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Health and Human Services Agency, Mental Health Division, recommending the Board adopt and authorize the Chair to sign Resolution 083-2015 designating specified professional personnel working at the Barton Healthcare System and Marshall Medical Center, pursuant to the Welfare and Institutions Code Sections 5150(a) and 5585.50(a), the authority to perform evaluations, and write and/or release involuntary psychiatric holds of adults and minors.
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DEPARTMENT RECOMMENDATION
Health and Human Services Agency, Mental Health Division (HHSA) recommending the Board adopt a resolution designating specified professional personnel working at the Barton Healthcare System and Marshall Medical Center to perform evaluations and write and/or release involuntary psychiatric holds of adults and minors pursuant to Welfare and Institutions Code (WIC) 5150(a) and 5585.50(a).
For purposes of this resolution, specified professional personnel includes the following classes of persons as “other professional persons” under WIC 5150(a) and 5585.50(a): Physicians, Psychiatrists, licensed Psychologists, Licensed Clinical Social Workers, and Marriage and Family Therapists working for Marshall Medical Center or Barton Healthcare System while on duty at said facility.
HHSA anticipates proactive and more efficient services to shared clients, a reduction in wait times for clients and families, a safer environment within the Emergency Department (ED) and a positive collaboration between the County Mental Health Division (MH) and hospitals in addressing the needs within the community as a result the changes herein. Under this Resolution, decisions regarding hospitalization, potential placement and treatment options will continue to reside with Mental Health clinical staff.
DISCUSSION / BACKGROUND
As of November 4, 2014, the County of El Dorado Board of Supervisors approved Resolution No. 195-2014 delegating to the HHSA Mental Health Director, the authority to carry out the responsibilities and functions of the Board with respect to the Psychiatric Health Facility, the Adult System of Care, and the Children’s System of Care (File ID 14-0517).
Historically, either peace officers or clinical staff of the MH have held the responsibility for upholding WIC 5150 (a) for adults and 5185.50 (a) for minors. A “5150 hold” is an involuntary hold of an individual who, as a result of a mental health disorder, is a danger to self or others or is gravely disabled. The current practice requires the MH crisis or outpatient services team to evaluate an individual and write and/or release the hold providing the authority to detain or discharge the individual for further evaluation and potential treatment. Individuals are typically transported to either Barton or Marshall Hospital ED for medical clearance and are then evaluated by the Mental Health staff.
MH has historically utilized various approaches in its response to the realities of staffing and cost limitations in their provision of professional and appropriate coverage for crisis response services. In December, 2014 MH discontinued provision of crisis response services between the hours of Midnight and 8 a.m. As such, individuals currently may wait in the ED until the next morning for evaluation and/or for holds to be written or released. Without the 5150 hold, the ED has no legal authority to detain an individual who may meet the criteria and be in need of emergency psychiatric care and treatment, nor do they have the ability to release an individual who may no longer need to be in the ED.
Hospital physicians have requested the ability to conduct evaluations and write and/or release holds, thus providing the needed legal authority pursuant to WIC. All specified professional personnel working at the Barton Healthcare System and Marshall Medical Center designated by the County will attend and complete both an initial training and certification process, as well as annual recertification training as determined by HHSA.
ALTERNATIVES
Should the Board decline to adopt the subject Resolution, the current practice of holding individuals at the respective hospital ED until Mental Health staff are available to evaluate the individual and write and/or release a hold would continue and potentially result in longer wait times for clients to receive needed services and continued safety concerns for clients and hospital personnel.
OTHER DEPARTMENT / AGENCY INVOLVEMENT
County Counsel and Risk Management
CAO RECOMMENDATION
It is recommended that the Board approve this item if it wants to continue to give specified professional personnel at Barton Healthcare System and Marshall Medical Center the authority to perform evaluations, and write and/or release involuntary psychiatric holds of adults and minors.
FINANCIAL IMPACT
There is no Net County Cost associated with this non-financial Agenda item.
CLERK OF THE BOARD FOLLOW UP ACTIONS
Clerk of the Board to obtain signature of Chair on two (2) original Resolutions and return one (1) to the Health and Human Services Agency Contracts Unit at 3057 Briw Road.
STRATEGIC PLAN COMPONENT
Health and Human Services Agency Strategic Plan Project 3.5 (Emergency Services); Objective 3.5.5, “Identify potential opportunities and develop efficiencies for Inter-Facility Transfers to Mental Health Facilities.”
CONTACT
Don Ashton, M.P.A., Director