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Law Enforcement's
Response to
Mental Health
Calls for Service
Law Enforcement's Response to Mental Health Calls for Service
SUMMARY
Approximately 8.8 million Americans have a severe mental illness such as schizophrenia, severe bi-polar disorder, or major depression with psychiatric features.' Almost half of these people are treated on a given day.2 Without proper treatment, people with severe mental illness are at risk of experiencing negative outcomes that seriously impact them and the people around them.
Decades ago, law enforcement officers in Orange County became mental health clinicians without proper training. While State legislation has since required police agencies to increase mental health training, Orange County law enforcement agencies have surpassed the State's expectations. The Orange County Grand Jury (OCGJ) believes that law enforcement in Orange County is a model for training law enforcement personnel on mental health crisis intervention techniques and collaborating with behavioral health organizations to improve service and reduce stigma for those affected by mental illness.
BACKGROUND
In March 2021, two Los Angeles County Sheriffs Department (LASD) deputies responded to a call regarding a deaf and autistic male adult named Isaias Cervantes who was experiencing a mental health crisis. When deputies arrived, they asked Cervantes to stand up so he could be handcuffed as a safety precaution, and the incident escalated. Cervantes became combative with the deputies, which resulted in one of the deputies shooting him in the back. Consequently, Cervantes is paralyzed and recently won a $25 rnillion settlement against the County of Los Angeles. The LASD Internal Affairs Bureau concluded that excessive force during this incident was warranted per departmental procedure, although Los Angeles County Risk Management prepared a Summary Corrective Action Plan that focused on numerous root causes for the escalation, including:
Desk personnel (i.e., dispatch) failed to ask about the nature of Cervantes' mental impairment.
Desk personnel (i.e., dispatch) failed to send the Mental Evaluation Team as part of the response.3
1 Treatment Advocacy Center, "Serious Mental Illness by the Numbers," 2022. haps:// www.treatmentadvocacycenter.org .
2 Ibid.
3 The Times Staff Editorial, "Sheriff's Shooting Cost Taxpayers $25 Million. Where's the Accountability?" Los Angeles Times, April 8, 2024.
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Orange County Grand Jury Page 1
Law Enforcement's Response to Mental Health Calls for Service The OCGJ felt it was vital to research via interviews with lav enforcement leaders, law enforcement educators, and mental health professionals how Orange County assists individuals who suffer from mental illness. It is important to note that this report does not focus on mental health issues that exist within the homeless community, although the OCGJ learned that a significant number of unhoused individuals suffer from mental illness, including substance abuse disorder, which leads to a significant number of police calls for se►vice.
METHOD OF STUDY
The OCGJ conducted thirty-one interviews. Twenty-three of these interviews involved key personnel from law enforcement agencies representing all cities and unincorporated areas in Orange County, including the police agency at the University of California, Irvine NCI). The OCGJ also interviewed representatives from the Orange County Sheriff's Regional Academy and Golden West College Police Academy, Orange County mental health stakeholders including the Orange County Health Care Agency's Mental Health and Recovery Services Department, the National Alliance on Mental Illness — Orange County Chapter (NAMI 00), and Project Kinship. In addition, the OCGJ conducted the follor✓ing tours:
• Orange County Central Jail Complex, including the Intake Release Center (IRC), Men's Jail, and Women's Jail
• Central Justice Center Holding Facility
• James A. Musick Jail (under construction)
• Theo Lacy Jail
• Yale Navigation Center and Bridges at Kraemer Place
• Orange County Juvenile Hall and Youth Leadership Academy • Be Well, Orange Campus
Members of the OCGJ attended monthly meetings of the Orange County Criminal Justice Coordinating Council (OCCJCC), which is a planning body of County government, law enforcement, courts/corrections, and social service agencies responsible for improving public safety on behalf of Orange County residents. These meetings were insightful and provided an understanding of how Orange County leaders collaborate to enhance law enforcement services.
The OCGJ also referred to previous Grand Jury reports, Peace Officer Standards and Training (POST) material, police training documents provided by the Orange County Sheriffs Regional Training Academy and Golden West College Police Academy, and local news articles and reports.
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Orange County Grand Jury Page 3
Law Enforcement's Response to Mental Health Calls for Service Learning Domains (LD). One of the topics covered is in LD 37, identifies! as People with Disabilities. It provides trainees instruction on disability laws, developmental disabilities, physical disabilities, and mental illness.9 While in the academy, recruits learn to recognize general indicators of mental illness so that appropriate actions can be taken.
The following indicators assist recruits in determining whether a behavior is related to mental illness:
• Fearfulness
O Inappropriate Behavior
• Extrerne Inflexibility and/or Frustration
• Symptoms of Excitability
• Impaired Self -Care
• Hallucinations and Delusions
• Disorganized Speech, Thought Patterns, or Disorientation • Clinical Depression
• Bipolar Disorder
• Schizophrenia
• Postpartum -Depression
• Psychosis CONFIDENTIAL
• Post-traumatic Stress Disorder (PTSD)
© Personality Disorder10
Surpe,rvi or a] ''ollce Officers
SB 29, which also went into effect on January 1, 20'16, requires police officers in supervisory roles who conduct field training to receive twelve hours of behavioral health training, including eight hours of crisis intervention instruction and an additional four hours in the Field Training Officer program, on how to interact with persons with mental illness or intellectual disability.
]nr ovallve Law E 'forcem,en't PaT:e eta] Health Strategies The OCGJ interviewed high-ranking officers from twenty-three law enforcement agencies representing all cities and unincorporated areas in Orange County, including 9 California Commission on Peace Officer Standards and Training Website, "Mental Health Training in the Regular Basic Course."
10 California Commission on Peace Officer Standards and Training, Learning Domain 37, People with Disabilities, Version 6.0, Chapter 4.
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Orange County Grand Jury Page 5
Lave Enforcement's Response to Mental Health Calls for Service and similar crises.11 In June 2023, the Orange County Board of Supervisors approved the County's budget for Fiscal Year 2023-24; and within its budget, allocated $2.8 million to expand the OCSD Behavioral Health Bureau (BHB).12 The bureau is a specialized crisis response team that consists of nine deputy sheriffs, three PERT deputy sheriffs and one PERT clinician. This specialized tears responds to mental health crisis calls including calls related to homelessness and conducts proactive follow- up calls. The goal is to assist with de-escalation and diversion to treatment and services, when appropriate.13
Some police agencies in Orange County are adopting an alternative mental health approach when responding to mental health calls for service. While there is an appeal to the idea of removing police from nonviolent psychiatric crisis calls, the challenge is training 911 dispatchers to gauge these calls and having experienced clinicians available to expediently respond to thein. In March 2024, the OCSD, in partnership with the OCHCA, launched a dispatch call diversion program that guides OCSD dispatchers to triage non-violent and non -criminal behavioral health calls (including homelessness) to determine if they can be diverted to OC Links, which is a 24/7 Behavioral Health Line.14 OC Links dispatches counselors to these non-violent and non -criminal calls instead of deputies, freeing up deputies to respond to traditional crime -related calls instead.15
Orange County Intake Release Center (RC)
The OCSD has partnered viith the OCHCA to reduce inmate behavioral health crises.
There are mental health hotlines available around the dock in each County jail so that deputies can report concerns regarding an inmate's mental health or behavior that might lead to self -harm. The IRC is part of the Central Jail complex in Santa Ana and houses inmates who suffer from severe mental illness. The facility can house up to 849 inmates and is staffed by sheriff's deputies from the BHB. The cells in the mental health unit have been modified to address safety and self -harm concerns. There are also visiting areas where inmates can use computer tablets for video calls with family, reading e -books, searching for jobs, receiving education, and playing cognitively stimulating games.
11 Orange County Sheriff's Department News Release, "00 Sheriff Partners with the 00 Health Care Agency to Support Individuals in Crisis." https//ocsheriff.gov. 12 Minutes of the Orange County Board of Supervisors Meeting on June 27, 2023; Adoption of the Fiscal Year 2034-24 Final Budget Resolution.
13 OC Cares Justice Through Prevention and Intervention, 2025 Quarterly Status Report, October — December 2023, p 16.
14 Orange County Sheriff's Department News Release "00 Sheriff Partners with the OC Health Care Agency to Support Individuals in Crisis," https//ocsherifff.gov. 15 /bid.
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Orange County Grand Jury Page 7
Law Enforcement's Response to 11/lental Health Calls for Service Orange County Service Planning Areas (SPAs)
Service Planning Areas (SPAs) are divisions of Orange County into North, Central, and South cities to coordinate homeless shelters and seNices on a regional basis. The North Orange County Service Planning Area (North SPA) is the most active and innovative of the three SPAs. It coordinates collaboration among thirteen cities in North Orange County. In 2018, North SPA was given over $12 million dollars by the State of California to address the crisis of hon elessness.17 The North SPA partnership is an effort to comply with a court ruling prohibiting enforcement of anti -camping laws on public property when local shelter beds are not available. The funding was used to open two homeless "Navigation Centers," one in Buena Park and the other in Placentia.
The HOPE Center was opened in 2022 to gain more reliable relief and consistent support for homeless individuals in the North SPA area. The HOPE Center is designed as a central command center for case workers, mental health clinicians, resource providers, and homeless liaison officers working together to address public health issues with an emphasis on horneless individuals. The goal is to end homelessness in the North SPA cities by getting "the right resource to the right person at the right time."18 The HOPE Center mobile office vehicle is used to respond to calls for service. Center clinicians engage in outreach activities when they are not ori calls. At the opening of the HOPE Center, State Senator Josh Newman (D-Fullerton/District 29) said the HOPE Center will be "a critical hub for subject matter experts, health care workers, community-based organizations, and local law enforcement to coordinate and deliver resources efficiently under one roof.'
17 "North Orange County Service Planning Area (North SPA) Received $12,062,300 in Homeless Emergency Aid Program (HEAP) Funding to Open Navigation Center in Buena Park and Placentia," November 9, 2018, https://www.buenapark.covniT2 . R49.php. 18 HOPE Center Orange County Mission Statement, htto.s://ochopecenter.orcc. 19 Tess Sheets and Alicia Robinson, "Governor Gavin Newsom Visits to Help Open New Hub for North Orange County Homeless Services," Orange County Register, October 27, 2022. 2023-2024
Orange County Grand Jury Page 9
Law Enforcement's Response to Mental Health Calls for Service mental health treatment for the residents of Orange County. Insurance is not a requirement to receive treatrnent.20
The first of three proposed Be Well campuses opened in January 2021 in the City of Orange to serve North Orange County. Funding was provided by the County Board of Supervisors, CalOptima, private donors, and major hospital systems. In October 2023, construction began on the second Be Well campus located in Irvine's Great Park that will serve South Orange County. This facility will be larger than the Orange Campus and will have the additional ability to support children, youth, and families. The campus is expected to open in 2025. A campus to serve Central Orange County is proposed.
Mind OC was established in 2017 as a California 501(c)(3) non-profit organization. The purpose of the non-profit is to partner with the County of Orange to establish behavioral health campuses in Orange County. When the Be Well Campus in Orange opened, it was under the responsibility of the OCHCA. In January of 2023, Mind OC assumed responsibility for the carnpus.2'
In addition to the Be Well campuses, Be Well 00 has a mobile response program. The slogan for the program is Hope Happens Here.22 Identifiable outreach vans with mental health crisis counselors (working in pairs) work in collaboration with lane enforcement to respond to mental health calls. The counselors are trained in de-escalation, crisis stabilization, and counseling. Seven municipal police agencies (Anaheim, Garden Grove, Huntington Beach, Irvine, Laguna Beach, Newport Beach, and Westminster) and UCI currently have mobile response contracts. Law enforcement agencies without contracts with the mobile response program can transport people in need to the Be Well Orange Campus.
Projecly Kinship (Hop; Lives Here)
ONFI DFNTIAL
In November 2014, California voters approved Proposition 47 that reduced some low- level felonies in the state to rnisderneanors. The proposition required the Board of State and Community Corrections to use a portion of the annual savings from Proposition 47 to administer grant programs for diversion, mental health services, or substance abuse treatrnent.23 Since 2016, Orange County has received $12 rnillion in grants from Proposition 47. Orange County's goal is to reduce the number of people with mild-to- moderate mental health and/or substance use disorders incarcerated in the county jail by reducing recidivism through intensive case management, linkages to treatment, housing and behavioral health services, and community supports upon release.24 20 ittos://bewelloc.or+_;/
21 Ibid.
22 https://mind-oc.org/
23 Libby Doyle, Leigh Courtney, Bryce Peterson of the Urban Institute, "Evaluation of Orange County's Proposition 47 Grant -Related Services," Executive Summary, September 2021, p.v. 24 Ibid.
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Orange County Grand Jury Page 11
L a W Enforcement's Response to Mental Health Calls for Service Table '1: Interview Results with Orange County Law Enforcement Agencies Law Enforcement
Agencies
Anaheim
Brea
Buena Park
Costa Mesa
Cypress
Fountain Valley
Fullerton
Garden Grove
Huntington Beach
Irvine
La Habra
Le Palma
Legune Beach
Los Alamitos
Newport Beach
Orange
Placentia
Santa Ana
Seal Beach
Tustin
UCI
Westminster
Orange County Sheriff
Be Well
Mobile
Response
Team
X
PERT
X
X
X
X
X
X
X
X
X
X
X
X
XX
X
X
City Net
•
NorthSpa/Hope
Center
X
X
X
X
X
X
�\
X
X
X
Behavioral
Health
Bureau
X
Non -Sworn
Crisis Worker
X
City of Fullerton is developing a pilot Social Worker Program within its police department.
UCI has several student counseling services on campus.
The cities of Stanton and Yorba Linda are members of North SPA.
COMMEND AT 9ONS
Orange County Criminal Justice Coordinating Council (OCCJCC) — The OCCJCC is to be commended for its efforts to improve public safety through greater inter -agency communication, coordination and collaboration regarding law enforcement and administration of justice issues including mental health.28 28 Orange County Board of Supervisors Resolution No. 2001-38, Adopted February 6, 2001, OCCJCC Proposed Reorganization.
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Orange County Grand Jury Page 13
Law Enforcement's Response to Mental Health Calls for Service
RESP RESPONSES
California Penal Code Section 933 requires the governing body of any public agency which the Grand Jury has reviewed, and about which it has issued a final report, to comment to the Presiding Judge of the Superior Court on the findings and recommendations pertaining to matters under the control of the governing body. Such cornment shall be macle no later than 90 days after the Grand Jury publishes its report (filed with the Clerk of the Court). Additionally, in the case of a report containing findings and recommendations pertaining to a department or agency headed by an elected County official, such official shall cornment on the findings and recommendations pertaining to the matters under- that official's control within 60 days to the Presiding Judge with an information copy sent to the Board of Supervisors.
Furthermore, California Penal Code Section 933.05 specifies the manner in which such cornment(s) are to be rnade as follows:
(a) As to each Grand Jury finding, the responding person or entity shall indicate one of the following:
(1) The respondent agrees with the finding.
(2) The respondent disagrees wholly or partially with the finding, in which case the response shall specify the portion of the finding that is disputed and shall include an explanation of the reasons therefore. (b) As to each Grand Jury recommendation, the responding person or entity shall report one of the following actions:
(1) The recommendation has been implemented, with a sumrnary regarding the implernented action.
(2) The recommendation has not yet been implemented, but will be implernented in the future, with a timeframe for implementation. (3) The recommendation requires further analysis, with an explanation and the scope and parameters of an analysis or study, and a timeframe for the matter to be prepared for discussion by the officer or head of the agency or department being investigated or reviewed, including the governing body of the public agency when applicable. This timeframe shall not exceed six months from the date of publication of the Grand Jury report. (4) The recommendation will not be implemented because it is not warranted or is not reasonable, with an explanation, thereof.
(c) If a finding or recommendation of the Grand Jury addresses budgetary or 2023-2024
Orange County Grand Jury Page 15
Law Enforcement's Response to Mental Health Calls for Service Newport Beac'ri F`I, F2, F3, F4, F5
Orange F1, F2, F3, F4, F5
Placentia F1, F2, F4, F5
Santa Ana F1, F2, F3, F4, F5
Seal Beach F1, F2, F3, F4, F5
Tustin F1, F9, F3, F4, F5
Westminster F `I , F2, F3, F4, F5
Findings y 90 Day Response Requested
University of California, Irvine F`1, F2, F3, F4, F5
REFERENCES
Be Well 00 website: https://bewelloc.orq/
California Commission on Peace Officer Standards and Training, Learning Domain 37, People ,✓vith Disabilities, Version 6.0, Chapter 4.
California Cornrnission on Peace Officer Standards and Training Website, "Mental Health Training in the Regular Basic Course."
"Fullerton Police Department Get $1 Million to Start a Pilot Program," Fullerton Observer, July 22, 2023.
HOPE Center Orange County Mission Statement, https://ochopecenter.org . https://california.public.law/codes/ca penal code section 13515.27, "North Orange County Service Planning Area (North SPA) Received $12,062,300 in Homeless Emergency Aid Program (HEAP) Funding to Open Navigation Center in Buena Park and Placentia," November 9, 2018,
https://www.buenapark.com/T2 R49.php https://www.buenanark.com; T2 R49.php.
Jennifer Peitz and Jesse Bedayn, "Many Big U.S. Cities Now Answer Mental Health Crisis Calls with Civilian Tearns - Not Police," Associated Press, August 27, 2023.
Jody M. Litchford, JD., "Partnering with Mental Health Providers to Improve Outcomes," Police Chief, December 2023.
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Orange County Grand Jury Page 17
Law Enforcement's Response to Mental Health Calls for Service
GLOSSARY
BHB Behavioral Health Bureau (Orange County Sheriff's Department) BHS Behavioral Health Services
BRU Behavioral Response Unit
CAT Crisis Assessment Team
CIT Crisis Intervention Training
HOPE Homeless Outreach and Proactive Engagement
IRC Intake Release Center
LASD Los Angeles Sheriffs Department
LCSW Licensed Clinical Social Worker
LD Learning Domain
NAMI 00 National Alliance on Mental Illness — Orange County Chapter OCCJCC Orange County Criminal Justice Coordinating Council OCGJ Orange County Grand Jury
OCHCA Orange County Health Care Agency
OCSD Orange County Sheriffs Department
PERT Psychiatric Emergency Response Team
POST Peace Officer Standards and Training
SB Senate Bill liFIDENTIAL
SPA Service Planning Area
UCI University of California, Irvine
2023-2024 Orange County Grand Jury Page 19
California Penal Code Sections 933 and 933.05
(Note: To reduce grand jury requests for additional response information, the grand Jury has bolded those words in §933.05 which should be appropriately included in a response.)
933. (a) Each grand jury shall submit to the presiding judge of the superior court a final report of its findings and recommendations that pertain to county government matters during the fiscal or calendar year. Final reports on any appropriate subject may be submitted to the presiding judge of the superior court at any time during the teen of service of a grand jury. A final report may be submitted for comment to responsible officers, agencies, or departments, inclnrling- the county board of supervisnre ,ri,hen ar,nlrrablP upon finding of tha nreQidinQ cadge- that the. repni-t is in compliance.with.this title.. For 45 days after the end of the term, the foreperson and his or her designees shall, upon reasonable notice, be available to clarify the recommendations of the report. (br
)__One copy or_eachfinal report,; -together with the responses thereto, found to be in compliance with this title shall be placed on file with the clerk of thecourt and remain on file in the office of the cleric. The clerk shall immediately forward a true copy of the report-and..the.responses to the State Archivist who shall retain that report and all responses in perpetuity.
(c) -No later _tha n 90 days after the grand jury submits_ a final report on the operations of any public agency subject to its reviewing authority-, the governing bod of the public agency shall comment to theresiding judge of the superior court on the-findings=and recomrnendations pertaining to matters under the control of the governing body, and every elected county officer or agency head for which the grand jury has responsibility pursuant to Section 914.1 shall comment within 60 .days to the presiding judge of the superior court, with an information copy sent to the board of supervisors, on the findings and recommendations pertaining'to matters under the control of that county officer or agency head and any agency oragencies which that.officer or agency head supervises or controls. In any city and county, the mayor sha11.a1so comment.on_the_findings and recommendations. All of these comments and reports shall forthwith be submitted to the_ presiding judge .of---thesuperior court who impaneled the grand jury. A copy of all responses to grand jury reports shall be .placed on file with the_ cleric ofthe public agency and the office of the county clerk, or the mayor when applicable; -and shall remain oni file in those offices. One copy shall be placed on file with the applicable grand jury final report by, and in the control of the currently impaneled grand jury, where it shall be maintained for a minimum of five years.
(d) As used in this section "agency" includes a department. 933.05. (a). Forpurposes•of-subdivision (b) of Section 933, as to each grand jury finding, the responding person or entity shall indicate one of the following:
(1) The respondent agrees with the finding.
. (2.) _The respondent disagrees wholly or partially, with the finding, in which case the response shall specify the portion -of the finding that is disputed and shall include an explanation of the reasons therefor. (b) For purposes.of subdivision -(b) of Section933, as to each grand jury recommendation, the responding person or entity shall report one of the following actions:
:(1) -The. reco>.nme.ndation.has.been implemented, with a summary regarding the implemented action. (2)-_The-recom-mendatioil- has- not yet:-been_implemented, but will be implemented in the future, with a timeframe for implementation.
.(3..) .:The. re_.commendation-requires further analysis, with an explanation and the scope and parameters of an analysis or study; and•a timeframe forthe matter to be prepared for discussion by the officer or head of the agency or department being investigated or reviewed; including the governing body of the public agency when applicable. This timeframe shall not exceed six months from the date of publication of the grand jury report. .. (4) The -recommendation will not be implemented because it is not warranted or is not reasonable, with an explanation therefor.
- _(c)__ -However; -if a finding_o.r_recommendation of the grand jury addresses budgetary or personnel matters of a county agency or. department; headed_by- an_ elected- officer,. both the agency or department head and the board of supervisors hall respond if. requested :b.yithe-grand jury;.but the response of the board of supervisors shall address only those budgetary or personnel matters over which it has: some decision making authority. The response of the elected agency or department head shall address all aspects- of the findings or recommendations affecting his or her agency or department.
(d) A grand. jurymay_request_a-subject person or entity to come before the grand jury for the purpose of reading and -discussing the findings s _of the -grand .rand ju re ort that relates to thatperson or entityin order to ver' the accuracyof the _. _. g -- g J rY- p � verify
findings prior to their release.
(e) During an. investigation, -the grand jury shall meet with the subject of that investigation regarding the investigation, unless the court, either on its own determination or upon request of the foreperson of the grand jury, determines that such a meeting would be detrimental.
(f) A grand jury shall provide to the affected agency-a.copy of the portion of the grand jury report relating to that person or entity two working days prior.to its public release and after the approval of the presiding judge. No officer, agency, department, or governing body of a public agency shall disclose any contents of the report prior to the public release of