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Stretched thin, L.A. County's mental health teams struggle to get patients out of jails and into hospitals

Daily News - 11/13/2017

Nov. 13--AN EDITOR'S NOTE TO OUR READERS: Because she is a minor, the name of the 13-year-old in this story has been omitted to protect the privacy of the girl and her family.

The 13-year-old held a knife against her throat one spring morning, looked her mom in the eyes and said she'd do it.

It was a threat built on depression, anger and despair. The teen had tried to run away from home. She twisted and pinched her skin until her arms and neck turned blue. She stole a cell phone from a student at school and used it to post photos of herself on an adult dating site. When her mother confronted her, the teen became upset.

She grabbed the blade.

In desperation, her mom called 911. It was the second time her daughter's behavior forced her to dial the trio of digits, to reach out to strangers for help.

But unlike the last time, the two Los Angeles County sheriff's deputies who responded weren't alone. They came with social workers who are part of the Mental Evaluation Teams, a growing program that the public and many in law enforcement across the nation want to see expanded. One of the goals of the Los Angeles County Department of Mental Health program is to divert people with psychiatric needs away from overcrowded jails and juvenile halls and even from scarce emergency room beds, and into consistent services.

Activists say these teams can be key to de-escalate situations between law enforcement and people who are mentally ill that can turn deadly.

But in L.A. County, where law enforcement officers serve a vast area stretching from Long Beach to the Antelope Valley and from the San Fernando Valley to the Inland Empire, there aren't enough beds or teams to help people like the 13-year-old.

Not enough beds

The last time the teen fell into depression, she was taken to Martin Luther King Medical Center, Jr. Medical Center in Willowbrook. There, she waited for three days in the hallway until a psychiatric bed opened up at the Del Amo Behavioral Center in Torrance. But there was no follow up.

This time, the members of MET determined she needed long-term, consistent care. After about an hour on the telephone searching through the maze of Los Angeles County's mental health system, a case worker found a psychiatric bed for her, but in Orange County.

Such distance has not gone unnoticed.

"We could put 1,000 mental health experts on the street, but if you don't have the beds that need to be in hospitals, then it's very frustrating for law enforcement and mental health workers," Los Angeles County Supervisor Kathryn Barger said.

In Los Angeles County, Barger noted, the 2,305 beds designated to help patients with psychiatric emergencies is not enough. And the system currently in place to treat these patients leads to a costly cycle, public safety officials said. Medi-Cal recipients placed on psychiatric hold may be admitted for 72 hours then released unless their needs are especially dire.

Barger said she is working with Los Angeles County Mental Health director Dr. Jonathan Sherin, to add 100 more beds.

"I believe in this program," Barger said of the MET units. But she also noted that even if teams increase, without more urgent mental health care centers or emergency psychiatric beds, the MET program won't be as effective.

That's because even getting admitted is an issue.

Average wait times at public emergency department hospitals is almost 3 hours.

"This equated to $18,000 in lost productivity in November of 2016," according to a report by the Sheriff's Department.

At private hospitals, the wait is about 42 minutes.

The psychiatric bed shortage means that Los Angeles County's jails have become the largest de facto mental institution in the nation.

In 2010, inmates with mental illness in the county jails in 2010 totaled 2,475. As of 2016 that number more than doubled and exceeded 4,000, according to the Sheriff's Department.

To help, Barger and other board members hope to expand mental health Urgent Care Centers which can alleviate emergency care. There are four such centers across the county so far, and a telecare service.

"The goal of mental health UCCs is to reduce the incidence of unnecessary and lengthy involuntary inpatient treatment while promoting care in voluntary, recovery-oriented treatment settings."

From July to September, there were 10,418 clients served. Almost 10 percent of them were brought in by law enforcement or probation officials.

Lt. John Gannon, who oversees the MET program, said he has been encouraged by county leaders who are looking at the issue comprehensively. By expanding the urgent care system, for example, both deputies and patients will be helped.

"This will free up deputies to help more people, so they don't have to wait in the emergency departments," Gannon added.

More teams needed

"It's all about the cell phone," a worried mother said as she stood in front of Anderson Elementary School in Compton, where her daughter had later run to after she threatened to commit suicide.

Inside the school, a deputy, social workers and the school principal talked to the teen, to ask her why she pulled the knife on herself.

Outside, her mother explained to another deputy that she had taken the cell phone away as punishment, and that's when the teen acted out.

"She started talking to herself, injuring herself," her mother said.

Such interactions are becoming an increasing part of police work for agencies whose officers and deputies aren't trained to be psychologists. From 2010 to 2015, calls for service to the Sheriff's Department involving mental health needs rose 54 percent, from 11,660 to 18,061.

Besides growing awareness, mental health needs have increased because of the closure of mental health hospitals, some say. In 1967, then California Gov. Ronald Reagan signed the Lanterman-Petris-Short Act, which stopped the involuntary commitment of people with mental health disorders and chronic alcoholism. As president in the early 1980s, Reagan cut federal funding for mental health services. Mental institutions let people out then shut the doors for good. Promised social services never came to fruition.

In the meantime, the Los Angeles County Sheriff's Department rolled out the first MET team in 1991, which became the first of its kind in the nation.

A preliminary report by the newly formed Los Angeles County Sheriff's Civilian oversight Commission praised the potential of such teams and efforts made, but also expressed concern with the county's jail population.

"Although the current expansion plan's proposed 23 teams may be a start, significantly more, 40 to 80 may be ideal and even necessary in the future to ensure effective coverage of Los Angeles County and to be adequate for use as a de-escalation tactic and diversion to resources accompanying first responders," according to the report. A final report is expected in December.

More teams, more training

Clinical psychologist Ronda Hampton, who advocates on behalf of families, agreed with the report's summary, but said more teams won't matter if deputies aren't trained properly.

Officers with the LAPD and deputies with the LASD receive 15 hours of training to learn if someone is experiencing signs of mental illness. In Chicago, police officers receive 30 hours. In Philadelphia, it's 40 hours, according to a recent LAPD "Use of Force" report.

"If we are going to allow officers to be first responders and give them the power to decide when behavior warrants a mental health evaluation, then these officers must be trained, not once, but frequently on how to recognize the signs and symptoms of mental illness or a mental health crisis and they must be trained on how to interact appropriately in those situations."

-- Ronda Hampton, clinical psychologist

Hampton has been a vocal critic of the Los Angeles Sheriff's department and the way deputies handled the case of Mitrice Richardson, a 24-year-old woman who went missing from the Malibu/Lost Hills sheriff's station in September 2009. Richardson was found dead 11 months later. Hampton has said the Sheriff's Department failed to take Richardson's mental health issues and disappearance seriously. Hampton knew Richardson and helped organize the search for her.

"It is often untrained deputies who are the first-responders that make the decision to call for the MET," Hampton said. "Officers do not always know when it is appropriate to make the decision to call for MET back up, or their impatience in waiting for the team to arrive leads them to take deadly action."

She also said an increase of teams, while helpful, will provide only a band-aide solution unless officers are trained better.

"If we are going to allow officers to be first responders and give them the power to decide when behavior warrants a mental health evaluation, then these officers must be trained, not once, but frequently on how to recognize the signs and symptoms of mental illness or a mental health crisis and they must be trained on how to interact appropriately in those situations," Hampton noted."Anything short of regular, ongoing training and education to all deputies is a death sentence to those who suffer mental illness and who may encounter an untrained officer, and costly to the county due to settlements and lawsuits for wrongful death."

Hope is stoked

Meanwhile, in front of Anderson Elementary school, members of the MET unit told a distraught mother to let her daughter go. Don't talk to her, they said. Don't look her way.

"I just want to help my child," she said, before agreeing.

Tears fell from her eyes as she crossed the street, without looking back.

In a few minutes, the 13-year-old walked out of Anderson Elementary and was led to a patrol car. She was given the school lunch she hadn't eaten that day and a book to read, but she sat frozen with both on her lap and looked straight ahead.

A thousand-mile stare came over her eyes as the deputy started up the engine and drove away.

'She's trying'

Months later, on a recent summer day, a tall, young teenager stood on the porch of the Compton home she shared with her mother, sisters and brother.

She was glad to be home, the teen said with a smile, but she was grateful for the help she received in Orange County a few months before.

"They said I was really depressed," the teen told visitors. "It wasn't a good time for me. I was going through a lot of things. I was really really stressed out with my mom. Things weren't going so well."

But since she returned home, social workers from the Department of Mental Health have been helping her. She liked that they visited.

"For me, I just thought dying was the answer, that taking my life away would have made it easier," she said. "Now I see it wouldn't have been easier, because now I see there are a lot of people who care for me, to make things easier."

She's getting along better with her mom, too, the teen added.

"I've been listening more," she said.

Her mother said she was glad she asked for help. She said more people need to reach out, to not be afraid. So far, it has been worth it.

"She's been trying," her mom said. "She really has."

-- Staff photographer Sarah Reingewirtz contributed to this story

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(c)2017 the Daily News (Los Angeles)

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