PERT: The Mental Health Backup for Law Enforcement Encounters During A Crisis

 

Last updated 8/26/2022 at 2:30pm



Living in Borrego Springs, calling the sheriff or fire department for help in a serious mental health crisis or drug scene gone badly, does not address the core issues, and can lead to tragedy. However, engaging the Psychiatric Response Team (PERT) can make a difference in law enforcement encounters with the mentally ill.

PERT is news to most, but has been in existence for 26 years. Calling 911, and requesting PERT, brings mental health specialists with law enforcement to intervene when the source of the problem may or may not be criminal, but is posed by someone suffering from mental health issues or addiction. PERT teams travel with law enforcement to assess a situation, deal with distraught or high individuals for safer outcomes for individuals involved and the sheriffs/police in local cities.

As usual, for Borrego Springs, like the entire County’s small, rural communities, accessing PERT’S services is more complicated.

In making a 911 call, if a mental health crisis is involved, one can request the PERT team. In Borrego Springs, where there’s no PERT team assigned to ride with the sheriff, the local sheriff can request an available team from larger communities, like Ramona and Escondido, and/or make a follow-up appointment. If no TEAMS are available, which is usually the case, since the teams work on limited schedules, an individual or the sheriff may also request a PERT-trained sheriff to respond. Also, the team may be accessed through the sheriff’s non-emergency line.


If none of these options work out here in never-never land, the sheriff or involved individuals may schedule a PERT visit and assistance when a team is available. PERT may only respond per a law enforcement request for intervention.

“There are many benefits of a PERT team,” said Mark Marvin, PhD, VP of the Community Resource Foundation, and director of the PERT division. “Primary, is the decrease in the use of force in situations between law enforcement and persons with mental illness. Plus, it’s a more efficient and effective way of caring for persons with mental health problems that come into contact with law enforcement.”


He added, “The team reduces the demand on emergency rooms, which are often not in a position to make timely assessments or referrals. PERT provides crisis intervention in the field and makes appropriate referrals and connections to community resources. And PERT provides follow-up services on a case-by-case basis, decreasing the number of repeat calls, and connects the troubled individuals and families to services needed.”

PERT is a program of the Community Research Foundation (CRF), a not-for-profit organization, in partnership with the San Diego County Health and Human Services Agency (HHSA), San Diego County Law Enforcement agencies, and the National Alliance on Mental Illness (NAMI San Diego).

The practice of accompanying untrained law enforcement with mental health specialists when mental health is the crisis, is finally getting recognition and utilization. Media coverage of incidents that ended in tragedy because police used armed and deadly force, rather than a more cautious, but safer approach to incidents arising from mental health issues have exposed the need for services such as PERT. Basically, it serves to close the gap between law enforcement and mental health professionals, agencies and services; safely de-escalates situations; and provides more appropriate alternative referrals other than jail.

According to the PERT fact sheet, “The purpose of the service is to contribute to the well-being of individuals living with mental illness by actively and compassionately assisting individuals in crisis, who come to the attention of law enforcement, to access appropriate services and optimize outcomes by on the scene assessments and referrals.”

The law-enforcement-based, mental-health-crisis intervention team pairs licensed mental health professionals with a police officer or deputy sheriff. Professionals on the PERT teams include psychologists, clinical social workers, marriage and family counselors and nurses. All must pass security checks through the Sheriff’s department.

PERT is funded through the County Of San Diego HHSA and the Mental Health Services Act (MHSA). The MHSA Act was approved by voters in 2009, and provides for a one cent tax on personal incomes of individuals making a million dollars or more a year. The money is dedicated to expand and transform California’s mental health system to better serve individuals with, and at risk of serious mental health episodes, and their families.

Maybe, it’s time to raise the one cent to one dollar, given how stretched and chaotic the mental health system seems to be for anyone trying to wind their way through the tangle of agencies, providers, private and public, insurance, etc., to help themselves or a loved one.

PERT currently has funds for 72 licensed, mental health professionals. In addition to 10 partner cities and the San Diego County Sheriff’s department, PERT provides services to the California Highway Patrol, U.S. Customs and Border Protection, Harbor Police, as well as campus and military police when requested and available.

“When requested and available” is where the rubber meets the road, especially in rural communities, like Borrego Springs, with only one deputy on duty. How to get PERT help for Borrego Springs is complicated and not complicated. The simple answer is for the County to fund a two-person, 24/7 patrol unit in Borrego with at least one PERT-trained deputy. The better option is to fund a PERT mental health/sheriff’s deputy team to cover North and East county rural communities.

With the placement of SVPs in Borrego Springs and other rural communities, this would be realistic compensation to increase safety.

According to Dr. Marvin, “The County funds the entire program with a $12 million budget. The budget only allows for teams three days a week in partnering cities and communities, like Ramona.

“Other problems, besides funds, are staffing: Competing with private sector salaries, filling out all the 72 positions; and overcoming the mental health stigma that prevents ill people from admitting to mental problems and seeking help.”

Particularly troubling, for families reaching out for help for an adult, are the prohibitions by HIPPA, and other laws that protect the rights of mentally ill individuals. Families seeking to intervene when the individual is not capable, find their hands tied when it comes to placing that person in a safe environment where the person can be evaluated and set on a case management, healing course.

PERT Coordinating Council member, Sheriff’s Lieutenant, Jim Emig, noted the program makes a difference, allowing flexibility for the deputies in terms of where to take an individual that has to be removed from the home, and/who requires medical attention, not incarceration. Resources and strategies known to mental health professionals are typically outside the deputy’s working environment.

“Prior to the PERT program’s inception, it was only law enforcement officers who responded to situations involving individuals suffering from a mental health crisis. However, now there are licensed mental health clinicians, partnering and riding in the patrol car with law enforcement. This provides a more complete and robust response for the communities we serve.

“The PERT program enables a licensed clinician, specializing in mental illness, to treat and assess individuals who are experiencing a crisis, while having a law enforcement officer present for the safety of the individual, the community, and the clinician.

“San Diego County and the entire nation have experienced an increased need and demand for mental health services. San Diego County is currently rolling out Mobile Crisis Response Teams (MCRT), which also provide care and services to individuals experiencing a mental health crisis, during lower risk situations. MCRT will assist PERT in its mission by responding to requests for mental health services that do not require the presence of an armed law enforcement officer. The PERT and MCRT Programs reflect the mission statement of the San Diego County Sheriff’s Department, which is to provide the highest quality public safety service to everyone in San Diego County,” explained Lieutenant Emig.

“This type of service is in great demand,” stated Darrel Weiss, Ranchita’s resident deputy, who at the time of this writing was covering for the Borrego Springs deputy, and his own home beat concurrently.

“It’s great the county is doing this, but we need more emphasis on the rural communities. It’s tougher for a single resident deputy in Borrego Springs to get someone having a mental health crisis to help than it is in Poway, or San Marcos. It’s a four-hour drive, whether it’s to a hospital or the jail, leaving the home turf uncovered. Something, deputies only feel they can do under the direct circumstances,” Weiss added, noting that, “Having mental health professionals working with us that can better evaluate and manage a situation would be a great help.”

Plus, having a PERT team on the scene allows the deputy to return to the field quickly while the PERT team facilitates the coordination of care for persons, which is often a lengthy and time consuming situation.

A deputy can remove an individual from a home with a 5051 code, which takes the person to jail with a 72 hour hold and release. Without other interventions, the cycles of continuing crises brought on by mental illness continues. Sheriff’s with the training and incentive can use the 5051 (Individual is an imminent danger to themselves or others) to take an individual to County Mental Health Hospital, or any available hospital emergency room for evaluation, and then, to potentially safe and curative placements. Unfortunately, like the jails, emergency room workers often have to release the individual to their own recognizance, due to a shortage of short- or long-term mental health treatment placements, and jail overcrowding.

The next snag is the availability of safe and curative placements. The quality as well as quantity of accessible treatment options such as rehabilitation facilities, and group homes is always fluid.

Group homes or emergency housing are usually packed and securing a bed is difficult. Insurance is an issue for many needing help. Private insurance makes a difference in treatment potentials. Individuals on government assisted insurance are not so lucky. Help for the mentally ill is also constrained due to the shortage of outpatient beds available at any given time. A solution, recommended by Dave Meyers, former candidate for Sheriff, is to have the Sheriff’s Department fund and reserve a number of beds in quality outpatient facilities designated specifically for PERT and law enforcement placement.

In 2021, 95 % of family members connected with PERT teams received services through a 911 call. That same year, PERT responded to 10,164 calls, with 8,950 attempted follow up without contact. There were 23,029 contacts made with providers, family members, etc., and 42,143 total clinical opportunities. The PERT Training Academy for law enforcement and District Attorney Partnerships hosted 85 events with 2,419 attending.