Jan. 7 2015 10:30 AM

Struggling to meet demand, psychiatric field-clinician program may get boost

Illustration by Lindsey Voltoline
Sources: San Diego Police Department, county Sheriff’s department, PERT

It was the third time in three days that a middle-aged man living in Lakeside called the Sheriff's Department out to his home. The neighbors, he explained, had let poisonous spiders loose in his apartment.

During the prior two nights, deputies left the scene after realizing the pernicious critters only existed in the man's imagination. However, this night, Kim Bozart was on duty. A licensed social worker, Bozart is a clinician with the Psychiatric Emergency Response Team (PERT), a county-funded program pairing trained mental-health professionals with law enforcement.

"He actually had contraptions set up all over his house," she said. "He wanted to show us ‘Here's where the poisonous spiders are,' and, of course, he lifts up a glass vase and there's nothing there. But in his mind, he was visually seeing these things."

Though Deputies previously determined the man posed no danger, Bozart recommended taking him to Sharp Grossmont Hospital for an emergency psychiatric evaluation. It turned out he was being evicted for his bizarre behavior and could have ended up homeless within weeks. If he'd run into law enforcement in that situation, he may have found himself in jail and with a criminal record. Instead, during the last few months, he's received intensive psychiatric care. With the proper treatment, he can likely manage his psychosis, Bozart said.

"He was living independently. He has had a lot of success," she said. "This is just one major setback for him."

In recent years, this type of mental-health-emergency call has increasingly inundated local law-enforcement agencies. The cause isn't precisely known, although experts speculate that it's related to the economic downturn and an influx of veterans traumatized by war.

Since 2008, the number of these kinds of calls dispatched to the San Diego Police Department and Sheriff's Department, such as suicide threats, nearly doubled to 21,125, up from 12,097. That doesn't account for incidents identified as mental-health emergencies after an officer has arrived at a scene.

At the same time, the number of mental-health-emergency calls to which PERT clinicians responded also bumped up, but not nearly fast enough to meet demand. Last year, clinicians missed out on 10,413 mental-health emergency calls, up from 7,360 in 2008.

In order to keep pace, PERT needs more clinicians, said Jim Fix, the program's executive director. For the last five years, the department has employed 23 clinicians, 15 of whom are dedicated to the San Diego Police and Sheriff's departments.

"We've kind of plateaued," he said. "We're maxed out."

While evidence of the PERT program's success is hard to quantify, county officials, at the behest of law enforcement, have recently recommended the program expand—a budget decision that ultimately rests with the county Board of Supervisors.

"I see an increase happening; to what extent is the question," said Alfredo Aguirre, the county's director of behavioral health. "But the chance of more teams coming on board is pretty high."

Having started as a pilot project in the mid-1990s at the San Diego Police Department, the PERT program also trains law enforcement to deal with mental-health emergencies. Police cadets receive seven hours of training on mental illness. However, officers must choose to attend a three-day course if they want to be paired with a PERT clinician.

During the last five years, only 227 of the city's police officers have attended the training, according to the department. The police force is more than 1,800 officers strong, and Lt. Debra Farrar, who oversees the training program, would like to see participation increase.

"In my opinion, it should be mandatory, because it's just so much of what we do on a daily basis," the 27-year veteran said. "Part of being able to do your job is being able to effectively deal with these calls that we get.

"The average officer needs to be better educated," she added. "I think most police officers come into the department thinking, I'm going to be catching bad guys. I don't think they realize how much of these mental-health calls we're responding to."

In large part, the PERT program started in response to a string of incidents in the early '90s involving deadly force by law enforcement, Farrar said. However, while clinicians can help deescalate volatile situations, the program's impact is usually more subtle.

Retired 32-year veteran John Reese, one of the department's first PERT-trained officers, remembers what it was like before the program: "If they were involved in a crime and they were being arrested, it was kind of disregarded that they were mentally ill," he said.

"We wanted to bridge this gap and reach out and help these people, you know, not incarcerate them," he added. "If they needed help, we would take them to a hospital, not to jail."

While paired with an officer in the field, a PERT clinician not only identifies mentally ill individuals but also makes sure a person is transported to a psychiatric facility that takes his or her insurance, giving preference to facilities where individuals have a history of care. The clinician can also recommend out-patient care if the situation is determined to be less severe.

"The PERT teams and all law enforcement now are really looking at all the different variables and trying to get people to the right place at the right time," Fix said.

Many systems around the country simply ignore or incarcerate the mentally ill, said John Snook, deputy executive director at the Treatment Advocacy Center in Washington, D.C.

"It should be considered a failure for you to have to treat someone when they've deteriorated to the point where they're dangerous," he said. "And right now, that's sort of the standard."

However, San Diego still incarcerates a substantial number of mentally ill people. Roughly 20 percent of inmates in jails nationwide have serious mental illness, according to a study by the Treatment Advocacy Center. Similarly, 22 percent of inmates in San Diego's jail system in 2013 reported having stayed overnight in a mental-health facility, according to the San Diego Association of Governments.

"I and all my colleagues that work in the jail like I do see a lot of mental illness in the jail," said Dr. James Dunford, the city of San Diego's medical director and a UCSD doctor. "So much of it is a failure of primary mental healthcare to move people to the treatment that they need."

Identifying those in need of treatment works only if the region provides a wide range of mental-health services, Snook said. "What we're finding is that San Diego, much like the rest of the county, has really eliminated far too many hospital beds. An individual is getting sick and they need an inpatient facility for some period of time. It just isn't available."

In recent years, mental-health services in the region have become more robust, Aguirre said, adding the main challenge today is getting people to those services using programs such as PERT.

"It really is being able to help someone navigate through the system, getting them from a place that's maybe more restrictive, whether it's jail or an inpatient facility or a street corner, to the right service," he said. 

Write to joshuas@sdcitybeat.com or follow him on twitter at @jemersmith.


See all events on Wednesday, Dec 7