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Home My WebLink About0499.000.. sept.aber 6, 1990 rRE HONORABLE CITY COUNCIL PALO ALTO, CALIFORll IA ~. u: Santa Clara County Crand JUry Report on Investigation Of Services fOr Mentally III Adult. Members of the Council. council .~tlon 1. requested to approve transmIttal of a letter from tha Ko.yor to the pruidinq Judge of the Santo Clara County Superior Court. the California Penal Code (Section 933) requires that, no later than 90 days after the Grand Jury submits a final report on the operations of any public agency subject to its reviewing authority, the governinq body of the public agency shall comment on the findings and recommendations. The comments must be submitted to the p<asidinq judge of the superi~r court who impanaled the grand jury, and a copy mast be placed on file with the clerk of the public agoncy and must remain on file in that office. Comments on the attached report of the 1989-90 Santa Clara County Grand Jury concerninq Investigation of Services for Mentally III Adults are due on or before September 25. Issues discussed in the report ~hlch warrant comment by the City ot Palo Alto are the followinq: POST training for law enforcement officers 1 handling of persona with mental illness; tralninq of 911 dispatchers in the handlinq of emergency calls that InVOlve the mentally 111: coordinatIon of servIces to the mentally 111 'Within the County'. Community Xental Health Subsystem. Staff has reviewed the report and has drafted tbe response for Caunc 11 approval. • \ \ -. 11 ..... ' _ .. -. .. ~ !. ' -- i I I ... / o o hi. Two "tQ1?M;n4l t'Ph It 1. ay reoo .. endat1on that Council authori •• the Xayar to •• nd th. attachd letter to Judge Ambler. R •• p".,tfully anai 8r allltug,o • , " :.- :1 , , - Cf'ncc: Of' TIoIt ...... "rQI'I ... ':>13.u·n .... o " I' J) '0 l.iip of (ill) ,Tllt{!J ~. o ... r:.k to,Jse #A"O "I.'TO,C" ~430;:) The Honorable Read Ambler Pr •• idinq JUdge, Superior Court County of Santa Clara 191 North Firot street San Jose, CA 95113 Dear Judqe Ambler: September ll~ 1990 The Palo Alto City Council haa reviewed the santa Clara County Grand Jury report entitled -Inveatiqation of $ervices for Kentally III Adults.-In addition, the Council bas reviewed the level of training received by Palo Alto officers and dispatcbers, .s ~ell as the department'. procedures dealIng with the mentally ill. palo Alto officers receive the POST .andated four-hour traininq block on _ental illne •• In the ba.ic academy. We understand the tralnlnq format includes lecture. and practical exercises. OUr depart.ent has :bequn including t.he tllo-bour trainiDi block for in-service Officer. duriD9 the annual adVanced officer courses. ThIs POST mandated traininq requirement just became effective July 11 1990. OUr dispatChers have already begun attending this training as well. We a9ree that additional training tor dispatchers i. needed in this area during the dis patcher. academy and have encouraged Ch!ef Durkin to york with other agencie. to that end. We also concur with the Grand Jury'. recommendation to im pl ... nt a plan tor r •• pondinq on a ZC-hour basi. to emergencies involving the _.nt.lty 111. OUr departaent r • use of the County's field response aystem ia very li.ited because they operate only " \) • A V o during v •• k~.y. ~tv •• n ••••• and 5 p ••• , .04 their average r •• pon •• tb. 1. thr •• hoUrs. w. appreciate the opportunity to review the report and to uke the.. coaaants. Sincerely, illite Cob!> xayor • · . o o 1989-90 santa Clara county Gran4 Jury FIllAI, BEp9RT ~. Investigation of Services for Mentally III Adults -,: ~ - ItJtRWSY county of Santa Clara ~.ental he-a1th •• rvicee have some .erious gaps in their ability to reach people >tho need mental health care and to serve them .ffectively. Although administered by experienced and dedicated professionals, care for the aeriously .entally 111 appears fragmented both in .anagement and executlOD. Handl1ng of uergencies involving the aeriously .entally 111 requires training and coordination among 911 communications dispatchers, law enforcement Officer., and mental health worker.. ErosIon of atate and federal-financial support end county revenue ahortfalls 9ive the county the disagreeable choice of cutting back on .ervices or continuing' to fund programs above the mandated matching levels. INTROQOCTIOK 'l'he COImty of Santa Clara serves approximately 5,COO seriously mentally ill adults,. .ost of whom are Indigent. An estimated additional 10,000 residing in the county are either belll9 carerS for by prIvate •• ans or are not in the public mental health system. Although there have long been efforts to maintaIn adequate care and treatment for clients. the county bas been faced with constantly eroding financial aupport from state and federal qovernment. When the state hospitals were emptied of aU bUt the ",cst acutely 111 or danqerous .ental patients in the late 60 l s end lOis, , " o In.~.qu&te stat. tundinq left the o local eo~unitJes with the reaponsibUity for the .. entally ill in n .. ~ of hoUsinq, aedicationa, counselll\9, and, in .ome CAles.. institutional care. The responsibility for provl~inq county services to the .entally ill lIes wIth the Kental Health Bureau. one ot five .. jor <Slvisions in the County Health Dep01-tmant. In aMitton to providinq direet serviees, it al,.o cOlltracts with • .."y community agencies for specified .. rvices and cooperates with non-profit community 9rouPS to accomplish its objectlvea. gUPIA Priaary financial responsibility for public mental health lies with the State of California under the Short- Doyle Act of 1968. It provides 90' of fundinq while the counties contribute 10' Ilatchinq funds. Under the Medicaid (MedICal In CalifornIa) proqram, federal insurance pays for defined types of treatlllent for the indigent who are mentally ill. Tne County Mental Health Bureau has the task of adlllinist~rll19 and operat.ing mental health programs as expressed in its .iss ion statement: ....• the promo.tion of optimum Individual and col>munity Ilealth through leadership in planning, coordination and provIding services .. .. . ut11.lz1nq all available resources in a cost effective Penal Code See. 13519.1 mandates that as cf July 1. 1990 ) ',<I. ~:l ,] , '1 • 1 I ~' I i 'I " I .. o o the Peace Officer. standards and ~ralnl~ Co~isslon should Instn.«lons for bandH~ persons with llln ... In the bade tra1ni~ of law .nforc .... nt officers. ~e code further .tates, ·~ .. the cour.e .ball a1.0 include lraformatlon on the cause and nature of ••• :mental illness, as vell .s tile community resources available to •• rve thase D1YESTIGaTION I'h. Grand Jury It-itelS Its investigation to county .ervices for seriously .~ntally ill adults. Xntervleva were conducted with administ.rators and advisors of the Mental Beal tb Bureau, directors of the three subsystems, ahdi the emerqency response coordinator. The Grand Jury also interviewed police 9fficials in regard to police traini~. Interviews aDd inspections were conducted at several county facilities as described In the Findi~s Section. Inte.rviews with staff were co~ucted at the following non-profit community agencies: o Mental Health Association o Community Companions o Mental Health Advocacy Project ~e Grand Jury reviewed county budget materials, Mental Health Bureau proposed planninq and restructurinq materials. and a publication on _tate fundi~ for .ental h .. lth, "n 89-91) Funding Requirements for Local Programs-III Conference of Local Mental Health Oirectors, June 1988. nNDINGS Tbe Grand Jury'. findings are pre.sented as folloW's: ------::-----" __ .. :_<r. ___ . 'L - • ,; ."-' , .' , , 'j I / o o o state and Federal Fundinq o Kental Health Bureau o County Facilitle. a. 1 •• rgency Psychiatric Services I Don Lowe P.vil!on l and Barbara Arons Pavilion ~. East valley Pavilion c. Vlr9inia Street Project and Downtown Kentol Health center o Psyehla~rlc services in tbe crt.inal JU5tlc~ system o Handllnq of P5~chiatric ~ergencies o Patients' Rights . o Typical Case scenario Stat. and Federal Funding The 1989-90 ~et of the Mental Health SUreau includes U1.8 aUlloa from the state Sllort-Doyle program • • 11oca~lon 1. based on historical factors and, more recently, the poverty population. The ~ounty Is also assigned 7( beds at Napa State Hospital, valued by the state at $6. II ai11ion.· Altho09h the county is obligated to contribute only lot In matchinq funds, it actually budgets 30t in order to ~eet existing mental health pr09ra~ service le ..... a-Is. While the Sllort-Doyle Act mandates that the state pay 90\ of public mental health care, it does not define level of service, and the state does not consider lIental health an ·entitlement-. Therefore, the state bas manipulated appropriations from year to year accord.ing to its own bUdgetary constraints. According t.o 'the Stat.e J..eqislatlve Analys't. fundif)9 bas de.:lined OVer 14\ in. the last ten years. and bas not kept. up with. inflation or population growth. Availability of care in state ,.ental hospitals has not kept 1Jp "ith population increases. The current state revenue sh~rtfall foretells further cuts rather than increases tor next year. • - • . i . . _1 ._~_. _____ . ___ -.::....._~_--.: .• __ ~;. '~~_"' __ ;;"."ii;",_ .. ~" ................ , o o MediCal regulations narrowly define proee~ures qualifying for reimbursement, depen.sing on whether the procedure is treatment or case .anaqe=ent and 15 at a clinic or at a patient'. bome.~ Thue regoulations affect the operation of county .ental health centers where anything ~lCal WDn't pay must be picked up by the county and/or the Sbort-Doyle program. Mental Health Bureau 'l'be Mental Bealth Bureau 4irector i.. responsible fC!r ov .... sedng anc5 coordinating the activities of the three aubsystama. Acute psYchiatric Services Subsystem has responsib1lity for the following: 1. Don Lowe Pavillon and the newly opene~ Barbara Arons pavilion -locked facilities for the acutely mentally 111. 2. Emergency Psychiatric services - a screRning center for the acutely mentally ill and entry center for both Don Lowe and Sarbara Arons Pavilions. 3. East Valley Pavilion part of Valley Medical Center, a locked, skilled nursing facility serving severely .entally ill a~ults who require a lesser level of bospitallzation than provided at the other two pavilions. 4. Mental health services at the county's jails. 5. Approval and monitoring of admissions to Napa State 1I0spital. Community Mental Health Subsystem. is d.ivid.ed into four . , • I I ....... ·,.ie' ~ ;J r~.· . . ' , , , o o veoqraphlc re91on&1 each having •• veral centers treatment of the .entally 111 on an outpatient b •• is. for This aubsyatell has the county'. only crisis intervention unit~ The Hental Healtb 8ureau director 1. considering a CORprehanaive restructuring plan. The plan provides for a 24-bour telephone crisis information and referral line, three regional access centers for walk-In crisis and brief treatJaent. and a .obile int.ervention program. 'I're.atlllent centers and contract programs 'Would be reorqanlz.ecS into target population divisions -the seriously .. entally ill, family and chl1aren services l and older .d~lts. COmmunity Support Subsystem encompasses :many programs, includinq services-at board and care homes and homeless shelters, vocational and employment programs, and self-belp and mutual support programs which help clients to cope with day-to-day living. Many Qf these programs are operate~ by contract agencies~ In all of theBe 8ubsyste~sl staff includes psycbiatri5ts. psychcloqists, psycbiatric nurses and technlclanf, marrIage and family counselors, clerical support. end volunteers. County [&9'11t{" a. EmergencY psychiatric Services. Don Lowe Pavilion, and Barbara Arons pavilion Althougb Emergency Psychi!ltric Serolices (EPS) and Don Lowe and Barbara Arons Pavilions are located on the grounds of Valle.y Medical Center, they are a part of the Mental . . .. -" • \ i I I I ·'~~~t,!/j -~-. . ~ , , . o o Health Bureau. EPS i •• 24-bour emergency center for the aentally 111. Patients .aT come in voluntarily: bowever. involuntary patients aIgbt be .ent by other ... ,ntal bealth facUitIes, but lIIDst are !:>rDll9ht in !:>y the poHce. All new arrivals are intervlevee! by a .taff aember,· and giVen ... dicatIons, if necessary. A voluntary patient .. ay choose to refuse .edication and .iIlY even leave EPS unless the evaluation inc!Icat.. that h. aigbt be a "anger to himself or other.&. t'bls patient then becom.-s an involuntary patient. ~e evaluation of p~tien~& may take as long as 2) hours cSue to the need for staff to observe and talk to the patient, as well as the nwober of patients to be evaluated. Patients aay rIOt .-moke and seldom converse with one another. Food ia brought In from a nearby fast-food restaurant because ether food Is not available.. 'l1i.ere are couches. but too few, for patIents to sleep on wbile waiting. Two "quiet rooms-are tor these who are violent or danc;:erous and ,.,ho .ust be heavily sedated or restrained. The new ~art.rs for EPS at the Barbara Arons Pavilion. opened in April lUO, include more quiet rooms, but the waiting areas. ",here troubled patients must wait for long hours. are aBlaller. At the t.iJae of the Crand Jury's inspection. the nay furniture ",as not in place. so no conclusion as to the n~mber or comfort of the coucbes could be drawn. fbe staff at EPS appears higbly motivated, and yet the • " 1~:{ .... ~~~-~' , ! t • " 1-- f; - • , .. - '- .. ..~ "ilillII.IiIII!II! •• ~~~iIiIi~~"''\"""",,;'-//~,:.~~.4b?'' 'tsi!.t ':I. jl;j ... ~ -",.:4, .• '.¥At&o _3,11"1 .,~ .,,;. ~ o 0 Grand Jury WBS tol~ by other agencies ~lich send patients to EPS that their ~ritten evaluation and histories with requests and recommendations are often ignored by the EPS ataU. A patient needing a high level of care would be admitted by EPS to the Don Lowe Pavilion, an .. cute care facility. 'l'Ila patient would be put on a ?2-bou .. hold and might then be transferred .. depending-on evaluation, to • skilled nursing facility 8uch as th" Eut Valley Pavilion, to one of the less secure contract fac!l! ties, to a board and ca.re home, 0 .. dischargecS to their family and .. efe .... ed to a comrnunity basecS clinic. b. E§st Volley Pavilion East Valley PavIlion (EVP). a locked~ sub-acute skilled nursing facIlity, is located in a semi-residential area near Alexlan Brothers Hospital. :It provides IDr'l9-tena care tor severely mentally 111 adults~ The median &ge of the patients is mid-30s, and the averaqe length of stay is three aonths, although a faw may stay as long as three years. The number of patients is almost always at the capacity of 99 .en and women. Most of the current residents come from Don Lowe PavIlion, while others come directly from EPS Qr otber skilled nursing facilities. While there are numerous activity programs, no drug or alcohol treatment progr-am is available at this time. Federal leqislotion enacted in 1981 prohibIts Medicaid reimbursement to _killed nursi~ facilities for patients '" -.-"": " J .. f . o o with behavioral .ental illnesses a But beC4u.se of federal delays In the evaluation of .any facUities and in the definition of .ental 111ne •• , EVP has not yet come up for evaluation. In the .eantlee, EVP, as a -distinct part- skilled nursing facility licensed under Valley Me~ical Center, qualifies for MediCal funding and receives reimbursement at $187 per patient per day, as opposed to $67 for other .!tilled nursing facilities. However... "the. GraM Jury vas told that •• soon .a the federal 90vernment evaluates EVP'. eligibility, not only coulc:l its current. level of funding be reduced, but EVP might lose its federal eligibility altcqetber. If EVP does lose a large part of its funding, the· fate ot .any of the residents .... ou1d be in doubt since other county f<icilities .... y not be appropriate. However ~ the Crand Jury was tolcl that if the rulIng is negative... the County vill be qive.n e. six Ilonths to one year adjustment period. c. Virginia street. Project and Downtown Mental Health Center VIrginia Street Pro'ect (VSPj and Downtown Mental Health Center are part: of a five-ye.ar research project~ endir19 in June 1994, which will try to deteraine the relative effectiveness and cost-efficiency of a smal~ client to staff ratIo and an intense case management approach in preventir19 institutionalIzation and promoting successful day-to-day livIng skills. potential clIents are carefully screened and .-_. ---"" --~ ---'-~ ----~L • : c• . ,-, , " o o tbelr progress aonltore~. once they enter the program. Vil'1.linla Street Project is a comlIlunity-based pr09Ta .. atarta<1 in 1986 ancS patterned aftar a pilot pr09ram now workIng successfully In Wisconsin. VSP has a client list of not aore than 50, with one .taft person tor each 15 clien~s. staffing 1s further auqmented by intorning qraduate atudents. All of the clients must have been hospitali~ed at least onoe and are classified as aeverely mentally disabled. Patients are referre<1 throuqh EPS or froll other faeiliU" • • uch as East Valley Pavilion. VSP is housed in a small one-story bUilding le .... <1 by the county near downtown San Jose and i. open • AM to 5 PMc Mon<lay throuqh Friday. The .."in focus of the Project is to keep seriously mentally ill people out of the bospital an<l functioning. Xf clients don't show up for an appointment or medication, a field team will locate them so that care and treatment wHl not be interrupted. VSP also conducts a family support qroup ancS has some clients placed in houses owne<l by Housing for rncSepen<lent People. Sometimes staff Is called out to belp someone wllo is violent or potentIally dangerous.. The polIce are usually called to stan<l by. but qenerally the staff, trained in dealing with assaultive beh.vior in the mentally 111, can handle these situations. The staff at VSP expressed to the Grand Jury the need for training of law enforcement personnel and 911 <lispatehers to deal with the .entally 111. in order t.o avoid some serious problems as have arisen in • dO t:he pest. Downtown Mental Health Center 1. the ·control- .... tpatient fa.,Ulty In t:he ......... .,h project. It differs frOli VSP maInly In t:h. lower level of _tafflnq, vit:h • much la'V .... cHent Ust Dr 600 and • staff of 28. '!'here fore, .taft cannot have the .ame amount of patIent contact. The Center 1_ boQsec! In t:he Downtown MUlti-service Center, 1075 E. santa Clara street, San Jose, and operates • AM to 5 PH, Monc!ay t:hrOU9h FrieSay. 'S"be Center treats ~lients who reeeive XediCal... which does not cove .. staff visits to clIents cutside t:he fa.,illty, althcuqh starr .embers regularly visit and treat clIents in t:he1r bOlles. The staff told t.he Grand Jury that the need for 2C-hour respons. Is vital.. Client. could! then receive the care and counseling ",hen t.hey neeli it, Including evenings and weekends.. perhaps keeping 80me of t.hem from qoinq to EPS and hospitalization. PSYChiatric Services in the CrIminal Justice System SOllIe of the mentally ill come to the attention of the mental bealth system through the Main Jail. Sometimes arresting officers are not able to distinquisb between druq or alcohol-induced behavior or mental illness. If a prisoner, after evaluation by a psychIatric n~rse, is perceived to be .entally ill, he Is sent to the psychiatric unit, Where he Is evaluated by a starr psycbiatrist. If the inmate 1. found to be severely psychotic, the staff rsycbiatrist can put bi. on a 72-hcur bold so that he can be . , - ,-: ' .. o o ~re comprebenaively evaluated. A conservatorship can be applied for, and the Inmate l1iqht then become a patient at Don Love Pavilion through EPS. OCcasionally a prisoner co ... into the jaIl very 111 and already conserved. After the completion of the .entence, the doctor can place him in "long-term care, thr0U9h EPS, pray JdecS space can be found tor hla. All custody Officer. ~ho volunteer to work In the psychiatric unit 90 throl>qh a training proqr"'" for the handling of mentally ill prisoners. !'hey are, however,. understandahly .ore interested in dealing with the crisis at h&Ddi than 1n its caus.es, since treatment Is not their pril1ary function. '!'he psychiatric t.echnicians are also trained in handling assaultive hehavior. Altbouqh they may help the prisoner,. they lIIust be concerned witb their own aafety and that of other prisonerG. Tbe county bas mental bealth workers at Elmwood Correctional Facility and at Juvenile Hall. They also deal only with the crids at hand and not vlth long term t.re.a tmen t. :If morE: intensive t.reatment is necessary,. the iruu.tes are sent to EPS for entry into the :Ilental bealth .yst .... Handling of FSYchiatric Emergencies Last fall an incIdent occurred In which the police were call~~ to a private home in response to what they were told The end result was the death, at the hands of police, of a mentally ill man who had been in o o an4 out of therapy and institutions for aome years. ~his incIdent highlIghted onee agaIn the need for central access to the .ental bealth .ystem and • trained r •• pOns. team to h.~le .. erg.nele. involving the lIentally ill, which ean operate Independ.n~ of, or In cooperation with, the police. It also indIcated that 911 dispo~ehera are not sufficiently trained In handlIng such ealls and relaying the pertinent information to r.sponding agencies. As a result of this Incident, a field response .yst .... 'Was foraed .. It b administered by the Co_unity lIentol Bulth Subsystea and operates 8 All to 5 PH, lIonday through Friday. When a call come.s In to the emerqe'I')CY number., the operator takes pertinent information a~ pages the director; who returns the call within five .inut~&. He haa aCCess to -a computer to deteraine if the person involved bas received aervlces In any other county program and What diagnosiS Yas indicated. If there are no entries in tbe data bank, the director aust. :make an evaluation based on what infoI'1Dation he can acquIre on tbe telephone to determln& whether the problem ia a crisis (not immediate) or an emerqeney (handle with haste). He works with factors such as the patient's aqe... language: apoke.n. use Qf alcohol or drugs. prior histDry, if any, and potential for violence. He also determines which center Is best equ!ppe~ to respond and then dispatehes ataff. fbis interia program bas been in operation since Deee]Dber 1989.. T'he Menti!lil Health Bureau is in the process of recommending a long terw: strateqy and ~ '~----""''''''''-'''' __ 't ..... ,_,_",.~ ..-.,_ -~ JAIL - • . .... -, • -~ . . ---. ,. f I , • '~ ~~'-'.'. , ."-,-: <" . - , " - .' . " o o funding to the county administration. However, the $2 ~ million county bUdget deficient. vblcb surfaced in late May. aay jeopardize this proposal. Community Cgl!!ponious, . a non-profit V.nite~ Way agency tounded in 1973, responds to emerqency calls in the evenings and weekends by contract vith the county. taking up the alack where county agencies leave off. Community Companions, like the other community-based programs described above, is dedicated to keeping mentally ill people oat of hospitals and functioning in society. They, tOO, work only with people who bave been hospitalhed before. With mobile units in the field, Community companions bas also been successful in gettinq some lIIentally 111 homeless people into shelters and works with those who refuse to enter county shelters and other facilities. Because its -case management-type of ser~ice conforms to MediCal quidolinos, last octot>er COmmunity Companions began receiving KediCal funds WIlen working with its clients in the field. and is able, therefore, to increase its client list. The Grand Jury was told, however, that the -extra- money brouqbt in to the 5ystem tllrouqb MediCal was considered by the county to be a .windfall-vhich the county ai9bt subtract from its contract with co~unity Companions. Patl,nts' Rights The Crand Jury cond,ucted interviews with .taff of t.he Ment, 1 Health Advpeaey Project, a p~ivate. non-profit association of atto~neys and paralegals whose sole . " . \ , , ! '~ - . -.. -: , , .'. o o responsi~il!ty Is the protection of the legal rIghts of the lIentally ill. rbe Project receives funds from the county. UnitecS Way, and private foundations as well as frOD state and Cederal qrants. Under "the Welfare and Institutions Code 5500, the Project... as the desiqnated advocate tor the .entally 111, bas access to patients' records and can lnvestLqate clLent complaints. !he Project bas its telephone number pcste~ in every in patient facility in the county and the staff visits each one on a reqular basi.. !be staff e1so visits clients who are 1n half-way houses, board. and care bomes, qroup homes. and. private resIdences. The Project ~a~es sure that each person In the jail psychiatric unit has a revie., with one of its .taft within one week of initial admIssion to the psychiatrIc unit. Staff told the Grand Jury that 24-hour emergency response capability by lbe county could bandle problems at the scene rather than b~ve the police take persons to Emerqency Psychla~rie Services or to the Main Jail~ typical Case ScenOrfo Each of the 5,000 seriously mentally ill persons in the .. ental health ayatem has a unique life history~ Bovever, typical patterns emerge on bew the seriously mentally ill interact with the system. A fairly representative scenario can be describe!! for -8 quy named Joe-. Joe starts having prObl~ in hi. teens cr early twenties. The cause aigbt be .anic depression or paranoid schizophrenia, for e~ample~ His • \ , " ~ J ::~~ r_, " .. ,', •. ,. f· ..:..J i 1 / o o parents are very concerned. Finally a .evere psychotic epia04. ca",.... thoo t51&tra1l9ht parent.s t.o call 9U, 'Which dispatch .. the police. The officers take Joe to Emergency Paychiat.ric Services where °he h evaluated and admitted to Don Lewe Pavilion. After .everal day .. he is stabilbed, pr')bably wit.h Iledication appropriate for his illness. His parents can't cope with having Joe back home, ~hich prompts them to join tbe Alliance for the Mentall.y III (AKI) , a family support qroup. Joe is. referred to a. mental bealth cent.er, such as Downtown Center, wbere be is assigned to the next available t.eall.. '!'he staff help Jce move to a board .nd. care home, and. they provide psycbiatric care and counseling. After several .onths Joe stops takinq zedicatlon, perhaps because of s!de- effects or .. feel1"9 of euphoria. His condition deteriorates, and be is involved in an incident which causes him to be "rreste~. Joe is tak~n to the Main Jall where staff determine that be should be in tbe psycbiatric unit. After a couple of days" be 1s again ta);en t.o EPS for evaluation. If his condition Is not severe enough to warrant admission to Oor~ Lewe Pavilion (or if no beds are available) he is sent to East Valley PavIlion, where he stays for several months. Upon release. he is referred to Virginia Street Project and • different treatment team. Joe's condition is likely to be chronic, so be will need continuing. help to .anage his life. In the Virginia Street Project questionnaire that he -~""-~'~l:l--",::-o". _ ...... _N ........ ,~~ ,,'""-'" ~ '. ",,:," '-"- -.. • \ '.- , i / --·~--------___ "'::-' ___ L ____ "'--__ ..... ~_-~ ... ..:"'C.-~~ o o fills out he write .. that all be vants is a place to live .. aOlllewhere to 90 to be with friends, zaybe a part-time job .. and to ••• h1. folks .qa1n. Thl. ae.narlo illustrates the fragmentation of services involving numerous workers .aOb getting a piece of Joe. The continuity of a single ca&e manasement team l WhIch will give Joe his primary eare and sbepherd hi. tbrough wbatever apec1alized t.reataent and community .upport he needs" may prevent Joe frOll -.. 1 ippi~ through the cracks.· £'QlICWS IONS 1. Erosion of state and federal fundinq over 20 years has placed an added burden on the resources of counties. state support of mental health programs has not kept up with inflation or population qrowth. Furtbenore, state legislation has not defined level of service: therefore, the state i. not accountable for a standard of funding_ (See end of report OTI!ER CONCERNS' 2. OrqanizaUon of the Mental Health Bureau divides servIces to the seriously mentally ill among the three Subsystems. Communication~ trust, and cooperation amonq the staffs dealinq directly with the same clients is deficient. (See Recommendation '1) 3. At £merggney Psychiatric services, clients may st~y from 12 to as many as 2) hours 'While bei"9 eval'Cilted. The lounqe-type aettinq is not conducive to sleepInq and eatinq needs of clients, and the lack of activity could be detrimental to their mental state. (See Reoommendation f6} f , ~' " ~' )',<~~:;::. '.~,. ;- " . ' , " . > .. ' ~_ ... lJ{lIl.'.:,.,:-·-... ' .. '~.-.... ---..... "",,,,,,, ,'. / ; II __ c· .~ .......... =~:""~"'''''"''''''''''_>""," __ M'''''' "~~~~:lIk,.2;;;:ii.t. " 0 0 ~'~ ;1 '~ I I -.- 4. last; VAlley f.yUfon may lose Itate and federal Contingenc, planning wIll be needed both fQr alternate care of its patients and budget implications. (See Recommendation '5) 5. virgInia Street pro1ect research study results, ci·ue In June 1994, .. ey lead to pol~cy and funding decisions re~arding tho levels of staffing needed to be cost effective In keeping clIents out Df institutions and functioning adequately. The Grand Jury commends the Board of Supervisors and the Hental Health B,'-rnu for supporting a project; which •• y lead to Innovative approacbes for providih9 more effective services and care. 6. Response to emergencies inVOlving the mentally ill is baing handled ",ith a temporary plan, whicb depends on evening end week-end response by a non-profit agency on contract vi th the county. '!'his should lead to a permanent plan supported by proper tundin~. (See Recommendation 'l) 7. cooperation and traini~ of S11 di&patchers and law enforcement cfficers is vital in the proper ~andllnq of calls involvIng the seriously .. "ntally 111. (See RecommendatIon 8. Care of a seriously mentally ill client is traqmented among numerous ~ental health workers depending on where aDd wben the client happens to interact with the 5ystem. There appears to be no pinpointing of responsibility tor tbe ongoing care of an individual client. ~e continuity of a s1nqle case management team, which vill provide primary , , .1 d j !, - / Q o care and t.rack interactions with other parts of the mental health syste., .a vell as community resources, appears to be needed. (See Recommendation '2) 9. Communi~y CcmpaniGns fill. an important qap in the care of the mentally 111 by providinq the only 24-bour outpatient response. It bas also shown ingenuity in the use of the case .an&gement .y.tem, _.king it eligible for .ddl~lon.l "edl-cal payments. RECOMMENDATIONS ~he Grand Jury recommends that the Board of Supervisors direct the 'Ili!.nagement. of the County of Santa Clara, the Health Department. and the Mantal Health Bureau to: 1. Take action t.o insure that the subsystems under the Mental Health Bureau work togetber to foster communIcation, ~rus~, and coopera~ion among the staffs dealing directly vitb clients. 2.. structure the treatlDent of seriously mentally ill clients 80 that they receive ongoIng care from a prl~ary case aanaqement team which 'Will coordinate and track all other interactions with the mental health system and coxnmunity resources to keep them froD gettinq lost in the system. Ose of the case manaqement system would result in acSd.itional Hedi-Cal payments. 3. Take immediate action to implement a permanent plan for responding to emergencies involving the mentally ilion a at-hour bash. 4. Train '11 dispatchers and sheriff's deputies in the • '. \ o o bandlinq of emergency calla that involve the mentally ill and take a 1eadenhip role in (ac11.ltatinq the !:raining of law enforcement officers 1n the citle •. 5. lnsure the fundiriq of a conti"9'eney plan for the pcsdble loss of state and federal tuncSi"9' tor East Valley payj11on .. 6. Hake the evaluation vaiting perlocS tor mentally ill persons at ~ergency PsychiatrIc ServiceA shorter by increasing: staff and :IIore comfortable by arranqing for hoOt meals and providing sleeping f~=ilities and appropriate act.ivities. This is especially important vhen the ",aiting periocS 15 beycnd three or four hours. The C:r:-and Jury recommends t.o the CitIes of Campbell, Gilroy~ Los Altos, Los Gatos, Milpitas, ~organ Bill, M~ntain View,. Palo Alto, San Jose, Santa Clara, and Sunnyvale th~t they iJDplement. the t.rainlnq of law enforcement officers for handling persons ~ho are ~entally ill as stated in penal Code Section 13519.2, and that they coordinate their efforts with the appropriate County of Santa Clara departments Including the Communications Oepartment~ Sheriff's Department, and the Mental Health Bureau. OTHER CONCE!U!S State and federal operations are not within the scope Qf the Grand JUry4 However. the Grand Jury recommends that the federal and atate legislators represe~tinq Santa Clara County work to .in!mIz. the ad .... erse impact of constant budget cuts on the mentally ill of Santa Clara County. ---:~"jlr-·. -. -..... ,,-~, "-"""-:~ .~.<.,.., .~ - • ,";~,{ ·9:r~· , ,,-. \ ~ i , I . l I ~ I , ! /' o n. Grand. Jury commends the Board of supervisors for .hoving its concorn by supporting •• ivices for ~he mentally ill vell beyond tho mandateeS .. atching funds for state and tederal fundlnq. / o o PASSEn ANn ADOPTEn by th~ Grand Jury of Sant.a Clara County this twenty-first day of June .. 1.990. ~bq~~ lIillie S. Damon Secretary • ') . ,