Mental Health Evaluation Team
A partnership between the Contra Costa Behavioral Health Division and local police agencies has established Mental Health Evaluation Teams (MHET). MHET reduces potentially dangerous psychiatric incidents by connecting mental health clinicians to mentally ill persons identified by police as presenting a serious danger to themselves and the public.
In recent years, officers of the Concord, Pittsburg, and Richmond Police Departments have recognized a growing population of residents diagnosed with serious and persistent mental illnesses. These persons have a history of multiple contacts with law enforcement, attempts or acts of physical aggression during encounters with law enforcement or others, domestic violence, firearm use or possession, and/or multiple visits to the Contra Costa County Hospital Psychiatric Emergency Department. For example, in 2014 a seriously mentally ill female reported to the Concord Police that she was going to shoot herself. Officers found her armed with a pistol and standing in her front yard in Concord’s busy downtown. She pointed the weapon at officers, who were forced to defend themselves. The female was shot and died from her injuries. The tragedy of this situation cannot be overstated; a person died and several officers now have to cope with the reality that they took a human life due to the dilemma of mental illness.
While this is an extreme example, mental illness also affects our communities in more subtle but still impactful ways. Contra Costa County Psychiatric Emergency Services (PES) processes approximately 10,000 persons annually who are in protective custody for mental health evaluations. These persons are determined to be a danger to themselves or others due to their mental condition, and are held in custody until PES staff deem them fit for release. In Concord alone, the police department responded to 982 complaints of mentally ill persons in 2015. Concord officers also responded to another 3200 complaints of suspicious and intoxicated persons, many of whom were determined to suffer from mental illness. This massive demand on police services is repeated in every city in Contra Costa County but pales in comparison to the long-term strain and struggle endured by affected persons and their families.
This problem is exacerbated further by the limited resources available to assist persons with mental illness, particularly when they are homeless. Protective custody for mental illness evaluation has become a revolving door, with the chronically ill enduring the process many times per year with little productive outcome. Worse yet, those with mental illness sometimes come to the attention of police only when their behavior has become so troubled that they present an immediate public danger. As a result, police intervention is often swift and assertive, and intended more to protect the public than to address the long-term needs of the distressed person. Mentally ill persons frequently experience an endless cycle of negative police contact and protective custody, short term treatment, a slow decline once they are released back into the community, and decompensation that results in their forced return to short-term protective custody.
To better address the various needs of the community and the mentally ill themselves, a partnership was formed between Contra Costa County Behavioral Health Division (BHD) and the Concord, Richmond, and Pittsburg police departments. Funded by a $380,000 grant from the California Public Safety Realignment Act (AB I 09) and a three-year $550,000 grant from the California Health Facilities Financing Authority, three Mental Health Evaluation Teams (MHET) were formed. Each team –West, Central, and East County MHET, consists of a police officer and a mental health clinician. The teams focus on the needs of mentally ill persons by providing welfare checks, clinical assessments, short-term case management, linkage to appropriate community mental health services, and alcohol/drug abuse services.
Each workday, the three MHET units respond to referrals from local police throughout the County. MHET visits persons identified as having a serious and persistent mental illness and a history of violence, access to weapons, or have otherwise behaved an a manner indicating the need for intervention. Through these visits, the MHET program is intended to create a reduction in the number of physically aggressive and negative interactions between the seriously mentally ill and law enforcement; a reduction in the number of repeat calls for service; a reduction in the number of avoidable visits to PES; and a safer, better quality of life for the service recipient, their family members, and the community at large.
The police officers assigned to MHET offer further support by providing regular training to law enforcement personnel on effective contact, interaction, and referral for persons suffering from mental illness.
Since the start of the program, MHET has responded to 223 referrals from police departments and mental health agencies. Of these, 85 have been initiated due to the immediate threat of violence by a mentally ill person and 18 have involved the use of weapons. Perhaps most telling, 61% of those persons contacted by a MHET team have generated no additional police calls for service.
However, statistics tell only part of the story. Instead, the value of the program is clearer with examples of recent MHET activity:
In one case, a homeless subject was generating numerous complaints to law enforcement, including camping, loitering, panhandling, public defecation, and nakedness. He was taken into protective custody for mental health evaluation numerous times, and he was issued citations and arrested for many public offenses. MHET successfully collaborated with PES and the man’s case management team to have him conserved and placed in a long-term psychiatric facility in the hopes of stabilizing and creating for him a better quality of life.
In another very tense case, citizens called police to report a male standing in a roadway, holding a handgun and threatening passing vehicles. He discarded his firearm when officers arrived, and he later admitted he intended to force officers to kill him. After he was treated by PES, MHET met with him and connected him with psychiatric treatment through his private insurance provider. The man has generated no calls for police or PES since MHET involvement, indicating his de-escalation from behavior that was extremely dangerous to the public, the police, and himself.
In a third example, a woman was continually receiving contact from police in multiple cities due to her aggressive and threatening behavior. At that time, she was not receiving any treatment for her mental illness. MHET personnel were able to contact her and link her to intensive case management services that ultimately resulted in her placement and long-term care. The woman is now on proper medication and stabilized, continuing to engage with her case management team. MHET also worked with her family to provide psychoeducation, safety planning and linkage to the National Alliance of the Mentally Ill.
Overall, the strength of the MHET program is founded on the manner in which it uniquely combines the skills, resources, and information systems of law enforcement and mental health staff. It is through this pairing that the program has seen, and will continue to see, unmatched success in helping those afflicted by mental illness.