Psychiatric Health Facility

COMMENTS

The mission of PHF "is "to provide acute psychiatric inpatient evaluation and short-term treatment, voluntary and involuntary to adults. The goal of hospitalization is to resolve the immediate crisis . . ." (Mental Health Services "Compendium of Services"). Although the PHE had attained this goal of short-term stabilization with the deceased in earlier crises, it tragically failed to do so the last time.

The Psychiatric Health Facility (P1-IF) is a mental health facility program within the Department of Mental Health (DMH) offering diagnostic and short-term treatment for patients with acute psychiatric distress. Lack of education and training among some of the treatment staff has resulted in some inconsistent assessments of patient needs. This report recommends remedies for correcting these deficiencies.

INTRODUCTION

The PHF provides acute' psychiatric inpatient evaluation and short-term treatment, voluntary. and involuntary to adults. The goal of hospitalization is to resolve the immediate crisis and arrange for the least restrictive level of care after discharge. PHF is a twelve-bed facility with two beds used for restraining aggressive or assaultive patients. Involuntary patients are referred to the facility by the courts, community hospitals, medical and psychotherapeutic practitioners. or law enforcement officers. Voluntary patients are self-referred, brought by family members or friends, or referred by private practitioners. The stated policy indicates that patients whose primary problems are drug or alcohol abuse are not accepted, nor are patients with medically acute or unstable conditions which require medical treatment.

REASON FOR INVESTIGATION

The Grand Jury investigated PHF as part of its oversight review of county government programs and in response to a citizen complaint.

PROCEDURES

Administrative and medical documents were reviewed. Employees of PHE, both the former and present DMH Patients Rights Advocates, former patients, private mental health practitioners, mental health advocacy groups and members of the legal community including law enforcement were interviewed. A site visit was made by members of the Grand Jury.

FINDINGS

1. PHF is headed by an experienced psychiatric nurse. Other personnel include a medical director, mental health technicians, aides, and on-call staff. No clinical psychologist is on the staff at PHE.

2. The Crisis Stabilization Unit (CSU), a separate program staffed and directed by PHF. was established in December 1996. This program, for voluntary patients, has less stringent admittance requirements than PHE and provides treatment for patients in acute psychiatric distress. CSU was viewed as a welcome addition to PHF by the professional mental health community. Seventy-five percent of the patients are returned home within 24 hours.

3. PHE provides good short-term stabilization of mental health patients in crisis. However. patients are often caught in a "revolving door' approach to crisis management. Discharged patients are usually given instructions to contact out-patient services or their private therapist. but patient follow-up is inadequate and discharge planning is inadequate.

4. PHF has a restrictive admissions policy that results in a reluctance to admit psychiatric patients with associated drug andlor alcohol problems. This places a burden on law enforcement, the County Department of Social Services, drug treatment programs. and families.

5 There is a lack of case management for patients who have had frequent admissions to PHF. which may result in inaccurate assumptions being made about a patient. In one instance. this led to a patient who should have been treated in a psychiatric setting being transferred into the criminal justice system.

6. The County contracts with the California Forensic Medical Group to provide psychiatric services for the Mendocino County Adult Derentior, Facility (Jail). Except for possible re'. iew at quarterly. informal quality assurance meeungs. PHF staff has no responsibility for psychiatric patients in the Jail, even if those inmates had beer'. patients at PHE.

7. In the past, the PHF unit has sometimes been reluctant to admit belligerent patients even though they are otherwise eligible for admission.

The Ukiah Police Department, which had been used to assist with violent or very aggressive patients, became reluctant to respond, so PHF contracted with Mendo-Lake, Security Patrol to fulfill this need.

8. The professional mental health community views PHE as somewhat isolated. Some mental health professionals reported that PHF does not collaborate with them regarding their patients.

9. There is no PHF for minors in this county; stay in the CSU is limited to 23 hours.

10. There is a need for family education and involvement in the treatment process and in discharge planning.

RECOMMENDATIONS

A qualified Social Worker should be assigned to PHF to provide for patients' needs at:zr discharge, including housing, out-patient treatment services, public assistance (if appropriate), and social and vocational rehabilitation. Discharge planning would reduce the "revolving door" outcome and decrease re-admissions and their subsequent costs. (See Findings 3. 5, 8, 10.)

2. PEF admissions policies should be broadly interpreted to include patients with both substance abuse and psychiatric disorders. Current practices burden other county programs which serve this population. (See Findings 4. 6, 7.)

3. PUF should contract with a clinical psychologist to assist with difficult or differential

diagnoses. A clinical psychologist has specialized training in the use of objective

psychometric testing which contributes to the accuracy of diagnosis. (See Findings 1, 4,5.)

4. The Board of Supervisors is urged to establish a PHF for children. Contracting with out-of-county treatment facilities removes the children from family and neighborhood. The County should consider the possibility of incorporating a PHF for children into the proposed emergency shelter for dependent children. (Refer to "Department of Social Services and Foster Parents," this Grand Jury Final Report.

5. All public and private facilities within the County that treat the mentally ill should form a review committee to assess each others' programs and plan for the future needs of the mentally ill in this County. This review committee should include representatives from community organizations which address the needs of the mentally ill. See Findings 3-8.)

COMMENTS

1. Mendocino County has a critical need for a psychiatric health facility; however. the management of PHF interprets its mandate so narrowly, that it leaves an underserved population of the mentally ill who have drug or alcohol problems.

2. There is a tendency for PHE to be aloof and isolated from the professional mental health community, and this tendency should be remedied by engaging that community.

RESPONSE REQUIRED

1. Mendocino County Department of Mental Health (Recommendations 1 - 5).

2. Psychiatric Health Facility Director (Recommendations 1 - 5).

3. Mendocino County Board of Supervisors (Recommendations 4. 5).

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