Prison in Mental and Behavioral Health Programs

Mentally well people are being incarcerated illegally in mental hospitals and held in mental health wards of prisons. I sent the following questions to our local county government department responsible for the public mental health hospitals and the private mental hospitals with whom they contract. It is also a concern at private hospitals with whom they do not contract.

A 5150 is an involuntary "hold", which is essentially an imprisonment in a mental health facility for 72 hours, and a person who is not a licensed healthcare professional but approved to do it, can sign one by stating someone is a threat to self or others. The reality is that sometimes that person is not a threat to self or others. A 5250 may extended it for an additional 14 days. The facility can deny access to contact information to procure a lawyers.

email text:

Dear Assistant Director;

I want to know, are County Crisis Stabilization Unit and 3rd party vendor staff:

1. Accepting 5150s without confirming and verifying they are legitimate?

She replied: All 5150s are taken seriously. Someone in the community has identified individual as being at risk and needs evaluation. If the hold was incorrectly written, the team at Crisis Stabilization Unit Hospital will evaluate and determine viability of the hold. If hold was incorrectly written but the individual meets criteria for danger to self, danger to others, or grave disability, the team at Crisis Stabilization Unit Hospital will re-write the 5150. No one is turned away if a hold was incorrectly written if their safety is at risk. No one will be kept on a hold if they are not assessed as meeting the criteria for a 5150 hold.

I responded: It isn’t true. People were and may still be routinely held against their will without having met the criteria for a 5150.

Did anyone interview former “patients” and ask for the truth? The interviews would need to be done by someone they believe they could trust, which would not be anyone employed by the County Behavioral Health Department, including the “advocates”. It is made clear complaints will result in problems for the reporter.

2. What is the protocol for confirming they are legitimate, not with the reporter, but with the “client” once they have had a chance to stabilize after being illegally moved?

She replied: Crisis Stabilization Unit Hospital completes a thorough clinical assessment to determine individual’s mental status and level of risk before determining treatment plan. Individuals may be released prior to the expiration of the 72-hour treatment and evaluation if they meet the criteria under WIC 5152.

I responded: It isn’t true; in the past, and possibly now, the staff at the Crisis Stabilization Unit Hospital did not do a thorough clinical assessment. Since some of the staff are the same, they possibly still don’t.

On average, how long do they actually speak to a “patient”; not what they claim on the medical records?

How often do they copy a prior colleague’s notes or listen to a colleague tell them what to report as if it was the “patient” who spoke?

3. Fabricating 5150 reports?

She replied: There are numerous checks and balances involved evaluating a 5150; with input from the different members of the multi-disciplinary team at Crisis Stabilization Unit Hospital; including psychiatrist, psych nurse, and licensed Behavioral Health clinician. The team determines if a 5150 is not indicated; not one person. It is not the decision of one person.

I responded: It simply isn’t true: numerous checks and verifications were not and possibly still aren’t implemented at the County Crisis Stabilization Unit Hospital The staff is very, very seldom in the unit talking with “patients”. They are on their computers, and often they appeared to be on personal computers, in a different room. Occasionally they may watch “patients” on a monitor in the other room, some of whom are trying to recover from having been kidnapped with no contact information of an advocate to get them released.

4. Allowing interns to write fabricated reports as if they were medical staff?

She replied: Staff interns, who are masters level working on their hours for licensure, are allowed to write 5150s only if they have completed our 5150 certification training.

I responded: Why would an intern be allowed to write a 5150 with certification training? The psychiatrist should need to write or confirm it clearer that it is currently done so a medical license is immediately at stake. A 5150 is a legal document and it ruins people’s lives.

5. Fabricating medical notes?

she replied: Medi-*** regulations are very strict regarding documentation requirements. We perform routine chart audits. If someone were to produce what is believed to be a fabricated medical note, regulation would require us to conduct an investigation. They can file a complaint which will start an investigation. The complaint form can be found in English and Spanish online on the County Behavioral Health website in the informational materials: https://county.**.gov/health-and-human-services/health-services/divisions /behavioral-health /contractor-resources/medi-cal-informing-materials. It is also available in the lobby of the Crisis Stabilization Unit. It is also quite common for the people we evaluate to disagree with the content of the evaluation or medical notes and it is their right to do so. And they have the right to access their medical record, including the right to request an amendment or addition. (County Notice of Privacy Practices)

I responded: The grievance process seems to serve only as a cover protecting the County employees. How would they document the instances of false reporting? With a broken crayon? On what paper? Where are the grievances published? And the consequence? …both of which can be anonymous, but probably shouldn’t be completely anonymous for the employees. Who are we protecting? Where in the Crisis Stabilization Unit lobby is the grievance form located and how would someone know where to find it?

People who have been illegally held in the Crisis Stabilization Unit are traumatized and unlikely to spend their mental energy and resources, unless they have significant resources, on fighting a system that is oppressive, revengeful, and essentially has, as this facility does, a sadistic culture.

Look at the identity and length of the link for the grievance form you printed in the response:

https://county.ca.gov/health-and-human-services/health-services/divisions/behavioral-health/contractor-resources/medi-***-informing-materials.

Why even bother to state that lengthy link is on a poster where a traumatized patient or person who was kidnapped, since they aren't allowed access to a computer, don't know what it's for, aren't told what it is for, and may not qualify to complain to that agency?

Is it available to "patients" in print?

Why does it say Medi-***? Please explain what you are implying. (Added later: It seems to imply the * County Crisis Stabilization Unit is being funded by State funding meant for people who are low income. Auditing the funding is another facet to explore.)

Your staff wouldn’t tell me where to find it when I called on the phone, they couldn't even find the links to County Mental Health boards public meetings, gave wrong information about the dates of County Mental Health board meetings, and when I politely complained, said they were refusing to receive my communications in the future. There seems to be a significant amount of information about which the staff claim they are unable to answer questions either because they don't know it, or they claim it is secret even if it is policy they state exists.

The staff member responsible for processing complaints routinely gave false names, phone numbers, and other wrong information, she does other unethical obfuscating, and complaints against her unprofessional behavior are sent to her to process. Has she ever found a complaint justified?

6. Copying non-employee medical or law enforcement staff, or colleague’s notes without confirming and verifying they are true? What is the protocol for identifying the source of the information in the notes?

she replied: Medical records will quote the information provided by a third party and we will also complete our own evaluation.

I responded: The County of *** Behavioral Health Department and their 3rd party vendor staff repeat unverified, falsified 3rd party medical reports in ‘patients’ medical reports and use them as a basis for decisions. Sometimes it is obvious without knowing anything about the situation the notes are absurd. The staff did not, and possibly still are not, writing truthful evaluations.

7. What is the protocol for documenting one has not actually conversed with one of the clients in a report?

she replied: Evaluation will be face to face. Sometimes individuals will not talk with Crisis Stabilization Unit staff, and this will be noted in the Medical Record. In these cases, behaviors will be noted/documented to determine safety and level of risk.

I responded: When a ‘patient’ refuses to talk, prior notes were copied as if there was a dialogue, and that may still be happening.

Why would a ‘patient’ talk to someone who condoned a kidnapping by not verifying the validity of a 5150 before admitting him or her?

8. Refusing access to an adequate phone directory to every client which would necessitate adequate access to the internet?

she replied: Everyone has a right to use of the phone. We will provide a phone to individuals if a call needs to be made. We will look up phone numbers for them. Crisis Stabilization Unit does prohibit individuals using cell phones on the unit because of privacy issues, such as taking photos of other clients. If an individual is using the provided phone in an inappropriate manner (such as repeatedly calling 911 when there is no emergency) and the phone must be taken from them, Crisis Stabilization Unit must file a “denial of rights” with the state.

I responded: The staff did not, and possibly still don’t, look up phone numbers for the "patients". A ‘patient’ should be allowed to talk to 911 and explain they have been illegally held on a 5150, and have an opportunity to have it immediately investigated. A "patient" should be allowed to do an internet search to find a lawyer.

Based on your comment, why are staff members allowed to use cell phones?

9. Obfuscating access to a lawyer or other competent advocacy?

she replied: All individuals have right to talk to advocate. They all have access to a “patients’ rights advocate”. This is the phone number 1-800-***-****. It is posted in the CSU.

I responded: That is untrue. Staff did not, and possibly does not, help with procuring an attorney. The ‘patient’s rights advocates’ of the past were not, and possibly still are not, competent. The attorney who presides over the hearings was not competent, and possibly still is not.

10. Testing County of Sonoma-provided advocates for competency?

she replied: County contracts for patients’ rights services with an outside organization which is responsible for hiring and training their staff. If there are complaints about particular advocates, individuals may file a grievance and the issue will be investigated.

I responded: You didn’t answer the question.

Also, the grievance coordinator in past years gives wrong names and telephone numbers for referrals and can't answer basic questions about protocol. Do you want documentation?

Do all of the grievances get a response of not finding a problem?

11. Denying access to a thorough handbook of one’s rights and a clear explanation of how to advocate for oneself by omission or hiding it?

she replied: Staff should not be denying access to the Patients’ Rights handbook. If that is an issue, Crisis Stabilization Unit leadership would certainly want to hear about it. Individuals should speak with the Patients’ Rights Advocate, with a manager, or file a grievance if access is denied. Patients’ Rights Handbooks are available at the Crisis Stabilization Unit. They and poster can also be found here: https://www.dhcs.ca.gov/services/Pages/Office-of-Patients-Rights.aspx. Crisis Stabilization Unit management will remind all staff that individuals at the Crisis Stabilization Unit must be given a handbook.

I responded: They did deny access via omission, and possibly still do. Who is claiming any type of Patient’s Rights Handbook is provided to ‘patients’, let alone one with a good explanation and directions?

How is a 'patient' supposed to access that website?

Which handbook are you promising to provide? The one with the better information--which is still inadequate?

Why would anyone believe you or the staff?

12. Denying notice of a hearing and adequate consultation with a lawyer, or, if the client prefers, a County of *** provided advocate, for a minimum of 48 hours before a hearing is scheduled?

"she replied: There is no requirement to notice individuals about a 5250 certification hearing 48 hours prior to the hearing. There is a requirement to notice them at the expiration of a 5150 if the person continues to meet criteria for an involuntary hold and a 5250 has been written. This might happen at any time prior to the hearing, typically at least one day before. Each individual for whom a 5250 hold is written is contacted by the Patients’ Rights Advocate for consultation, to learn about their rights in the process, and to express their wishes prior to the hearing, usually on the same day as the hearing.

I responded: You are stating "patients" are denied notice of a hearing or trial and are not given ample time to, or allowed to, procure a lawyer. Is that legal? Is a 10-minute consult, if that, with an incompetent ‘patient’s right advocate’ immediately before a hearing or trial legal? Particularly when the incompetent attorney is the presiding judge? And particularly when the stakes are as high as they are in a 5250 hearing? 5150s and 5250s ruin lives.

Why do you try to state an unethical legal standard is adequate? Is that the standard you would want for someone you love?

13. Holding a hearing before one has been allowed to talk to a lawyer and has been given every informational resource needed to procure one?

she replied: The Crisis Stabilization Unit is obliged to follow the above steps, including noticing the Patients’ Rights Advocate about an impending 5250 hearing so that the Advocate has adequate time to meet with the individual prior to the hearing.

I responded: You are stating "patients" are denied notice of a hearing or trial and are not given ample time to procure a lawyer. Is a 10-minute consult, if that, with an incompetent ‘patient’s right advocate’ immediately before a hearing or trial legal? Particularly when the incompetent attorney is the presiding judge?

‘Patients’ weren’t and probably aren’t told the charges or what caused them. Is that legal? They heard the charges in the hearings which were rushed, and the incompetent 'patient's rights advocates' did not have enough information to provide any defense.

14. Deceiving people by telling them they will be released quicker if they agree to take medications they do not need?

she replied: Staff often provide information about recommended treatment and how that may quicken the release process. For example, if the individual is experiencing a manic episode, staff may say that taking a mood stabilizer might control the mania, allowing the individual to be released and not have to go to a higher level of care such as a psychiatric hospital. Staff at the Crisis Stabilization Unit cannot force medications or other treatment unless there is an imminent risk of physical harm to the individual or to others due to the person’s behavior. That all said, there are times when the individual disagrees that the medications are needed, and if they are evaluated to still be unsafe if they were released, it may prolong the stay at the Crisis Stabilization Unit and/or a hospital. There are other times when the medication does not work as expected and release does not happen as quickly as anticipated. The nuances in these conversations are important, and should not result in individuals at the Crisis Stabilization Unit feeling that they are being coerced into treatment, however we acknowledge that it can happen. Individuals can ask to speak with the psychiatrist, the manager, the patients’ rights advocate, or file a grievance if they feel that they are being deceived about their care.

I responded: Ask whom? The 3rd party security guard whose job is to block them from the staff? Why are you implying patients are allowed to speak with a staff member when they have a need or a question? They weren’t, and possibly still aren’t. Why are you implying a doctor is available, and if available, willing to talk to them? Did something change?

Writing implements and paper were not, and still may not, readily available. The complaints were manipulated and documented in medical reports against the reporter.

For example, one 'patient' who complained about the poor nutritional quality of the junk food snacks was told they were ordered by someone 'very high up' and then it was reported in that patient's medical records as complaining she was being poisoned.

‘Patients’ were told they cannot receive their medical records to complain about them until they have left.

15. Keeping the client area at a less comfortable temperature than the staff area?

she replied: The heating and air conditioning system is a bit tricky at the Crisis Stabilization Unit and staff are often lowering or raising temperatures based on requests from clients. If staff are not responding to requests to increase or lower the temperature, individuals can ask to speak to the patients’ rights advocate or a manager.

I responded: The temperature was, and sounds like it still is, kept at a level comfortable for staff, but not for clients who do not have access to sweaters and socks.

Why are you saying the ‘patients’ are allowed to speak with a staff member when they have a need or a question? They weren’t, and possibly still aren’t.

(I am adding: Unless something changed, you lie. Please stop lying.)

16. Not providing clean, filtered water to clients?

she replied: Clean tap water and cups are available to individuals on all of the Crisis Stabilization Unit units to make water available at all times. Cold, filtered tap water is available upon request.

I responded: Why are you saying the ‘patients’ are allowed to speak with a staff member when they have a need or a question?

Why is the filtered water in the staff’s kitchen not readily available to ‘patients’?

17. Not supplying sweaters or socks? Or clean clothes in which to leave?

she replied: The Crisis Stabilization Unit has 2 washing machines and 2 driers specifically so that client clothing can be washed as needed. The Crisis Stabilization Unit also stocks clothing and supplies it when individuals do not have adequate clothing at discharge.

I responded: That wasn’t true in the past. Are you saying the staff is now mandated to have clothes available for "patients"?

18. Not holding high standards for client area cleanliness?

she replied: The individual units at the Crisis Stabilization Unit are cleaned by janitorial staff twice daily and as needed. Complaints about cleanliness should be reported to staff.

I responded: Areas were not, and possibly are not, cleaned as needed. Complaints were, and possibly still are, manipulated and documented in medical reports against the reporter.

19. Does a non-employee ministry team member need to do anything beforehand to get access to the County of *** Crisis Stabilization Unit or other mental health service provider so when they come to the outside entrance spontaneously and asks if a client wants a visitor, and someone does, they can enter? Areas were not, and possibly are not, cleaned as needed. Complaints were, and possibly still are, manipulated and documented in medical reports against the reporter.

she replied: Family and significant others of individuals at the Crisis Stabilization Unit are able to visit and provide support.

Non-family or significant others of individuals at the Crisis Stabilization Unit have to be vetted through the County Human Resources Department. If interested, those organizations or individuals should contact management at the Crisis Stabilization Unit at ***-***-**** to initiate the process.

There are also volunteer positions available at the Crisis Stabilization Unit that have specific job descriptions, and there are peer internship positions available for those who have been through the County Community Services Peer Support Training Program.

I responded: Are you saying a minister must get him or herself declared mentally incompetent so he or she can attend the County Community Services Peer Support program to talk to a ‘patient’ who would like a visitor? (I am adding, I researched this, and that is what the County policy is stating.) And cannot come unannounced and ask if any ‘patient’ would like someone with whom to talk? Yet staff allowed in non-family and significant others at will?

20. A sign needs to be clearly displayed near the telephone for the clients with a list of five contact organizations, a brief description of each, and the phone numbers so a client can make contact if he or she needs advocacy or a friend. Do you need a list of organizations with ministry departments?

she replied: We are unaware of this requirement. We are required to post information about patients’ rights and the patients’ rights phone number on each unit at the Crisis Stabilization Unit. If organizations or individuals have resources for individuals served at the Crisis Stabilization Unit, they should contact management at the Crisis Stabilization Unit at ***-***-****.

I responded: The ‘patient’s rights advocates’ are possibly still incompetent, and even if they are competent, alternative advocates need to be posted.

I am adding, I find the response, "We are unaware of this requirement." as if an outside force needs to require something so basic--something she would want for herself or her child--very offensive.

Also, please confirm with me today the staff in the Crisis Stabilization Unit and all vendors with whom the County contracts have made plans for good, traditional meals for Thanksgiving, Christmas, Easter, and any other traditional holidays. Prepared food can be ordered at *** or ***, etc.

My response email was sent November 17, and about ten months later, in spite of four or more request, it has not been answered.

I would like to remain anonymous. I am concerned for the safety of my family.

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