Don’t walk away

New programs can direct some away from jail and toward mental health

When it comes to dealing with an individual with a possible psychiatric disorder, law enforcement typically has three choices: make an arrest, hospitalize or walk away. The first two options, officers say, can be traumatic for the person involved and often do little to address the underlying cause of the immediate distress.

Walking away—the path usually taken by law enforcement in such cases—usually ensures that the person’s distress will continue to grow, eventually requiring the involvement of another government agency at some point down the road, often with traumatic consequences.

But Sacramento may be at a turning point.

An influx of nearly $2 million has allowed the county’s mental-health division to start new programs aimed at transforming the way services are delivered. The funds result from the 2004 passage of Proposition 63, the Mental Health Services Act. In a short time, the county will learn whether the state Department of Mental Health will approve an additional request of $1.7 million to fund the creation of mobile crisis units composed of specially trained law-enforcement officers and mental-health clinicians—an approach used successfully in other communities.

The psychiatric-emergency-response-team program, PERT, has been discussed in Sacramento County with various levels of intensity for the last five years and has received widespread support from many corners. Representatives from all involved local parties—city police, county mental-health officials and the county sheriff’s department—say publicly they support the program. But no one can agree on who should pay for what.

Yet, at least 17 other counties, including those as small as El Dorado and Shasta and as large as Los Angeles and San Diego, have PERT or similar programs operating, mostly funded through a combination of federal grants and general fund dollars, with each agency paying its own costs.

Which way will Sacramento County go if the state denies funding?

Right now, it’s anyone’s guess.

“There are significant costs out there that we’re piling up because we don’t have PERT,” said Sacramento Police Chief Albert Nájera. “Real money, real emotional toll on consumers, on the officers, incarceration costs, the whole system.”

Proponents of PERT and similar collaborative programs point to some evidence of what happens when nothing is done: The San Rafael Police Department’s Mental Health Liaison Program cites a study showing that people with severe mental illness account for 1 million of the 12.5 million national detentions each year in county jail.

In Sacramento County, at any given time, there are 650 jail inmates receiving ongoing psychiatric care, and about 500 of those are on daily psychiatric medication—about 22 percent of the total daily jail population. The sheriff’s department spends $1.2 million of its annual $5 million pharmacy bill on psychiatric medication.

According to Capt. Mark Iwasa, jail commander, the jail’s 18-bed psych unit admits 73 inmates per month with an average stay of five-and-a-half days per inmate. UC Davis psychiatrists, nurses and clinicians log an average of 2,100 psych contacts per month in the jail, Iwasa reported.

A 22-year veteran with the department, Iwasa said the potential is there for PERT teams to direct people away from jail.

“I’m not an expert on PERT,” said Iwasa, “but instead of just dealing with the behavior, which is what law enforcement normally does, [PERT teams] can look at the cause and do an assessment. Instead of an arrest, it could lead to a referral.”

The team is equipped with resources that the two agencies working alone don’t have: access to past medical history, insurance information and social-service programs.

“A PERT team has more ability to get to the heart of the problem,” said Undersheriff George Anderson. “They can investigate other influences involved—just go much more in depth and hopefully avoid both hospitalizations and jail.”

“A main objective of the PERT team is to direct consumers away from the criminal-justice system and guide them into mental-health treatment,” said Ann Edwards-Buckley, director of the county’s Mental Health Division in a June 22, 2006, follow-up letter to the Department of Mental Health regarding law enforcement’s role in PERT.

The way PERT works, officers and clinicians are on the scene during the initial response for assistance, thereby freeing up regular-duty patrol officers to return to patrol duties.

Renee Difuntorum, the first mental-health outreach worker with Project HOPE, a former collaboration between county law enforcement and mental health, agrees that “business as usual” will result in further hospitalizations instead of crisis interventions, “where the person’s stress level is high because it’s the end of the month, and they need to see their doctor, and they need some food. They need some resources. Regular law enforcement doesn’t have the time or training to do that.”

Edwards-Buckley said if the state fails to fully fund the PERT proposal, her agency will still be willing to pursue the program if law enforcement pays its own salaries.

However, Anderson noted that the sheriff’s department hasn’t recovered from 2002-03, when its budget required a slash of 50 deputies from its patrol ranks—deputies it has yet to replace. And, for his part, Nájera was noncommittal on what might happen if the funding gets denied, saying it’s a matter of balancing needs, “which are great at this time.”