Individuals in Crisis The Right Care at the Right Time

Conclusions 6

• CL1
  The Jury finds that increased implementation of the 5150 holds by trained law enforcement officers and more Behavioral Wellness clinicians would benefit all citizens of Santa Barbara County.
• CL2
  Disagree with partial explanation
• CL3
  Response to Recommendations shall be one of the following: Has been implemented, with brief summary of implementation actions taken
• CL4
  Will be implemented, with implementation schedule
• CL5
  Requires further analysis, with analysis completion date of no more than six months after
• CL6
  the issuance of the report Will not be implemented, with an explanation of why •

Observations 1

• OB1
  Behavioral Wellness BWell has mobile crisis teams which are trained, designated, and empowered to issue the 5150 holds in Santa Barbara County. In most instances BWell endeavors to rapidly respond, de-escalate and stabilize individuals with mental disorders that pose serious risks. Their intervention often reduces the danger to the person and the community, avoids unnecessary emergency department care, and lessens or circumvents law enforcement involvement. In many responses, the individual of concern is stabilized on site, sometimes agreeing to a voluntary admission into a mental health facility, and therefore no involuntary hold is required. Beginning January 2024, BWell no longer relies exclusively on a phone assessment in requests for their mobile crisis response services. Staff must respond in person within 60 minutes. The usual response time is now 20-40 minutes. BWell is currently faced with a shortage of qualified personnel to fully staff their mobile crisis services and the Co-Response Teams, which often leads to delays in attending each mental health related request 24/7/365. Weekends and nights are of particular concern especially when absences occur due to staff vacations and sick leaves. In the fiscal year 2022-2023 there were 425 involuntary 5150 holds written by BWell in Santa Barbara County. Police Departments There are eight incorporated cities within Santa Barbara County. Santa Barbara, Santa Maria, and Lompoc have independent police departments; the others contract with the Santa Barbara County Sheriff's Office for law enforcement. Santa Barbara and Santa Maria City Police Departments and the Sheriff's Office have Co-Response Teams. The LPS Act allows for a law enforcement officer to respond to an undetermined 911 call to determine whether to issue a 5150 involuntary hold. The Co-Response Team model includes a qualified BWell clinician responding with law enforcement when dispatched to a suspected or clearly defined mental health crisis. In times of urgency, if a BWell clinician is not available, peace officers should not hesitate to issue a 5150. Law enforcement officers are often the first on the scene for most, if not all, crisis concerns reported to 911. Data suggests that 7-10% of law enforcement calls are in response to individuals displaying moderate to severe mental illness behaviors. All California police academies have a 40-hour course in Crisis Intervention Training (CIT) which is included in their basic Police Officer Standards and Training curriculum. Furthermore, the Sheriff's Office currently has a clinician who instructs law enforcement officers in CIT and the proper procedures for 5150 issuances. This is in direct response to the need for some officers to receive supplemental training to ensure competency when responding to individuals in mental health crises. The Santa Barbara County Sheriff's Office launched a pilot program allowing its officers, under highly specific circumstances, to issue 5150 holds. In 2023 only one such 5150 hold had been issued. This low number has been cited to rebut widespread concerns among emergency department doctors and mental health care administrators that their facilities would be overrun by enabling law enforcement to issue 5150 holds. The intent has never been to issue more 5150 holds, but rather to have law enforcement officers fully trained to evaluate, stabilize or refer mentally ill persons to a Crisis Stabilization Unit (CSU), PHF, emergency department, or available alternative and social services. This change would help guarantee future protection of individual civil rights and assist in providing the right treatment at the right time to those in need. The County Sheriff deputies, along with the Santa Barbara and Santa Maria City police officers, participated in CIT training and were authorized to make 5150 holds. It was stated to the Jury that the Sheriff's Office has issued only two 5150 referrals through February 2024. Holding Facility Capacity A critical concern in the discussion of which agency or department is authorized to issue 5150s focuses on the number of available beds in the PHF run by BWell. Under federal and state medical guidelines, to be eligible for Medi-Cal and Medicare reimbursements, the County is permitted one PHF with a 16-bed maximum. There are preliminary plans, based on updated State allowances, for the PHF to be expanded to 19 beds by 2026. It has been estimated that for Santa Barbara County's population the number of beds should be closer to 40, and even that number is considered a low estimate when compared to the guidelines established by the State. The 16-bed limitation often begs the following question: Who is the gatekeeper for patients that require the services provided in the 72-hour hold in the PHF? The answer to this question is subject to some dispute. Community-based mental health advocates and social watchdog groups state that simply claiming a lack of available beds does not properly address the urgent needs of those in their time of crisis. Mentally distraught patients who are a danger to themselves or others are entitled to the same medical services as for any other emergency. When the local PHF is at capacity, new patients who require an involuntary detention can be sent to an out of county psychiatric facility. The experience at the Marian Medical Center's Crisis Stabilization Unit (CSU) in Santa Maria, opened in 2022, has demonstrated that 70% of the admitted patients stabilize within the 24-hour By receiving de-escalation, social services, and medications, patients are often timeframe. released to family members, caregivers, or into the general population. An added benefit is that the CSU diverts these patients from entering the emergency department, which can be overburdened, sometimes chaotic, and therefore not an altogether safe environment for someone with serious mental issues. In July of 2024, a Crisis Stabilization Unit is slated to open in Santa Barbara with an eight-bed locked facility admitting patients for detentions of up to 24-hours. Santa Barbara Cottage Hospital has a locked psychiatric ward. The Emergency Department Physician can place an individual on a California Health and Safety Code 1799.111 hold to detain the person for 24 hours until a designated professional is able to evaluate the patient for a 5150 hold. All patients presented to the Emergency Department (ED) for psychiatric assessment will be registered as an ED patient and seen per ED protocol. Because Cottage Hospital is not an LPS Act designated holding facility, efforts to secure placement for each patient placed on a 5150 hold will begin immediately upon admission.

Agency Responses 4

Government agencies' official responses to this report's findings and recommendations. Click on a response to see the structured breakdown.

No Responses Found 1

Government entities assigned to respond to this report. No response documents have been linked in our database.