Sheriff Makes Plans to Deal With Added Mentally Ill : Law enforcement: Officials gird for expected wave of potentially violent patients who will be forced onto the streets because of county budget cuts.

As Los Angeles County prepares to sharply cut back psychiatric services, law enforcement officials said Friday they are gearing up for waves of violent mentally ill people who need hospitalization but instead will be on the streets, causing harm to themselves and others.

Concerned about the cutbacks--particularly in inpatient and emergency care--the Los Angeles County Sheriff’s Department is preparing a contingency plan to send to all of its stations.

Its aim is to help authorities better cope with an expected onslaught of the mentally ill by defusing volatile situations and by making sure they do not get too agitated during the predicted long waits for treatment.

“We see it as a real disaster,” Sheriff’s Sgt. Barry Perrou said of the downsizing of mental health services, which is slated to take effect by Oct. 1. “The mental health system has been in collapse for years. And you get to the point where the Band-Aid does less and less and then you have a gaping wound where you say, ‘Why waste the Band-Aid?’ We are there.”

Perrou, the department’s mental health liaison, said he could not discuss the substance of the contingency plan because it has not been publicly released.

In general, he said, the plan says, “Be prepared, the system is in collapse and we may be seeing more people on the streets who need intervention. When we deal with them, use compassion and understanding and realize that the emergency rooms will be very crowded.”

Contained in the proposed plan is at least one potentially controversial strategy: Instead of arresting the mentally ill for minor offenses, the Sheriff’s Department is proposing writing a complaint and taking them to a psychiatric clinic.

Perrou said he wants it to circulate to as many law enforcement officers as possible because the vast majority of them have no specialized training in dealing with the mentally ill, especially when they become violent. Historically, a lack of training has aggravated tense situations, he said.

On Friday, The Times reported that the county has quietly begun dismantling its system of treating the mentally ill, and plans to eliminate its huge outpatient psychiatric headquarters at County-USC Medical Center as well as inpatient and outpatient psychiatric services at its other hospitals.

The changes come after the Board of Supervisors approved transferring responsibility for all mental health care from the Department of Health Services to the Department of Mental Health, which has provided mostly outpatient and residential care since 1978.

Mental Health Director Areta Crowell--predicting that “a lot of people won’t get served”--said at least 40% of the estimated 5,000 patients who receive acute inpatient care each year will no longer receive treatment.

In recent weeks, word of impending cutbacks has spread among the ranks of law enforcement. Perrou said he and other county officials have taken steps to notify officers of what is going to happen and to assure them that stripped-down psychiatric emergency rooms will remain open at County-USC and three other county hospitals.

Even so, long waits are expected in the emergency rooms, where the mentally ill are brought in by police for diagnosis and treatment.

Now, law enforcement authorities from dozens of police departments bring people into county emergency rooms under what is known as the 5150 statute, meaning that they are a danger to themselves or others.

Police said Friday they are concerned that they will have no place to take these people, or that it will take so long for them to be diagnosed that other policing chores will be shortchanged.

Perrou, who also serves on the county’s Mental Health Commission, said the absence of basic services such as inpatient beds potentially will throw thousands of mentally ill people into a crisis mode. Without medication and continued treatment, he said, they will resume delusional, paranoid and violent behavior, “and become problems for themselves and for the community.”

Kathryn Barger, health services deputy to Supervisor Mike Antonovich, said she has been working with law enforcement officials as they gear up for major changes in the county’s treatment of the mentally ill.

“Law enforcement is going to see an increase in people acting out on the street when they do not get medication or access to treatment,” she said.

“I know it is going to have an impact on law enforcement, which is why it is so imperative that we try to at least ensure the health and safety of those mentally ill people on the streets, and also those people who come in contact with them. We don’t want to see a situation where law enforcement comes in contact [with a mentally ill person] and someone is killed.”

Dr. Rod Burgoyne, medical director for the Department of Mental Health, said is concerned about the influx of the mentally ill into communities. He said shorter inpatient stays are to be expected, and that it will be more important than ever to keep the mentally ill on prescribed medication and in outpatient treatment as insurance against relapses.

Raul Caro, County-USC’s administrator for psychiatric services, said he is worried that his facility’s emergency room will not be able to handle all of the mentally ill people brought in for treatment and diagnosis, and he was worried that there would be no place to send them.

As a result, Caro said, the lack of inpatient beds for the mentally ill will cause many to be released into the community before they are ready.

“Where will they bring them? I have yet to be told what kind of emergency room service I am going to run. What kind of staff am I going to have left? . . . No one is telling us anything, or our patients. The only direction I’m getting is that it will be drastically reduced.”

As concerns about the county’s cuts in psychiatric services mounted, the financially struggling county got more bad news from Wall Street as a second major credit rating agency downgraded the county’s bonds Friday.

Standard & Poor’s Corp., as expected, cut its rating on the county’s various lease debt from A- to BBB, and the rating on the general obligation debt from A+ to A-. Also, the rating on the county’s pension obligation bonds was cut from A to BBB+.

S&P;’s ratings on the lease debt and the general obligation bonds are one notch below what rival rating service Moody’s Investors Service gave the county this week, when it also reduced its ratings on the county’s debt. Like Moody’s, S&P; said its ratings cut was prompted by the county’s current budget woes.

Times staff writer Tom Petruno contributed to this story.