County to Improve Psychiatric Care for People in Criminal Justice System

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The County Board of Supervisors today voted to direct the County, the District Attorney and the Sheriff to develop a plan to strengthen the County’s ability to help people with mental health issues and substance abuse, both of which intersect with the criminal justice system.

The Board also got the first quarterly update on advancing the behavioral health continuum of care through regional collaboration and innovation.

During Chairwoman Dianne Jacob’s State of the County Address in February, she called for action on three proposed solutions for the critical needs of people who suffer from mental illness and cycle through the criminal justice system.

The goal is to respond to behavioral health crisis situations in the criminal justice system by implementing the following three objectives:

  • Develop a timely, follow-up care and case management system for people involved in a Psychiatric Emergency Response Team (PERT) /law enforcement crisis call. PERT pairs a licensed mental health clinician with a specially trained Sheriff’s deputy or police officer. Together, the pair responds to emergency calls where mental illness could be a factor.
  • Establish regional Mental Health Crisis Stabilization Centers that can provide 24/7 walk-in mental health and substance use disorder services, including law enforcement drop-offs.
  • Work with school districts and the County Office of Education to develop enhanced school-based crisis response, including possible expansion of existing PERT programs for threats or crisis situations involving students.

Challenges in providing those impacted by mental illness, substance abuse and homeless community with community sited care and support has contributed to their disproportionate numbers in and frequent cycling through emergency medical care and the criminal justice system.

Over the past year, District Attorney Summer Stephan has led several County-wide efforts, bringing approximately 200 stakeholders and experts together to map the intersection of mental health, homelessness and criminal justice, to better identify the problems and recommend concrete solutions.

These efforts have identified opportunities to work together to address the needs of people living with both mental illness and substance use disorders and allowed for the development of solutions to enhance systems of care for people in the local judicial system.

Similarly, Sheriff William Gore has expanded the availability of mental health services to inmates in County jails, as well as increased the quality of those services.

Intensive programming efforts have greatly reduced the likelihood of an inmate completing a local sentence to reoffend, compared to those released from state prison both before and after criminal justice realignment. Those programs include the PROGRESS program, which offers an alternative custody setting focused on community reentry, as well as vocational training, cognitive behavioral therapy, high school and college courses, and substance abuse counseling

Also, the expansion of County Psychiatric Emergency Response Teams and the universal training of all field deputies in crisis communication and de-escalation has resulted in more positive outcomes on mental health related calls for service.

Behavioral Health Continuum of Care Update

County supervisors also got the first quarterly update from County Behavioral Health Services and a contractor on how they plan to improve the continuum of care for people with mental health issues or substance abuse problems.

Supervisor Kristin Gaspar initiated a Board Conference last October with behavioral and mental health experts that looked at ways to address the entire continuum of care for people in psychiatric crisis.

Today’s presentation outlined the steps that will be taken to address shortages of psychiatric beds, overcrowded emergency department and local jails that are sometimes viewed as mental health institutions.

“We will need to take a broad and collaborative approach that involves health, human services, and public safety,” said Luke Bergmann, Director of County Behavioral Health Services. “Our work will need to address the full continuum, not accepting current practice as necessarily the best practice, but looking for any opportunity to more intelligently design the entire system that cares for behavioral health conditions, and any opportunity to prevent such conditions.”

Christian Jones from the Public Consulting Group is working with the County to lead the group’s efforts, which will include:

  • First, gather stakeholder input and learn from the experiences of people actively involved in a local behavioral health system.
  • Second, conduct research on the region and analyze data and policies that impact those with behavioral health issues, including the places where they work.
  • And finally, develop best practices and regulatory analysis.

“Our work will focus on improving overall population health,” Jones said. “Not just the folks who come to our doors looking for help, but the folks who would, in the future, need a lot more help if we didn’t give them some support now.”

The overarching objective is to optimize efforts to improve the behavioral health of all county residents, one of the goals of Live Well San Diego, the County’s vision for healthy, safe and thriving communities.

Since the Board Conference in October, County Behavioral Health Services has already established 67 long-term residential Institutions for Mental Disease beds and is in contract for another 56 psychiatric beds, pending licensure.

Those new beds have already reduced wait list for psychiatric beds by 69 percent and decreased the waitlist for placement in acute psychiatric hospitals by 58 percent.


José A. Álvarez is a communications specialist with the County of San Diego Communications Office. Contact