8/17/2018 scgrandjury.org Mail - Board of Supervisors Response: Mental Health Crisis: Seeking an Integrated Response

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 Board of Supervisors

Having law enforcement be the primary responder to non-threatening 9-1-1 EDP calls reduces the overall availability of law enforcement to the community. 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 Board of Supervisors

The Mobile Emergency Response Team (MERT) is not accessible through 9-1-1, resulting in overuse of law enforcement. X AGREE PARTIALLY DISAGREE – explain the disputed portion DISAGREE – explain why Response explanation (required for a response other than Agree): While we agree that the MERT is not accessible through 9-1-1, we do wish to clarify one point. We do not consider dispatching public safety officers to any 9-1-1 call to be "overuse." We encourage residents to call 9-1-1 even if they are unsure whether an emergency situation exists. Consequently, public safety officers frequently respond to calls that turn out to not pose imminent threats to life, safety or property, or even require any law enforcement attention. Even so, we do not consider these calls to be "overuse" of public safety resources. As discussed later, differentiating threats based on a mental health-related 9-1-1 call, particularly one from family or loved ones in obvious distress, can be difficult. In these cases, we would not consider dispatching an officer to be "overuse" of resources should the call turn out to require a strictly clinical response. Response Required by August 15, 2018 Mental Health Crisis Santa Cruz County Board of Supervisors

Current dispatch procedures do not distinguish between threatening and non- threatening EDP calls. Making this distinction would create an opportunity for MERT to respond to the 70 percent of 9-1-1 EDP calls that do not involve a threat. AGREE X PARTIALLY DISAGREE – explain the disputed portion DISAGREE – explain why Response explanation (required for a response other than Agree): Current procedures do not designate a specific dispatch-related code to distinguish between threatening and non-threatening EDP calls. While some calls present as threats and could be distinguished immediately, the implication that all other calls are non-threatening and thus safe for unaccompanied mental health workers is untrue. In April 2017, a City of Berkeley psychologist employed by the Mental Health Mobile Crisis Team was dispatched to a report of an individual threatening to harm himself. The worker was at first unable to find the patient. She was subsequently attacked and strangled. The County is unwilling to expose our employees to similar risks. Based on its interviews, the Grand Jury estimated that 70 percent of 9-1-1 EDP calls turn out to be non-threatening. We have not analyzed our data to examine whether that figure is supported. Further, making those determinations beforehand based on a phone conversation creates unnecessary risks and potentially dangerous situations. Response Required by August 15, 2018 Mental Health Crisis Santa Cruz County Board of Supervisors

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 Board of Supervisors