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HOME > ABOUT > PRESS > OFFICIALS DEBATE SOLUTIONS TO MENTAL HEALTH CRISIS
Article published - February 15, 2008
Credit: SONOMA WEST TIMES
Officials debate solutions to mental health crisis
By Laura McCutcheon, Staff Writer
Sonoma County is in the midst of a mental health crisis, precipitated by a reduction in facilities that has strained remaining resources.
“I am extremely interested in seeing an improvement in the mental health system and police protocols for treating mentally ill people,” said Phyllis Clement, the grandmother of 24-year-old Jesse Hamilton, who was shot and killed last month during an altercation with local law enforcement.
Before the Norton Center's inpatient facility closed in June of 2007, when police picked up someone who was mentally ill, they would take them to psychiatric emergency services. There they would be assessed by a psychiatrist who would then determine whether the patient needed outpatient services, or admission to a hospital, said Terry Scannell, clinical director at Creekside Mental Health Rehabilitation Program, in Santa Rosa.
However, she said, even without an inpatient facility, psychiatric emergency services still exist in this county - and local law enforcement will increase its training to better prepare for incidents involving mental health consumers.
“The question is can people who stop their medication and become very psychotic be managed adequately with this sort of service? The mental health community is not in agreement about that,” Scannell said.
Asked her stance on it, she said: “The purpose of our hospital is to get people into community living, we have taken people out of the state hospitals and prepared them to live in the community and they have been successful. But not everybody is. I become concerned if any seriously mentally ill consumer, who is conserved, is out in the community and not taking their medications,” she said.
Additional crisis intervention training on the horizon for local law enforcement
Law enforcement is concerned about some of the incidents involving officers and mental health patients. As a result, the Sonoma County Sheriff's Department is going to do some additional training, Sheriff Bill Cogbill said.
“It's called crisis intervention training. We have done training for dealing with the mentally ill for years, this is not something new, but we are going to do some additional training,” the sheriff said. “It came down to the fact that since mental health services were being cut back, that the possibility existed that law enforcement may become more involved with those suffering from mental illness.”
No amount of training, however, would have changed the outcome of the recent high profile cases, Cogbill said. “Those subjects were armed and were having a mental health crisis at the time, and in talking to our mental health experts, no amount of training would have altered the outcome,” he said.
What the additional training will do, Cogbill said, is help deputies with people who aren't armed and who are not an immediate threat, to determine the best treatment and course of action.
Crisis intervention training should be available to officers later this year, Cogbill said, noting this particular training is going to be more inclusive than what was offered in the past and will include having experts in the field - such as mental health workers and psychiatrists - come in.
The pros and cons of mobile crisis intervention teams
Scannell would like to see some of these experts working on mobile crisis intervention teams.
Mobile crisis intervention teams, formerly called psychiatric emergency teams, were a good piece of mental health services, she said. “They usually are connected to psychiatric emergency services in the county. They are county-funded. What happens is law enforcement might get a call of someone in crisis and the psychiatric emergency services for the county is alerted to that. They usually have a clinician - meaning a licensed person - it could be a registered psychiatric nurse, psychologist, social worker, or doctor. And that person goes out to the site where the mental health client is and they attempt to do the first intervention. So if someone were armed they would attempt to do verbal intervention, try to calm the person down, make an assessment and try to get the person to put their weapon down. The person then goes into a psychiatric hospital instead of jail.
“In the ‘80s almost all counties in California had them. It was a good piece of mental health services,” Scannell said, noting the teams dissolved due to a lack of funding at the local, state, and federal levels.
Mobile crisis intervention teams work in some areas, but not others, Cogbill said.
“Imagine Sonoma County with 1,600 square miles, and you have a crisis center in Santa Rosa, how are they going to get there before, or at the same time, as law enforcement? So does law enforcement stand there while waiting for the crisis teams, or do they get there and do what they are suppose to do?”
In other words, mobile crisis intervention teams work well in small geographical cities where a team can get to the incident quickly, he said.
“These calls come in a couple times a day. Š People envision a mobile crisis intervention team that can go anywhere. That is a good concept, but where are they? Are they working 24 hours a day? What is their response time going to be, given the amount of resources they are going to have? It would cost millions and millions of dollars to have teams set up geographically so that their response would be immediate,” which is what is needed during a crisis, he said.
Meanwhile, law enforcement has an obligation if they are called, he said. “We would be remiss in our duties if we didn't take action in a life-threatening situation. Great, if response teams could be there at the same time, or sooner than law enforcement (the Sonoma County Sheriff's Department alone has 20 to 30 deputies patrolling the county at any given time), but in reality, teams are not going to be able to do that,” he said, noting, for example, what if the team was stationed in Santa Rosa and the crisis was happening in Petaluma or Cloverdale.
“When these people call 911 they are afraid,” Cogbill said, noting, many of the callers are used to dealing with the person they are reporting and have already tried - and failed at - what they thought would work.
Law enforcement has a different purpose than mental health clinicians do, Scannell said.
“They are suppose to protect the community, and their lives can be put in danger every day. So, in other words, they get a directive if someone is armed and comes toward them in a menacing way, they have to stop them. It's in split seconds that they have to make these decisions, so they are in a very difficult situation.
“And for us to think that in that moment when their own life is at risk, to make the determination that this is a mentally ill person and I should treat them differently, is really too much to ask, ‘cause they get, what, maybe two weeks training, whereas someone in crisis mobilization, if they have a license they have four or five years minimum experience,” she said, adding, “It is concerning when in seven minutes someone is shot and killed. That certainly needs to be looked at.”
At what point is a police officer authorized to fire on a civilian?
“Our policy follows the law with regard to the use of deadly force,” Sonoma County Sheriff's Capt. Dave Edmonds said. “Essentially, a deputy can use deadly force to protect himself or others from what he reasonably believes could be an immediate threat of death or serious bodily injury.”
All the more reason, high-risk mental health consumers get the services they need.
“Our state allocation for state mental health services has been eroding for several years,” Sonoma County 5th District Supervisor Mike Reilly said. “At the same time we've got the statewide Mental Health Bill (Proposition 63) - passed three years ago - putting new money into the system, so you have new dollars for community prevention and intervention services, but the bill didn't allow you to replace any money you were losing in your core services for the most acute patients,” he said.
“So we are in this unique situation of planning and implementing new community mental health preventative services under this new state law passed, and at the same time we are making reductions in acute care.”
Meanwhile, the hope is to create a community-based system that will, as much as possible, make up for the lack of having an inpatient psychiatric facility, he said, noting, the county still has the crisis emergency center open 24 hours a day, seven days a week, where people can be evaluated to make sure they get an appropriate referral.
Asked if he thought the county needed an inpatient unit here, Reilly said: “If we could afford it I think it would be ideal, but there are many counties in California that don't have one.”
Reilly said the Board of Supervisors is expecting the health department to come to the board sometime this month or next, with its plan to deal with the mental health deficit.
“I can't speak for the county, but I can tell you that as a director of mental health at Southwest Community Health Center, we have been asked to take on additional county patients, in view of the fact that county resources have dwindled,” Bob Benavides said, adding, “That is not to say that the county is not capable of providing resources.
“More than anything else this is a community problem. It's not a county mental health problem,” Benavides said. “As a community we need to step up to the plate and make mental health a priority. When the community decides that mental health is a priority, resources begin to appear,” he said. “A county's mental health is a reflection of our community, not the other way around.”
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