Our County Can Do Better: the Crisis Inside the Walls of the Psychiatric Health Facility This report on the Psychiatric

The Grand Jury observations of the PHF show an antiquated facility that does not meet the crisis needs of the County’s mentally ill population. While the staff at the facility is dedicated, there can be insufficient staff present at times to ensure safety and provide optimal treatment.

The staff and management of the PHF are commended for their dedication to doing the best possible job with such limited and antiquated resources.

Facility The PHF facility is licensed by the California Department of Health Care Services (DHCS), who regularly inspect the facility for cleanliness and patient services. The overall facility is old and is not well maintained. The facility houses walk-in patients, W&IC 5150 patients or inmates, and PC 1370 inmates. The inmate patients are generally treated the same as all other patients, except that anyone charged with being a sexual predator is always escorted. Any juvenile residents are housed in an administration area, separated from adult patients. Inmate patients are not accompanied by security personnel, as they would be in a medical treatment facility. The policy has recently changed to not permit juvenile patients if inmates are currently housed. This causes many juvenile patients to be treated out of the County. This can conflict with treatment involving family therapy or counseling. The facility appeared crowded and does not contain dedicated spaces for therapy, physical exercise, or other treatments. The PHF houses up to 16 full time patients and has up to 10 staff members. The 16-bed limit on the PHF is from a Medicaid rule for psychiatric facilities not attached to a hospital. There is no area with sufficient room for normal physical activity as part of therapy or treatment, nor is there an area with dedicated treatment or therapy rooms. The medical examination room doubles as an administrative office, due to the extreme lack of space. There is one conference room and a common area, both of which are also used for therapy. At the time of the inspection, supplies were stacked high enough to impede the pattern of the fire sprinklers, and cleaning supplies were stored near one of the emergency exits. The minor health and safety issues were addressed with the staff and were found to be corrected in the subsequent inspection. There is very limited natural lighting within the facility, and the standard office type lighting contributes to the dingy appearance. The damaged ceiling tiles accentuate this appearance. Submitted May 10, 2018 4 Video cameras operate within the facility; however, there is only one video monitor in operation and it is at the staff desk. The surveillance system has low resolution and appears to be quite old. The PHF has six emergency exits that are automatically unlocked if the alarm is activated. An evacuation of the facility during the second or third shifts presents a risk to the surrounding community if inmate patients are present. Procedures are in place to sweep the facility from one end to the other, keeping the patients (and inmates) with staff members. During this process or after exiting the facility, the inmates would have a nearly unfettered path for escape. With a ratio of up to four patients to each staff member and without the ability to apply mechanical restraints (such as shackles or handcuffs), there is little to prevent an inmate or group of inmates from deciding to leave. During this time of heightened stress on all patients, the staff is put in an untenable situation: one type of an emergency can cause a second type of emergency. Staff The number and distribution of staff is in accordance with the County practices and procedures and meets the state’s minimum criteria. While the staff appears to be dedicated to the welfare of the patients, this level of staffing can leave as few as three or four mental health professionals on duty for the overnight shifts. There are no Sheriff’s Deputies or Correctional Officers on staff at the facility at any time. The staff is trained in the ProACT de-escalation techniques, which includes 16 hours of training. In the event of a medical emergency with an inmate-patient, the inmate will be accompanied by a member of the PHF staff or local law enforcement, if available. County Policies and Procedures The County policies follow state regulations and allow staff levels as low as three for the third shift (midnights) and four for second shift (evenings). Day shift staff must have at least seven. In the event of an emergency, all six exits are unlocked and staff directs patients to the nearest safe exit. Safety of patients is the main priority; no provisions are made for control or segregation of inmates with respect to other patients. During the second or third shifts, there is not enough staff to monitor the unlocked exits while an emergency evacuation is taking place. Evacuation drills are held monthly to train the staff in dealing with patients in an evacuation scenario. Submitted May 10, 2018 5 The Behavioral Health staff at the jail now begins treatment prior to transporting inmates to the PHF; immediate communication with the PHF is established concerning inmate care, providing continuity of care for the inmate.