Butte — Mental Health Diversion Application Cover Sheet

Source: https://www.butte.courts.ca.gov/system/files/mental_health_diversion_application_cover_sheet.pdf

1 IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA, COUNTY OF BUTTE

2 MENTAL HEALTH DIVERSION APPLICATION

3 THE PEOPLE OF THE STATE OF CALIFORNIA, Case No.: __________________ 4 Plaintiff,

5 v. COVER SHEET

6 _______________________________ 7 Defendant. ______________________________________________ 8

9 1. Application and Waiver form signed by the Defendant and filed on: ___________ [date]

10 2. Request for Information and Waiver form signed by the Defendant and filed on: ___________ [date]

11 3. Mental Health Disorder diagnosis of: _____________________________________ was opined to by a Qualified Mental Health Expert: ____________________________ [name, title] on: ___________ [date] 12 4. QMHE opines the defendant’s symptoms of the mental disorder motivating the criminal behavior would 13 respond to mental health treatment, as stated in the current Assessment Report dated: ______________

14 5. A Treatment Plan by the QMHE is attached attesting the plan will meet the individual needs of the defendant

15 6. Defendant is currently charged with the crime(s) of: ___________________________________________

16 7. Charge(s) is/are not precluded within the meaning of PC section 1001.36(b)(2)

17 8. Opinion Defendant’s mental disorder was a significant factor in the commission of the charged offense, and substantially contributed to the defendant’s involvement in the commission of the offense, is based on 18 relevant and credible evidence that includes one or more of the following: police reports, preliminary hearing transcripts, witness statements, statements by the defendant’s mental health treatment provider, medical 19 records, records or reports by qualified medical experts, or evidence that the defendant displayed symptoms consistent with the relevant mental disorder at or near the time of the offense, and further summarized 20 herein

21 9. District Attorney’s Office has been consulted prior to the application and will likely take the position of:

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23 10. Other factors addressed in this application include: The facts of the crime; criminal history of the defendant; 24 any source of Formal Supervision; housing during treatment; prior Mental Health Treatment history

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26 Date: ____________ ____________________________ 27 Counsel for the Defendant

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MHD CALENDAR APPLICATION COVER SHEET: 7.22.19