San Francisco Police Department Workload Estimates Related To Providing Services To The

San Francisco Police Department Workload Estimates Related To

Providing Services To The Seriously Mentally Ill Population

Bill McConnell, Ph.D. Officer Kelly Dunn Helynna Brooke

Presented t Board and o the San Francisco Mental Health

San Francisco Police Department

May, 2010

SFPD‐SMI of 19 May 2010

EXECUTIVE SUMMARY

Overall Summary

This report provides data on the actual and projected workload of the San Francisco Police Department related to providing services to the Seriously Mentally Ill (SMI) population of the City.

Individual SFPD officers have contact with an average of about 3.5 SMI individuals per day and spend at least one hour per day on these contacts.

SFPD officers combined make between 8.6 and 9.4 involuntary mental health admissions per day.

. SFPD officers combined respond to about 28.3 mental health‐related 911 calls per day

Three of the four indicators of potential police interactions related to SMI individuals predict that San Francisco would require more officer resources to work with SMI individuals than most other counties.

Detailed Summary

he dat T

a in this report are of two categories:

ata based on information developed from the actual work of SFPD officers with SMI Dindividuals (Category A).

Data about factors potentially influencing police department workloads for San Francisco compared to other California and Non‐California jurisdictions (Category B).

he ma T

in findings from the actual work of SFPD officers with SMI individuals (Category A) :

SFPD officers have an average of 3.5 contacts with SMI individuals during a typical shift, although about 1% of the officers have between 10 and 20 contacts per shift. Officers spend about one hour per shift with mentally ill persons, although 35% of the officers spend between 1 and 3 hours, and 4% spend 3 hours or more. Based on a 10‐hour shift, this means at least 10% of all police field time is spent in this one area.

SFPD Involuntary Detentions (5150s): SFPD officers place an estimated 3,372 individuals on involuntary holds per year ‐ 281 per month or 9.4 per day. Southern, Mission and Tenderloin Districts handle about twice as many 5150s as the other districts. 92.2% of the individuals placed on 5150s are dangerous to themselves and 38.8% are dangerous to others. This means SFPD officers 5150 between 3 and 4 individuals per day who are judged to be dangerous to others.


SFPD Involuntary Admissions to Psychiatric Emergency Services: SFPD officers are involved in an estimated 3,108 involuntary admissions to Psychiatric Emergency Services every year ‐ 259 per month or 8.6 per day. This and the previous estimate are similar even though they are somewhat different kinds of estimates and involve different time periods.

SFPD Responses to Mental Health‐Related 911 Calls: SFPD responds to approximately 10,200 mental health‐related 911 calls per year ‐ 850 per month or 28.3 per day. About 26% of these calls (7.4 per day) result in a 5150

The main findings from factors potentially influencing SFPD workloads (Category B): hese indicators are standardized across counties by converting the indicator data into rates per T10,000 population. These potential workload indicators vary in how directly they are related to police workload and therefore their usefulness in predicting potential workloads. In terms of usefulness based on the irectness of their relationship to police workload, these indicators are from most to least useful: 1‐150 rad5

tes, 2‐homeless rates, 3‐SMI need rates, 4‐suicide rates.

5150 Rates per 10,000 Population: Alameda, San Francisco and Sacramento counties had similar rates for total county 5150s. The rates for these three counties are about double the rates for most of the other counties. Based on this data the police departments in these counties would be expected to expend twice the police resources of other California counties in carrying out 5150s, assuming the police are involved in about the same proportion of 5150s in all the counties.

Homeless Rates per 10,000 Population: San Francisco has the highest homeless rate among California counties by about a 50% margin, and San Francisco’s rate is about 20% higher than the highest of the non‐California counties. Assuming the homeless rate is a reasonable indicator of potential police effort, this data predicts that San Francisco would expend somewhere between 20% and 50% more effort than other comparable counties.

Mental Health Service Need Rates per 10,000 Population: There are no outstanding rate differences among a variety of California and non‐California counties in terms of SMI individuals in the population in need of mental health services. San Francisco and Alameda rates are relatively low compared to other counties whereas the Sacramento rate is among the higher rates. This data alone would predict relatively lower SMI‐related police effort for an Francisco. However, these estimated rates do not take into account county‐specific Sissues which influence these rates.

Suicide Rates per 10,000 Population: San Francisco has the third highest rate suicide rate among selected California and Non‐California counties. Based on this data, more police resources would be predicted for San Francisco than most other counties. Although there is no direct evidence, the suicide rate may be particularly relevant for Officer‐Involved‐Shootings (OIS). A higher suicide rate in a jurisdiction might increase the likelihood of OISs as a function of suicide‐by‐cop.


INTRODUCTION

The police are the frontline professionals responsible for a large proportion of the management of Seriously Mentally Ill (SMI) persons when they are in crisis. Lamb, Weinberger and DeCuir (2002) have pointed out that “ . . . two common‐law principles provide the rationale for the police to take responsibility for persons with mental illness: their power and authority to protect the safety and elfare of the community, and their parens patriae obligation to protect individuals with w

disabilities.” In spite of the major role played by the police in the management of SMI individuals, a search of the iterature revealed no studies which attempted to quantify the amount of police time that is lexpended on this major police activity. This report provides data on the actual and projected workload of the San Francisco Police Department related to providing services to the Seriously Mentally Ill (SMI) population of the City. In general, Serious Mentally Illness (SMI) in this report is defined as having a diagnosable mental, behavioral, or emotional disorder that meets criteria as defined by the American Psychiatric ssociation (1994) and results in functional impairment that substantially interferes with or limits Aone or more major life activities.

hese d T

ata are provided in two categories:

ategory A contains data based on information developed from the actual work of SFPD Cofficers with SMI individuals.

Category B contains information about factors potentially influencing police department workloads for San Francisco compared to other California and Non‐California jurisdictions.

RESULTS

CATEGORY A: SFPD Workload Related to SMI Individuals 1. Second Follow‐Up Evaluation of the San Francisco Police Department Crisis Intervention

Training (PCIT). [McConnell and Pirkle, 2009]

The first source of workload data comes from the second follow‐up evaluation of the PCIT. This follow‐up evaluation included a mail‐in survey sent to all 617 officers trained in the 24 trainings between May, 2001 and January, 2008. The goal of this follow‐up questionnaire was to further assess the long‐term effects of the training and to identify areas for improvement. The survey ontained several questions about the number and characteristics of officers contact with SMI cindividuals. SFPD officers have an average of 3.5 contacts with SMI individuals during a typical shift, although about 1% of the officers have between 10 and 20 contacts per shift. Officers spend about one hour


per shift with mentally ill persons, although 35% of the officers spend between 1 and 3 hours, and % spend 3 hours or more. Based on a 10‐hour shift, this means at least 10% of all police field time 4is spent in this one area. The full report of the Second Follow‐Up Evaluation of the San Francisco Police Department Crisis Intervention Training contains much additional information about officer contacts with mentally ill individuals

2. W & I Code § 5150) by San Francisco

s Evaluation, December, 2009. Involuntary Detentions for Mental Health Evaluation (olice Officers: Phase I of the Dore Urgent Care ProcesP[McConnell, W., Haley, M., Dunn, K., Brooke, H., 2009]

This second source of workload data comes from a study of all 5150s performed by SFPD officers between January 1, 2009 and March 31, 2009.

The data analysis of these 5150 incidents identified 843 separate incidents involving 638 individuals. Most individuals (78.7%) had only one incident in the study period clearly showing that most of the 5150s involved a single incident per person.

Analyzing the 843 separate 5150s by police district shows that 5150s are not evenly distributed among the districts, Southern, Mission and Tenderloin handle 19.1%, 16.5% and 13.4% of the 5150s, respectively. The average percentage handled by the other districts is 7.1%, so these three districts handle about twice as many 5150s as the other districts.

The 843 separate 5150 incidents were also analyzed by reason for the 5150‐‐Danger to Self and/or Danger to Others (See table below). While 92.9% of the incidents involved people who were judged to be a danger to themselves, 35.4% of these same people were also judged to be a danger to others. Of the small percentage judged not be a danger to themselves (7.1%), 83.3% were perceived as being dangerous to others. Overall, 38.8% (327 of 843) of the incidents involved people who were dangerous to others which certainly includes the police officers.

Based on this data, officers 5150 about 280 individuals per month (9 to 10 per day) who present a potential for a serious negative outcome such as such as suicide or suicide‐by‐cop for those who are a danger to themselves. For those who are a danger to others, there are additional risks for officers such as injury and the potential for an officer‐involved‐shooting.

The full report of the Involuntary Detentions for Mental Health Evaluation (W & I Code § 5150) by San Francisco Police Officers contains much additional information about 5150s performed by SFPD officers.

% Danger to Self Yes

Danger to Others Total


% No % Number Yes 277 35.4% 506 64.6% 783 92.9% No

Total 50 83.3% 10 16.7% 60 7.1%

100.0% 327 516 84338.8% 61.2%

Incidents by Danger to Self and Danger to Others


3. Involuntary Admissions to Psychiatric Emergency Services: Role of the San Francisco Police Department and Mental Health Board Training. [Kessell, E, Shumway, M., Unick, G., 2005]

In 2005, a study found there were about 1,760 admissions at San Francisco General Hospital Psychiatric Emergency Service between January 1, 2005 and March 30, 2005. Clinical records were located and abstracted for 1,580 (90%) of these admissions. The study also utilized SFPD dispatch data for the period January‐March, 2001‐2003. Dispatch data for the matching period was not available.

Of the 1,580 admissions, 1321 (83.6%) were involuntary admissions that met 5150 criteria. Of the 1,321 admissions, 56 involved a law enforcement officer from a non‐SFPD authority. Of the remaining 1,265 admissions, 668 (52.8%) involved the SFPD.

Analysis of the 911 dispatch records for the first three months of 2001, 2002 and 2003 showed an average of approximately 2,550 mental‐health‐related calls for the three 3‐month periods. Extrapolating this number to 2005 means the SFPD responded to about 2,550 mental‐health‐related 911 calls in the study period. Taken together this means that only 668 (about 26%) of the 2,550 calls result in a 5150.

CATEGORY B: Factors Influencing Police Department Work Loads for San Francisco and Other California and NonCalifornia Jurisdictions.

The following four indicators are presumed to have an impact on the workload of police epartments related to providing services to SMI individuals. These indicators are standardized dacross counties by converting the indicator data into rates per 10,000 population. These potential workload indicators vary in how directly they are related to police department workloads and therefore their usefulness in predicting potential workloads. In terms of usefulness based on the directness of their relationship to police workload these indicators are listed below, in escending order, from most to least useful, along with bullet points explaining their ranking. This

indicators. dis followed by the results for each of the four Category B Indicator Rankings of Usefulness First: The 5150 rate data is the most useful measure of probable police workload and time becaus

data reflects a specific need ‐ SMI who are a danger to themselves or a danger to others in

e:

the community and to which the police must respond;

data involves an identifiable sub‐population ‐ the SMI who are a danger to themselves or others; and

the police are directly involved in providing a substantial proportion of this needed service as seen in the workload data presented above.


Second: The homeless rate data is second in usefulness because:

data reflects a specific need ‐ the homeless population that is SMI;

(Overall, 26% of the sheltered homeless population are SMI [US Department of Housing and Urban Development, 2009, Chapter 2, p. 17.])

data involves an identifiable sub‐population ‐ the part of the homeless population who are SMI; and

estimating the potential involvement of the police is more tenuous than for 5150 rate data due to the absence of any specific data relating homelessness to police workload.

(However, in a 2005 study McNeil, et.al. found that homeless individuals accounted for “ ...30% of the service episodes in San Francisco General Hospital Psychiatric Emergency Services and were more likely than other emergency service patients to have multiple episodes of service. . . and . . . eight percent of the homeless had exhibited

service.”) violent behavior in the two weeks before visiting the emergency

Third: The SMI mental health need rate data is third in usefulness because:

MI population; data reflects only a general need that exists in the whole S

data does not have an easily identifiable sub‐population;

there is no basis for estimating the level of police involvement due to a lack of data; and

data does not take into account certain factors which may increase the number of SMI in the population such as any “magnet city effect,” the relative availability of services, a county’s tolerance for deviant behavior, etc.

these factors.) (The 5150 rates and the homeless data are more likely to reflect

Fourth: The suicide rate data is the least

useful of these indicators because:

data reflects only a general need;

data does not have an easily identifiable sub‐population;

there is no basis for estimating the level of police involvement due to a lack of data;

the influence of the suicide rate on police workload would be mediated by a number of other factors such as the availability of other intervention services; and

the absolute number of suicides is relatively small and would therefore have minimal olice work loads. impact of p

Category B Results

1. California Involuntary Detention Rates for Adult 72‐Hour Evaluation and Treatment ] (§ 5150), County and Statewide for 1990‐2007. [California Department of Mental Health, 2010

Chart 1 shows the 5150 rates per 10,000 population for a number of selected California counties. The data that supports this table is in Appendix 1. Although not shown in this data, Alameda and San Francisco counties have had the two highest rates going back as far as 1979‐80. The Sacramento rate has increased dramatically since 1996‐97. The Alameda rate has continued to increase since 2001‐02.

Alameda, San Francisco and Sacramento had similar rates from 2002‐03 through 2006‐07, the latest year for which data is available. The rates for these three counties are about double the rates of most of the other counties. Based on the level of 5150 activity the police departments in these counties would be expected to utilize double the number of police hours of other California counties n carrying out 5150s, assuming the police are involved in about the same proportion of 5150s in all he counties. it

0.00

20.00

40.00

60.00

80.00

100.00

120.00

140.00

160.00

Per 10,000

Chart 1: 72 Hour Adult Evaluation and Treatment RatesPer 10,000 Adult Population by County

Alameda

Contra Costa

Los Angeles

Orange

Sacramento

San Diego

San Francisco

San Mateo

Santa Clara

Continuum of Care Point‐in‐Time Sheltered and Unsheltered Homeless Cou2. nts for 2008. [US Department of Housing and Urban Development, 2009, Appendix C‐3]

Chart 2 shows the Sheltered and Non‐Sheltered homeless rates per 10,000 population produced by HUD for selected California and Non‐California communities. The data that supports Chart 2 is in ppendix 2, including the appropriate population data. The 2008 data was used because it is the A

most recent available in the 2008 Annual Homeless Assessment Report to Congress. San Francisco has the highest homeless rate among California counties by about a 50% margin. San Francisco’s rate is about 20% higher than the highest of the non‐California counties. Assuming the homeless rate is a reasonable indicator of potential police workload, this data would predict that an Francisco would expend somewhere between 20% and 50% more police staff hours than other omparable counties. Sc


32.81

39.45

16.7712.12

18.7613.67

63.92

25.23

40.82 38.61

25.47

54.84

47.47 45.35

Chart 2: Sheltered and NonSheltered Homeless CountPer 10,000 Population in 2008

3. Collaborative Psychiatric Epidemiology Surveys (CPES) Estimates of Need for Mental Health ervices for Selected California and Non‐California Counties. [C. Holzer, personal Scommunication, April 6, 2010]

Chart 3 shows the estimated mental health service need in each county per 10,000 population for 2007, which is the latest year for which comparable data are available for all the selected counties. The data that supports Chart 3 is in Appendix 3, including the appropriate population data. California counties are identified, but non‐California counties are not because this information is privileged. The non‐identified counties are medium to large counties in the Northeast, Midwest, and Northwest.

The estimates of need for mental health services in Chart 3 were supplied courtesy of Charles Holzer III, Ph.D. Dr. Holzer considers these estimates to be the best overall estimate of SMI individuals in a population in need of mental health services at the current time. The Holzer estimates of need are based on an indirect needs assessment method which uses average estimates of need for persons of a particular type and applies those estimates to other people of that type in other locations. The detailed description of the methodology used by Holzer is in Appendix 3 following the data table. Chart 3 shows there are no outstanding rate differences among the counties used for this comparison. San Francisco and Alameda rates are relatively low compared to other counties whereas the Sacramento rate is among the higher rates. This data alone would predict relatively lower SMI‐related police workload for San Francisco


These data are somewhat at odds with the 5150 rate data in Chart 1, suggesting that the two sets of data are possibly measuring two unrelated phenomena. The Chart 3 estimates based on the indirect needs assessment method suffer from the weakness of not being able to take into account unique characteristics of a location. Consequently, the estimates do not take into account certain factors which may increase the number of SMI in the population such as any “magnet city effect,” the elative availability of services, a county’s tolerance for deviant behavior, etc. The 5150 rates and rthe homeless rates are more likely to reflect these factors. The 5150 rates are also more important to potential police hours and staffing since these rates easure m actual mental health‐related service need rather than potential need based on SMI ndi iduals in the population. i

v


. Suicide Rates Per for Selected California and Non‐California Counties for 2006. [Centers for 4

624

Chart 3: Estimated Need of Mental Health Services

555 536 535 550

461 450 440

503

426 461

404 393383 383

Per 10,000 Population by County in 2007

Disease Control and Prevention, 2010] Chart 4 shows the suicide rates per 10,000 population of selected California and Non‐California counties. The data that supports this chart is in Appendix 4. Sacramento and Marin (which is inflated by Golden Gate Bridge suicides) have the highest suicide rates and the San Francisco rate is the third highest. Based on this data, more police effort would be predicted for San Francisco than most other counties. Also, the suicide rate may be particularly relevant for Officer‐Involved‐Shootings (OIS) because a higher suicide rate in a jurisdiction might increase the likelihood of OISs as a function of suicide‐by‐cop.

Chart 4: Suicide Rates per 10,000 Population for Selected California and Non‐

1.61.4

1.21.0


0.6 0.8 0.7 0.9 1.4

1.0 1.1

0.7 0.7

1.41.2

0.60.9 1.0 1.1

0.8

0.60.4

0.2

0.0

California Counties for 2006


SUMMARY

Below are summary tables for the two categories of data presented in the report. Each table provides a concise summary of each source in that category as well as some projections and conclusions based on the data presented.

Summary for Category A: SFPD Workload Related to Severely Mentally Ill Individuals

Source No.

Source Title

Summary

A‐1 Second PCIT Follow‐Up Evaluation

Contacts with SMI per shift Number: Range = 1 to 20 Average = 3.5

Time: Range = <1 to 3+ hours Average = 1 hour for 3.5

contacts

A‐2 Involuntary Detentions (5150’s) by SFPD in 3 months

Num ividuals = 638ber of detentions = 843 Number of Ind Percent with only 1 detention = 78.7%

Percent dangerous to self = 92.9%

Percent dangerous to others = 38.8%

Projected detentions assuming the same proportions: Per year = 3,372 Per month = 281 Per day = 9.4

d Tenderloin Districts handle about twice Southern, Mission anas many 5150s as the other districts

A‐3 Involuntary Admissions to PES (5150’s) and 911 Mental‐Health Related Calls in 3 Months

Involuntary Admissions Total = 1,760 Clinical records Involuntary admissions based

available = 1,580 (89.8%) on records = 1,321 (83.6%) SFPD involved = 668 (52.8%)

ionPro sjections for total 1,760 admissions assuming same proport

hs Involuntary admissions = 1,760 x 83.6% = 1,471 in 3 mont SFPD involved = 1,471 x 52.8% = 777 in 3 months (This is reasonably close to the 843 detentions in A‐2.) jected detentions assuming the same proportions:Pro

= 259 Per day = 8.6 Per year = 3,108 Per month 911 Mental‐Health Related Calls

Total = 2,550 (of which 668 resulted in a 5150) Projected 911 calls assuming the same proportions:

Per year = 10,200 Per month = 850 Per day = 28.3

In summary:

Individual SFPD officers have contact with an average of about 3.5 SMI individuals per day and spend about one hour per day on these contacts.

SFPD officers combined make between 9.4 and 8.6 involuntary admissions per day.

SFPD officers combined respond to about 28.3 mental health‐related 911 calls per day.

Summary for Category B: Factors Potentially Influencing Police Department Work Loads for San Francisco and Other California and NonCalifornia Jurisdictions.

This table is a summary of the source number and title from the text in columns 1 and 2. Column 3 is an estimate of the usefulness of that data for projecting police workload and column 4 is an estimate of the projected SFPD workload, both based on the explanation in the text of the report.

In summary: Three of the four indicators of potential police workload related to SMI individuals redict that San Francisco would be required to expend more resources on staffing and training han most other counties. pt

Source No.

Source Title

Usefulness

for Estimating Police

Workload

Findings for San Francisco

Projected Police Workload for San

Francisco

B‐1

California

ry Rates

InvoluntaDetention(5150’s)

High

OUBLE THE RATES in D

other California counties Alameda and Sacramento re also double a

DOUBLE other counties for San Francisco, Alameda, Sacramento

B‐2

Homeless Rates

Medium to High

Very High

Very High

B‐3

SMI Need Rates

Medium

Marginally Lower

Marginally Lower

B‐4

Suicide Rates

Low

High

High

CONCLUSION

This report has documented in some detail the amount of time the San Francisco Police Department spends providing services to the SMI population. Based on this information it would be beneficial to the police department and the City as a whole to make every effort to ensure that this considerable amount of time spent interacting with the SMI population is maximally efficient and effective.



REFERENCES

merican Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders A

(DSM‐IV). Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File 1999‐2006. CDC WONDER On‐line Database compiled from Compressed Mortality ile 1999‐2006 Series 20 No. 2L, 2009. Accessed at http://wonder.cdc.gov/cmf‐icd10.html on Apr F4, 2010 3:20:01 PM. California Department of Mental Health. (1990‐2007). Statistics and Data Analysis: Involuntary etention Reports. Retrieved March 30, 2010 from D http://www.dmh.ca.gov/Statistics_and_Data_

Analysis/Involuntary_Detention.asp. California Department of Mental Health. Series P5 Estimates of Need for Mental Health Services For California for Serious Mental Illness (wsmi01) for 2007, Index for Population, all ages. CPES (Draft 0OCT08):w1xmhm2asq_3 for California for 2007. Retrieved March 30, 2010 from 3http://www.dmh.ca.gov/Statistics_and_Data_Analysis/Total_Population_by_County.asp. Goldsmith, H.F., Lin, E., Bell, R.A, and Jackson, D.J. (Eds.) (1988) National Institute of Mental Health, eries BN No.9, S Needs Assessment: Its Future, DHHS Pub. No. (ADM) 88‐1550. Washington D.C.: Supt. of Docs., U.S. Govt. Print. Off. olzer, C. and Nguyen, H. Estimation of Need for Mental Health Services. Chapters 1‐3. Retrieved H

April 22, 2010 from http://Charles.Holzer.com. essell, E., Shumway, M., Unick, G. Involuntary Admissions to Psychiatric Emergency Services: Role K

of the San Francisco Police Department and Mental Health Board Training, June, 2006. amb, H. R., Weinberger, L. E. and DeCuir, W. J. (2002). The police and mental health. L Psychiatric Services, 53, 1266‐1271. McConnell, W. and Pirkle, E. The San Francisco Police Department Crisis Intervention Training: eport on the Second Follow‐Up Evaluation. Submitted to the San Francisco Mental Health Board Rand the San Francisco Police Department, January, 2009. McConnell, W., Haley, Michele Lyn, Dunn, K., Brooke, H. Involuntary Detentions for Mental Health valuation (W & I Code §§ E 55115500)) bbyy San Francisco Police Officers: Phase I of the Dore Urgent Care Process Evaluation, December, 2009. cNeil, D. E., and Binder, R. L. (2005). Psychiatric emergency service use and homelessness, mental M

disorder, and violence, Psychiatric Services, 56, 699‐704 US Department of Housing and Urban Development, Office of Community Planning and Development. (2009). The 2008 Annual Homeless Assessment Report to Congress. Washington, D.C.: Author.

http://www.dmh.ca.gov/Statistics_and_Data_ Analysis/Involuntary_Detention.asp

http://www.dmh.ca.gov/Statistics_and_Data_Analysis/Total_Population_by_County.asp





APPENDICES

Appendix 1: California Involuntary Detention (5150) Count and Rate Table by Fiscal Year (Rates are per 10,000 population using the population numbers appropriate for hat year.) t


County Number Rates Number Rates Number Rates Number Rates Number Rates Number RatesAlameda 8,315 87.40 8,043 81.40 8,567 85.70 7,600 75.60 7953 78.50 8,303 82.70Contra Costa 2,027 35.00 2,475 40.10 2,726 43.20 2,857 44.50 3245 49.80 3,030 47.10Los Angeles 22,160 36.50 22,737 34.40 24,494 36.70 27,367 40.70 31065 45.80 34,579 51.70Orange 6,172 35.80 5,987 32.20 7,354 38.80 6,799 35.30 7336 37.50 8,226 43.00Sacramento 3,966 53.90 2,531 31.70 3,235 39.70 3,412 41.10 3527 41.70 4,061 50.50San Diego 4,077 22.60 3,951 20.40 4,382 22.30 5,032 25.20 5723 28.30 6,240 31.90San Francisco 6,136 96.50 6,923 112.70 6,113 98.00 8,002 128.20 7857 126.00 8,623 140.40San Mateo 2,442 49.30 2,448 47.40 2,799 53.20 2,954 55.60 2848 53.10 2,685 51.00Santa Clara 2,390 21.40 2,050 17.80 1,718 14.70 2,387 20.20 2120 17.80 2,153 18.00

County Number Rates Number Rates Number Rates Number Rates Number Rates Number RatesAlameda 10,484 103.30 10,095 97.50 9,908 94.20 8,759 82.00 9,218 85.10 3,036 27.60Contra Costa 3,167 48.70 3,067 46.20 2,993 44.20 3,078 44.80 3,051 43.90 3,462 49.10Los Angeles 38,136 56.90 39,866 58.90 40,098 58.80 39,175 56.90 45,753 66.20 50,438 72.10Orange 8,565 44.50 8,606 44.00 8,590 43.50 8,709 43.50 9,284 45.80 9,105 44.40Sacramento 4,569 56.20 5,682 69.00 6,715 80.10 7,788 90.90 9,013 103.10 9,352 104.80San Diego 6,986 35.50 6,951 34.60 6,787 33.10 7,423 35.50 7,578 35.60 8,405 38.70San Francisco 9,317 149.00 9,261 146.70 9,039 142.20 8,626 135.20 8,451 132.30 7,360 115.10San Mateo 2,463 46.40 2,181 40.40 1,931 35.30 1,636 29.50 1,186 21.10 1,669 29.20Santa Clara 2,377 19.50 2,895 23.40 3,011 23.90 3,721 29.10 3,867 29.70 3,417 25.80

County Number Rates Number Rates Number Rates Number Rates Number RatesAlameda 10,330 92.60 11,834 104.50 12,683 110.50 13,995 118.50 14,575 127.10Contra Costa 3,605 50.50 3,488 48.10 4,008 54.60 3,903 50.70 3,960 51.10Los Angeles 51,613 73.20 52,137 73.40 48,401 67.70 47,294 64.40 44,306 59.90Orange 9,434 45.50 10,068 48.00 9,822 46.30 8,058 35.50 8,770 38.50Sacramento 9,262 101.80 9,812 105.70 10,408 110.00 10,715 104.40 10,832 106.80San Diego 8,642 39.00 9,131 40.50 9,460 41.40 8,780 37.30 8,828 38.80San Francisco 7,552 118.10 7,446 116.40 8,504 133.10 7,438 110.50 7,298 106.20San Mateo 2,234 38.50 1,887 32.20 2,035 34.40 2,118 38.00 1,727 30.70Santa Clara 3,862 28.70 4,494 32.80 4,294 30.80 3,626 27.60 2,858 21.50

1995-96

1996-97 1997-98 1998-99 1999-2000

1990-91 1991-92 1992-93 1993-94 1994-95

2000-01 2001-02

2006-072002-03 2003-04 2004-05 2005-06

Appendix 2: Sheltered and NonSheltered Homeless Counts and Total Rates Per 10,000 Population for 2008.

California Counties Sheltered Unsheltered Total Population Per 10,000Oakland/Alameda County Coc 2,342 2,496 4,838 1,474,368 32.81Richmond/Contra Costa County 903 3,159 4,062 1,029,703 39.45Los Angeles City and County CoC 11,442 5,101 16,543 9,862,049 16.77Santa Ana/Anaheim/Orange County Coc 2,578 1,071 3,649 3,010,759 12.12Sacramento City & County CoC 1,349 1,266 2,615 1,394,154 18.76San Diego County CoC 1,799 2,302 4,101 3,001,072 13.67San Francisco CoC 2,400 2,771 5,171 808,976 63.92Daly City/San Mateo County 704 1,094 1,798 712,690 25.23San Jose/Santa Clara City & County 2,101 5,101 7,202 1,764,499 40.82

Counties Outside California Sheltered Unsheltered Total Population Per 10,000County A 2,371 662 3,033 785,618 38.61County B 5,415 1,801 7,216 2,833,321 25.47County C 2,284 1,634 3,918 714,567 54.83County D 6,414 457 6,871 1,447,395 47.47County ECounty F 5,808 2,693 8,501 1,875,519 45.33

Not Available

Count for 2008

Count for 2008


Appendix 3: Estimated Number of Cases, Population and Percentage of the Population in Need of Mental Health Services for Selected California and NonCalifornia Counties in 2007.

California Counties No. of Cases Population Per 10,000Alameda 64,361 1,464,202 440Contra Costa 43,487 1,019,640 426Los Angeles 529,580 9,878,554 536Orange 138,272 2,997,033 461Sacramento 74,153 1,386,667 535San Diego 149,695 2,974,859 503San Francisco 30,929 764,976 404San Mateo 27,081 706,984 383Santa Clara 68,719 1,748,976 393

Counties Outside California No. of Cases Population Per 10,000County A 36,369 788,994 461County B 27,081 5,294,664 51County C 38,603 701,986 550County D 90,453 1,449,634 624County E 39,609 713,049 555


County F 83,627 1,859,284 450

2007 Prevalence Rates

2007 Prevalence Rates

Holzer Indirect Estimation Methodology

The Holzer estimates of need are based on an indirect needs assessment method. Goldsmith (1988) described the difference between direct and indirect assessment methods. Direct methods presume that data about need are collected in the location for which estimates are required—typically through an appropriate local survey. Unfortunately, there are few mental illness prevalence surveys of states and counties that provide direct estimates of need. The only other option is to use an indirect estimation method. In the indirect estimation method used by Holzer a direct estimate available for one population is applied to a different population.

The basic assumption underlying indirect needs assessment is that demographic characteristics have a consistent general relationship to psychiatric disorder throughout the U.S. That is, persons with particular demographic characteristics are more likely than others to need mental health services, regardless of where they live. Therefore, average estimates of need for persons of a particular type are applied to other people of that type in other locations. This approach assumes that demographic variation is more important than geographic variation. In this approach, estimates are made for specific demographic subgroups and then the estimates are summed across all demographic subgroups to produce an overall estimate of the numbers of people in need of mental health services.

While this basic idea behind indirect estimation of need is a simple one, the actual procedures for indirect estimation are complex. The details of the method can be found on the Holzer website (http://Charles.Holzer.com).

http://charles.holzer.com/

Appendix 4: Suicide Deaths and Rates Per 10,000 Population for Selected California and NonCalifornia Counties for 2006.

CountyNo. of Deaths

Rate per 10,000

Alameda 97 0.6Contra Costa 83 0.8Los Angeles 671 0.7Orange 269 0.9Sacramento 185 1.4San Diego 290 1.0San Francisco 102 1.1San Mateo 49 0.7Santa Clara 116 0.7Marin 37 1.4Ventura 93 1.2Cook Co/ Chicago 344 0.6Baltimore Co/Baltimore 79 0.9Philadelphia 140 1.0King Co/Seattle 212 1.1

2006 Suicide Rates


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