AOT CRITERIA

  • 18 years of age or older, suffering from mental illness (MI)
  • Clinically determined that person is unlikely to survive safely in the community without supervision
  • Historical lack of compliance with treatment and at least one of the following is true:
    • MI has, at least twice within the last 36 months, has been a substantial factor in necessitating hospitalization or receipt of services in a forensic or mental health unit of a state correctional facility or local correctional facility.
    • MI has resulted in one or more acts of serious and violent behavior toward themselves or another or threats or attempts to cause serious physical harm to themselves or another within the last 48 months.
  • Offered an opportunity to participate in a treatment plan and continued to fail to engage.
  • Condition is substantially deteriorating.
  • Participation in AOT is the least restrictive placement necessary to ensure recovery and stability.
  • Person needs AOT to prevent relapse or deterioration that would likely result in grave disability or serious harm to the person or others.
  • Likely that the person would benefit from AOT.

OBJECTIVE & GOALS OF AOT

  • It allows individuals to be ordered into treatment without ordering them into a hospital.
  • The criteria to place someone in AOT are easier to meet than the “imminently dangerous” standard often required for impatient commitment.
  • The law not only allows courts to commit the patient to accepting care, but it also allows courts to commit the mental health system to providing it. The law includes strict eligibility criteria and numerous patient protection.

AOT CORE TEAM

  • Court hearing officer
  • Public defender
  • Triage team
  • Data tracking and collection
  • Court
  • Clinical treatment team

What is MCAT and why is it so important these days? MCAT is the Mobile Crisis Assessment Team, an arm of the San Jose Police Department which uniquely and jointly teams up with the Santa Clara County MCRT (Mobile Crisis Response Team) a team of licensed mental health clinicians. This is a trial pilot program which has experienced great success thus far; funding ends in December 2021. Mental illness and disability are widespread in the United States. Families, police and community leaders are ill equipped for the volume of mental health issues and the wide variety of needs and demands placed on a system not designed for mental health advocacy. MCAT working alongside with MCRT have new procedures to address those shortcomings.


“1 in 5 adults in America experience a mental illness. Nearly 1 in 25 (10 million) adults in America live with a serious mental illness.” (1)


When the patrol police respond to a 911 call, they are trained and ready to engage in a criminal situation. However, with the myriad of mental illnesses and disabilities there are instances when an enforcement-only approach does not serve either the publics or the individual’s best interest. There are situations which may involve behavioral manifestations of: Alzheimer’s, autism, bipolar, schizophrenia or schizoaffective disorders which could be more successful managed by a different arm of the police. The MCAT has been fully trained in peaceful negotiation by the FBI.


San Jose is not unique in its difficult struggle to assist the unhoused while also confronting the profound complexity of mental health issues. And the police need a variety of tools including MCAT officers. “The reported magnitude of mental disorders among homeless people ranged from 25 to 50% across the studies [9,10,11]. This prevalence rate rises to about 92% among those who are street homeless [7]. Nov 27, 2019” (2) The San Jose Police are dealing with an increase of 911 calls to encampments leading to delayed response times to other urgent calls. Many calls to encampments have a mental health component and arrests are not necessary. The tactical conduct policy for the patrol police demands that no force is justified if there is no crime; and mental health is not a crime.


“Street Crimes officers spend about 60% of their time responding to encampments, according to the report.” (3) MCAT support allows patrol police to withdraw and attend to other cases; while MCAT takes over and provides: crisis analysis, stabilization, de-escalation, and assessment to get to the appropriate level of care within a developed safety plan. This alone is an incredible benefit from MCAT, enabling patrol officers to respond faster to other incoming emergencies. In the short life of this program which started on October 2020, there are many MCAT calls that require substantial time; patrol police officers, charged with enforcing the law, do not have the time to stay and manage mental health care situations. MCAT does the job.


What do other police think of this program? MCAT officers explained that police have always wanted alternatives. They are the catch all, last resort for every problem and unfortunately, they do not have every solution. They want to do everything but they cannot. They need a mental health component.


Day in the Life. Going on tour with MCAT officers, as they start their long shift from 10:00 am until 8:00 pm, was an exciting opportunity to see how this pilot program is serving our community. The officers themselves are impressive as they speak Bosnian, two dialects of Indian-American, and Vietnamese, in addition to Spanish and English. Some had master degrees in everything from sociology to engineering while others came from the Marines. These are folks who believe in and are fully committed to the job they are doing.


Our first call was to a large downtown encampment that stretches along the freeway, through parking lots, and along bike paths. As we walked through, the MCAT officers proactively smiled, greeted and announced to folks that they were there for wellness checks, to make sure folks know the resources available to them, and make service connections to build trust; not to enforce laws. This approach immediately puts many communities at ease and allows an openness not always shared with direct enforcement.


We walked the maze of camps in different styles and structures, some with enclosures and doors others with tents. The structures, refuse and trash were accompanied by a special personalized comradery and unique group rules. At one site there was a grand barricade around the low end of a bridge where a camp resident had removed a base covering to the bridge and was now living inside. However creative and weather resistant, none of us were comfortable with the thought of driving over someone who was living inside the freeway bridge.


We also took a call to a mobile home park. The patrol police had departed since the complainant had declined to make a complaint and thus no crime. The MCAT team came to verify the situation was stabilized and to help reduce the occurrence of another 911 call. We were met at the scene by two clinicians from Santa Clara County (MCRT) who, together with MCAT, went and spoke with the 85-year-old mother and her 60-year-old adult daughter to assess the situation and provide resources. The mother had made a 911 call because her daughter was off her meds and broken things in the house; the mother did not know where to turn other than 911.


MCAT made an immediate assessment to determine if there was a crisis and made the scene safe for the clinicians. Immediately building rapport and credibility with both the mother and daughter, their safety plan including family support, potential hospitalizations, clinical care, sobering centers, and directing mother and daughter to the best level of care. After I left, MCAT did a follow up to determine if the intervention worked effectively or if the situation might be progressing, in order to prevent future 911 calls.


The MCAT grant funding will expire in December 2021. Congresswoman Zoe Loftgren has applied for a grant to support the MCAT pilot but more staff is needed.


What does MCAT Need? Obviously, our communities need a variety of mental health services; one size fits all, hardly fits anyone. MCAT with the grey area between illegal behavior and mental health behavior and potentially avoid unnecessary jail time. This pilot, first and foremost, must be continued and funded with more staff. The process will be to first continue the program and then to fund it to a level of success required by our community.


9/10/21 Irene Smith, JD, PhD

https://www.nami.org/nami/media/nami-media/infographics/generalmhfacts.pdf
https://www.nami.org/mhstats

https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-019-2361-7

https://www.mercurynews.com/2021/04/18/how-much-do-san-jose-agencies-spend-on-homeless-encampments/

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