Mendocino County Grand Jury • 2006-2007

Transport in Crisis: Safety Issues in the Transport of Mental Health Clients March 22, 2007

Published: March 22, 2007 5 pages
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Findings and Recommendations 27 findings

F1
Crisis Services are State mandated but do not receive earmarked State funding.
Related Recommendations (2)
R6
mental health protocols be developed for the MCDH and Howard. (Findings 1, 2, 10, 11, 18, 20, 21)
R7
the Health and Human Services Agency meet with Howard Hospital management to develop a residential psychiatric unit in the new Frank R. Howard Memorial Hospital to serve the Northern California Counties. (Findings 1, 2, 16, 26) Comments Closing of the PHF in Mendocino County in 2000 did not remove the need for local residential psychiatric services. It resulted in the need for an extensive, quality, transport system for mental health clients in crisis. Currently the transportation system for the Crisis Service is not always safe and effective. The Grand Jury recognizes a hard working dedicated staff that provides humane, compassionate services for their clients.
F2
Many Crisis Service clients are indigent, Medi-Cal ineligible, and have no insurance or financial resources, making the County responsible for costs incurred by the client.
No recommendations for this finding
F3
Management and supervisory staff reported that Crisis Services are under- funded. Non-competitive staff salaries make hiring and retaining qualified staff difficult.
Related Recommendations (1)
R1
the salary schedule for crisis staff be adjusted to be comparable to other rural counties.( Findings 1-7, 10)
F4
The Ukiah CSC currently employs five permanent HSW/drivers (one female) and seven Crisis Workers. An additional Crisis Worker and female HSW/driver are being recruited as extra- help employees.
No recommendations for this finding
F5
Willits has two Crisis Workers, and one Client Services Specialist who may drive on occasion.
No recommendations for this finding
F6
The Fort Bragg office is staffed by one supervisor, three Crisis Workers and seven HSW/drivers whom are called as needed. This office is currently recruiting for an additional Crisis Worker.
No recommendations for this finding
F7
Extra-help HSW/ drivers are paid only for the hours they work.
No recommendations for this finding
F8
Night staff at the Ukiah CSC lock the door for safety at 11 p.m.; they may be reached by telephone.
Related Recommendations (1)
R5
a video camera be installed at the entry to the CSC. (Findings 8, 11, 12)
F9
The Grand Jury heard testimony that additional female drivers are needed to transport women and children.
Related Recommendations (1)
R4
cell phones be replaced with a communication system that can reach local law enforcement. (Findings 9, 11, 12, 13, 16, 17, 22, 25)
F10
Under contract the Ford Street Project provides after-hours on-call Crisis Workers for the coast. The Grand Jury heard testimony that they receive less supervision and training, resulting in some Crisis Workers being less qualified.
Related Recommendations (1)
R2
the after-hours procedures of the Ft. Bragg Crisis Services be reviewed and improved. (Findings 10, 18, 19)
F11
Many clients have a dual diagnosis of mental illness and addiction problems.
No recommendations for this finding
F12
Many clients have chronic conditions and have been repeatedly hospitalized.
No recommendations for this finding
F13
The Grand Jury heard testimony that current training of drivers does not meet the requirements of the Crisis Services Policy Manual.
No recommendations for this finding
F14
Testimony revealed differing opinions of management, supervisors, and staff regarding the suitability of the vehicles used to transport clients in crisis to out-of-County facilities.
No recommendations for this finding
F15
The vehicles the Grand Jury observed in Ukiah are Ford Taurus compact sedans; these had been modified by the installation of safety panels fabricated at the County garage where the vehicles are serviced. a. The safety panels between the driver and passenger do not cover the lower part of the drivers seat. b. The safety panels, in some vehicles, have plexiglas in the upper portion which make communication between the driver and client difficult. c. The rear seat is narrow and may be uncomfortable for persons of more than average weight or height. d. The leg room between the front and rear seats is very limited.
Related Recommendations (1)
R3
as funding becomes available, the transport vehicles be replaced with ones equipped with more comfortable rear seats, roof to floor barriers, internal communications systems, and dash board video cameras facing the rear seat. (Findings 12, 15 a-d)
F16
Mendocino County Mental Health Department has contracts for clients at hospitals located in St. Helena, Santa Rosa, Sacramento, Yuba City, and other parts of the State. Many of these locations require travel in excess of three hours each way.
No recommendations for this finding
F17
The cell phones that drivers use for communication do not function for much of State Route 20 from Ft Bragg to Ukiah and through parts of Lake County.
No recommendations for this finding
F18
The Grand Jury heard testimony that the quality of after-hour services for crisis clients at MCDH is inconsistent.
No recommendations for this finding
F19
The “Client Transport Request and Report Form” given to drivers by Crisis Workers at Fort Bragg may not be completely filled out.
No recommendations for this finding
F20
Neither MCDH nor Howard has provided a mental health protocol for assessment and treatment of clients of the Crisis Service as required by the MOU signed in May-June 2003 by the Department of Mental Health, the three Hospitals and the Sheriff and three city police chiefs.
No recommendations for this finding
F21
Testimony indicated that clients at MCDH may be disrobed and gowned for medical examination or to prevent leaving without permission. The clothing may or may not be searched or returned to them before transport. Clients are occasionally transported in a hospital gown.
No recommendations for this finding
F22
Crisis staff may not touch or restrain clients, only peace officers have that authority by law.
No recommendations for this finding
F23
If either the driver or client requires the use of a restroom, depending on the escape risk of the client, drivers must locate a police station, a hospital, or provide a portable urinal.
No recommendations for this finding
F24
HSW/drivers have learned to call and alert their destination to insure a second person is available to escort the client into the facility.
No recommendations for this finding
F25
Much of the training of new HSW/drivers is received from their trips with experienced drivers; they are also given a written manual of department policies.
No recommendations for this finding
F26
There is an average of eight clients from Mendocino County hospitalized out of the County at any given time.
No recommendations for this finding
F27
Staff at all levels report their work is stressful and potentially dangerous. They believe they are providing a necessary service and like their jobs.
No recommendations for this finding

Comments 1

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Mendocino County Board of Supervisors Elected County Office
Mendocino County Sheriff Elected County Office