Responding to Individuals in Behavioral Health Crises

Department Policy SUBJECT:

POLICY #:

RESPONDING TO INDIVIDUALS IN BEHAVIORAL CRISIS CALEA STANDARDS REFERENCE(S):

511 SUPERSEDES:

[1.1.3, 4.1.1, 41.2.7]

I.

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511 CIRT – 7/21/16

25 EFFECTIVE DATE:

MARCH 25, 2021

Purpose The purpose of this policy is to provide Department employees with the guidance necessary to perform department operations decisively, consistently, and legally when responding to individuals in behavioral crisis.

II.

Definitions Apprehension by Peace Officer Without Warrant – If a person is having a mental health crisis and police are called to the scene, a peace officer may take the person into custody if the person’s behavior indicates severe emotional distress or deterioration of a mental condition and the peace officer believes the person presents a substantial risk of serious harm to himself or others. The officer will transport the individual to a mental health facility or to the nearest hospital emergency room for a mental health evaluation. This is referred to as an emergency detention. [Texas Health & Safety Code, Section 573.001] Behavioral Crisis - A situation where an individual’s safety and health are threatened by behavioral health challenges, to include mental illness, substance abuse, medical conditions, situational stress, and developmental disabilities. A crisis can involve an individual’s perception or experience of an event or situation as an intolerable difficulty that exceeds the individual’s current resources and coping mechanisms and may include unusual stress in their life that renders them unable to function as they normally would, which may make them a danger to self or others.

Behavioral Health - The term “behavioral health” in this context means the promotion of mental health, resilience and wellbeing; the treatment of mental and substance use disorders; and the support of those who experience and/or are in recovery from these conditions, along with their families and communities.

Clinician and Officer Remote Evaluation (CORE) Program - An innovative, award winning program connecting a patrol deputy in the field with a clinician from The Harris Center for Mental Health and Intellectual and Developmental Disabilities (IDD) via a computer tablet.

Consumer - A person with mental illness.

Crisis Intervention Response Team (CIRT) – Detentions - A sub-unit of the Detentions Mental Health Unit (MHU) comprised of those personnel assigned the duty of responding to a MHU call-out of an inmate in behavioral crisis. CIRT assists department detention personnel with contacts involving individuals in behavioral crisis; provides intervention, referral, or placement for a person in

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POLICY #:

RESPONDING TO INDIVIDUALS IN BEHAVIORAL CRISIS

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behavioral crisis; and assists the Detention Command Containment Team with cell extractions. CIRT is the jail’s highest-level response to individuals in behavioral crisis.

Crisis Intervention Response Team (CIRT) – Patrol - A co-responder unit pairing a CIT trained deputy with a masters-level clinician from our local mental health authority, The Harris Center for Mental Health and IDD. These teams respond to situations involving persons who may be experiencing a behavioral health crisis. [CALEA Standard 41.2.7] Crisis Intervention Training (CIT) - National best practice scenario-based training developed by the Memphis (TN) Police Department for law enforcement first responders. The course contains information on the major mental illnesses and communication/de-escalation techniques that are proven to help first responders safely resolve situations involving individuals in crisis due to mental illness, substance use, and other psychosocial issues.

Crisis Intervention Trained (CIT) Member - A deputy or detention officer who has successfully completed a TCOLE 40-hour Mental Health Peace Officer/CIT course.

De-escalation Tactics and Technique - Actions used, when safe and feasible without compromising law enforcement priorities, that seek to minimize the likelihood of the need to use force during an incident and increase the likelihood of voluntary compliance.[CALEA Standard 4.1.1] Department - Harris County Sheriff’s Office.

Detentions Mental Health Unit - A unit in detentions housing inmates with serious mental illness. The unit is staffed by department personnel and staff from The Harris Center for Mental Health and IDD. Developmental Disability - Having a physical or mental impairment (such as autism, cerebral palsy, or spina bifida) that becomes apparent shortly after birth or during childhood and delays, limits, or prevents the progression of normal development (as in language, learning, or mobility).

Elope - To abscond, depart, leave, or walk away.

Emergency Medical Treatment and Labor Act (EMTALA) - A federal statute that governs when and how a patient may be refused treatment or transferred from one hospital to another when he/she is in an unstable condition.

Judge Ed Emmett Mental Health Diversion Center - A pre-arrest, pre-charge alternative to incarceration for individuals with a mental illness, developmental disability or neurocognitive disorder who have committed non-violent, low level offenses. [CALEA Standard 1.1.3]

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Mental Health Resource Sheet - Also known as the Green Sheet. A list of mental health resources provided to consumers, family members, and other members of the public. The Mental Health Resource Sheet can be found on the Department’s intranet under the Common Forms tab.

Mental Illness - An impairment of an individual’s normal cognitive, emotional, or behavioral functioning, caused by physiological or psychosocial factors. A person may be affected by mental illness if he or she displays an inability to think rationally (e.g., delusions or hallucinations); exercise adequate control over behavior or impulses (e.g., aggressive, suicidal, homicidal, sexual); and/or take reasonable care of his or her welfare with regard to basic provisions for clothing, food, shelter, or safety.

NeuroPsychiatric Center (NPC) - A psychiatric emergency center operated by The Harris Center for Mental Health and IDD. The NPC is not a hospital and does not accept mental health consumers with serious medical conditions.

Notification of Emergency Detention - The state-approved form used by Texas peace officers to bring a person in a mental health crisis to a facility to be evaluated. [Texas Health & Safety Code, Section 573.001] Offender - A person with mental health issues who is also being charged with a crime.

Premise History – Information connected to a specific address that may be of interest to responding deputies.

Psychosocial Issue - The psychological and social factors that influence mental health. Social influences such as peer pressure, parental support, cultural and religious background, socioeconomic status, and interpersonal relationships all help to shape personality and influence psychological makeup.

Receipt and Notice of Rights for Seized Firearms - A form that is provided to the person whose firearm is seized when that person is taken into custody for an emergency detention. This form can be found on the Harris County Sheriff’s Office Intranet under the Common Forms tab.

Tactical Disengagement - The decision to leave, delay contact, delay custody, or plan to make contact at a different time and under different circumstances.

This tactic should be considered when continued contact may result in an undue safety risk to the person, the public, and/or agency members.

The Harris Center for Mental Health and IDD - The state designated local mental health authority for Harris County which provides assistance to persons who may suffer from mental illness or developmental disabilities.

Triage/Diversion Desk - Located in the Joint Processing Center (JPC), the Triage/Diversion desk works to divert persons with mental impairments from the criminal justice system into treatment services.

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Unlawful Elopement - To elope in violation of legal/commitment status.

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a civil or criminal

Victim - A person with mental health issues who is not being charged with a crime, e.g., a person in custody for emergency detention, a person being brought voluntarily to a mental health facility.

III.

Policy The Harris County Sheriff’s Office is committed to responding to incidents involving individuals in behavioral crisis with the foremost regard for the preservation of human life and the safety of all persons involved. It is the Department’s policy to develop, implement, and incorporate mental health training and strategies to enable employees to safely resolve incidents involving people in behavioral crisis without the use of force, whenever possible, and to refer persons in crisis to community mental health service providers or other resources as appropriate.

A. Facilities Ben Taub Hospital Ben Taub Hospital 1504 Taub Loop Houston, TX 77030 Individuals exhibiting mental health crisis AND who have a medical condition may be brought to Ben Taub Hospital.

Judge Ed Emmett Mental Health Diversion Center Judge Ed Emmett Mental Health Diversion Center 6160 S Loop E Freeway Houston, TX 77087 Harris County’s pre-charge jail diversion facility. For offenders committing low-level, non-violent offenses when it is believed mental illness and/or psychosocial issues were a factor in the commission of the crime.

Michael E. DeBakey VA Medical Center Michael E. DeBakey (VA) Medical Center 2002 Holcombe Boulevard Houston, TX 77030 Prior to transporting any person for a mental health evaluation, deputies should inquire if the person is a military veteran. Veterans in crisis are

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accepted at the VA Medical Center for either voluntary or involuntary treatment.

NeuroPsychiatric Center (NPC) NeuroPsychiatric Center (NPC) 1504 Taub Loop Houston, TX 77030 The NPC is an emergency mental health crisis center, not a medical facility.

Persons requiring medical attention shall not be taken to this facility.

B. Procedures for Responding to Individuals in Behavioral Crisis: Emergency Communication Division Emergency Communications call takers ask all callers if they, the caller, believes the call involves a person in behavioral crisis. If the answer is yes, dispatchers make every attempt to dispatch the call to a CIT trained deputy, CORE deputy, or patrol CIRT unit.

It is essential that calls involving persons in behavioral crisis are properly categorized and dispatched and that sufficient information is provided to responding patrol deputies. This includes information such as diagnosis, medication(s), threatening behavior, and/or weapons (if available).

If available, CIRT-Patrol teams should be dispatched to special threat situations, hostage/crisis negotiations, barricaded individuals, persons with suicidal/homicidal ideation, and other calls with a behavioral health component.

A premise history shall not be placed on a location solely because a person has a mental illness. If, however, there is reason to believe the person poses a safety risk to responding deputies or others due to his/her mental illness or behavioral crisis, then a premise history shall be completed.

Requests for premise histories are emailed to UnitNumbers (HCSO) Monday through Friday 8 am to 4 pm at: Unitnumbers@sheriff.hctx.net and to EDC Watch Command, (HCSO) EDC Watch Supervisors after 4 pm and on weekends at: ComSupv@hctx.net. Personnel emailing a request for a premise history must include their supervisor in the email communication.

C. Recognizing Abnormal Behavior Only trained mental health professionals can diagnose mental illness, and even they may sometimes find it difficult to make a diagnosis. Department employees are not expected to diagnose mental or emotional conditions, but are expected to recognize behaviors that are indicative of persons affected by mental illness or in behavioral crisis, with a special emphasis on those that suggest potential violence and/or danger.

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D. Procedures for Responding to Individuals in Behavioral Crisis: Assessing Risk Department employees will assess risk to themselves, the involved person, and others in determining a course of action. Many persons affected by mental illness or in crisis are not dangerous and some may only present dangerous behavior under certain circumstances or conditions. Employees may use several indicators to assess whether a person in crisis represents potential danger to themselves, the employee, or others. These include the following: 1. The availability of weapons.

2. Threats of harm to self or others or statements by the person that suggest they are prepared to commit a violent or dangerous act.

3. Personal history that reflects prior violence under similar or related circumstances.

4. The amount of self-control the person exhibits, particularly the amount of physical control over emotions such as rage, anger, fright, or agitation.

5. Indications of substance use, as these may alter the individual’s selfcontrol and negatively influence an employee’s capacity to effectively deescalate.

6. Aggressive behaviors such as advancing on or toward an employee, refusal to follow directions or commands combined with physical posturing and verbal or non-verbal threats.

7. A person in crisis may rapidly change his/her presentation from calm and command-responsive to physically active.

E. Procedures for Responding to Individuals in Behavioral Crisis: Employee Response When responding to persons exhibiting symptoms of mental illness or behavioral crisis, Department employees shall consider the following actions to manage the situation for the safety of all at the scene: 1. Attempt to arrive at the scene with a coordinated approach based upon initial information and any pre-existing knowledge of the individuals involved.

2. Take time if immediate action is not required. Time gives Department employees the opportunity to communicate with the individual, refine plans, and call for additional resources, if necessary.

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3. Take steps to calm the situation. Where possible, eliminate emergency lights and sirens, disperse crowds, and assume a quiet and nonthreatening manner when approaching or conversing with the person.

4. Move slowly. Do not excite the disturbed person. Provide assurance you are there to help and that the person will be provided with appropriate care.

5. The dynamic nature of most incidents will require plans to be flexible, and responders will need to adapt their plan(s) as additional information or factors become known.

6. Evaluate the nature of the situation and the necessity for intervention or other referral. Continually assess the situation as circumstances change and new information is received.

7. Communicate with the person in an attempt to determine what is bothering him/her. Relate concern for his or her feelings and allow the person to express his/her feelings. Where possible, gather information on the person from acquaintances or family member and/or request professional assistance, if available and appropriate, to assist in communicating with and calming the person.

8. Do not threaten the person with arrest or in any other manner, as this will create additional fright, stress, and potential aggression.

9. Avoid topics that may agitate the person and guide the conversation toward subjects that help bring the person back to reality.

10. Always attempt to be truthful. If the person becomes aware of deception, he or she may withdraw from the contact in distrust and may retaliate in anger.

11. If the individual is failing to comply with orders, attempt to determine whether the individual’s lack of compliance is a deliberate attempt to resist or an inability to comprehend the situation due to environmental, physical, cognitive, or other conditions.

12. Evaluate the need for assistance from individuals with specialized training in dealing with mental illness or crisis situations (e.g., Crisis Intervention Response Team - Patrol, Crisis Intervention Response Team – Detentions, CORE deputy, supervisor, behavioral health professional, medical personnel, etc.).

13. Once a patrol scene is stabilized, the on-scene deputy may request the Crisis Intervention Response Team (CIRT) – Patrol. If available, CIRT Patrol will be dispatched and will provide assistance, direction, and guidance. Scenes CIRT – Patrol responds to the following: special threat situations, hostage/crisis negotiations, barricaded persons, calls involving H AR RI S C O U N T Y , T E X AS

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individuals with suicidal/homicidal ideation, and other calls with a behavioral health component.

14. If intervention is necessary, evaluate the need to utilize additional cover officers and the ability to notify and/or utilize a supervisor.

15. If custody is necessary, develop and communicate a tactical plan taking advantage of the most effective options that may safely resolve the incident.

16. If custody is not necessary, and the person could benefit from behavioral health services, the deputy should provide the Mental Health Resource Sheet (Green Sheet) to consumers, family members, and other members of the public. The Mental Health Resource Sheet can be found on the Department’s intranet under the Common Forms tab.

F. Procedures for Responding to Individuals in Behavioral Crisis: Tactical Disengagement Law enforcement agencies across the nation are using “disengagement” strategies that allow them to leave calls without confronting someone in crisis.

These tactics are used most often when the person is alone and does not present a threat to anyone else, and no crime is being committed. This is a tactical decision to leave, delay contact, delay custody, or plan to make contact at a different time and under different circumstances.

The following are two examples of tactical disengagement: Example #1: San Francisco (CA) Police Department The San Francisco (CA) Police Department responded to a suicide call from an elderly father who said his adult son, who suffers from mental illness, was threatening to cut his wrists. Arriving officers saw through a window that the son was holding a knife and heard him arguing with his father not to let police enter. The officers got the father out. During an hours-long standoff, the son barricaded himself in his room. Officers entered the house but did not force their way into the bedroom. Instead, they looked for blood, a possible sign the son was hurt. Finding none, and in consultation with a mental health clinician on the scene, the officers decided it was best to walk away. They advised the father not to return to the house and left.

The son did not kill himself, and the next day, though the man was still barricaded in his room, officers were able to make contact and persuade him to accept help. The son told the officers that if they had gone into his room the previous day he was ready to die. He was ready to charge the officers so they would shoot him.

Source: Chabria, Anita. “Police fear ‘suicide by cop’ cases. So they’ve stopped responding to some calls.” Los Angeles Times. Aug. 10, 2019.

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https://www.latimes.com/california/story/2019-08-09/suicide-calls-californiacops-stopped-responding. December 2, 2020.

Example #2: Fargo (ND) Police Department After a four-hour effort to get in contact with an armed suicidal man at a south Fargo apartment, Fargo police officers decided the best way to deescalate the situation was to leave the scene. Deputy Chief Todd Osmundson said the tactic is something Fargo Police has done quite a few times. Chief Osmundson added that the best chance they had for the person not hurting himself was to leave instead of knocking on the door with their weapons drawn. Officers consulted with the man’s family before making the decision to leave.

Chief Osmundson said there were several Crisis Intervention Trained (CIT) officers on the scene to help to better communicate and understand the mental health situation. However, the chief added that the presence of law enforcement can sometimes make a situation more stressful for a person in a mental health crisis.

Although they tactically disengaged from the scene, Fargo officers conducted a follow-up with the man and his family the next day.

Source: Hurley, Bailey. “Fargo Police say leaving suicidal situations is sometimes best option.” Valley News Live. Apr. 19, 2019. https://www.valleynewslive.com/content/news/Fargo-Police-say-leavingsuicidal-situations-is-sometimes-best-option-508813711.html. December 2, 2020.

If employees determine that tactical disengagement may be appropriate, they shall contact the on-duty patrol supervisor for the incident. The patrol supervisor for the incident must report to the scene. If, after attempting contact and de-escalation techniques, the patrol supervisor determines that the person is not a known or reasonable threat to others and that interaction or further interaction with the individual may result in an increased risk to the person, the public, or deputies, the on-scene supervisor should develop a plan for tactical disengagement.

1. Procedures: If a subject is not responding or cooperative, does not present a known or reasonably believed threat to deputies or others, does not present an undue safety risk, and the on-scene supervisor determines that an immediate arrest is not required, the supervisor should proceed as follows: a. Verbally brief the watch commander or appropriate district commander for the incident.

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b. Attempt to use all appropriate and available department resources to safely resolve the situation. The watch commander or dispatch should ensure a patrol CIRT unit is dispatched to the scene if available. If patrol CIRT is not available, a Crisis Intervention Trained (CIT) deputy shall be dispatched to the location. c. Ensure that family members, friends, and the subject are provided information about resources and services available to them, as reasonably possible under the circumstances. A Mental Health Resource Sheet (Green Sheet) should be provided to them. d. After reasonable attempts are made to contact the subject without resolution, the supervisor shall contact the watch commander and apprise him/her of the situation. The watch commander will make the decision to disengage. If the watch commander makes the decision to disengage, the supervisor will order deputies to withdraw from the area.

2. Under these circumstances, deputies should not: a. Escalate or make forced entry into the location or close distance on the person while attempting tactical non-engagement or tactical disengagement, unless a change in circumstances make a closer intervention appropriate under the Department’s policies. b. Force entry to arrest the subject for pending misdemeanor charges or misdemeanor warrants. This does not prevent the subject from being charged out of custody.

3. Reporting Tactical Disengagement When the decision is made to tactically disengage, the on-scene supervisor must create an incident report documenting the following elements: a. Details of the call b. Reasons for tactical non-engagement or tactical dis-engagement c. Actions taken to deescalate the situation d. Actions to promote safety e. Follow-up plans and referrals made The supervisor for the incident will ensure that deputies write appropriate incident reports, including an original report, and all supplemental reports.

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The supervisor for the incident will ensure a request for a premise history of the location be placed into the CAD system to assist in managing future calls for service at the location. Requests for premise histories are emailed to UnitNumbers (HCSO) Monday through Friday 8 am to 4 pm at: Unitnumbers@sheriff.hctx.net and to EDC Watch Command, (HCSO) EDC Watch Supervisors after 4 pm and on weekends at: ComSupv@hctx.net. Personnel emailing a request for a premise history must include their supervisor in the email communication.

The supervisor for the incident will ensure that deputies email incident and supplemental report numbers to the Behavioral Health Investigations Unit (BHIU) by the end of the supervisor’s shift. The BHIU’s email address is: BHIU@Sheriff.hctx.net.

G. Procedures for Responding to Individuals in Behavioral Crisis: Disposition (Law Enforcement) In determining the appropriate resolution for a person in crisis, Department employees shall consider the totality of the circumstances, including the behavior of the person with a suspected mental illness, behavioral crisis, or developmental disability, and the governmental interests at stake. The following is a list of dispositions that may be appropriate, among others: 1. Take the person into custody and to jail for a criminal offense that supports custodial arrest and presentation to a magistrate for charging.

2. Refer to a mental health agency, crisis hotline, or other related service agency.

3. Consult with a mental health or medical professional.

4. Deputies are not obligated to transport a person to a mental health or medical facility for voluntary care if the person does not meet the criteria for emergency detention. However, if the deputy feels it is in the person’s best interest to transport him/her, the deputy may do so. In these situations, deputies are to wait with the person until a safe handoff is made to facility staff. Department employees will complete a report to document the incident and transport.

5. Take the person into custody on an emergency detention, an exercise of civil authority, when there is probable cause to believe the person poses a substantial risk of imminent serious harm to self or to any other person, or is unable to provide for basic personal needs and is not receiving the care necessary for health and safety, and is in need of immediate care, custody, or treatment for mental illness.

6. Department employees will transport the individual taken into custody on an emergency detention to the following facilities: H AR RI S C O U N T Y , T E X AS

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a. The NeuroPsychiatric Center if the person is in mental health crisis and does not have a medical condition; b. Ben Taub Hospital if the person is in mental health crisis and does have a medical condition; c. The Michael E. DeBakey VA Medical Center if the person is in mental health crisis and is a veteran with VA benefits. The VA Medical Center will accept veterans with medical conditions.

7. If the facilities listed above are not available (on diversion, the person is not a veteran, etc.) Department employees may take the person to any hospital in the county with an emergency department (ED) under the Emergency Medical Treatment and Active Labor Act (EMTALA). Any patient brought to the ED requesting examination or treatment for a medical emergency must be provided with a medical screening examination. A mental health crisis is a medical emergency. If a serious medical condition exists, the ED is obligated to either provide treatment until the person is stable or transfer the patient to another hospital.

8. A Notification of Emergency Detention form shall be completed on all people taken into custody for emergency detention. The form shall be provided to intake personnel at the facility the member takes the person for evaluation. A copy of the emergency detention shall be uploaded to the incident report. Document the name of the staff member the emergency detention was given to in the incident report. A mental health facility or hospital emergency department may not require a peace officer to execute any form other than this form as a predicate to accepting for temporary admission a person detained under Section 573.001, Texas Health and Safety Code.

H. Apprehension by Peace Officer Without Warrant The authority given to Texas peace officers to detain an individual who is in mental health crisis is found in Section 573.001 of the Texas Health and Safety Code. The following is a summary of the law: A peace officer, without a warrant, may take a person into custody, regardless of the age of the person, if the officer: 1. Has reason to believe and does believe that: a. The person is a person with mental illness; and b. Because of that mental illness there is a substantial risk of serious harm to the person or to others unless the person is immediately restrained; and

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c. Believes there is not sufficient time to obtain a warrant before taking the person into custody.

A substantial risk of serious harm to the person or others may be demonstrated by: 1. The person’s behavior; or 2. Evidence of severe emotional distress and deterioration in the person’s mental condition to the extent that the person cannot remain at liberty.

The peace officer may form the belief that the person meets the criteria for apprehension: 1. From a representation of a credible person; or 2. On the basis of the conduct of the apprehended person or the circumstances under which the apprehended person is found.

A peace officer who takes a person into custody under this section may immediately seize any firearm found in possession of the person.

Since the mentally ill person has been found by the peace officer to be in need of immediate restraint due to the substantial risk of harm to self or others, it is evident that under emergency circumstances there is seldom, if ever, sufficient time to get a warrant.

After taking the person into custody, the officer shall immediately transport the person to the nearest appropriate inpatient mental health facility or a mental health facility deemed suitable by the local mental health authority, if an appropriate inpatient mental health facility is not available.

I. Peace Officer’s Notification of Detention The law governing the form that needs to be completed when taking a person into custody in accordance with Section 573.001 above is Section 573.002 of the Texas Health and Safety Code. The following is a summary of that law: A peace officer shall immediately file with a facility a notification of detention after transporting a person to that facility. The notification of detention must contain the following: 1. A statement that the officer has reason to believe and does believe the person evidences mental illness; 2. A statement the officer has reason to believe and does believe that the person evidences a substantial risk of serious harm to the person or others; 3. A specific description of the risk of harm; H AR RI S C O U N T Y , T E X AS

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4. A statement the officer has reason to believe and does believe that the risk of harm is imminent unless the person is immediately restrained; 5. A statement that the officer’s beliefs are derived from specific recent behavior, overt acts, attempts, or threats that were observed by or reliably reported to the officer; 6. A detailed description of the specific behavior, acts, attempts, or threats; and 7. The name and relationship to the apprehended person of any person who reported or observed the behavior, acts, attempts, or threats.

NOTE: A mental health facility or hospital emergency department may not require a peace officer to execute any form other than this form as a predicate to accepting for temporary admission a person detained under Section 573.001, Texas Health and Safety Code.

J. Individuals in Behavioral Crisis Who Have Committed a Class C Misdemeanor If a person meets the criteria for emergency detention and has committed a Class C misdemeanor, deputies should use their discretion regarding the filing of the Class C charge(s).

K. Individuals in Behavioral Crisis Who Have Committed a Serious Offense When dealing with individuals in behavioral crisis who have committed a serious offense (Class B misdemeanor or greater), the deputy shall contact the Harris County District Attorney’s Office Intake Division and describe the person’s condition and the elements of the offense. Deputies will follow the most applicable of the three options below: Option 1 – District Attorney’s Office Declines Charges If the person meets the criteria for emergency detention, transport the person to the NPC, Ben Taub Hospital, VA Medical Center if eligible, or hospital emergency department and complete the one-page Notification of Emergency Detention form. Once the form has been completed and accepted by facility staff, the deputy may return to duty. (A copy of the Notification of Emergency Detention form is in the appendix.)

If the person does not meet the criteria for emergency evaluation, but wants behavioral health care, deputies may transport the person to the appropriate facility for treatment.

If the person meets the criteria for jail diversion (section XXIII), transport the person to the Judge Ed Emmett Mental Health Diversion Center.

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Option 2 – Serious Medical Condition and Exhibiting Behavioral Health Crisis and assistant DA declines charges The suspect shall be transported to a hospital by ambulance. Follow normal procedures for suspects taken to a hospital for a serious medical condition.

If the person meets the criteria for an emergency detention, the deputy shall follow the ambulance to the hospital and complete the Notification of Emergency Detention form. Once the form has been accepted by facility staff the deputy may return to duty.

Option 3 – District Attorney’s Office Accepts Charges File criminal charges as you normally do. Notify staff at the Joint Processing Center that the person is suspected of having behavioral health problems.

Option 4 – Serious Medical Condition and Exhibiting Behavioral Health Crisis and assistant DA accepts charges In accordance with Patrol Policy #210 – Transporting Prisoners, deputies shall have an ambulance respond to the scene. If the prisoner is transported to the hospital by ambulance, a deputy shall accompany the prisoner and guard him or her until relieved by a deputy from the Transportation Division.

Criminal charges take precedence over the behavioral health crisis. A Notification of Emergency Detention form will NOT be completed in these situations. The prisoner shall not be left in the hospital to have his or her behavioral health needs treated. Advise personnel at the Joint Processing Center of the prisoner’s behavioral health condition when processing him/her.

L. Procedures for Responding to Individuals in Behavioral Crisis: Disposition (Detentions) 1. Contain the inmate in his/her present location.

2. Call for assistance by Detentions CIRT. 3. Relocate the inmate if necessary to the safest and most appropriate area available by on-scene personnel.

4. Transfer the inmate to a separation cell.

5. Consult with a mental health or medical professional. Mental health resources include the following: Detentions Mental Health Unit, StepDown Unit, general population mental health services, Chronic Care Clinic, Forensic Single Portal, and the Rider 73 Peer Re-entry Program.

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6. If the incident involves a criminal component, the details of the incident will be presented to the District Attorney’s Office to determine if charges will be accepted on the inmate.

M. Procedures for Responding to Individuals in Behavioral Crisis: Handcuffing and Searching Anyone exhibiting a behavioral crisis and being transported to a jail facility or a facility for a mental health evaluation shall be handcuffed and searched.

N. Procedures for Responding to Individuals in Behavioral Crisis: Seizure of Firearms During the 83rd session of the Texas Legislature, Senate Bill 1189 was passed authorizing Texas peace officers to immediately seize firearms in the possession of a person being taken into custody with a Notification of Emergency Detention under Section 573.001, Health and Safety Code.

HCSO deputies taking a person into custody for emergency detention will seize any firearm found in possession of the person being taken into custody.

Department employees shall follow Department policy on tagging firearms.

Firearms shall be placed in a properly sealed package separated from any live ammunition. Note: All firearms shall be unloaded prior to being placed into the evidence locker and have the action strapped open.

Department employees seizing a firearm under this section shall immediately provide the person the following in compliance with Article 18.191 (b) of the Code of Criminal Procedure: A written copy of the receipt for the firearm and written notice of the procedures for the return of the firearm. This document can be found on the Harris County Sheriff’s Office Intranet under the Common Forms tab.

The document is titled Receipt and Notice of Rights for Seized Firearm. A copy of the receipt for the firearm shall be uploaded to the incident report along with the emergency detention that was filed. Deputies shall send an email to BHIU@sheriff.hctx.net prior to the end of their shift advising a firearm was seized.

The Behavioral Health Firearms Investigator will conduct an investigation on the person to determine if the person‘s firearms may be returned to him. If the person is found not to be able to possess a firearm, firearms may be released to a family member or other designee provided the following requirements are met: 1. The law enforcement agency holding the firearm conducts a check of state and national criminal history record information and verifies that the designee may lawfully possess a firearm under 18 U.S. Code Section 922(g).

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2. The person provides the law enforcement agency a copy of a notarized statement releasing the firearm to the designee; and 3. The designee provides to the law enforcement agency an affidavit confirming that the designee: a. Will not allow access to the firearm by the person who was taken into custody under Section 573.001 Health and Safety Code, at any time during which the person may not lawfully possess a firearm under 18 U.S. Code Section 922 (g); and b. Acknowledges the responsibility of the designee and no other person to verify whether the person has reestablished the person’s eligibility to lawfully possess a firearm under 18 U.S. Code Section 922(g).

4. An unclaimed firearm that was seized from a person taken into custody under Section 573.001, Health and Safety Code, may not be destroyed or forfeited to the state.

O. Procedures for Responding to Individuals in Behavioral Crisis: Incident Reports (Patrol) As stated in Patrol Policy #207 – Reports, employees shall complete an incident report for any incident that has a mental health component.

Employees shall place a “Y” in the CIT box and complete the CIT form. If the person has committed a crime and the person is to be arrested, the title of the report shall be the criminal offense committed. The secondary title should be Mental Health Investigation. The person is listed as the offender.

If the person has not committed a crime and is being handled for mental health purposes, the title of the report is Mental Health Investigation and the individual should be listed as the victim.

For any incident resulting in a Notification of Emergency Detention form, deputies shall document the name of the staff member who took custody of the person exhibiting mental health crisis. Deputies shall upload a copy of the Notification of Emergency Detention form to the incident report.

If the individual has a License to Carry (LTC) or is a licensed commissioned security guard, employees shall document these facts in the incident report and, if possible, include the LTC number and name of any security company employing the individual.

P. Mandatory Check Boxes for Clearing Calls (Patrol) Two mandatory check boxes were added to the Superion RMS program for clearing calls on the MDT (Superion release July 2020). These check boxes ask if the call involved anyone with a mental health issue and anyone who was homeless.

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Employees not able to clear a call via the MDT (no access, equipment failure, etc.) may request dispatch to clear the call by disposition. In these situations, it is the employee’s responsibility to provide information essential to closing out the call. This includes the answers to these two check boxes.

Q. Procedures for Responding to Individuals in Behavioral Crisis: Incident Reports (Detentions) Department employees shall complete an Informational Report and Referral for Psychiatric Screening on all incidents involving inmates in behavioral crisis.

R. Helmets Safety helmets are utilized in the jail and by patrol CIRT. The helmets are used when a consumer/subject is at risk of harming his/her head.

S. Response to Mental Health Facilities and Hospitals Response in General: It is the responsibility of mental health facilities and hospitals to have the proper resources to manage people in behavioral crisis and to transport persons under their supervision to other care facilities. It is the expectation that mental health facilities and hospitals will not request law enforcement assistance with behavior management, such as gaining physical control of a person who is aggressive, resistive, or refuses to go with facilityarranged transportation. Department employees should not become involved in these behavior management matters. However, employees should respond to assaults in progress and/or other serious events in which immediate intervention is required to stop or mitigate injury to a person and the investigation of crimes.

Elopement: If a consumer is being held on a mental health commitment and elopes without permission from a facility, the consumer has unlawfully eloped and law enforcement may be called to bring that person back to the facility. In these situations, employees shall: 1. Verify the Order of Commitment exists. The facility should have a copy of the Order on location. If the facility cannot verify the Order, take no action.

2. Determine if taking civil custody of the person named on the Order of Commitment may be achieved in a safe manner. Delaying custody may be used if the employee determines that taking the person into custody under present circumstances may result in an undue safety risk to employees, the involved person, and/or others. If delaying custody, employees shall notify a supervisor and develop a plan to determine a safer time and method to take the person into civil custody.

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3. Transport the named person back to the facility unless the employee determines the person meets the criteria for emergency detention. If the person does meet the criteria for emergency detention, follow Department procedures.

4. Complete the appropriate incident report.

5. If a person is not on commitment status and elopes without permission from a facility, that person if free to leave.

6. If a person wishes to voluntarily return to the facility, members may transport that person to the facility.

7. Should members receive a call alleging the eloped person is deemed to be dangerous to self or others, members must assess the person in accordance with Department policy.

T. Response to Boarding/Group/Care Homes Many boarding/group/care homes house individuals with behavioral health problems. When completing an incident report involving one of these facilities, indicate this by placing a “Y” for “Care Home” in the Consumer Information section of the Crisis Intervention Team (CIT) Report in the Superion Incident reporting program.

Whenever a deputy responds to a boarding/group/care home, the deputy shall email the Behavioral Health Investigations Unit information regarding the incident, e.g., address of the facility, reason for the call, actions taken, observations of the facility (physical condition of the facility, health and safety violations, physical condition of the tenants, complaints by tenants, etc.) The email address is: BoardingHomes@Sheriff.hctx.net.

U. Juveniles (15 years of age and under for mental health purposes) When the juvenile is in need of treatment and there are no criminal charges: 1. Juveniles in need of emergency mental health treatment when there are no criminal charges may be transported to a facility without a parent. It is always best, however, to have a parent or guardian follow you to the facility if available. Deputies shall complete a Notification of Emergency Detention form at the facility. Once this form is accepted by facility staff the deputy may return to duty. Recommended behavioral health facilities for juveniles include the following: Texas Children’s Hospital Medical Center, Ben Taub Hospital, NeuroPsychiatric Center (if no medical issues), Texas Women’s Hospital, and St. Joseph’s Medical Center.

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that treatment without a parent or guardian. For this reason, the deputy shall remain with the juvenile until a parent or guardian is located. If a parent or guardian cannot be located, the deputy is to contact Harris County Protective Services to act as guardians. The phone number for Harris County Protective Services is 1-800-877-5300. The identification number of the call taker and the reference number should be added to the incident report.

When the juvenile is in need of treatment and there are criminal charges: 1. Follow the procedures in Patrol Policy #208 – Handling Juveniles. Notify staff at the facility you take the juvenile that he/she is believed to be in need of behavioral health treatment. Contact the Juvenile Division for guidance and to coordinate the facilitation of the criminal charges.

V. Excited Delirium Syndrome (ExDS) Excited Delirium Syndrome (ExDS) is a medical disorder generally characterized by observable behaviors including extreme mental and physiological excitement, intense agitation, and hyperthermia (elevated body temperature) often resulting in sweating and nudity, hostility, exceptional strength, endurance without apparent fatigue, tolerance to significant pain, rapid breathing, non-compliance, and unusual calmness after restraint accompanied by a risk of sudden death. ExDS represents a true medical emergency.

Although there is much unknown about ExDS, it is believed the majority of cases are caused by psychostimulant use or mental illness, usually mania associated with bipolar disorder or psychosis associated with schizophrenia, or a combination of psychostimulant use and mental illness.

Individuals in a state of ExDS pose a risk to deputies and detention officers.

These are among the most dangerous calls Department personnel can make.

Refer to Department Policy #515 – Excited Delirium for additional information regarding this condition.

W. Jail Diversion From the Field It is the Department’s policy (#513 – Mental Health Diversion Center) to attempt to divert individuals detained on low level, non-violent offenses who are not in crisis and who do not meet the criteria for an emergency detention when it is believed the person has a mental illness or psychosocial issue that was a factor in the commission of the crime. An example is a person detained for trespassing because the person is homeless and in need of a place to sleep. These suspects may be diverted to the Judge Ed Emmett Mental Health Diversion Center. Deputies may call the Jail Diversion Desk via a Law Enforcement Only number for information and/or assistance. The number is 346-286-1299.

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X. Jail Diversion From the Joint Processing Center Suspects taken to the Joint Processing Center who have committed low-level, non-violent offenses such as trespassing who appear to be in need of psychosocial services will be screened during the intake process. Suspects with a mental health/psychosocial history meeting the criteria for possible diversion will be directed to the Jail Diversion Desk for evaluation by behavioral health personnel.

Y. Specialized Resources Available to Department Employees Behavioral Health Investigations Unit (BHIU): A unit in the Special Projects section of the Patrol Bureau that investigates all incident reports with a mental health component/nexus, investigates the seizure of firearms from individuals in mental health crisis, liaisons with the Mental Health Division of the Harris County District Attorney’s Office on matters related to individuals with mental illness, liaisons with the Harris County Senior Justice Assessment Center (SJAC), creates premise history advisories, and conducts follow-up investigations providing resources to consumers and their families.

Behavioral Health Administrative Training Detail: A unit in the Special Projects section of the Patrol Bureau that provides behavioral health and Integrating Communications, Assessment, and Tactics (ICAT) training to Department employees, coordinates the Clinician and Officer Remote Evaluation (CORE) program, and administers Projects Guardian and Lifesaver.

Behavioral Threat Management Unit: An investigative unit that proactively manages reports of workplace violence, threats to educational campuses, threats directed at high-profile individuals, including county and district court officials, and stalking suspects who suffer from some form of mental instability.

Provides intervention, referral, or placement for a person with mental illness to facilitate the speedy return of field deputies to other field duties.

A. Prevents unnecessary incarceration and/or hospitalization of persons with mental illness.

B. Provides alternate care in the least restrictive environment through a coordinated and comprehensive system-wide approach.

C. Assist with intelligence functions at critical incidents.

D. Assists with psychologically impaired victims at disaster scenes.

E. Assist other agencies upon request.

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The senior CIRT deputy on a scene involving a person in behavioral crisis has the responsibility and authority to direct police activities during the event unless relieved by a supervisor. For more information on CIRT, see Patrol SOP 209 – Crisis Intervention Response Team (CIRT). [CALEA Standard 1.1.3] Homeless Outreach Team (HOT): A team of specialized deputies that collaborate with behavioral health professionals and homeless organizations to engage in outreach to the homeless community by offering shelter, aid, and assistance. HOT focuses on locating, engaging, and assisting the homeless and providing them with an opportunity for housing, basic nutrition and hygiene, and medical and mental health services. They seek to reduce incarceration by diverting the homeless with low level crimes and mental illness into behavioral health services. They work collaboratively with community partners to connect the homeless to social services. For more information on the Department’s Homeless Outreach Team see Department Policy #516 – Response to Persons Experiencing Homelessness.

Project Lifesaver: A community based, public safety, non-profit organization that provides law enforcement, fire/rescue, and caregivers with a program designed to protect, and when necessary, quickly locate individuals with cognitive disorders who are prone to the life threatening behavior of wandering. Citizens enrolled in Project Lifesaver wear a small transmitter on their wrist or ankle that emits an individualized frequency signal. If an enrolled client goes missing, the caregiver notifies their local Project Lifesaver agency and a trained emergency team responds to the wanderer’s area. The first responders use the client’s individualized frequency to locate the position of the individual. For more information on the Department’s Project Lifesaver program see Patrol Policy #302 – Missing Persons and Runaways.

Project Guardian: A program to help keep individuals with autism safe. This is a free, voluntary, and confidential database offered, managed, and maintained by the HCSO for residents in the unincorporated areas of Harris County that are patrolled by the Harris County Sheriff’s Office. Residents interested in the program complete an application on their loved one with autism. The application contains information that is shared with a deputy if the deputy is dispatched to the person’s residence. Information on the application includes de-escalation techniques that work with the individual, hobbies, areas of interest, behaviors to be expected (hand flapping, body rocking, spitting, etc.), name he/she likes to be called, etc.

Residents may access the online application in two ways: A. Go to www.harriscountycit.org. There is a tab at the top of the homepage tilted “Project Guardian.” Select this tab. There is information on the program and, at the bottom of the page, there is a link to the online application.

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B. Go to www.harriscountyso.org. On the bottom of the homepage is a section titled “General Information and Services.” There is a section on Project Guardian. Select this section and you will be taken to a page with information on the program and the link to the online application.

References 18 U.S. Code Section 922(g) Criminal Justice Command CJC 301 - Addressing Inmates with Mental Health Issues/CIRT Call-Out Procedures CJC-302 - Detention Command Containment Team (DCCT) CJC-310 - Inmate in Crisis Policy Post Orders D-731 - Detention Command Training Staff Department Policy #515 - Excited Delirium #513 – Mental Health Diversion Center #516 - Response to Persons Experiencing Homelessness #601 - Reports Patrol SOP #208 – Handling Juveniles #209 - Crisis Intervention Response Team (CIRT) #221 – Public Intoxication – Houston Center for Sobriety #227 – Clinician and Officer Remote Evaluation (CORE) Telehealth Program #302 – Missing Persons and Runaways

Texas Code of Criminal Procedure - Article 18.191 Texas Health and Safety Code - Chapter 573 Texas Penal Code - Chapter 45

Revision This policy has been revised on the below listed dates: March 25, 2021

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Appendix Notification of Emergency Detention Form

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NO. ___________________

Date: ___Sept. 10, 2020______ Time: ___10:00 AM_____

THE STATE OF TEXAS FOR THE BEST INTEREST AND PROTECTION OF:

___Doe, John / W/M / 08/03/1989____________________

NOTIFICATION OF EMERGENCY DETENTION Now comes Sheriff’s Office

Deputy J. DoGood , a peace officer with (name of agency) , of the State of Texas, and states as follows:

Harris County

1. I have reason to believe and do believe that (name of person to be detained) __Doe, John__ evidences mental illness.

2. I have reason to believe and do believe that the above-named person evidences a substantial risk of serious harm to himself/herself or others based upon the following:

The consumer appears to be deteriorating. He has defecated throughout his apartment and has been making unsafe decisions. The consumer has stopped taking his psych medication and has verbally and physically assaulted residents. Due to his deterioration and behavior, he is a danger to himself and others.

3. I have reason to believe and do believe that the above risk of harm is imminent unless the above-named person is immediately restrained.

4. My beliefs are based upon the following recent behavior, overt acts, attempts, statements, or threats observed by me or reliably reported to me:

The consumer appears to be a danger to himself and others. He is defecating throughout his apartment and has become verbally and physically threatening and aggressive towards other residents. The consumer has diagnosed mental health illness and has not been taking his prescribed medication.

5. The names, addresses, and relationship to the above-named person of those persons who reported or observed recent behavior, acts, attempts, statements, or threats of the above-named person are (if applicable):

Jane Doe_________________________________________________________________ 12345 Falling Creek _______________________________________________________________ Houston, Texas ______________________________________________________________________ 713-123-4567 _______________________________________________________________________ For the above reasons, I present this notification to seek temporary admission to the (name of facility) ___NeuroPsychiatric Center__________ inpatient mental health facility or hospital facility for the detention of (name of person to be detained) ____Doe, John_______________ on an emergency basis.

6. Was the person restrained in any way? Yes □ No □ _________Deputy J. DoGood________________________ PEACE OFFICER’S SIGNATURE

BADGE NO. _______2396____________

Address: _____1200 Baker Street_________________________________ Zip Code: _____77014____________ Telephone: ______713-221-600___________________ A mental health facility or hospital emergency department may not require a peace officer to execute any form other than this form as a predicate to accepting for temporary admission a person detained under Section 573.001, Texas Health and Safety Code.

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