Emergency Call 

Alameda County has the highest rate of psychiatric detentions in the state, but has failed to adopt a law that could help severely mentally ill adults.

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DeWitt's father, Al DeWitt Jr., said his son was diagnosed with paranoid schizophrenia and has been in mental health facilities at least nine times. "We wanted him to be treated and taken care of because we love him," DeWitt Jr. said. "We advocated for that so many times with the hospital, with the doctors, with the psychiatrists. We tried to inform them how he was thinking and what was going on and they just kept letting him go, kept putting him out. They would give him a BART ticket and a voucher for a shelter and say, 'Goodbye.' That's John George [Psychiatric Pavilion of Alameda County Medical Center]. It's a shame.

"Even though we've lived with him — we know him — they just don't listen to the loved ones," DeWitt Jr. continued. "We've had so many people call us who we don't know who say they are going through the same thing. It is just unbelievable how many people are out there and can't get help.

"If we had Laura's Law," he added, "it definitely would have helped us."

In Alameda and Contra Costa counties, police bear the burden of responding to emergency calls for help involving the mentally ill. At John George Psychiatric Pavilion of Alameda County Medical Center, 9,431 individuals received psychiatric services during the two years ending December 2011, and virtually all of them were originally detained by police or sheriff's deputies under Section 5150 of the California Welfare and Institutions Code.

For many, it was not their first or even their second trip to that psychiatric emergency hospital during those two years: 1,691 entered three or more times (18 percent). According to Patty Espeseth, a hospital administrator in the county acute-care system, police are even busier responding to psychiatric emergencies than the numbers indicate: "Typically, you have to call the police at least two times, sometimes three, before you get lucky enough to have them write a 5150. They come, but end up not writing the 5150. Sometimes that's because the family is so traumatized by how horrifying it is to watch a loved one lose their mind or become aggressive when they never have before, the family doesn't know what to say."

"Emergency psychiatric detentions are inherently dangerous," retired Oakland Police Captain Anthony Hare pointed out six years ago in his Ph.D thesis in psychology, which focused on the chronically high rate of 5150 incidents in Alameda County and corrective efforts at that time. Forty percent of the emergency psychiatric detentions originate in Oakland. "I had many encounters with mentally ill persons in the course of my job in Oakland," said Hare, a 24-year veteran of the department who later chaired the Mental Health Board, the advisory panel to Alameda County Behavioral Health Care Services, and is now the executive director of UC Berkeley's Center for Catastrophic Risk Management. "I responded as a hostage negotiator, or the leader of the hostage negotiations team, to dangerous situations involving mentally ill persons, including suicidal subjects and people who had committed other dangerous acts. ... There are areas in Oakland that house disproportionally large numbers of mentally ill persons who periodically go off their meds or whose condition deteriorates in one way or another such that they become a danger to themselves or others."

Who are held for observation? "I would say there are three general categories of people on a 5150 who land here," Espeseth said. "There's the depressed and suicidal, either because of body chemistry and/or life events; then there are people who have some form of mood [disorder] combined with thought-disorder symptoms, such as bipolar disorder where they've gotten really grandiose or paranoid or some form of symptoms that have caused them to be unsafe out in the community; and the third is a straight thought disorder like schizophrenia who are having some sort of disabling thought-disorder symptoms — voices telling them to kill themselves or so paranoid that they are running into traffic thinking someone else is trying to kill them."

Severe mental illness — schizophrenia and bipolar disorder — is rare, and violent behavior by people who have those diseases is uncommon. But a National Institute of Mental Health study published in 2006 of schizophrenic patients throughout the country found that 20 percent had been violent during the six months prior to being interviewed for the study. Violence among those who did not abuse drugs or alcohol was three times more prevalent than in the general population without the disease, and the incidence of violent behavior among those who did abuse those substances was ten times greater than among the general population. Living with parents and being unemployed raised the risk for violence.

Cognitive impairment is the signature of schizophrenia. The disease often renders its victims incapable of recognizing their symptoms or even comprehending they are ill, which is why the parents of adult children afflicted with schizophrenia face a terrible dilemma. If they shelter their schizophrenic adult daughter or son who would otherwise be homeless and potentially violent, they may risk their own safety. But they have no legal standing, because of medical privacy protections, to get help for their child or any other adult who refuses treatment. Their only recourse in Alameda or Contra Costa County is calling the police in the event of a psychotic break.

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