in the report, the County did provide the grand jury a floor plan. Response Required by August 15, 2018 Mental Health Crisis Santa Cruz County Health Services Agency