On a May evening in 2022, Mountain View resident Patrice Moore heard a knock on her front door that would change her life.

Her wife opened the door to find two Mountain View police officers. They were there to conduct a welfare check after receiving a call from Moore’s employer, who said they were concerned that she was in danger of hurting herself.

After speaking with Moore, the police officers decided to place her on a 5150 hold, a type of involuntary hospitalization.

These involuntary holds are designed to keep people safe and stop them from harming themselves or others. But for Moore, who told the Voice that she had no intention of hurting herself that night, the experience was traumatizing.

“I’m an ordinary citizen. I’m not trained in how I’m supposed to interact with police,” Moore said. “It’s not my job to have the training to say the right things to avoid being 5150-ed.”

Moore was handcuffed and placed in a police car. She was taken to a behavioral health facility, where she said she was referred to as a man and misgendered as “male” on her hospital bracelet (Moore is a transgender woman). She stayed overnight on a reclining chair, not a bed, barely able to sleep with the bright lights overhead, and was released the next morning after a psychological evaluation determined that she was not suicidal.

Dr. Meghan Fraley, a Mountain View-based psychologist who works with both adult and adolescent patients experiencing depression and anxiety, said 5150 holds are sometimes necessary to keep a person safe. But from her perspective, the system also has a lot of flaws. Fraley believes police should not be the ones conducting most mental health calls, namely because they don’t have the same level of training that mental health professionals do to determine suicidality, and because of the trauma associated with being handcuffed and taken from one's home.

“They’re in uniforms, they have guns,” Fraley said. “That’s just the reality – It’s terrifying, it’s stigmatizing, it's criminalizing and it’s often done in public, in front of other people. … It does so much damage to people.”

Santa Clara County has multiple initiatives in place to allow mental health professionals to accompany police on wellness checks, a resource that Mountain View Police Chief Mike Canfield said his officers use in certain scenarios. Most recently, with the launch of the county’s TRUST (Trusted Response Urgent Support Team) program, mental health workers can respond without police in certain situations. Police officers in Mountain View also undergo training for how to handle and deescalate mental health crisis situations.

According to data from the Mountain View Police Department, the annual number of 5150 holds conducted by police officers goes up and down depending on the year, but spiked in 2020 with 286 holds – the highest recorded number in the past decade. But Canfield said it’s challenging to include a licensed mental health professional on every wellness check that his officers conduct.

“A regional asset is one thing, but from a Mountain View-specific (perspective), it would be hard to justify a full-time clinician in a car,” Canfield said. “It can be feast or famine: We can have a flurry of activity for whatever reason, but we can also have droughts when there’s very little calls for service for people in mental crisis. So it’s hard to staff.”

Moore said she believes that removing the police from the equation would have made her 5150 hold less traumatic. But as a transgender woman, she also believes the Mountain View Police Department needs more training around gender issues. Studies show that transgender people face higher levels of discrimination and violence against them by police, and Moore said this reality can make interacting with law enforcement terrifying for people like her – even in situations where no violence occurs.

Grounds for an involuntary hold

Whether it’s a police officer or a mental health clinician assessing an individual in crisis, there are specific criteria that must be met before someone can be placed on an involuntary mental health hold.

Melanie Roland, senior attorney with the Law Foundation of Silicon Valley, represents patients who have been placed on involuntary holds. Having worked with thousands of patients during her time with the Law Foundation, Roland said she has witnessed how the system operates first hand.

A person can be placed on an involuntary hold if they are found to be a danger to themselves, a danger to others, or if they are gravely disabled – meaning that due to their mental health disorder, the person is unable to take care of their basic needs. If an individual meets any of these three criteria, they can be placed on a 5150 hold.

Roland added that a person must fall into one of these three categories at the time of the incident.

“So for example, if you were a danger to yourself a year ago, you’re not supposed to be put on a mental health hold,” Roland said.

But determining whether someone falls into one of these categories is not simple. Fraley said that figuring out whether someone is a threat to themselves is more complicated than asking them if they want to hurt themselves.

“It’s not easy because you’ll have clients who do need to be in a safe environment where they can’t hurt themselves, but who don’t want to be,” Fraley said. “And they’ll say, ‘No, I’m fine, no problem.’”

Fraley said she assesses a combination of factors – whether someone has suicidal ideation, and whether they have the intent, plans and means to hurt themselves – to determine if someone needs to be placed on a hold.

“Unfortunately it’s not straightforward, which is why there should be a licensed mental health professional right off the bat,” Fraley said.

In California, both mental health professionals and law enforcement officers can place individuals on 5150 holds.

Chief Canfield said that every officer must complete a minimum standard of training while in the police academy that allows them to conduct a hold, and those standards are governed by state law. Then, officers can complete further training in order to engage in more advanced crisis negotiations.

But no amount of training can possibly prepare someone for every situation they might encounter.

“These 5150s exist in this kind of complex social web of everything from exclusively mental health, to substance abuse, to third-party conversations about something that someone else said,” Canfield said. “It’s definitely difficult to kind of boil it down to, does the person meet the criteria of being a danger to themselves or others. But that is the goal.”

Mental health clinicians don’t accompany police on every call where they might be needed in Mountain View, Canfield said.

“If we have a clinician responding, it’s because of a specific problem,” he said. “Either they’ve got a caseload and they want us to come with them, or an incident has occurred and we’ve requested the Mobile Crisis Response Team (MCRT) respond, and then they work in concert with us.”

MCRT is one of several distinct programs run by Santa Clara County’s Behavioral Health Department that allow clinicians to accompany officers on mental health calls, or in some cases, respond to situations without police.

Sandra Hernandez, a licensed clinical social worker who oversees the county’s mobile crisis services, said that MCRT can go both ways: sometimes mental health professionals will respond without police, and other times they’ll call upon law enforcement for back up if they perceive the situation might require it. Police officers can also request that a mental health professional accompany them on a call to help deescalate or offer resources.

The county also operates a program called PERT, the Psychiatric Emergency Response Team, in which clinicians are assigned full-time to a specific law enforcement jurisdiction.

“The design of PERT is you would need a dedicated officer to accompany a dedicated clinician,” Hernandez said. “For some of the smaller agencies, that’s a challenge, to have a dedicated officer established just for that.”

The Mountain View Police Department does not have a dedicated clinician assigned through the PERT program, Hernandez said. Currently, the county has PERT clinicians assigned to the Sheriff’s Department and the Santa Clara Police Department.

The most recent addition to the county’s resource repertoire is the Trusted Response Urgent Support Team, or TRUST, a community-based program that is not connected to law enforcement and responds to crisis situations without police. TRUST currently operates in the Gilroy area, San Jose, and in North County, including Mountain View and Palo Alto.

Last year, the county rolled out 988, an alternative to calling 911 that’s meant solely for mental and behavioral health situations. The Behavioral Health Department encourages county residents to call 988 for mental health crisis situations that don’t require police involvement and to get connected with programs like TRUST.

“Our 988 call takers are trained to triage and determine the direction in which somebody might need a higher versus a little bit lower level of care,” Hernandez said.

Dealing with the trauma

In an ideal world, Hernandez said, a mental health clinician would be present on every mental health-related call that police respond to. But due to limited resources and funding, that’s not currently the case in Santa Clara County.

When Moore received a welfare check last year, there was no mental health clinician at the door. She was greeted by two Mountain View police officers who were there after a co-worker called in with concerns about her mental wellbeing.

After speaking with Moore and asking her some questions, the police decided to detain her and put her on a 5150 hold. Body camera footage that Moore shared with the Voice shows her being placed in handcuffs without resistance and led to a police car outside her house. A few minutes later, an officer brings Moore some shoes and puts them on for her, as her arms remain behind her back.

From Moore’s perspective, she feels that the police did an inadequate job of vetting whether she was a danger to herself. She was granted an early release from her hold the next morning, she said, after a psychological assessment determined that she wasn’t in danger.

As a transgender woman, Moore is also acutely aware of how her identity can influence the way people treat her, even unknowingly. In the transcript of the 911 call that Moore’s co-worker originally made to dispatchers, one of the few descriptions that the individual offered was that Moore is transgender.

“There is this concept of unconscious bias,” Moore said. “This mental image that trans people are crazy people.”

Having watched back the body camera footage himself, Chief Canfield stood by his officer’s choice to place Moore on a hold, and does not believe bias played a role in the situation.

“The officer would have been in trouble or written up had they not taken the action that they took,” Canfield said.

Moore said she wasn’t just traumatized by being detained, but also by what happened when she arrived at the behavioral health facility. She said she was repeatedly referred to as a man, and gendered as male on her hospital bracelet. Moore recalls barely sleeping that night – she didn’t get a bed to rest in, but rather, a reclining medical chair. She remembers pulling a sheet up over her head, trying to block out the muttering sounds of other patients around her.

After spending a few months processing what she went through, Moore ended up filing a complaint with the Mountain View police department in October 2022, a copy of which she shared with the Voice. By January 2023, Moore said she hadn’t received a response from the department, leading her to speak out at a Jan. 24 council meeting where former Chief Chris Hsiung was in attendance. After speaking publicly, Moore was able to set up a meeting with Mountain View police to talk about what happened, she said.

Canfield said MVPD determined there was no wrongdoing in Moore’s case. However, he said he regrets the delay in getting back to her. Canfield said that Moore’s complaint came in right as some large shifts were happening within the department administratively, and he believes this could be part of the reason for the delay.

“I don’t like giving that answer,” Canfield said. “That shouldn’t really happen. Regardless of who’s in what position, we should be able to get back to people that file complaints.”

Fixing a problematic system

Moore is not alone in the trauma that she faced from her 5150 experience.

Psychologist Fraley has witnessed first-hand how her clients experience trauma from involuntary holds, even in cases where the hold is necessary to keep the person safe.

“Being on a hold where a person already has lost their freedom and privacy, and then the level of powerlessness and damage it does. … You could have someone go in not suicidal, and leave suicidal from the kind of experience that they have,” Fraley said.

Hernandez with the county Behavioral Health Department added that getting police involved can be triggering for someone who may already be in a tenuous mental state.

“I think people respond better when it’s non-law enforcement. We don’t always know what people’s experiences have been in the past, and so they may have had a poor experience,” she said. “Let’s not retraumatize somebody by bringing in four police officers in marked cars and all that, and maybe exacerbating the situation that probably was something we could have managed had we not had all these people participate.”

Lawyer Roland, who represents people on long-term mental health holds during their hearings, said the 5150 hold system can be particularly traumatizing for members of the LGBTQ+ community.

“I've seen people being misgendered, and that's very common,” Roland said, whether it's by doctors or hearing officers.

This was one of the most traumatic parts of Moore’s experience, she said – the way that those involved, without knowing anything about her, felt “privileged to decide that I am male.”

“That they have the ability to decide my fundamental identity,” Moore continued. “That they have authority over me at a real fundamental level.”

Moore said she’d like to see the Mountain View Police Department undergo more training around gender issues, something that Canfield said he’s open to pursuing.

Currently, Canfield said his department receives training through the state’s Peace Officer Standards and Training, also called POST, which includes some state-mandated training about gender and sexuality issues.

Outside of state-mandated training, Canfield said there are other groups that his department has communicated with on these issues, such as TCOPS, the Transgender Community of Police and Sheriffs.

“They do make recommendations for training, both for scenario-based, but also for internal processes as well,” Canfield said.

But Canfield said that speaking with Moore about what she went through has been more informative than most formal training he’s received. In particular, Canfield said his conversations with Moore have taught him about “the power of gender affirming language, as subtle as it may be to a cisgender person, how impactful that may be.”

Gender affirming language, Moore said, simply means referring to someone the way they identify. For Moore, who identifies and presents as a woman, being referred to as a man during her 5150 hold was a trauma that she believes could have easily been avoided, had all the people involved been better trained.

As much as Moore said she appreciates her conversation with the Mountain View Police Department, she said she’d like to see a stronger commitment to change going forward.

“My preference is that the police department proactively come to the city and say, ‘We would like to have a budget for this,’” Moore said, “rather than have me sit up there, make a public stink of announcing something I don’t really want to announce.”

Chief Canfield shared that he will be sending the department’s training sergeant and lieutenant to a conference in August on LGBTQ+ policing matters, hosted by nonprofit Out to Protect.

“We will be incorporating the recommendations and training content from Out To Protect into our next department bias training,” Canfield said. “It’s important to me that we are thoughtful in how we approach this training and lean on trusted resources to both reduce potential trauma but also to ensure we are a department that serves our entire community.”