County of Santa Clara
Office of the Board of Supervisors
Couniy Government Center,East Wing
70 west Hcdcting Street, l otli Floor

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San Jose, California 951 i o
(408) 299-5040

CLN

Fax:(408)299-2038 TDD 993-8272
www.jimbeall.org

James T. Beall, Jr.

Supervisor Fourth District

MEMORANDUM
November 2,2004

TO: o

Board of Supervisors

CC:

Peter Kutras

County Executive
FROM:

James T,Beall,Jr.

Supervisor, Distri^ Four

Accept referr^^egarding de-escalation training and crisis intervention for

RE:

first responders to calls involving mentally ill consumers.

RECOMMENDED ACTION

Direct Administration to report back to the Board of Supervisors in early December

2004 related to providing training in mental health issues and de-escalation techniques,
and direct crisis intervention for first responders to incidents involving mentally ill
consumers.

Staff report should include, the.following:

♦ Recent history and current status of collaboration between County Mental Health

Department and first responders when addressing incidents involving mentally ill
constinxGrs•

,

♦ Provide estimates of the un-reimbursed General Fund dollars spent on medical care
for the mentally ill in the criminal justice system; pre-sentencing through
incarceration.

♦ Provide list of services or rights to medical care that mentally ill clients lose once
placed in the criminal justice system.

Acid Free Paper

Provide medical perspective of case management challenges for mentally ill clients
within criminal justice system.

Provide description of potential consequences of interruption of medical treatment
to incarcerated mentally ill clients.

Describe best practices that improve both practices and communications between
mental health professionals and first responders/ and improve client outcomes.
FISCAL IMPACT

No fiscal impact to the general fund.
REASONS FOR RECOMMENDATION

From a humanitarian and treatment perspective the criminal justice system is an

inappropriate environment to place individuals with serious mental illnesses. Many

people with mental illness; especially those who are poor,homeless,or challenged with

substance abuse problems, are unable to obtain mental health treatment while
incarcerated. If they commit a crime,even for a nonviolent offense,sentencing laws
mandate imprisonment.

I believe that successful jail diversion is essential to ensuring the success of mental
health treatment programs.By referring and treating the non-violent mentally ill within
the community health and human service system,the County can provide better case
management,and provide appropriate treatment.An successfuljail diversion program

promotes public health and improves public safety by expanding treatment alternatives

and thus improving outcomes for mentally ill clients.

Depending upon the outcome of Proposition 63 and the state efforts to obtain a MediCal waiver,there may be expanded opportunities for addressing the needs of ^
incarcerated mentally ill clients in our commiinity. Although the Board has prioritized
care for mentally ill clients within our community for many years,these additional

funds may assist in preserving services as we experience several years of budget deficits.
For 2004-2005, the Large Urban County Caucus of the National Association of Counties
has selected the loss of federal entitlement benefits for the mentally ill in county jails as
one of its top four legislative priorities (See attachment).

I believe that jail diversion programs for the mentally ill when appropriately applied
are ethically and fiscally prudent. Furthermore,I believe that such programs are
consistent with basic human rights.

BACKGROUND

The fatal police shooting of the mentally ill have become a critical issue for our

community. The most recent incident occurred in September and resulted in the death
of a Bosnian refugee who had shown signs of a mental disorder. It was the fifth fatal
officer involved shooting by San Jose police this year alone.

In June 2002 the Board approved the elimination of Mobile Crisis Team ($376,998). The
Mobile Crisis Team had consisted of 4.5 PTEs Psychiatric Social Workers and Rehab

Counselors who provided de-escalation training and direct crisis intervention in
response to San Jose Police Department. Staff states that this budget elimination was

justified, because fewer referrals had been forwarded to this program as more police

officers became more directly trained in Crisis Intervention Team services. However,
staff has also indicated that there are important areas where collaboratton between the

mental health department and police department were improved as a result of the
Mobile Crisis Team.

This referral seeks to better understand what resources exist in the absence of the
Mobile Crisis Team and within the current budget. Furthermore, the referral seeks to

clarify what services incarcerated mentally ill clients receive and how those services are
paid for.