Reason
for Review
Reason
for ReviewFrom 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.
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:
Outpatient psychotherapy at the clinic and at
schools
Medication evaluations and monitoring
Support groups
Crisis evaluations for involuntary
hospitalization
Inpatient hospitalization at five contracted
hospitals (none of which is located
in Amador County)
Children’s System of Care Services
Adult Day Rehabilitation (at the Day Treatment Center) for the severely mentally ill
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:
Individuals
who appear to be mentally ill and who are having problems coping in the
community are often reported to law enforcement and transported to Sutter
Amador Hospital for an evaluation by Mental Health.
A Mental Health worker is summoned to the hospital emergency room to
evaluate whether the person being held is eligible for and needs psychiatric
hospitalization.
A
mentally ill person can be held up to 72 hours in a psychiatric facility on
a “5150 hold” which is the legal means for securing the safety of
persons who are threatening harm to themselves, harm
to others, or who are “gravely disabled.”
A
finding of grave disability is made if the mentally ill person cannot feed,
clothe, or house himself, and if no other person is available to do this for
him.
Amador
County Mental Health contracts with El Dorado County Psychiatric Health
Facility (PHF) for inpatient services to persons held on a 5150 hold.
Mental Health also contracts with private hospitals to take those
patients who have health insurance and who meet 5150 eligibility.
Those
persons who have been hospitalized at the PHF and who do not respond to
treatment and need longer-term care are sent to a variety of placements.
Facilities falling into this category include board and care homes,
transitional residential programs, skilled nursing facilities, mental health
rehabilitation centers, and institutes for mental disease.
Mental Health pays a daily bed rate averaging $80 to these
facilities.
Mentally
ill inmates in the County Jail may also be transferred to the PHF or the
Tuolumne General Hospital on a 5150. A
Sheriff’s deputy must accompany each inmate during the hospital stay.
Treatment generally means keeping the patient safe while evaluating
him for appropriate psychotropic medication.
Jail
inmates who are chronically mentally ill and need longer-term treatment and
who are felons are sent to State hospitals, usually Atascadero.
State personnel interview the inmates and make the arrangements for
hospitalizations. The State
pays the cost, which is $306 per day.
Jail inmates who are chronically mentally ill and are incarcerated because of a misdemeanor may also be sent to Atascadero. The $306 per day cost is paid out of the County Mental Health budget. County Mental Health evaluates these inmates and makes the arrangements for their hospitalizations.
Both the Sheriff’s Office and Mental Health noted
there is a need for a detoxification facility in the County, outside of
the jail.
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:
Director,
Health and Human Services
Director,
Mental Health
Four
full-time Therapist/Case Managers
Amador
County Undersheriff
Sheriff’s
Office – Captain in charge of Operations
Sheriff’s
Office – Commander in charge of the Jail
Representative of California Forensic Medical Group
Documents examined:
County
Mental Health Budget 1998-1999, 1999-2000
Income
and Expense Statements for Mental Health July 1997 - June 30, 2000
Amador
County Mental Health Staff Listing (2/01)
“Procedures
Used for Securing Care for Severely Mentally Ill Individuals”
Narrative
Reports from Amador County Jail
Call Out Routine for on-call Mental Health Workers
Sites visited:
Day Treatment Center
Mental Health offices
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.
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.
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.
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.