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One woman threatened to stab herself in the neck. A man said he would kill himself and everyone around him.

They were among thousands of people taken each year to the county's mental health facility, perched on a wooded hillside between several north Santa Rosa neighborhoods. There, they were placed on temporary holds to prevent them from hurting themselves or others.

But the Charles M. Norton Mental Health Center, designed to be a safe haven for people suffering severe psychiatric disorders, is not secured.

About once a week, staff call police to report that a patient under a psychiatric hold walked away from the Chanate Road facility, according to a Press Democrat analysis of police dispatch records over the first eight months of 2012.

"It's a problem," said Michael Kennedy, Sonoma County's director of mental health services. "We would like zero people to leave. That is our goal."

While in some counties people are taken to emergency rooms or directly to psychiatric hospitals, Sonoma County's Psychiatric Emergency Services facility is among just a handful in the state designed as an intermediate place where people are evaluated outside of the commotion of a hospital. About 10 patients a day are seen there and the facility has at least eight beds for overnight stays.

At the Norton Center, a security guard posted at the front door is prohibited in most cases from physically restraining people who try to leave, Kennedy said. These people are patients, not prisoners, he said. When one tries to leave, staff often walk or run alongside and talk them into coming back.

Kennedy said it would be costly to upgrade the 73-year-old facility to comply with modern safety codes, which would allow it to lock its doors.

The rules require locked psychiatric care facilities to have alarms and unlocking systems in place so people can exit in emergencies, such as a fire. The cost of refurbishing the building could be very expensive, in the "six figures," Kennedy said.

"We can't lock the place," Kennedy said. "We have no choice, with the facility that we have. We have no ability to secure it."

Psychiatric Emergency Services, or PES, is the county's triage center where people come for immediate treatment during a mental health crisis. It serves about 3,400 people each year.

About half of its patients arrive voluntarily seeking help, and many of those patients are free to leave.

The other half have been deemed by a court to be unable to care for themselves or were brought in by police or a mental health professional and placed on a temporary "hold."

So far, Kennedy said each person who has fled the facility has been found or returned on their own, most within an hour. The longest case this year took four days.

But some mental health advocates and law enforcement officers say the Norton Center's unlocked-door policy exposes officers and the public to unnecessary risk.

The county becomes "legally and ethically responsible" for people who are under temporary civil commitment, said David France, deputy director of Sonoma County's National Alliance of Mental Illness.

France said he was "shocked" that the program doesn't do more to keep people safe.

"It just takes one person to have something serious happen," France said.

Santa Rosa Police Lt. John Noland, the department's liaison with the county mental health department, said the calls are a high priority for patrol officers.

"You can't provide services if people are walking away. It slows everything down," Noland said.

PES staff called Santa Rosa police on 52 occasions between Jan. 1 and Sept. 8 to report that a patient had walked away from the Norton Center, according to police dispatch records.

During 34 of those calls, dispatchers noted that the missing person was "on a hold" or "on a 5150 hold," which refers to the section of state law that allows police or medical staff to involuntarily confine people suspected of suffering mental disorders that make them a danger to themselves or others.

And in six additional cases, the person was said to be a conservatee, meaning they are gravely disabled and a judge decided they cannot care for themselves.

The outcomes varied.

Of the 52 calls reporting people who walked away from the Norton Center, police records do not clearly show the resolution in about 35 percent of the incidents.

About 30 percent of the call records indicate police were able to locate the missing individual.

But 21 percent of the call records state police were unable to immediately find the subject. And 11 percent of the call records indicate the individual returned on his or her own.

Only one call record states that Norton Center staff recovered the missing person.

"That should not happen," said Rafael Herrera, a retired UC Berkeley professor and mental health expert.

Herrera helped found Alameda County's mental health crisis response team in 1988. The program became a model for mobile crisis units that have on-call mental health workers who can respond to aid police.

"Those facilities exist to hold people involuntarily. They are usually locked," Herrera said. "It happens that people elope, but it's rare."

Kennedy said he asked staff to review his department's records of "walkaways" during the first eight months of the year. They found reports of 28 calls to police for help involving 26 fleeing patients. Four of those people were not on holds, despite what staff told police dispatchers, he said.

Last week, the county posted an additional guard at a back door to improve security, Kennedy said.

The vast majority of patients at the Norton Center do not leave without authorization. The walkaway cases represent only about 2 percent of the people brought into PES from Jan. 1 to Sept. 8, the span of the police records analyzed by The Press Democrat.

During that time, PES served 2,645 people and of those about 51 percent of people were placed on emergency holds.

Sneaking away is exactly what one 21-year-old Santa Rosa woman started doing two years ago when she began hearing voices and hurting herself.

The woman, who spoke on condition that her name would not be published, was on a 5150 hold at PES for the fourth or fifth time Sept. 19 when she ran, she said.

"I was smoking a cigarette on a bench out front, and for some reason had it in me to take off running," said the woman, interviewed at Santa Rosa's Creekside Mental Health Program.

She ran down the hill and headed west on Chanate Road. Staff called 911, according to the woman and police records.

"They looked the other way and she was gone," said her mother, a Santa Rosa resident who works at a nursing home. "She walks out in traffic without looking. The reason she's there is she can't make rational decisions."

The woman said "the voices" often tell her to run away and she doesn't always remember what happens next. But she said she remembered a police patrol car blocking her path as she fled.

An officer "got out of the car, grabbed my arm, pulled it back and pushed me to the ground with enough force to scratch my face," she said.

She said she was not seriously injured and was taken back to PES.

Under Section 5150 of the California Welfare and Institutions code, police or other approved staff can take a person who appears to pose a danger to themselves or others to be evaluated by a mental health professional.

That person must be evaluated within 24 hours of their arrival. Within 72 hours, they must be released or referred to further care, according to the law.

"The 5150 designation allows for the facility to keep you against your will. You cannot just walk away," said Henry Omoregie, bureau chief for mental health treatment licensing for California's Department of Social Services.

"It matters because they are a danger to themselves and to the public. They are there to receive treatment," Omoregie said.

People are given medication if needed and sent home or referred to outside programs, ranging from outpatient programs to psychiatric hospitals, the nearest one in Marin County.

Of 1,351 people on holds treated at PES between January and September, 27 percent were hospitalized and 3 percent sent to a voluntary crisis residential program, Kennedy said.

The remainder, 70 percent, were released, and in many cases, referred to outpatient services.

Dr. Gary Bravo, medical director of Sonoma County Mental Health, said the agency's goal is to help people return to the community as soon as they're able.

Mental health services are more successful when people choose to participate.

"The less coercive they are, the less restrictive, the better they work," Bravo said.

"What we don't have right now is the physically secure setting for people with access to medical services," he said.

But that is the county's long-term goal.

Kennedy said that he is debating whether the agency will upgrade the Norton Center or simply move.

A major factor in the decision is that Sutter Medical Center's emergency room will move from its current location on Chanate Road to a new campus under construction next to the Wells Fargo Center.

Kennedy said the agency wants to locate its PES center in a separate facility near an emergency room.

A 93-bed psychiatric hospital under construction on Fulton Road, which is slated to open early next year, will also help, Kennedy said.

Right now there are no inpatient psychiatric options in Sonoma County, which in some cases means people wait longer at PES before they can be sent to an out-of-county psychiatric hospital.

"If we could move people faster, it could alleviate the problem," Kennedy said.

(You can reach Staff Writer Julie Johnson at 521-5220, julie.johnson@pressdemocrat.com or on Twitter @jjpressdem.)

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