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Governor's budget proposal could hurt county's mental health needs
By Michelle Durand
Filling the anemic ranks of state hospital staff with hefty pay increases could have a two-pronged negative impact for San Mateo County, officials said yesterday in reaction to Gov. Arnold Schwarzeneg-ger’s most recent budget proposal.

The proposal, county officials said, will winnow from the jail mentally incompetent inmates whose hospitalization is delayed by a lack of employees while making it difficult to recruit and retain skilled mental health professionals.

The May budget revise proposes salary increases for psychiatrists and psychologists between 66 percent and 74 percent and other staff increases ranging between 10 percent and 40 percent. The higher pay scales are expected to fill vacancies at institutions such as Napa, Patton and Atascadero state hospitals whose patients include criminal defendants deemed unable to aid in their own defense and sexually violent predators whose terms are extended by the court. Currently, some facilities are running at less than 50 percent staffing — an employment drought that has kept defendants who would otherwise be hospitalized in local jails like the overcrowded Maguire Correctional Facility in Redwood City. As a result, the jail stays packed and incompetent inmates are denied the treatment and medication they need and to which they are entitled.

Competency refers to a defendant’s ability to aid in his or her own defense after a crime. Sanity is the defendant’s state of mind at the time the crime was committed. When a defendant’s mental state is questioned, criminal proceedings are typically halted while it is evaluated by two court-appointed doctors.  Defendants found incompetent are supposed to be treated at state mental hospitals until doctors there find them cured. At that point, the man or woman returns to the county and stands trial on the original charges.

The current backlog, however, means these defendants aren’t necessarily being treated as they would in a hospital.

In December, Belmont resident Robert Simmons, 27, was deemed incompetent before standing trial for allegedly running a pot house in 2005. Despite the finding, the man who declares himself a reverend was not immediately transported, said Chief Deputy District Attorney Steve Wagstaffe.

Likewise, Curtis Commo, 25, returned to court a number of times since being deemed incompetent in September. Commo and another man were accused of robbing two South San Francisco pedestrians and committing the takeover robbery of the Boys and Girls Club on bingo night.

During one hearing, the court was advised that Atascadero State Hospital refused to admit any new inmates because of the loss of psychologists to the Department of Corrections. The court asked Commo’s defense attorney and jail psychologists to create a competency treatment program for him locally.

Both men and approximately six other incompetent inmates were eventually hospitalized after Judge Jack Grandsaert threatened the hospital administration with an order to show cause, Wagstaffe said.

The hospital gave in but the real test, he added, will be when the next county inmate is deemed incompetent.

By then, the state may have taken action itself to ease the problems.

In February, Federal Judge Lawrence Karlton ordered mental health officials to draft a plan to attract new hires, such as a headhunter and loan repayment plan, but vacancies continued increasing while workers left for state prisons.

Attorneys for some patients called the plan inadequate and argued the shortages jeopardize the safety of both them and staff.

Karlton then ordered the state Mental Health Department to raise some salaries to equal those in the state prison system. Atascadero State Hospital workers picketed outside the facility Monday demanding raises, according to published reports.

While the federal order and May budget revise proposal could stem the tide of outgoing professionals at state hospitals, San Mateo County Manager John Maltbie said it isn’t helping the employee ranks locally.

A number of psychiatrists and psychologists have already gone to the state prison system, lured by the higher wages, and raises at the hospital won’t help matters.

The county has already seen its ability to recruit and retain professionals in a shallow pool dented. Psychiatrists, particularly the physicians at the San Mateo Medical Center’s Psychiatric Emergency Service department, are especially scarce, Maltbie wrote in an analysis of the May revision.

“We’re having one devil of a time trying to retain psychiatrists in our own mental health programs,” Maltbie said.

The exact employment figures were not immediately available yesterday, said hospital spokesman Dave Hook.

Maltbie warned the Board of Supervisors to expect to take future action to retain mental health professionals, such as salary hikes.

“We’re trying to keep pace with these changes,” he said.

As the county scrambles to keep the professionals here, law enforcement is hoping the mentally ill inmates will soon be transported to state hospitals.

A similar backup happened in the fall of 2005 when more than a dozen incompetent inmates accused of felonies as severe as murder lingered at the jail when hospitals claimed a lack of bed space. Hospital officials also refused to accept patients who would not voluntarily agree to medication.

During that period, without the ability to force medication, already stretched jail staff were left caring for some inmates with severe mental trauma and violent tendencies.

The jail has a specific floor for inmates with medical needs but is typically reserved for physical ailments or mental illnesses, like schizophrenia, that don’t necessarily play a role in incompetency.

Judge Mark Forcum ultimately ordered the director of Napa State Hospital to accept inmates or be found in contempt. Some of the incompetent inmates eventually acquiesced to medication, allowing them to be hospitalized.

Michelle Durand can be reached by e-mail: michelle@smdailyjournal.com or by phone: (650) 344-5200 ext. 102. 

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