Mental health calls to local authorities up 84%

June 07--Calls to San Diego County police agencies about people with mental-health problems skyrocketed 84 percent over a six-year period starting in 2009 -- while the county's population grew only 5 percent during that time.

A new study by the San Diego Association of Governments is shining light on a topic that has implications for police and medical resources, in addition to perceptions of people who otherwise might have only been viewed as potential criminals.

Mental-health calls to 911 operators and other authorities totalled 17,300 in jurisdictions around San Diego County in 2009. By 2015, that figure had jumped to more than 31,700 -- and researchers say that number may be significantly under-counting the true picture.

Police say the volume of overall calls has not risen at anywhere near that pace. For example, the San Diego County Sheriff's Department's overall call volume increased 17 percent during the same period, an official said.

What's driving the surge is less easy to calculate. Increased drug use, such as easy access to methamphetamine, may be one answer, according to anecdotal evidence. Another could be a changing landscape regarding jail time.

SANDAG surveyed law enforcement groups about their perceptions of what's behind the increase.

"We know it's not just homelessness. It's not just the military coming back with post-traumatic stress. It's not just an increase in drug use and substance abuse that's causing it," said Lt. Chris May, sheriff department liaison for mental health issues. "I think the best answer is it's most likely a combination of all of that."

The anecdotal evidence compiled by SANDAG also included greater awareness of mental health issues in the population, fewer treatment programs, fewer treatment sessions authorized under public- or private-sector insurance, a limited number of providers who accept Medi-Cal.

Additionally, recent legislation -- including Proposition 47 in 2014, which changed some felonies to misdemeanors -- has meant people who might otherwise be on medication while behind bars are instead on their own recognizance, said Cynthia Burke, director of SANDAG's applied research division.

A spokeswoman for the San Diego chapter of the National Alliance on Mental Illness said the regional findings are not a surprise and largely mesh with what's being observed at the national level.

Nearly 1 in 5 adults in the United States -- about 43.8 million -- experiences mental illness in a given year, according to the National Institute of Mental Health.

Nationally, rates of schizophrenia have remained fairly flat, said Shannon Jaccard, chief executive officer of NAMI'sSan Diego chapter. It's an open question whether an uptick in bipolar cases is due to greater understanding of the condition, or more prevalence, she said.

As the issue has crystalized, San Diego County has added more psychiatric emergency response teams, which pair a licensed mental health clinician with uniformed law enforcement officers to do emergency assessment and referral.

The county now has funding for about 40 so-called PERT teams, up from roughly 25 a few years ago, May said.

The difference is that a deputy usually has few choices at hand: Jail, a county mental facility or the emergency room. The trained clinician can make a more nuanced assessment and a referral that doesn't always mean a packed ward, May said.

"The PERT team can take over the call, and they can get the best location where they will get the best care," he said. "They can evaluate their insurance, and they can deliver them to the place that'll be best for that person. What we've seen, since we really got into training on this, we've seen fewer use of force. Our deputies say, we feel like we can assess things better."

SANDAG's Burke said the topic deserves more study.

She got interested in the issue when she heard chatter from police about surging mental-health calls.

"That 84 percent increase was just so dramatic. ... But the numbers alone don't tell the story," she said. "I'd love to dig into it a little deeper."

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