Table of Contents


 

Mental Health

Reason for Review

From May through August of 2000, the case of an apparently mentally ill person incarcerated in Amador County Jail generated a lot of citizen attention from numerous reports in the local media.  Citizens discussed the case and had opinions about it based on these reports.  Many felt that Mental Health Services was mishandling the situation.  Because of that case, the Grand Jury felt that a review of procedures for securing care for mentally ill individuals was needed.  In addition, a general review of Mental Health was undertaken.

Background

Amador County Mental Health is a part of the County Health and Human Services Agency.  The 1999-2000 Grand Jury conducted a routine review of Mental Health and found that “the standards and procedures appeared to be in compliance with State standards.”  Services provided by Mental Health include: 

The Director of Mental Health has been in the position for 4-1/2 years.  In that time, the staff has almost tripled from 11 to 30 employees.  The Mental Health budget is currently $1.4 million.  State sales tax provides 40% of the funding and 60% is billable to Medical. 

There has been an increase of clients in the past several years, particularly children.  The increase is attributed to a greater understanding that catching small problems in the earlier stages can alleviate bigger problems in the future. 

The Department has been at its current site since February of 1999.  Minor remodeling is currently being done to make individual offices out of a larger treatment area.  Even after this remodeling, sharing of office space and computers will be necessary. 

Mental Health has established procedures for securing care for mentally ill individuals. According to these procedures: 

Both the Sheriff’s Office and Mental Health noted there is a need for a detoxification facility in the County, outside of the jail.

Methodology

Members of the Grand Jury conducted interviews with Mental Health, the District Attorney’s Office and the Sheriff’s Office, toured the facilities, reviewed pertinent documents, and held a joint meeting between representatives of Mental Health, Sheriff’s Office, and District Attorney. 

Persons interviewed:

Documents examined:

Sites visited:

Facts

1.       The Court system has jurisdiction over those arrested, including the mentally ill.

2.       There is no procedure in place to notify Mental Health when a potentially mentally ill individual is arrested and charged with a misdemeanor.

3.       Individuals picked up by law enforcement because they are threatening to harm themselves or others often have high blood-alcohol or drug levels.

4.       High blood-alcohol or drug levels make it difficult to assess mental health problems.

5.       If Mental Health cannot determine whether a person qualifies under 5150, and has not committed a crime, the person cannot be held.

6.       The County Jail has the only detoxification room in Amador County.

7.       Mental Health has a procedure in place regarding response time (the Call Out Routine) to calls by the Sheriff’s Office for evaluation of potentially mentally ill individuals.

8.       There is a formal mechanism in place to facilitate communication and understanding between Mental Health Services and the Sheriff’s Office in the form of the County Mental Health Advisory Board and the Mental Health Quality Assurance Committee.  A representative from the Sheriff’s Office attends those meetings.

9.       Communication is lacking between Mental Health and the Sheriff’s Office.

10.   Mental Health is not always notified of Court proceedings that are taking place involving mentally ill persons.

11.   Mental Health does not have a clear understanding of the Court system.

12.   The Amador County Sheriff's Officers receive less than ten hours of mental-health training.

13.   Caseworkers who customarily work in the field (for example, in the schools) have no designated office space, computer, or phone and must carry all their files with them in hard-copy form.

14.   Mental Health maintains a list of facilities in which mentally ill patients can be placed.

15.   The information in the list of placement facilities changes often with respect to available beds.

16.   A large van is available from the Alcohol and Tobacco Reduction program for use by Mental Health and is used regularly by Adult Day Rehabilitation.  A Class B driver’s license is required to drive this van.

Findings

1.       Mental-health evaluations of those potentially mentally ill individuals who are arrested and charged with a misdemeanor may be delayed due to the lack of a procedure to notify Mental Health.

2.       Due to the lack of a detoxification facility within the County outside of the jail, a mentally ill person could be released without being evaluated by Mental Health when he is under the influence of drugs or alcohol but is not under arrest.

3.       The placement and treatment of mentally ill persons could be delayed due to Mental Health’s lack of awareness of Court proceedings involving the mentally ill.

4.       An out-of-date list of placement facilities could delay the placement and treatment of mentally ill persons.

5.       A small van that doesn’t require a Class B driver’s license to operate could be driven by a Mental Health worker, allowing the Adult Day Rehabilitation group to be more spontaneous in its outings as part of its living-skills training.

6.       The lack of computer access for Mental Health workers who mainly work away from the office causes them to be inefficient in their duties.

Recommendations

1.       Establish a procedure with the Sheriff’s Office to immediately notify Mental Health when a person believed to be mentally ill has been taken into custody and charged with a misdemeanor.

2.       To facilitate the timely placement of mentally ill individuals, maintain an up-to-date listing of all possible facilities along with current admittance standards and availabilities.

3.       Be sure a Mental Health worker follows the Call Out Routine when a law enforcement officer takes a person believed to be mentally ill into custody or to the emergency room.

4.       Evaluate the need for a detoxification facility within Amador County but outside of the jail.

5.       Utilize the services of County Counsel to become aware of cases going to Court involving the mentally ill and also to gain a greater understanding of Court procedures involving the mentally ill.

6.       Establish better communication and understanding of the various competencies of Mental Health Services, the Sheriff’s Office, and those involved in the Court system so all can work together in the best interest of the mentally ill.  Informal meetings on a regular basis could help in that regard.

7.       Obtain use of a van that doesn’t require a Class B license for operation.

8.       Obtain laptop computers for use by field-going workers.

Response Required

As required in Section 933.05 of the Penal Code, Amador County Mental Health Services must respond to the findings and recommendations in the manner indicated on page one of this report.  While the Grand Jury understands that some of the recommendations cannot be accomplished without the support of other bodies, the Grand Jury proposes that Mental Health take the lead in establishing a closer working relationship with these entities.