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Mental health: The on-going effort to learn more

“Oh, she’s sweet but a psycho

A little bit psycho

At night she’s screaming,

‘I’m-ma-ma-ma out my

mind.’”

Those are the beginning words to an Ava Max single.

While the music, singer and words might be attention getting to some, their meaning can send an entirely different message to law enforcement, therapists, nurses, doctors and family members of those who are experiencing mental health issues.

Mental illness, especially focusing on what California’s legal term 5150 and other closely-related codes really mean, was the subject of a one-day training given by Agi Schenley, a crisis intervention specialist.

Schenley holds a Ph.D. in clinical and forensic psychology and is a licensed marriage and family therapist.

In 2008 Schenley began sharing the crisis intervention program she developed. “We’re giving the officers a basic understanding on how to recognize someone who may be mentally stressed and how can we help individuals get into programs so they can get further help,” she said following a week-long training for law enforcement officers and first responders in Santa Clara County in 2012. “It actually saves lives — not only those of law enforcement but mentally ill in the public as well.”

Plumas Rural Services organized a local training in March and April through the California Institute for Behavioral Health Solutions.

Schenley’s focus is working with law enforcement officers. During the recent training it included many deputies and sergeants with the Plumas County Sheriff’s Office. According to one sergeant, Schenley succeeded in conveying her message because she spoke their language.

Schenley also presented technical information surrounding 5150 and related codes that held more meaning than previous trainings.

But Schenley’s message wasn’t only for law enforcement. Hospital staff, including those from both Eastern Plumas Health Care and Plumas District Hospital, including PDH Chief of Staff Dr. Joseph Schad, nurses, those from Careflight and others were present. Plumas County Behavioral Health added several therapists to the program. The audience also included the parent of an adult who has been suicidal since her teenage years.

“I will have a lot of questions not answered,” Schenley told her audience. The code 5150 is interpreted a lot differently depending on where you are, she explained. And there lies the source of questions that are difficult to answer.

Terminology

5150 refers to the California penal code for the temporary, involuntary psychiatric commitment of individuals who present a danger to themselves or others due to signs of a mental health disorder.

5150 has come to be known in slang terms as someone who is mentally unstable, acting irrationally or possibly “crazy,” according to Schenley.

For many who haven’t been confronted with the system surrounding a call for 5150, it might mean a hospital where trained doctors, nurses and therapists work with an individual to resolve the issue.

Since 1996, Schenley has focused on people who work with the mentally ill, or 5150, or the clients themselves in a hospital setting.

Although a 5150 expires in 72 hours, no one can end a 5150 hold, but a psychiatrist, Schenley told her audience. In Plumas County there isn’t one. A Behavioral Health therapist explained they are attempting to recruit a visiting psychiatrist, but now telemedicine is the next best option. And Schenley doesn’t think much of telemedicine services, she said.

A 5150 hold is based on probable cause by a peace officer, Schenley explained, or a county authorized professional as a legal mechanism to take a person involuntarily to a designated facility for assessment. But a 5150 hold is only good for 72 hours and it expires at the state line. If services are required in Reno, for instance, then Nevada laws must be applied.

As part of Schenley’s work she’s devised a new 5150 form for law enforcement. The old form is one page; the new form is four. The Sheriff’s Office currently uses the shorter form.

Schenley said it’s important to know how to fill out the form correctly in order to get the best results for the individual involved in an incident.

“I am not an attorney,” she explained about the form. “I am an obsessive-compulsive person.” Therefore, that’s some of her reasoning for her longer form. But her form makes more sense within the system.

Schenley said she encountered her first 5150 patient in San Diego in the 1990s. At that time “I decided I was going to write the best 5150 this universe has ever seen.”

When she submitted her report to the doctor, his comment was that she shouldn’t use psychiatric jargon. The 5150 form should be an easy form for law enforcement and others to fill out so everyone can understand it, she learned.

Schenley said she tried to bridge the gap between different disciplines, including law enforcement and mental health professionals.

What Schenley pointed out is that a 5150 report isn’t a clinical document, but a legal document. And that can lead to many issues if law enforcement doesn’t follow Schenley’s recommendations for using the longer form. “Document, document, document, that’s the only way you can cover your butt,” she told officers about filling out the form simply, but thoroughly.

Sgt. Jeremy Beatley brought up a relatively common situation between the sheriff’s department and a local hospital. There are people who should be 5150ed, he said, “but we put them in jail.” The hospitals don’t have the security to manage these patients and deputies can’t sit there in the hospital.

“When we leave they’re back to cutting down trees with a spoon,” Beatley said about what often happens with the individual.

Beatley did go on to say that more talks are occurring with PDH staff, mental health and law enforcement since Behavior Health Director Tony Hobson came to the area about a year ago. He genuinely wants to find solutions that work.

Schenley said that some hospitals she is familiar with use medications for psychosis to solve the problem. But there again it’s difficult or impossible to administer some of these drugs if the individual is under the influence of alcohol or narcotics.

Schenley asked officers if they routinely search anyone they arrest. And they answered, “Yes.”

Some peace officers don’t do that, she said. Some facilities routinely have the patient change immediately into hospital gowns and their clothing is secured, which solves some issues, she said.

Unfamiliar ground

Schenley threw out another code many seemed a little less familiar with — 5150.05.

This code deals with determining probable cause concerning taking someone into custody. Schenley explained that in this case a reliable third party could be considered to relate what’s going on with an individual’s mental health state.

Schenley then asked what a reliable person might do?

Schenley’s example of a reliable person was someone who called the sheriff’s office dispatch with concerns about a man named “Jim” who has schizophrenia. He’s been hospitalized three times in three months and is not taking his medication.

This is Jim’s mother making the call. She stated, “I call you out today because Jim told me that God told him to kill himself. He refuses to go to the ER with me and he became agitated when I pressed the issue.”

Jim’s mother is there when officers arrive. She follows him to the hospital and is genuinely concerned for her son’s well-being.

Schenley’s example of an unreliable person is another mother who has her mentally disturbed adult son, Bob, living at home.

She calls authorities and says that her son isn’t taking his medication and is making threats to harm someone in the family. The mother makes sure that Bob is admitted to a facility as quickly as possible.

At the facility, mental health workers realize that the man has been taking his medication and he isn’t depressed or making threats.

When repeated calls to the mother meet with no success one of the workers drops by the house to gather more information. No one is home. The worker learns from the neighbor that the family has gone to a wedding and will return in a week.

This is a case of dumping someone on the system, Schenley explained.

Mental health, first stop

Frequently it’s a deputy or sergeant who first comes into contact with someone who is experiencing some form of mental health disorder.

Someone from the individual’s family might call 911 and report an incident or that the caller can’t deal with the individual.

Perhaps the individual is on the streets and is observed acting in an unusual manner — screaming, yelling, talking to himself, behaving in a bazaar fashion — doing something that is unseemly to the general population. Or an individual could be harmful to himself or someone else.

Law enforcement essentially has two choices; the deputy can take the individual to jail or to the hospital. Or after attempting to glean the facts of what is happening with the individual choose to do nothing.

Taking the individual to jail does serve a purpose in that it gives the individual a safe place to stay.

Taking the individual to the hospital should mean that the individual receives a certain level of care and that a mental health therapist is notified.

Plumas County doesn’t have a designated local Lanterman-Petris-Short (LPS) facility. The county has a long-standing contract with a mental health facility in Woodland. And it’s difficult finding an available bed at this or other facilities. This factor presents other problems for those seeking services for the individual in need.

Plumas County uses other facilities, but again, it’s a matter of finding a bed available.

A 5150 hold is only good for 72 hours. It can take longer than that to find a place for the individual. And then there’s travel time. By the end of that time the individual is legally able to make his own decisions.

Short-term facilities are generally not equipped to handle patients under 12, or patients with other medical issues, such as diabetes, Schenley explained. “I only know one hospital in the Central Valley, a 12-bed unit, that takes medical and psychiatric” patients.

Woodland accepts these patients, one of the hospital representatives added, “But we can never get in.”

Facilities also won’t accept anyone who is under the influence of drugs or alcohol.

LPS Act

LPS was co-authored by state assemblyman Frank Lanterman and two state senators, Nicholas C. Petris and Alan Short. It was signed into law in 1967 by then California Governor Ronald Reagan. It went fully into effect July 1, 1972.

LPS set mental health commitment procedures not just in California, but eventually throughout the United States.

One of the major intents of LPS was to end inappropriate, indefinite and involuntary commitment of people experiencing mental health disorders, developmental disabilities and chronic alcoholism.

Some of the thinking behind the bill involved the fact that it was too easy for families — including husbands and wives — to involuntarily commit someone to an institution. It also placed individuals who had other disabilities into the same category as those with mental health issues.

LPS was also meant to provide prompt evaluation and treatment for people with mental health disorders. Due process was at the forefront of the landmark legislation.

LPS was at the same time designed to significantly reduce state institutional expense, according to sources including from the Hospital Association of Southern California. Schenley said that what the state saw was a significant number of mental health hospital or facilities shut down.

“The LPS Act set precedent for modern mental health commitment procedures across the U.S. and ended most state hospital commitments by the judiciary system — except in extreme criminal cases,” according to “It’s Time to Modernize the Lanterman-Petris-Short Act.”

What has really happened throughout the mental health system is an adverse impact of individuals receiving prompt evaluation and treatment. When LPS went into effect it essentially stripped or diverted mental health funding.

There is proportionally less dedicated funding as the percentage of mental health needs grows along with the population.

While LPS has given power to those with mental health disorders over their own lives, it has become more difficult to meet the needs of someone who can’t realize those needs.

This coupled with less funding — fewer mental health professionals and facilities — means that LPS safety issues for both the individual with mental health disorders and the public, are not being met.

In California alone, it’s estimated there are more than 1,000 individuals on 5150 holds in an emergency room on any given day, according to the Southern California hospital study.

Of that number, it’s estimated that 65 percent of those cases don’t result in an inpatient stay. The reasons for this are complicated, but it often comes down to no placement facilities available.

“The reality is that California has a disproportionate dependence on hospital emergency departments, which leaves patients with mental illness languishing for hours, days and sometimes weeks – awaiting psychiatric assessment and treatment because there are no clear guidelines,” according to the report.

So how common are mental health illnesses?

According to the Centers for Disease control and Prevention, one in five Americans will experience some form of mental illness in a given year; one in five children are either currently or at some point in their life have a seriously debilitating mental illness; and one in 25 Americans lives with a serious mental illness such as schizophrenia, bipolar disorder or major depression.

Her own story

“English is my third language,” Schenley said as she began to tell her audience something about herself.

Sometime during the 1980s she’d had enough of the life that Communism left for her and her 3-year-old daughter. She made it out of Hungary before the wall came down.

Probably little in Schenley’s early background would have prepared her for the flight she undertook to escape her mother country. Her father was a concert pianist and she was a singer and dancer.

Besides her young child, she had little money, a backpack and “I had to fight my way through a lot of things,” she said about that flight to freedom.

She ended up in Vienna “and I didn’t speak German,” she said about a change that could have crippled her. “In 1984 in the U.S. I became a citizen. I’m extremely grateful to be in this country,” she said.

In her own way she is doing her part to assist others who are often overlooked.

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