MH Commission Packet June 22, 2017

Office: 3282 Adeline Street, Berkeley, CA 94704 • bamhc@cityofberkeley.info (510) 981-7644 • (510) 596-9299 FAX

Health, Housing & Community Services Mental Health Commission To: Mental Health Commissioners From: Karen Klatt, Commission Secretary Date: June 15, 2017 Documents Pertaining to 06/22/17 Agenda items: Agenda Item Description Page 2. A.

Approval of June 22, 2017 Meeting Agenda

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2. C.

Approval of May 25, 2017 Meeting Minutes

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2. E.

Commission Comfort Agreement

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4. Possible Action Item: Discussion on Public Comment

• Handout on Public Comment Guidelines from the Commissioners Manual

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5. Action Item: Mental Health Services Act FY17/18 – 19/20 Three Year Program and Expenditure Plan Public Hearing

• Handout on how to access and review the Mental Health Services Act FY17/18 – 19/20 Three Year Program and Expenditure Plan

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6. Possible Action Item: Mental Health Division Update on Report on Mobile Crisis Research

• Memorandum for Counties with a Crisis Line and Mobile

Crisis Team

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Health, Housing & Community Services Department Mental Health Commission

Berkeley/Albany Mental Health Commission

Regular Meeting Thursday, June 22, 2017

Time: 7:00 p.m. – 9:00 p.m. North Berkeley Senior Center 1901 Hearst Ave., Workshop B

AGENDA All Agenda Items are for Discussion and Possible Action

Public Comment Policy: Members of the public may speak on any items on the Agenda and items not on the Agenda during the initial Public Comment period. Members of the public may also comment on any item listed on the agenda as the item is taken up. Members of the public may not speak more than once on any given item. The Chair may limit public comment to 3 minutes or less.

7:00 pm 1. Roll Call

2. PRELIMINARY MATTERSA. Action Item: Agenda ApprovalB. Public CommentC. Action Item: Approval of the May 25, 2017 MinutesD. Staff Announcements/Updates

3. Action Item: Vote on Mental Health Commission Chair

4. Possible Action Item: Discussion on Public Comment

5. Action Item: Mental Health Service Act FY17/18-19/20 Three YearProgram and Expenditure Plan Public Hearing – Karen Klatt

6. Possible Action Item: Mental Health Division Update – SteveGrolnic-McClurgReport out on Mobile Crisis Research; Update on Adult Mental HealthService locations; Provide information on following Council Items thatare on the June 13, 2017 Council Agenda: Contract with Jackson andCoker for Psychiatric Services at BMH; Funding recommendation for thecreation of a Mental Health Peer Education Program.

7. Discussion on MHSOAC Bay Area Crisis Triage Session

8. Council Report on Suicide Prevention Resources

A Vibrant and Healthy Berkeley for All Office: 3282 Adeline St • Berkeley, CA 94703 • (510) 981-7644

(510) 596-9299 FAX • bamhc@cityofberkeley.info1

9. Action Item: Vote on additional Commissioner for the Site Visit

Committee

10. Prioritize Agenda Items for July Meeting

11. Announcements

9:00pm 12. Adjournment

Communications to Berkeley boards, commissions or committees are public record and will become part of the City’s electronic records, which are accessible through the City’s website. Please note: e- mail addresses, names, addresses, and other contact information are not required, but if included in any communication to a City board, commission or committee, will become part of the public record. If you do not want your e-mail address or any other contact information to be made public, you may deliver communications via U.S. Postal Service or in person to the secretary of the relevant board, commission or committee. If you do not want your contact information included in the public record, please do not include that information in your communication. Please contact the secretary to the relevant board, commission or committee for further information. The Health, Housing and Community Services Department does not take a position as to the content.

Contact person: Karen Klatt, Mental Health Commission Secretary at 981-7644 or kklatt@ci.berkeley.ca.us.

Communication Access Information: This meeting is being held in a wheelchair accessible location. To request a disability-related accommodation(s) to participate in the meeting, including auxiliary aids or services, please contact the Disability Services specialist at 981-6342 (V) or 981-6345 (TDD) at least three business days before the meeting date. Please refrain from wearing scented products to this meeting. Attendees at trainings are reminded that other attendees may be sensitive to various scents, whether natural or manufactured, in products and materials. Please help the City respect these needs. Thank you.

SB 343 Disclaimer Any writings or documents provided to a majority of the Commission regarding any item on this agenda will be made available for public inspection in the SB 343 Communications Binder located at the Family, Youth and Children’s Clinic at 3282 Adeline St, Berkeley.

3282 Adeline St.• Berkeley, CA 94703 • (510) 981-7644 • (510) 596-9299 FAX bamhc@cityofberkeley.info

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Department of Health, Housing & Community Services Mental Health Commission

Berkeley/Albany Mental Health Commission Unadopted Minutes

North Berkeley Senior Center Regular Meeting 1901 Hearst Ave. May 25, 2017 7:00pm Workshop B Members of the Public Present: Christopher Court, Margaret Fine, Jonah Markowitz, Andrew Phelp, Jamari Snipes. Staff Present: Andrea Bates, Paul Buddenhagen, Steve Grolnic-McClurg, Karen Klatt, Laura Schroeder. 1. Call to Order at 7:00 pm Commissioners Present: boona cheema, Paul Kealoha-Blake, Jenne King, Herve Michel, Shirley Posey. Commissioners Absent: Cheryl Davila (arrived after roll call), Shelby Heda (arrived after roll call), Carole Marasovic (arrived after roll call). 2. Preliminary Matters

A. Approval of May 25, 2017 Agenda – PASSED M/S/C (Posey, Michel) Move that the agenda be approved written.

Ayes: cheema, Kealoha-Blake, King, Michel, Posey; Abstentions: None; Absent: Davila (arrived after the vote), Heda (arrived after the vote), Marasovic (arrived after the vote).

B. Public Comment – Two members of the public introduced themselves and two provided public comments. In one of the public comments a community member shared concerns over how they felt a member of the public was addressed at the April 27, 2017 meeting, and that Easy Does It’s two year contract has been approved. In the other public comment a community member shared information from Young Mind’s Advocacy.

C. Approval of the April 27, 2017 minutes - PASSED

M/S/C (King, Michel) Move to approve the April 27, 2017 Meeting minutes. Ayes: cheema, Heda, Kealoha-Blake, King, Michel, Posey; Noes: None; Abstentions: None; Absent: Davila (arrived after the vote), Marasovic (arrived after the vote). D. Staff Announcements/Updates Mental Health Commission Secretary, Karen Klatt made the following announcements: Herve Michel’s last night is at this meeting (May 25, 2017); the two

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new Mental Health Commissioner’s first official Mental Health Commission meeting will be the July 27, 2017 meeting; due to a matter of procedure the Mental Health Commission will need to nominate and vote on a Mental Health Commission Chair at The June 22, 2017 meeting. 3. Presentation: “Impact Berkeley” – Results Based Accountability – Laura Schroeder – No Action Taken. Two community members had Public Comments on this item. 4. Mental Health Division Update – Mental Health Manager Steve Grolnic-McClurg provided updates on the following: Mental Health Clinic locations and hours; Mobile Crisis Triage Report which will be ready for the June Mental Health Commission meeting; the Mobile Crisis 30-Day Safety Review, current operating procedures and hours (11:30am-10:00pm); and the Berkeley Mental Health Equity Committee. He also distributed a Fiscal Summary Report from FY15/16 and provided information on the Governor’s Budget proposal to utilize Mental Health Realignment growth monies to fund a portion of In-Home Supportive Services. 5. Possible Action Item: Discussion on SB82 Feedback Session and Request For Applications – No Action Taken. 6. Possible Action Item: Suicide Prevention Resources – PASSED M/S/C (Marasovic, King) The Mental Health Commission recommends to City Council that the Department of Health, Housing & Community Services issue an RFP for a consultant with expertise in Suicide Prevention to research suicide prevention strategies in other jurisdictions and recommend strategies to be utilized in Berkeley.

Ayes: cheema, Davila, Heda, Kealoha-Blake, King, Marasovic, Posey; Noes: None; Abstentions: None; Absent: Michel (had already left the meeting). *At this point it was 8:55pm and a motion was made to extend the meeting M/S/C (King, Marasovic) Move to extend the meeting to 9:15pm - PASSED Ayes: cheema, Davila, Heda, Kealoha-Blake, King, Marasovic, Posey; Noes: None; Abstentions: None; Absent: Michel (had already left the meeting). M/S/C (King, Marasovic) Jenne King and Carole Marasovic will collaborate and write a Suicide Prevention Resource Council Report and the report will come to the Commission prior to submission.

Ayes: cheema, Davila, Heda, Kealoha-Blake, King, Marasovic, Posey; Noes: None; Abstentions: None; Absent: Michel (had already left the meeting). 7. Possible Action Item: Discussion on Housing Trust Fund Request for Proposal (RFP) Priorities – PASSED M/S/C (cheema, King) Recommend that a certain percentage of the units be prioritized for the homeless population that meets criteria for severely mentally ill and that the development include supportive housing.

Ayes: cheema, Davila, Heda, Kealoha-Blake, King, Marasovic, Posey; Noes: None; Abstentions: None; Absent: Michel (had already left the meeting). 8. Discussion on 2017 Commissioners Manual – Didn’t get to this item. 9. Prioritize Agenda Items for June Meeting – Vote on Commission Chair; MHSA Three Year Plan and Public Hearing; Mobile Crisis Report. Future agenda: Alta Bates

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Emergency Room planned closure; 101 Finance. 10. Announcements – None. 11. Adjournment – 9:15pm Minutes submitted by: _______________________________ Karen Klatt, Commission Secretary

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As approved by the Berkeley/Albany Mental Health Commission, 9/27/12

Corrected 10/25/12

• Do not use language derogatory to others, or yell or

scream

• Be attentive when others are speaking

• Be respectful when others are speaking

• Please do not talk over anyone

• Hold a goal to allow people to feel heard (this is a

value the group holds vs. a behavior)

Berkeley/Albany Mental Health Commission

COMFORT AGREEMENT

“Rules to make it comfortable to work together”

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Information on Public Comment from the Commissioners Manual

(pgs. 46-47)

Public Comment a. When? At the beginning or during each item?Decide whether to allow comment at the beginning or during each item asauthorized under section 54954.3. Since the Act requires that publiccomment for regular meetings be permitted on any subject within thesubject matter jurisdiction of the city, if you decide to allow commentduring each item, you will also need to decide when you will allow generalcomments on subjects not related to anything on that agenda.

b. Any overall time limits and/or limit per speaker?Section 54954.3(b) allows a commission to adopt reasonable regulationsto govern public comments. Typical of such rules are time limits onspeakers and overall time limit on public comment. You should decidewhether to set an overall time limit and/or limit per speaker.

c. Want to draw a distinction between public comment at regularmeetings versus special meetings?Section 54954.3(a) requires public comment at special meetings as wellas at regular meetings. At special meetings, the comment can beconfined to the subject matter to be considered at the special meeting. Bycontrast, at regular meetings the speaker can address any matter withinthe jurisdiction of the commission. You should distinguish betweenregular and special meetings on the agenda for purposes of publiccomment.

d. No Discussion of Items Raised At Public CommentPublic comment cannot be used to start a discussion betweencommissioners or to take action in response to comments. Section54954.2 does allow members of the legislative body or its staff to makebrief responses to comments made at public comment. It is alsopermissible for a member of a legislative body to ask a question forclarification, make a brief report on his her own activities and make areferral to staff or ask that an item be placed on a future agenda.F. Meeting Procedures

e. Formal Participation by the Public/PresentationsAn individual wishing to formally address the commission or make apresentation should prepare a written request to the secretary to bescheduled on a future agenda. The request is discussed at the nextmeeting and the commission may grant or deny the request.

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The Mental Health Services Act FY17/18, 18/19, 19/20

Three Year Program and Expenditure Plan can be viewed at:

http://www.ci.berkeley.ca.us/uploadedFiles/Health_Human_Services/L

evel_3_-_Mental_Health/MHSA%20Three%20Year%20Plan.pdf

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To: City of Berkeley Mental Health Commission From: Magaly Chavez, Consultant for the City of Berkeley - Health, Human, and Community Services Department Title: Memorandum for Counties with a Crisis Line and Mobile Crisis Team Date: June 15th, 2017 Introduction The Health, Human, and Community Services Department has hired a consultant to do additional research on the crisis line and mobile crisis team, within specific counties. This research is being done at the request of the Mental Health Commission, which has requested that the mental health division explore additional possibilities of providing a crisis line that links community members directly to mobile crisis treatment. In addition, to explore the possibility of having the mobile crisis team change their model and respond to crisis calls without police accompaniment. The following memorandum outlines the process of gathering information, the research questions utilized, a summary of the 10 counties interviewed, a breakdown of the criteria utilized, an overall evaluation of all the interviewed counties, and recommendations for closer examination on highly prioritized county models. Process for Gathering Information

1. Initial gathering of information for counties, was done in two ways: • Information from the California Behavioral Health Directors Association Survey1 was categorized,

reviewed, and ranked. • Counties that received a sb82 grant were contacted through their access line.

2. Counties whom received a ranking score of 1 or 2, were prioritized for a phone interview. Counties were prioritized based on a desired criterion for a crisis line and mobile crisis team model. Counties with an access line were also targeted for interview.

3. Top prioritized counties were reached through email or phone. Some counties information was obtained through the information they provided on the survey monkey form. Other counties, who did not participate in the survey monkey questionnaire, but had an access line were reached through their access line and were asked to participate in a phone interview.

4. 10 out of the 15 contacted counties agreed to participate. Interviews ranged in time, anywhere from 20 minutes to an hour.

1 The survey was conducted by the California Behavioral Health Directors Association, through survey monkey. At the request of the City of Berkeley’s Mental Health Commission, in order to obtain relevant information around crisis response in a variety of mental health plans.

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Research Questions Questions for interviews were divided into 2 sections; a crisis line portion and mobile crisis team portion. The intention of the questions was to find how the crisis line or mobile crisis team was operated and ran. The questions also followed specific scenarios. Depending on the initial question answered from the interviewee, different questions would be asked. The questions asked for the interview are listed below:

Crisis line Questions: • If someone calls your crisis line who needs an immediate response, for 5150 evaluations, do you have a

standard way to connect that person to an immediate field base response, whether by PD or MCT? • Please tell us what that procedure is? How does it work? How do you connect them to an immediate

field base response? • How do staff your line? What hours do you operate? • How do you handle situations if there is not a staff person available to answer the phone? • What training or licensure do the staff have? (on the crisis line) • How does your front line staff determine when an immediate field base response is needed? • What is the budget for the crisis line?

Mobile Crisis Team Questions: • For the MCT, who responds first on a field base possible 5150 evaluations?

• If it is a joint response between MCT and Police: o Who first arrives at the scene? o Who first (Police or Mental Health Specialist) talks to the individual in crisis?

• If MCT responds without Police cover or back-up: o How does that County identify which calls the MCT can respond without police involvement? o What percent of the time do they think the staff goes out with police back up?

• Does the MCT go out in pairs? How many people go out in the call? • What is the staffing of the MCT? • What is the budget for the MCT? • Is there anything innovative that your team does from other counties?

Summary of County Findings

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County Small, Medium, or Large

Is there a Crisis Team?

Crisis Line Accessible

By the Community

Crisis Line Refers to

MCT/PD for Immediate Response

Crisis Line Accessible Only through Police Department

Send MCT Without Police, unless

deemed necessary

Send MCT Out with Police, unless it is a specific location

MCT Always Police

Crisis Line Available

to the Community AND Send

MCT Without

Police

Amador Small Yes X X X

San Joaquin Large Yes X X X

Yolo Medium Yes X X X

San Bernardino Large Yes X X X

San Francisco Large Yes X X X

Marin Medium Yes X X X

Crisis Line Available

to the Community

BUT Operates MCT W/

Police Sometimes or All the

Time

Santa Cruz Medium Yes X X X

San Luis Obispo Medium Yes

X No Response X

Tulare Medium Yes X X X

Lake Small Yes X X X

Tuolumne Small Yes X X X

Do Not Have Crisis Line Available to the Community AND MCT Responds with Police Most or All of the Time

Kern Large Yes X X

Sonoma Medium Yes X X

Riverside Large Yes X X

Alameda Large Yes X X

Monterey Medium Yes X X

Contra Costa Large Yes

X X

Does Not have a Crisis Team

Modoc Small No Mendocino Small No Plumas Small No Mono Small No Solano Medium No

Has an Access

Line, No response

Imperial Small

Sacramento Large Santa Barbara Medium Ventura Large

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Amador2 Crisis Line: Community members have direct access to Amador’s crisis line, which connects them to supportive services, administered by a crisis coordinator. After business hours, the services for the crisis line are contracted out. During office hours, community members calling the crisis line will be asked a few questions, by the receptionist, and connected to a crisis coordinator, if necessary. The crisis line is operated during business hours and staffed by one clinician, who is a crisis coordinator. Mobile Crisis Unit: During the interview, Amador’s representative was clear that their unit was not considered a mobile crisis unit, due to limited police involvement. Instead, they call themselves a mobile support unit. The mobile support unit’s main goal is to reduce rates of hospitalization and stabilization. Therefore, all community calls requiring field assistance are handled by Amador’s mobile support unit. With the exception of calls deemed too dangerous for a mental health specialist or require an immediate response. Upon initial contact, the crisis coordinator will determine the safety and imminence of the situation. If the call is deemed too dangerous or requires immediate assistance, law enforcement will be informed and take the call. At this point, the call will be handled only by law enforcement, without a joint response. If the call is considered safe, the mobile support unit will respond. About 75 to 80 percent of crisis community calls are handled by the mobile support unit. Lake3 Crisis Line: Community members have a direct connection to Lake’s crisis line. Incoming calls are connected to a case manager. The case manager determines the services and response needed, based on each situation. Upon the call, the case manager will ask a series of questions resembling questions for a 5150 evaluation. Depending on the answers, the case manager will determine the type of response necessary. The crisis line is operated during business hours. They are staffed by 5 full-time crisis workers and a full-time case manager, but all calls go to the case manager first. After business hours, the services for the crisis line are answered by the Alameda night watch, which answers calls at all times. Mobile Crisis Unit: Lake’s mobile crisis unit is limited to crisis evaluations, crisis outreach, and pre-scheduled appointments. They require a lot of police involvement, due to limited capacity. If community members call requiring immediate assistance or response to a potential 5150, they are directed to law enforcement or an emergency room. Community members will call the mobile crisis unit’s telephone number. By contacting that number, they will be linked to a case manager. Depending on the situation, case managers will determine if the patient comes in for an appointment or if immediate attention is necessary. Calls requiring immediate attention are directed to law enforcement. If the mobile crisis team is out in the field, doing outreach, or attending to a pre-scheduled appointment and the situation escalates into a 5150 criteria, they will do a joint response with law enforcement. Otherwise, law enforcement does most of the outreach calls, around 70 percent, due to lack of capacity and poor transportation infrastructure. Marin4 Crisis Line: Community members have a direct connection to Marin’s mobile crisis line, but that is not the only avenue community members have to access a mental health specialist or the mobile crisis team. Community members can contact Marin’s access line, mobile crisis line, crisis stabilization unit, or the police department and be transferred to a mental health specialist. But the mobile crisis line is the most popular avenue for contact with a specialist and the contact information is spread widely through the community. Community members can call the crisis line anytime. Depending on the time they call and urgency of the situation, they

2 Phone interview with Melissa Cranfill, Amador County Behavioral Health MHP Director. 3 Phone Interview with Stephanie Wilson, Lake County Behavioral Health Crisis Team Leader 4 Phone interview with Todd Paler, Marin County Behavioral Health and Recovery Services Program Manager

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will be directed through various avenues. When calling the crisis line, community members are responded with an operating system. If the situation is immediate they will be directed to a clinician. But if the situation is not immediate, they will be prompted to leave a recorded message and a clinician will follow-up, when available. If a community member is calling from 1 to 9pm and the situation is immediate, callers will be connected to a clinician. If they are calling outside those hours and the situation is immediate, they will be connected with law enforcement. Marin’s mobile crisis line is operated at all times, but at varying capacity, depending on the time called. Clinicians are on call from 1 to 9pm, 6 days a week. Calls received outside of those hours are sent to a contracted party or if the call is not considered immediate a recorded message will be left and a clinician will follow-up when they can. For calls answered by a clinician, the clinician will ask a series of questions to gauge the situation, determine how safe the situation is, and the level of response needed. Depending on the level of concern, the mobile crisis unit can service the call alone or have a joint response with law enforcement. Mobile Crisis Team: The mobile crisis unit, serves multiple functions within Marin. Aside from providing mental health services, it serves as a resource information center. Due to Marin’s structure, it is difficult to embed the mobile crisis team into any particular police department. Therefore, the mobile crisis team is a stand-alone service, not embedded within law enforcement and utilizes law enforcement resources only when necessary. Situations not posing a safety concern will always be responded with only the mobile crisis unit, which is about 50 percent of all calls. When the mobile crisis unit responds, it is usually done with 2 clinicians and sometimes a senior peer provider comes along, to connect the client with additional services. When there is a safety concern, there will be a joint response between the mobile crisis team and law enforcement. Depending on the situation, either law enforcement or the mobile crisis team can respond first and have the other team as back-up. San Bernardino5 Crisis Line: Community members have direct access to San Bernardino’s crisis line, which connects them to supportive services, administered by the quality management division. After business hours, the services for the crisis line are handled by after-hours staff. During office hours, community members calling the crisis line will be answered by a clinician. The clinician will evaluate the situation. Depending on the circumstances of the call and level of severity, a decision will be determined by an on-site supervisor. The supervisor receives a record of information, filled out by the clinician on the call. From that point, the supervisor will determine what type of response is needed. Dependent on the time called, the crisis line has various levels of response, but is operated at all times. Depending on the shift, there can be anywhere from 2 to 17 people on staff (AM, PM, nocturnal shift). Mobile Crisis Unit: San Bernardino’s response is dependent on the level of severity and acuity of the call. On the lowest level of severity, the mobile crisis team will respond alone. On the highest level of severity, there will be a joint response between law enforcement and the mobile crisis team. The response of the call is determined by a clinical supervisor, once they have looked over the record of information. Responses done solely by the mobile crisis team tend to be to schools and groups homes. Attending homes are the most difficult for the mobile crisis unit. The team will search for an established record and dependent on the information and safety, law enforcement might assist. For situations that are joint response, dependent on the situation, either law enforcement or the mobile crisis team will respond first. The amount of staff that respond on the mobile crisis team is dependent on the situation. One clinician will respond for responses done to emergency rooms. 2 clinicians will go out for responses to homes and required transportation.

5 Phone interview with Nancy Olsen, Interim Senior Program Manager and Julie Hale, MFT Program Manager. 13

Santa Cruz6 Crisis Line: Community members have a multi-step process for being directed to Santa Cruz’s crisis line. Community members will call an ACCESS intake number. The person answering will collect basic demographic information. From there, they will be connected to a triage worker. The triage worker will then connect the community member to either a crisis worker or law enforcement. After business hours, the services for the crisis line are handled by mental health liaisons, embedded within Santa Cruz’s police department. During office hours, community members connected will be answered by a crisis worker. The crisis worker will evaluate the situation, depending on the level of severity and where the client is, a decision will be made on the form of response necessary. Mobile Crisis Unit: Santa Cruz’s response is dependent on the party making the call and the level of safety. If the situation is vetted for safety, the client is known, or the client is in an already secure facility (school, clinic, hospital) the mobile crisis team will respond alone. If the situation is not vetted for safety or the client is unknown, there will be a joint response with law enforcement. Responses done solely by the mobile crisis team tend to be to already known clients and to schools, private doctors, or a therapist’s office. For situations involving a joint response, dependent on the situation, either law enforcement or the mobile crisis team will respond first. Situations involving a joint response usually involve an unknown client or a site where safety is unsure. Around 80 percent of the mobile crisis unit’s responses, are done without police involvement because responses are at a clinic or school. The amount of staff that respond on the mobile crisis team is dependent on the situation. Responses usually involve 2 clinicians. But responses already vetted for safety, such as, a school, clinic, or facility only require one clinician. San Francisco7 Crisis Line: Community members have direct access to San Francisco’s crisis line. A crisis respondent will answer the call and conduct a phone screening. Asking the community member, a series of question, in order, to gather information on the situation. Once the phone screen is complete, the decision to send out a mobile crisis team or law enforcement, is made on a case by case basis. The crisis respondent is determining the severity of the situation and the best response available. The final decision on the form of response necessary is done by the officer of the day. The crisis line is operated at all times. After business hours, the crisis line is still answered, but calls go to a transfer service. Mobile Crisis Unit: San Francisco’s response is prioritized due to the acuteness of the client’s mental health. A response for any situation is vetted for safety and the officer of the day is consulted to make a final decision on the response necessary. If the situation is considered safe, a mobile crisis team will respond alone. Situations where a joint response between the mobile crisis team and law enforcement are necessary, involve an unsafe situation or potentially aggressive client. Most calls are answered only by the mobile crisis unit. Except when a situation is considered unsafe or aggressive. In these cases, the mobile crisis team will go out with law enforcement, around 35 percent of the time. Regardless of the situation, the mobile crisis unit always goes out in pairs. San Joaquin8 Crisis Line: Community members have direct access to San Joaquin’s crisis line. A mental health specialist will answer the call and conduct a risk assessment. Dependent on the situation, the person will be referred to law

6 Phone Interview with Marty Riggs, County of Santa Cruz Acute Services Program Manager 7 Phone Interview with Stephanie Felder, County of San Francisco Director of Comprehensive Crisis Services 8 Phone interview with Giselle Borillo, San Joaquin County Chief Mental Health Clinician

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enforcement or a mobile crisis team will be sent out. If the call is not an emergency, the person will be put under a referral list and contacted at another time or scheduled for walk-in services. The crisis line is operated at all times, staffed by a mental health specialist and a psychologist technician. There is also a “warm-line” available at all times, available for phone support only. Mobile Crisis Unit: San Joaquin has four mobile teams, operating at different times and populations. They focus on minors, forensics, people involved in the justice system, and 2 teams serve the rest of the adult population. The form of response is dependent on the risk assessment and potential danger to self and others. The risk assessment is attempting to determine the level of danger the client possess to themselves or others. If the client has an established history, there is no aggression or hostility, and no substance is involved, a mobile crisis unit will be sent out alone. Situations where a joint response between the mobile crisis team and law enforcement is necessary, involve an unsafe situation or potentially aggressive client. About 80 to 85 percent of calls are answered without law enforcement. Regardless of the situation, the mobile crisis unit always goes out in pairs. San Luis Obispo San Luis Obispo responded to the California Behavioral Health Directors Association Survey, but did not respond to a phone interview. Based on their response to the survey, we know they have a crisis line available to the community and a mobile crisis unit that responds without police, under specific circumstances. The responses done without law enforcement involve schools and clinical facilities. We are unable to further discuss in a detailed manner the county’s operation and model structure, for their crisis line or mobile crisis team. Tulare9 Crisis Line: Community members have a multi-step process for being directed to Tulare’s crisis line. Community members call a dispatch number. The dispatch worker will take down all relevant information and connect the person to the relevant agency. Depending on the time and issue, the person will get connected to a crisis worker. The crisis worker will receive the call, triage the call, and complete an intake evaluation. The crisis worker will look at various factors. Multiple points of information will be gathered, creating a comprehensive understanding of the situation and the client’s history. The dispatch center is open at all times, but the crisis line is only operated during business hours. After business hours, weekends, and holidays are serviced by contract providers. Mobile Crisis Unit: Tulare’s mobile crisis team has a strict no hands policy, therefore they will only respond to clients in a local site, hospital, or jail. If it is a home, law enforcement will be sent out to respond to the call. If the situation is vetted for safety, the client is known, and the client is in an already secure facility (prison or hospital) the mobile crisis team will respond alone. If the client is a potential threat to themselves or others, there will be a joint response with law enforcement. Around 80 percent, of the mobile crisis unit’s calls are done without police because they are done at a hospital or prison. Calls requiring attendance to a home are always sent to law enforcement, due to Tulare’s no hand policy. Responses to a secured facility, involve 1 clinician, unless the client is aggressive or possess a potential threat. Tuolumne10 Crisis Line: Community members have direct access to Tuolumne’s crisis line, but those who call are encouraged to call law enforcement or an ambulance themselves, unless they are unable to do so. A crisis

9 Phone Interview with Christina Agda, Tulare County Psychiatric Emergency Team Manager 10 Phone Interview with Debora Diets-Neves, County of Tuolumne Supervisor of Walk-In and CAIP Program

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worker will respond and ask a series of questions to understand the situation, and do an assessment of the situation. If they are in need, the person will stay on the line and law enforcement will be sent out. The crisis line is operated Monday through Friday, from 8 am to 10 pm, and from 8am to 8pm on weekends. After the mentioned hours, calls are sent to a hotline. Mobile Crisis Unit: Tuolumne’s mobile crisis team is focused on crisis response to hospitals. All of their responses are focused on hospitals and transporting clients to hospitals. Any other calls requiring assistance are responded by law enforcement. Yolo 11 Crisis Line: Community members have direct access to Yolo’s crisis line, which connects them to supportive services, administered by one clinician. After business hours, the services for the crisis line are contracted out from 5pm to 8am. During office hours, community members calling the crisis line will be asked a few questions, by the clinician. The clinician will set up a meeting, if appropriate. If a scheduled appointment is not appropriate, the community intervention program (CIP) or law enforcement will get sent out based on the immediacy of the situation. Mobile Crisis Unit: Yolo has a distinct model from most counties. Their mobile crisis unit is a contracted out service, working in collaboration with law enforcement, called the Community Intervention Program (CIP). CIP’s main goal is to offer “more effective resolution and linkage to mental health systems within the county.”12 Clinicians are paired with law enforcement agencies throughout the county. CIP receives information on potential clients and responds to individuals identified by law enforcement, in order to reduce psychiatric hospitalizations, inappropriate incarcerations, and county homelessness13. Response is determined by the situation and assessed by a clinician. “Great disability situations”, such as, depression or suicidal thoughts will be responded by CIP. If there is a potential threat or an immediate response is necessary, such as, possession of a weapon, attempted suicide, or overdose, first responders will be contacted first. Counties with an Access Line Based on the sb82 grant, we are aware Imperial, Sacramento, Santa Barbara, and Ventura counties have at minimum an access line available. All 4 counties were contacted for a phone interview, but were not able to give an interview based on the City of Berkeley’s timeline. Criteria for Prioritizing Counties

1. Crisis line is available to the community. 2. Crisis line refers most calls, with the exception of extreme situations, to their Mobile Crisis Team. 3. Mobile Crisis Team goes out to a field response without police back up, unless deemed necessary. 4. County is preferably small or medium (a model that Berkeley could replicate).

11 Phone Interview with Robert Villareal, Yolo County 12 Turning Point, Community Intervention Program, https://www.tpcp.org/programs/community-intervention-program-cip/ 13 Turning Point, Community Intervention Program, https://www.tpcp.org/programs/community-intervention-program-cip/

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Evaluation and Scoring of Each County

County

Crisis line is available to

the community

(30)

Crisis line refers

most calls to their Mobile Crisis Team

(30)

Mobile Crisis Team goes out to a field response without police

back up (30)

County is preferably small (10)

or medium (5)

Score

Amador 30 30 30 10 100 Lake 30 30 0 5 65 Marin 30 30 30 5 95 San Bernardino 30 30 30 0 90

Santa Cruz 30 30 0 5 65 San Francisco 30 30 30 0 90

San Joaquin 30 30 30 0 90 Tulare 30 30 0 5 65 Tuolumne 30 30 0 10 70 Yolo 30 30 30 5 95

Recommended Counties for Further Prioritization Given Evaluation Scores

All 6 counties listed below, satisfy the main criteria for Berkeley’s ideal response model, which are: 1. Crisis line is available to the community. 2. Crisis line refers most calls, with the exception of extreme situations, to their Mobile Crisis Team. 3. Mobile Crisis Team goes out to a field response without police back up, unless deemed necessary.

The difference in scoring and prioritization is due to the counties size and resources available to them. Due to the City of Berkeley’s ability to replicate any given model. Small counties were prioritized first and medium counties prioritized second. Large counties were prioritized last, due to their population size and the amount of resources available to them. Therefore, prioritization of counties based on their evaluation score are: Amador, Marin, Yolo14, San Bernardino, San Francisco, San Joaquin.

14 . Based on the interview and criteria ranking, Yolo county’s model technically satisfies the evaluation criteria for top prioritization. Due to the mental health commission’s interest in limited cooperation and involvement with law enforcement Yolo county’s model might not represent the commission’s true goals, due to the county’s model of cooperation with law enforcement. Further research and understanding of the model might be necessary.

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Missing Research • Description, comparison, and analysis of the Berkeley model for the crisis line and mobile crisis team. • Several counties, with an access line, have not responded to calls and emails for an interview. These

counties are: San Luis Obispo, Imperial, Sacramento, Santa Barbara, Ventura.

Further Information Needed • Gathering of specific details for prioritized county models are needed. If available, day to day data is

necessary, to further understand how specific crisis line and mobile crisis team models operate. For example, in the crisis line model: how many calls are received per day, what is the average length/ time range of calls, what percentage of those calls lead to some form of service being utilized (MCT, next day appointment, 911 dispatch). For example, in the mobile crisis team model: how many field responses are there in a day, what is the average length/ time range of a response, how long do officers vs. MH specialists stay, what percentage of responses are done by law enforcement only, joint response, or only the mobile crisis team.

• Details on the pay of staff, is necessary, including the salary of police officers and mental health specialists. • Information on budget of the program for both crisis lines and mobile crisis team is needed for all counties

(most counties interviewed were not aware of the answer for the budget question, in a detailed way).

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