San Bernardino — 13-14627-360

Source: https://sanbernardino.courts.ca.gov/system/files/13-14627-360applicationfordiversionofindividualwithmentaldisorder.pdf

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO CONFIDENTIAL Joshua Tree Courthouse: 6527 White Feather Road, Joshua Tree, CA 92252 FOR COURT USE ONLY Rancho Cucamonga Courthouse: 8303 Haven Avenue, Rancho Cucamonga, CA 91730 San Bernardino Justice Center: 247 W. Third Street, San Bernardino, CA 92415 Victorville Courthouse: 14455 Civic Drive, Victorville, CA 92392

Attorney Name: Street Address:

City, State, Zip Code: Attorney for (Name): Telephone Number: ( ) State Bar Number:

PLAINTIFF: PEOPLE OF THE STATE OF CALIFORNIA

DEFENDANT:

APPLICATION FOR DIVERSION OF INDIVIDUAL WITH MENTAL DISORDER CASE NUMBER:
(PC 1001.35-PC 1001.36)

Offense Level: Felony Misdemeanor

REQUIREMENTS FOR DIVERSION OF INDIVIDUAL WITH MENTAL DISORDER(S)

1. The defendant was recently diagnosed by the following qualified mental health expert, who has determined that the defendant
suffers from a mental disorder(s) as identified in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders,
(see attachments)
2. The court is satisfied that the defendant’s mental disorder was a significant factor in the commission of the charged offense
3. In the opinion of a qualified mental health expert, the defendant’s symptoms of the mental health disorder motivating the criminal
behavior would respond to mental health treatment
4. The court is satisfied that the defendant will not pose an unreasonable risk of danger to public safety, as defined in PC 1170.18, if
treated in the community
5. The court is satisfied that the following recommended inpatient outpatient program of mental health treatment will meet the
specialized mental health treatment needs of the defendant:
6. The following provider of the mental health treatment program in which the defendant has been placed shall provide regular
reports to the court, the defense, and the prosecutor on the defendant’s progress in treatment:

7. Defendant consents to diversion and waives his or her right to a speedy trial

On behalf of my client, I acknowledge the above requirements and am requesting diversion.

Date:

Attorney Name (Please Print) Attorney Signature

DEFENDANT ACKNOWLEDGMENT

I, consent to diversion and waive my right to a speedy trial

Print Defendant Name

I agree to comply with treatment as a condition of diversion

Defendant Signature Date

Local Court Form (Rev. 8/30/2018) APPLICATION FOR DIVERSION OF INDIVIDUAL WITH MENTAL DISORDER Page 1 of 2 13-14627-360 (PC 1001.35-PC 1001.36)

Defendant Advisal as Modified from PC 1001.36

(d) If any of the following circumstances exists, the court shall, after notice to the defendant (you), defense counsel, and the prosecution, hold
a hearing to determine whether the criminal proceedings should be reinstated, whether the treatment should be modified, or whether
you should be conserved and referred to the conservatorship investigator of the county of commitment to initiate conservatorship
proceedings pursuant to Chapter 3 (commencing with Section 5350) of Part 1 of Division 5 of the Welfare and Institutions Code:

(1) If you are charged with an additional misdemeanor allegedly committed during the pretrial diversion and that reflects a propensity
for violence.

(2) If you are charged with an additional felony allegedly committed during the pretrial diversion.

(3) If you are engaged in criminal conduct rendering you unsuitable for diversion.

(4) If, upon notice by the program to the court, you fail to conform/comply with all rules/requirements of the program a bench warrant
may issue for the alleged violation and the court may terminate diversion

(5) Based on the opinion of a qualified mental health expert whom the court may deem appropriate, either of the following
circumstances exists:

(A) If you are performing unsatisfactorily in the assigned program.

(B) If you are gravely disabled, as defined in subparagraph (B) of paragraph (1) of subdivision (h) of Section 5008 of the Welfare and
Institutions Code. You shall only be conserved and referred to the conservatorship investigator pursuant to this finding.

(e) If you have performed satisfactorily in diversion, at the end of the period of diversion, the court shall dismiss your criminal charges that
were the subject of the criminal proceedings at the time of the initial diversion. A court may conclude that you have performed
satisfactorily if you have substantially complied with the requirements of diversion, have avoided significant new violations of law
unrelated to your mental health condition, and have a plan in place for long-term mental health care. If the court dismisses the charges,
the clerk of the court shall file a record with the Department of Justice indicating the disposition of the case diverted pursuant to this
section. Upon successful completion of diversion, if the court dismisses the charges, the arrest upon which the diversion was based shall
be deemed never to have occurred, and the court shall order access to the record of the arrest restricted in accordance with Section
1001.9, except as specified in subdivisions (g) and (h). If successful in completing diversion you may indicate in response to any question
concerning your prior criminal record that you were not arrested or diverted for the offense, except as specified in subdivision (g).

(f) A record pertaining to an arrest resulting in successful completion of diversion, or any record generated as a result of your application for
or participation in diversion, shall not, without your consent, be used in any way that could result in the denial of any employment,
benefit, license, or certificate.

(g) You shall be advised that, regardless of your completion of diversion, both of the following apply:

(1) The arrest upon which the diversion was based may be disclosed by the Department of Justice to any peace officer application
request and that, notwithstanding subdivision (f), this section does not relieve you of the obligation to disclose the arrest in response
to any direct question contained in any questionnaire or application for a position as a peace officer, as defined in Section 830.

(2) An order to seal records pertaining to an arrest made pursuant to this section has no effect on a criminal justice agency’s ability to
access and use those sealed records and information regarding sealed arrests, as described in Section 851.92.

(h) A finding that you suffer from a mental disorder, any progress reports concerning your treatment, or any other records related to a mental
disorder that were created as a result of participation in, or completion of, diversion pursuant to this section or for use at a hearing on
your eligibility for diversion under this section may not be used in any other proceeding without your, unless that information is relevant
evidence that is admissible under the standards described in paragraph (2) of subdivision (f) of Section 28 of Article I of the California
Constitution. However, when determining whether to exercise its discretion to grant diversion under this section, a court may consider
previous records of participation in diversion under this section.

(i) The county agency administering the diversion, your mental health treatment providers, the public guardian or conservator, and the court
shall, to the extent not prohibited by federal law, have access to your medical and psychological records, including progress reports,
during your time in diversion, as needed, for the purpose of providing care and treatment and monitoring treatment for diversion or
conservatorship.

Local Court Form (Rev. 8/30/2018) PETITION FOR DIVERSION OF INDIVIDUAL WITH MENTAL DISORDER Page 2 of 2 13-14627-360 (PC 1001.35-PC 1001.36)