WELCOME!

1. Riverside County Department of Mental Health 5150 Training WELCOME!

2. Today you will learn: How to evaluate for a 5150 in Adults and Children How to evaluate risk and conduct evaluations How to accurately complete the 5150 form What is Tarasoff? Your obligations as a Riverside County 5150 Authorized person …and then we will test you on all of it! Introduction

3. Lanterman-Petris-Short (LPS) Act - 1969 De-institutionalization (p. 5) Community Mental Health (p. 5) Involuntary Detainment (pp. 6-7) Patient’s Rights (p. 8) History and the Law

4. Involuntary Detainment (5150) Defined authorized staff Defined criteria for 5150 (p. 6) Established use of reliable witness information Designated facilities Assessed and offered treatment within 72 hours Guidelines for evaluating minors History and the Law (cont’d)

5. A locked, psychiatric facility that has been certified by a county to receive 5150s Not ALL psychiatric hospitals are designated. Each county has its own designation process A facility may be designated by more than one county What is a “Designated Facility”?

6. Riverside County Regional Medical Center – Emergency Treatment Services, Riverside, CA Oasis Rehabilitation Center Psychiatric Health Facility – Indio, CA Canyon Ridge Hospital, Chino, CA Aurora Charter Oak Hospital, Covina, CA Redlands Community Hospital San Bernardino Community Hospital Loma Linda Behavioral Medicine Center, Redlands, CA College Hospital of Costa Mesa Alhambra Hospital, Rosemead, CA College Hospital, Cerritos, CA Western Medical, Anaheim, CA Silver Lake Medical Center – 2 Campuses: Rosemead and Los Angeles, CA Riverside County Designated Facilities, pp. 2-3

7. County residents with private insurance may be transferred to any RCDMH designated facility that insurance will cover. Try to keep consumer close to home ITF and Oasis have priority to serve indigent and Medi-Cal recipients Determine insurance status, ascertain if privately insured can be transferred Involuntary Holds and Private Insurance (p. 4)

8. Non-law enforcement personnel who write a 5150 hold must hold CURRENT RCDMH authorization to write a legal hold Sending 5150 detainees to hospitals NOT designated by RCDMH is illegal Requiring willing, voluntary clients to have a 5150 for admission is illegal Illegal Holds, (p.4)

9. Relevant only in Riverside County Outlines who can be authorized Parameters of authorization Reauthorization process Quality assurance: FAX 951-358-5038 RCDMH Policy 142 – 5150 Authorization for Professional Persons (pp. 9-17)

10. RCDMH Employees Consult with a Supervisor or Manager Facilitate needed voluntary interventions Document the reassessment, consultation(s) and planned follow-up Send copies of original 5150 and reassessment justification to QI: FAX 951-358-5038 RCDMH Policy 221 – Interrupting 5150 Applications in the Field (pp. 18-20)

11. Non-RCDMH Employees Any Riverside County 5150 Authorized Professional can interrupt Must follow your agency’s policies and procedures related to this Must have a clinical basis for the interruption (i.e. no longer meets the criteria for a 5150 upon reassessment) Send copies of original 5150 and discontinuation justification to QI : FAX 951-358-5038 RCDMH Policy 221 – Interrupting 5150 Applications in the Field (cont’d)

12. (p. 21) Medical Risk Consultation with receiving facility Consider all medical conditions Ask yourself: If not on a 5150, would the patient be discharged to home with no medical follow-up? Facilitating Medical Clearance Medical Clearance

13. Danger to Others (DTO), Danger to Self (DTS), and Grave Disability (GD) due to a Mental Disorder LEGAL CRITERIA

14. What does a 5150 get you? ONLY an assessment at a designated facility Can last up to 72 hours, but can be just a few hours or less No guarantee the consumer will be admitted to the hospital LEGAL CRITERIA

15. As a result of a mental disorder the person must be suicidal or expressing significant harm to himself or herself (p. 22) Through words or actions What is the difference between Danger to Self and Grave Disability? DANGER TO SELF (DTS) - ADULTS

16. eans bility nwilling ntent DTS – ADULTS (Cont’d) M A U I

17. M.A.U.I. is a guideline for what to write on the 5150 application Reliable Witnesses - AB1424 - Use quotes - False statement liability DTS – ADULTS (Cont’d)

18. As a result of a mental disorder the person expresses harm to others or demonstrates reckless disregard for the safety of others (p. 23) Through words or actions What is “reckless disregard”? The risk needs to be related to the symptoms of a mental disorder DANGER TO OTHERS (DTO) - ADULTS

19. eans bility nwilling ntent DTO – ADULTS (Cont’d) M A U I

20. Destruction of Property: must put people at risk (seek consultation when consumer presents with any violent ideation) Reliable Witnesses: Same standards apply as DTS DTO – ADULTS (Cont’d)

21. As a result of a mental disorder the person is not able to provide for the basic needs of food, clothing and shelter, or voluntarily utilize such provisions when offered (p. 24) Grave Disability (GD) - Adults

22. Carry out measures to “sustain life:” is the consumer’s life in danger? Ask yourself: Is something really bad going to happen to this person if I do not intervene? Emphasize clinical objectivity, not your personal standards GD – Adults (Cont’d)

23. FOOD Assess context: What is the whole picture? Has there been a change? Is there a rational plan to obtain food? Common examples - food at home, but now eats out of garbage cans - unaware/unconcerned that he is eating spoiled food - paranoid delusions of poisoning - command auditory hallucinations not to eat - not eating or drinking for no apparent reason GD – Adults (Cont’d)

24. CLOTHING Again, assess context: What is the whole risk picture, not just the clothing issue? Consider climate GD – Adults (Cont’d)

25. SHELTER Context, again. Homelessness - change in context or in getting daily needs met? - increase or change in symptoms? - ability to navigate homeless resources? - experienced at being homeless? Reliable witness GD – Adults (Cont’d)

26. Voluntary Caregivers (p. 25) - should I put it in writing? Health and Medications (p. 26) - Right to refuse medications - Refusal due to a mental disorder (only applies to treatment required to sustain life; does NOT include psychotropic meds) GD – Adults (Cont’d)

27. * Not used in Riverside CountyRCDMH Quality Improvement Division 10/2005

28. Each criterion has a separate legal course Only GD can lead to conservatorship Make a thorough risk assessment: only mark those criteria that apply, but mark all that apply Ensure documentation supports criteria marked Civil Commitment Flow Chart, p. 28

29. Assess as any potential 5150 Must be exhibiting psychiatric symptoms: substance-induced symptoms are psychiatric symptoms Must meet legal criteria for DTS, DTO, and/or GD Substance Use and 5150

30. Principles and Guidelines for Evaluating DTS, DTO and GD in Children and Adolescents 5150s and Minors P. 29

31. Both DTS and DTO in minors are the same criteria as for adults: Due to a mental disorder and… Means Ability Unwilling to accept treatment Intent DTS & DTO – Children/Adolescents

32. When considering DTO and DTS factors in minors it is also important to consider developmental stage Can affect what a minor is able to do or what a minor has access to for the purposes of hurting self or others DTS & DTO – Children/Adolescents(cont’d)

33. Gravely Disabled Minor: “..as a result of a mental disorder, is unable to use the elements of life which are essential to health, safety and development, including food, clothing and shelter, even though provided to the minor by others.” (W&I Code, Section 5008) Grave Disability – Children/Adolescents

34. (pp. 30-32) Question to Ask Yourself: “Is there significant impact on the minors health, safety or development from the inappropriate or non-use of food, clothing, and shelter that results from a mental disorder?” Grave Disability – Children/Adolescents(cont’d)

35. (p. 33) “in loco parentis” “in place of the parents” – you have limited rights and responsibilities to provide for reasonable care and safety of the minor Allows for detainment even at the objection of the minor’s parents Principles and Guidelines for Assessing Children

36. Assessing without Parent/Guardian Present Every effort should be made to contact parents/guardians, and efforts to do so should be documented Parents/Guardians have valuable information that will be helpful for your assessment Principles and Guidelines for Assessing Children (cont’d)

37. Least Restrictive Placement As with adults, every effort should be made to assess for all options to keep a minor safe and ensure that a 5150 is the last available choice based on the criteria discussed in this training Principles and Guidelines for Assessing Children (cont’d)

38. (p. 34) Risk Assessment Expectations Assess for the likelihood of danger and risk Minimize but not eliminate risk Broadly consider the person and their environments to develop possible alternatives to a 5150 Document a defensible rationale for your final decision Risk Assessment

39. Assessment Safety Be aware of all exits Make sure you and client both have escape routes Ask for backup when needed Believe all threats Risk Assessment (cont’d)

40. Articles In Your 5150 Manual “Thirteen Defensible Hypotheses Concerning Violent Behavior” (p. 35) “Helpful Advice for Conducting Assessments in Highly Stressful or Dangerous Situations” (p. 36) “Suicide Fact Sheet” (pp. 37-39) – includes risk factors and protective factors Risk Assessment (cont’d)

41. Instructions p. 41 Examples pp. 42-44 Always us BLACK INK and please WRITE LEGIBLY - this is a legal document - will be copied many times Completing the 5150 Document

42. Advisement Section Check “Advisement Complete” or “Advisement Incomplete” box If applicable, write out cause for an incomplete advisement Print name of person who advised, title and date of the advisement Completing the 5150 Document (cont’d)

43. Designated Facility In the space next to “To” print the name of the designated facility at which the person is to be evaluated Note: This must be a Riverside County designated 5150 facility Completing the 5150 Document (cont’d)

44. Client Information Next to “admission of” print the name and d.o.b./age of the client Next to “residing at” print the known address of the client. If the client is homeless, print “Homeless” If the client is a minor, please list the appropriate parent/guardian, social worker or probation offices information in provided space If the client is an adult on conservatorship, please list the conservator’s name and phone number in the space provided Completing the 5150 Document (cont’d)

45. First Narrative Section Print how the situation was brought to your attention Print a description of the alleged or observed behaviors or situations Print relevant historical information (prior hospitalizations, dangerous behaviors, treatment history) Completing the 5150 Document (cont’d)

46. Skip to Criteria Boxes Check one or more (up to three) criteria boxes appropriate for this client based on the information you have from you assessment. A person can meet criteria for more than one category, but you must document the rationale for each… Completing the 5150 Document (cont’d)

47. Second Narrative Section Print enough information to support the criteria you checked below. Include: - a brief description of the client - observable behaviors/quotations from your assessment - justification for the 5150 based on training criteria Completing the 5150 Document (cont’d)

48. Signature Section Sign your name and title in the box provided Under your signature, print the name of the agency under which you are authorized to do the assessment Completing the 5150 Document (cont’d)

49. Signature Section (cont’d) Print Date and Time the 5150 was written. This is what is used to calculate the 72 hours so these sections must be complete and accurate - use a.m./p.m. or military time - inaccurate completion of these boxes can result in a return to this training… Completing the 5150 Document (cont’d)

50. Signature Section (cont’d) Print your agency phone number (with area) code in the appropriate box Print your agency address in the appropriate box Completing the 5150 Document (cont’d)