The Rutherford Report: A New Approach to Mental Health Care

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“The measure of who we are is what we do with what we have.”

—Vince Lombardi
A New Approach to Mental Health Care

Individuals suffering from a mental health crisis are often routed to hospital emergency rooms where they can be held for up to 72 hours while doctors evaluate whether they would benefit from in-patient psychiatric hospitalization or a lower level of care.

This involuntary detention is commonly referred to as a “5150 hold” after the Welfare and Institutions Code that authorizes it. While many patients placed on 5150 holds end up not requiring psychiatric hospitalization, if they do not receive on-going care to stabilize their mental health issues, they end up back in the ER.

That revolving door costs taxpayers millions of dollars annually and does not serve the best interests of patients. San Bernardino County’s Department of Behavioral Health is trying to close that revolving door by using an approach that involves early intervention, intensive follow-up care and, when necessary, residential treatment in a home-like setting.

Behavioral Health’s Community Crisis Response Teams are the frontline of this effort. The multidisciplinary teams provide field response throughout the County for crisis intervention and transportation to appropriate services. The teams are co-located in the San Bernardino Police Department and Fontana Police Department to assist law enforcement on calls involving behavioral health issues. The goal is to avoid unnecessary and costly incarceration or hospitalization for those experiencing a psychiatric crisis.

While police would typically take these individuals to a hospital for possible 5150 holds, the Community Crisis Response Team may determine hospitalization isn’t needed and direct individuals to other care options.

Behavioral Health has also established Triage Engagement Support Teams to provide intensive case management services that link patients with needed resources for ongoing stability and support. These Triage Teams are co-located at critical access points with several law enforcement agencies and other entities throughout the County.

Behavioral Health’s Crisis Walk-In Clinics—located in Rialto, Victorville and the Morongo Basin—are one alternative to hospitalization. Individuals may be referred to a clinic by a Crisis Team or they may check themselves in for voluntary crisis intervention services.

In addition, Behavioral Health is in the process of constructing two Crisis Stabilization Units in San Bernardino and Fontana that will provide consumers with up to 23 hours of psychiatric urgent care. The Crisis Stabilization Units will be open for services 24 hours a day, seven days a week.

“Individuals don’t go to the hospital if they don’t need it,” said Sharon Nevins, a Deputy Director for the County Department of Behavioral Health. “Emergency room resources can be better utilized for individuals who need emergency medical care.”

After individuals are treated at a Crisis Walk-In Clinic, they may be released to go home, connected to an outpatient clinic, or transferred to a higher level of care. Behavioral Health staff follows up with patients to help ensure they continue any necessary treatment, such as psychiatric medications or counseling.

The department connects homeless patients with resource agencies to help get them into a stable living environments where their mental health issues can be more appropriately addressed.

“We strive to ensure no one is discharged without a plan for follow-up care,” Nevins said.

The third prong in Behavioral Health’s strategy is a network of Crisis Residential Treatment Centers. The facilities—which will be located in San Bernardino, Victorville, Joshua Tree, and Fontana—are currently under development and will be funded with grants provided through the Investment in Mental Health Wellness Act of 2013. The centers will be open 24 hours a day, seven days a week and will provide up to 90 days of voluntary residential treatment for people suffering from mental health crises.

“We need to make sure consumers have access to services at all times because that’s what a crisis treatment facility is designed to provide,” Nevins said.

The Crisis Residential Treatment program is designed to provide structured recovery-based, enriched treatment services and activities that support individuals in their efforts to restore, maintain, and develop interpersonal and independent living skills.

The buildings will feature a homelike décor and environment including living and dinning rooms, outdoor patios and gardens, and they will be staffed with on-site security and mental health professionals around the clock.

“It’s not going to be an institutional setting,” Nevins said. “It will be a home-like environment to ensure individuals have an easy adjustment back into their community.”

Behavioral Health is working with San Bernardino County’s Project Management Division and Department of Community Development and Housing to develop the facilities. The agencies are hosting outreach events to gather community input and to answer residents’ questions about the planned Crisis Stabilization Units and Residential Crisis Treatment Centers.

“We want residents to know what the projects are and how they will improve access to mental health services in their community,” Nevins said.

To learn more about the services provided by the San Bernardino County Department of Behavioral Health, visit or call the Access Unit (888)743-1478 or (909) 386-8256 or 711 for TTY users.
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