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County adopts new tool for providing emergency services

Services will go to those gravely disabled by mental illness

REGION — San Diego County has adopted new means of providing services for those gravely disabled by mental illness by allowing extended psychiatric treatment for people who are committed involuntarily. The new tool may save the county thousands of dollars.

An individual suffering from mental illness can be involuntarily detained for treatment in a hospital or mental health clinic. To be committed involuntarily, a law enforcement officer, mental health clinician, or doctor must determine that the person is unable to care for themselves or may be a danger to themselves or others.

Currently in San Diego County, doctors have the ability to keep a person for treatment for up to 17 days. If a doctor believes that a patient will need psychiatric treatment beyond those two-and-a-half weeks, the doctor must petition for temporary conservatorship.

A temporary conservatorship appoints a person to make medical and legal decisions on behalf of another person who is deemed unable to do so on their own. In cases involving the gravely mentally ill, a temporary conservatorship gives the appointed conservator and doctor the legal authority to continue involuntary psychiatric treatment beyond 17 days.

The catch is that doctors do not have the full 17 days to decide whether or not to petition for temporary conservatorship on behalf of a patient, according to Dr. Michael Krelstein. Krelstein is the clinical director for the county Health and Human Services Agency’s Behavioral Health Services.

Doctors need to decide about the petition by the twelfth or thirteenth day of a patient’s treatment to allow the county conservator’s office enough time to investigate the case before the petition is decided in court.

According to Krelstein, less than two weeks is not enough time for a doctor to make a determination about petitioning for a temporary conservatorship. He explained that most of the time, psychiatric medications take about two weeks to fully take effect.

Because of this, doctors often end up filing temporary conservatorships that later turn out to be unnecessary when a patient responds to treatment and is ready to be discharged by the sixteenth or seventeenth day of involuntary treatment.

“The difference between discharging (a patient) at day 12 versus day 17, 18 is really significant clinically,” said Krelstein. “This is right at the time period where the medicine might kick in.”

“Conservatorship is good for those who need it, but it also involves court. It’s a long process,” said Shannon Jaccard, NAMI (National Alliance on Mental Illness) San Diego’s CEO. “It should be used if it’s appropriate, not just if you need more time in a hospital.”

The unneeded filings of temporary conservatorships also racks up costs for The Office of the Public Administrator, Public Guardian, and Public Conservator.

To address these issues, theSan Diego  County Board of Supervisors voted unanimously on Tuesday to adopt California’s Welfare and Institutions Code 5270.

Code 5270 allows doctors and mental health clinicians to continue treatment for those suffering from mental illness for an additional 30 days without a temporary conservatorship. Due process and hearings still occur to protect the patient’s rights during that period.

Furthermore, a 5270 does not have to be filed until the seventeenth day of treatment, which allows more time for medications to take effect and for doctors to determine if a patient requires further psychiatric treatment.

“It makes a big difference,” said Krelstein.

Eliminating unnecessary filings of temporary conservatorships could save the county between $130,000 and $220,000 in conservator costs, but will increase costs for the courts by about $151,000.

It also benefits patients, who can avoid having a temporary conservatorship on their permanent record.

The move allows more flexibility for patients, their families, and doctors, Jaccard said.

“We think this is a really good thing for the county,” she said.