Point Reyes Light - July 29, 1999
Jails becoming mental health facilities
Sheriff's deputies in West Marin refer to them as 5150s, and virtually every week, officers are called out to respond to their antics.
Most of these citizens seem merely eccentric, but a handful are occasionally threatening - to other people or themselves.
The 5150s, as people with mental disabilities are referred to on law enforcement's radio code, can be found throughout West Marin, but Bolinas, Point Reyes Station, and the San Geronimo Valley have a disproportionately visible share.
While mentally disabled people can periodically be a problem for their neighbors, it is often the neighbors themselves who allow them a semblance of normality. In West Marin, as in other small towns, residents often go out of their way to keep sometimes-irrational townspeople out of trouble.
But Marin County officers are increasingly having to deal with mentally disordered residents, and state government has responded by making more than $76,000
available to train officers here how to cope with people who have various disabilities.
The grant from the State Council on Developmental Disabilities will be administered by Critical Focus, a Mill Valley organization which works in conjunction with the Sheriff's Office and city police departments. Training will begin in October.
Dianne Wolfe, the co-founder of Critical Focus and a former member of the Marin Mental Health Board, said that the training will develop teams of officers capable of recognizing and working with developmental disabilities, which include cerebral palsy, autism, mental retardation, and epilepsy.
"There is almost no training for law enforcement officers to deal with mental health patients and disabilities in general," Wolfe told The Light.
The state currently requires officers to take only six hours of training in handling and recognizing people who are mentally impaired. The new training will focus on how to de-escalate confrontations, communicate with the mentally ill, and recognize them, Wolfe added.
Sheriff Bob Doyle this week acknowledged the need for such training. "Jails are turning into mental health facilities," he said. "This [state grant] is to turn that around."
Doyle said he expects the deputies' training will concentrate on detecting and recognizing early warning signs of mental illness. He explained that learning to recognize signs of mental illness will help patrol officers determine people's needs, especially when they don't inform deputies of their condition.
Too often when a mentally ill person has been jailed, he noted, "we [would] find out later, he needs - or isn't taking - medication."
In West Marin, sheriff's deputies work with the Point Reyes Station office of county Health and Human Services to assist the mentally disordered residents.
Together they decide if a person is "gravely disabled" and whether or not the person should be taken to Marin General Hospital's crisis unit. When someone's mental disorder makes him unable to provide for his basic needs, such as food, clothing, and shelter, he is considered to be "gravely disabled" and can be legally detained for treatment and a 72-hour evaluation at the crisis unit.
Developmental disabilities, alcoholism, or drug abuse do not alone constitute grounds for designating someone as 5150. The person being evaluated must also be considered a danger to himself or others.
Dave Sexton, head of Health and Human Services in West Marin, said his office is dealing with about 50 mental health cases at any given time. Occasionally, Sexton said, one of his staff will escort a handcuffed 5150 when a deputy takes the person to the crisis unit. "Unfortunately, they have to be cuffed," he added.
Although West Marin deputies regularly refer people who have not broken any law and are not "gravely disabled" to agencies such as Health and Human Services, the county jail is increasingly serving as Marin County's main facility for the mentally ill.
But the treatment that mentally disordered inmates receive in the jail is extremely limited. Only one counselor serves these inmates although they have access to a psychiatrist throughout the week. Treatment generally consists of visits from the psychiatrist, as well as medication for the most severe cases, who are also segregated from the rest of the jail population.
When mentally ill patients leave jail, they are often referred to social service agencies, but others are merely released through the "revolving door" of the criminal justice system, observed Richard Marcantonia, spokesman for Legal Aid of Marin.
Ironically, despite the challenge local government faces in coping with a burgeoning population of mentally ill inmates, the state's major mental-health facility in Napa is operating at less than one-fifth of its capacity, Dr. Forrest Fulton, a San Francisco Police sergeant who works with Critical Focus, told The Light.
Before the 1970s, people with significant mental disorders were treated in California's mental hospitals. But during the administration of Governor Ronald Reagan, many patients were released with the state expecting a multitude of community-based facilities to provide better care.
In fact, most of those facilities never materialized, and the criminal-justice system began providing the main treatment facilities for California's mentally disordered citizens, said Dr. Fulton.
He added that the Critical Focus training will attempt to educate law officers about making referrals to agencies that can handle "gravely disabled" people. However, he warned, some agencies "cherry pick" clients that are the most manageable and can afford to pay for treatment.
Bruce Gurganus, program manager for the county's Community Mental Health program, noted that "on a typical day there are around 300 people in the county jail, and of those, around 30 or 40 are mentally ill and receiving treatment."
The most common disorders, he said, are schizophrenia, severe depression, and bi-polar illness, otherwise known as manic depression.
Paradoxically, at the same time that mentally disordered people are being increasingly jailed, treatments for their illnesses have improved dramatically with the advent of drugs like Prozac (for depression) and Prolixin (for schizophrenia).
A variety of drugs, several of them initially developed to control epilepsy, are now commonly used to control manic depression.
Many anti-depressive medications cause side effects, such as reduced libidos, but these are considered minor in comparison to the problems caused by mental disorders, Jules Burstein, a former psychologist with the Alameda County Criminal Justice Clinic, told The Light.
Gurganus of Community Mental Health noted that certain mentally disordered individuals are jailed eight or nine times per year, and for some, the experience can be negative.
"A homeless person," he noted, "might benefit from being arrested, as he can receive food and shelter ... For others it creates a situation where they're isolated from family and friends, lonely and depressed. It can make the illness worse." The county is currently in the process of hiring a case manager who will target repeat offenders for special assistance.
In West Marin, said Sheriff's Lt. John Brunslik, commander of the West Marin substation, deputies must deal with certain mentally disordered people repeatedly. "There are probably eight to 12 people we see on a regular basis," he noted.
"But legally we have to let them go if they're not a danger to themselves ... We don't take them in just for being a nuisance. We prefer to seek a local resource."
Said Marcantonia from Legal Aid of Marin, "There's a vastly disproportionate number of police responses to the mentally ill ... It's not right from a legal, moral, or medical standpoint."