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Extracted from Consolidated Report

This investigation was originally published as part of a larger consolidated report containing multiple investigations. View the consolidated PDF for the complete document.

Orange County Grand Jury • 2014-2015

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

Published: June 25, 2015 56 pages Consolidated Report

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⚠️ Translation Notice: This content has been automatically translated. The original English text is the official version. Translation may contain errors.

⚠️ Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.

Findings 14 findings

Deputy Sheriffs and police officers receive insufficient training on how to evaluate and handle the mentally ill in the field.

Deputy Sheriffs and police officers receive insufficient training regarding Laura’s Law.

Orange County’s Centralized Assessment Team is inadequate in that it takes too long for them to respond to the scene to assist police officers in their evaluations of the mentally ill.

Orange County’s mental illness triage system is inadequate in that there are no field screening protocols that would allow medical clearance in the field by law enforcement personnel or paramedics.

Orange County’s mental illness triage system is inadequate in that the police agencies either do not have a triage desk to advise and assist officers in the field or do not have psychiatric crisis mobile response teams at their disposal.

Orange County’s Psychiatric Evaluation and Response Team clinicians are insufficient in number to meet the needs of police agencies in Orange County.

Orange County’s Evaluation and Treatment Services facility is inadequate in that its capacity is insufficient to permit police officers to take all the mentally ill to it and drop them off at the facility, instead of transporting the patient to a hospital emergency room.

Orange County’s Evaluation and Treatment Service facility is inadequate in that the County does not permit medical triage or medical clearance in the field, and therefore directs police officers to obtain medical screening for even minor health conditions that could easily be treated at the facility.

Orange County’s Evaluation and Treatment Service facility is inadequate in that it directs police officers to take the mentally ill who may be under the influence of alcohol or drugs to a hospital emergency room rather than to a psychiatric emergency facility.

F10

Orange County’s crisis intervention system is inadequate in that there is only one Evaluation and Treatment Service facility for the entire County.

F11

The County’s crisis intervention system is inadequate in that it does not provide strategically located, stand-alone, drop-off psychiatric emergency stabilization facilities with medical treatment capability at convenient locations throughout the County.

F12

The County’s crisis intervention system is inadequate in that there is no real-time, empty-bed registry to enable officers and clinicians in the field to determine bed- availability at the Evaluation and Treatment Service facility and at designated hospitals.

F13

The County’s crisis intervention system is inadequate in that there is no 5150, case management, and conservatorship database in place to assist officers and clinicians in the field to triage the mentally ill who do not qualify for a 5150 hold.

F14

The Health Care Agency has not established benchmarks and a complete 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 2014. RECOMMENDATIONS In accordance with California Penal Code sections 933 and 933.05, the 2014- 2015 Grand Jury requires (or, as noted, requests) responses from each agency affected by the recommendations presented in this section. The responses are to be submitted to the Presiding Judge of the Superior Court. Based on its investigation titled “The Mental Illness Revolving Door: A Problem for Police, Hospitals, and the Health Care Agency,” the 2014-2015 Orange County Grand Jury makes the following 14 recommendations:

Recommendations 14

R1

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

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

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

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

All law enforcement agencies should either have a psychiatric triage desk to advise and assist officers in the field or a psychiatric crisis mobile response team. (F.5.)
R6

The Orange County Psychiatric Evaluation and Response Team staff should be 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.)
R7

Orange County’s Evaluation and Treatment Services facilities should be expanded to easily accommodate all 5150 walk-ins and all 5150s dropped off by police, paramedic, or ambulance. (F.7.)
R8

Orange County Evaluation and Treatment Services should acquire the capability of conducting limited medical screening for minor health problems and cease from directing police officers to obtain medical screening for 5150s with minor health conditions that could easily be treated at Evaluation and Treatment Services facilities. (F.8.)
R9

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 requires medical clearance at a hospital. (F.9.)
R10

The Orange County Health Care Agency’s crisis intervention system should be expanded so as to provide a minimum of four Psychiatric Emergency Service facilities—one in South County, one in Central County, one in West County, and one in North County. (F.10.)
R11

The County’s Health Care Agency should provide strategically located, stand- alone, drop-off psychiatric emergency stabilization facilities with medical treatment capability at convenient locations throughout the County. (F.11.)
R12

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 facilities and at designated hospitals. (F.12.)
R13

The County’s Health Care Agency should create and maintain a 5150, case management, and conservatorship database in place to assist officers and 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.)
R14

The Health Care Agency should establish benchmarks and a complete 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 2014. REQUIRED RESPONSES The California Penal Code section 933 requires the governing body of any public 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 recommendations pertaining to matters under the control of the governing body. Such comment shall be made no later than 90 days after the Grand Jury publishes its report (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 County official (e.g. District Attorney, Sheriff, etc.), such elected official shall comment 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. 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: (a) As to each Grand Jury finding, the responding person or entity shall indicate one of the following: (1) The respondent agrees with the finding (2) The respondent disagrees wholly or partially with the finding, in which case the response shall specify the portion of the finding that is disputed and shall include an explanation of the reasons therefore. (b) As to each Grand Jury recommendation, the responding person or entity shall report one of the following actions: (1) The recommendation has been implemented, with a summary regarding the implemented action. (2) The recommendation has not yet been implemented, but will be implemented in the future, with a time frame for implementation. (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 investigated or reviewed, including the governing body of the public agency when applicable. This time frame shall not exceed six months from the date of publication of the Grand Jury report. (4) The recommendation will not be implemented because it is not warranted or is not reasonable, with an explanation therefore. (c) If a finding or recommendation of the Grand Jury addresses budgetary or personnel 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 the Grand Jury, but the response of the Board of Supervisors shall address only those 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 findings or recommendations affecting his or her agency or department. Comments to the Presiding Judge of the Superior Court in compliance with Penal Code section 933.05 are required from: Responses are required for Findings F.3 through F.14. and for Recommendations R.3 through R.14. from the Orange County Board of Supervisors. Responses are required for Findings F.1 and F.2. and for Recommendations R.1. and R.2.from the Orange County Sheriff-Coroner. Comments to the Presiding Judge of the Superior Court in compliance with Penal Code section 933.05 are requested from: Responses are requested for Findings F.3 through F.14. and for 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