June 30, 1998

 

 

 

Honorable Frank J. Ochoa, Presiding Judge

Santa Barbara County Superior Court

1100 Anacapa Street, Second Floor

Santa Barbara, California 93121-1107

 

Dear Judge Ochoa:

 

RE: Alcohol, Drug & Mental Health Services Director’s Response to Certain Findings and Recommendations in the 1997-98 Grand Jury Report on Housing the Mentally Ill

 

 

The following is the Alcohol, Drug & Mental Health Services (ADMHS) Director’s response as required by law to the Grand Jury’s Interim Final Report "Housing the Mentally Ill" issued May 11, 1998.

 

INTRODUCTION

 

The Grand Jury report titled "Housing the Mentally Ill" addresses four major areas of housing and twenty-four hour care in Santa Barbara County: (1) long term supported housing (2) acute psychiatric hospitalization (3) crisis / urgent care, and (4) alternatives to jail for mentally ill inmates. These separate areas have a complex interaction and impact on each other, on the seriously mentally ill residents of Santa Barbara County and on the county’s resources.

 

The department’s responsibilities for the seriously and persistently mentally ill have been expanded over the years beyond the limited inpatient and outpatient treatment services of the 1960s when State Hospitals first were emptied and clients were transferred to local community care. Time and research have revealed that in order to successfully protect both seriously mentally ill adult clients and the general community, core treatment services must be augmented by rehabilitation, case management, housing and employment supports.

 

Housing and 24 hour crisis supports include:

 

  1. specialized affordable housing units targeting the disabled and the homeless with rehabilitation supports
  2. licensed group homes (providing supervised room & board) which have augmented staffing to work with difficult clients towards rehabilitation
  3. 24 hour access to urgent and crisis care services
  4. short-term inpatient psychiatric hospital care

 

ADMHS has successfully worked with South County housing and mental health agencies to obtain federal funds to rehabilitate single room occupancy housing for the homeless, the disabled mentally ill and the dually diagnosed. ADMHS has also financed intensive group home supports, intensive independent living supports and coordination of shared rental units. These efforts initially focused on South County where there is a general lack of licensed group homes due to the high cost of housing there. In 1996 the first North County project, an augmented 10 bed group home, was funded with intensive independent living supports for 40 other clients. In the past year ADMHS has increased the use of overflow out-of-county psychiatric hospital beds when the 16 bed Psychiatric Health Facility is filled to capacity.

 

In the last few years numerous studies have revealed a national, state and local problem of increasing numbers of seriously mentally ill being arrested and serving time in jails and prisons. This phenomenon is a result of the wholesale release of patients from state hospitals (with legal protections against involuntary treatment) without the transfer of adequate state funding to local communities to care for them. Recommended solutions include intensive treatment and case management with a continuum of pre and post booking jail diversion. A pilot post plea project has been started by ADMHS in collaboration with the Probation Department. The project provides intensive mental health and probation care and oversight; residential, evening and weekend supports are in development.

 

The Mental Health Commission and the department recently completed a Five Year Strategic Plan for Adult Mental Health Services, which, in effect, supports the Grand Jury’s findings, identifying the two highest needs for development:

 

 

  1. urgent / crisis care to prevent unnecessary psychiatric hospitalizations, to prevent unnecessary jail bookings and to work with persons in crisis who may not fit the criteria for hospitalization.
  2. transition to a team structure to better meet the demand for seamless, one-stop, 24 hour care

 

closely followed by the following four high areas of need:

 

 

 

SPECIFIC RESPONSES TO GRAND JURY REPORT

 

Penal Code Section 933.05 requires that for each finding and for each recommendation in the Grand Jury report for which the department is noted as an affected agency, the department must respond. We will restate the Grand Jury’s findings and recommendations as well as our response.

 

 

FINDINGS 3 AND 8

 

Finding 3: There is a special need for temporary shelter for patients in crisis above and beyond current hospital space. Next year, Santa Barbara Rehabilitation Institute will vacate a building that is leased from the county and is located next door to the Mental Health department. This building has long been on the county’s list to be used by Mental Health, but it needs extensive and expensive renovation.

 

Alcohol, Drug & Mental Health Services Director’s Response:

 

We agree. There is a special need for temporary shelter for patients in crisis above and beyond current hospital space. Urgent / crisis care has been identified by the department and the Mental Health Commission as one of the two top priorities for development.

 

In addition, the department agrees that the Santa Barbara Rehabilitation Institute will vacate its building in the future. The department had previously indicated an interest in moving the Psychiatric Health Facility to that site; however, the extensive rehabilitation and renovation required to meet hospital codes would prohibit such a usage. The facility would also need costly renovation for other uses such as a crisis stabilization center or a crisis residential treatment program. As the department in recent years has been expected to fund capital maintenance and renovation, and does not have the necessary reserves to renovate this site, the department withdrew its request for future use of the Rehabilitation Institute during this year’s capital planning cycle.

 

 

Finding 8: Personnel changes have negatively impacted departmental morale.

 

Alcohol, Drug & Mental Health Services Director’s Response:

 

We agree. Administrative support staff were understandably impacted when the Assistant Director of Administration left county service. They were asked to function in new roles; they learned for the first time of multiple new projects about which they had not been previously informed. They were asked to provide support for a new division, Alcohol & Drug Programs. These stressors negatively impacted their morale. In addition, while the Director was covering three major departmental functions (directing the department, managing the administrative support division and managing the alcohol and drug division), it was necessary to cancel the Director’s regularly scheduled meetings with each program team in the department. Communication channels were impacted and morale is always negatively impacted when communication is reduced.

 

 

RECOMMENDATIONS 3, 4, 5 AND 6

 

Recommendation 3: The Mental Health Department should find space for mentally ill patients in Santa Maria. [Finding 1]

 

Alcohol, Drug & Mental Health Services Director’s Response:

 

The recommendation is noted as being in response to:

Finding 1 "There is a shortage of suitable housing for the mentally ill countywide. North County has no hospital beds for short term psychiatric placement. Patients from Santa Maria must be transported by ambulance to PUF (sic) in Santa Barbara, or if it is full, to hospitals in Ventura."

 

The recommendation requires further analysis, pending the passage of Senate Bill 1485 (Rosenthal and Rainy) which proposes to fund pilot projects to provide appropriate responses for mentally ill offenders in the criminal justice system, and also pending the successful application by the department to receive such a grant. A report on progress will be submitted in six months on January 15, 1999.

 

The recommendation to create psychiatric hospital beds in North County will not be implemented by the department. While we are in sympathy with North County residents’ desire to have a psychiatric hospital in North County, it would not be cost effective for the department to develop an additional psychiatric hospital there at this time.

 

The ADMHS Psychiatric Health Facility’s operating budget projected for FY 98-99 is $3.5 million. The overflow requirements beyond the capacity of this 16 bed locked unit are not enough to warrant the development of a new facility. If a North County hospital were to develop a private locked psychiatric unit, it would certainly be in the county’s best interests to contract for overflow beds with such a unit. However, such a development is unlikely in the near future as a new 20 bed gero-psychiatric unit will open within a week at St. Francis Hospital in Santa Barbara, and the Santa Barbara Cottage Hospital 21 bed psychiatric unit is expected to apply for certification within the month to admit involuntary patients. We believe that these developments will saturate the Santa Barbara County market, and doubt that there will be further development of private psychiatric beds for some time in the future.

 

Pending negotiations for competitive bed rates, this new availability of in-county psychiatric hospitals should eliminate the need to transport overflow involuntary adult patients to out-of-county hospitals. This will greatly improve discharge planning by county staff and access for families and friends of North County patients.

 

However, we do believe that it would be costly but economically and programmatically feasible at this time to develop a specialized urgent care / crisis service for voluntary patients in North County through a crisis drop in center. While North County involuntary patients would continue to be hospitalized in South County, individuals accepting crisis care on a voluntary bases would receive those services close to their homes, family and friends. Such a service could also be utilized by local law enforcement as an alternative to jail for mentally ill individuals committing minor offenses who do not fit criteria for involuntarily hospitalization but who are willing to accept crisis treatment in lieu of jail.

 

The development of this service cannot be made by carving it out of the present budget or transferring present staff to this function. The core outpatient treatment, case management and rehabilitation program is already thin, with caseloads higher than best practices models. Funding is not presently available to create this service. However, the Board of Supervisors on June 19, 1998 created a $100,000 reserve to provide a county match to any grants provided to counties through SB 1485 (pending legislation for pilot projects to provide appropriate responses for mentally ill offenders in the criminal justice system). If this legislation is passed and if the department’s proposal is approved, the development of a North County Urgent Care / Crisis Service is a highly desirable service augmentation which is in accordance with both the Grand Jury recommendations and the ADMHS Adult System of Care Five Year Strategic Plan.

 

 

Recommendation 4: The Mental Health Department should acquire the county building next door and ask the county to renovate it.

 

Alcohol, Drug & Mental Health Services Director’s Response:

 

It is not within the purview of the department to unilaterally acquire the Rehabilitation Institute, nor does the department presently have the ability to fund a renovation of its buildings. However, the department will review its space needs and submit its findings to the County Administrator’s office in conjunction with the county’s planning for capital development.

 

 

Recommendation 5: If the Mental Health/Probation Program is successful it should be augmented to include all jailed mentally ill patients. Provision should be made for monitoring the effectiveness or failure of the program. Monitors should consist primarily of members from outside the Sheriff and Mental Health departments.

 

Alcohol, Drug & Mental Health Services Director’s Response:

 

If the Mental Health / Probation Program Pilot Project is successful the department will recommend its expansion to North County clients. It is not feasible to expand the program to all jailed mentally ill patients. The program is limited to jailed mentally ill individuals who have not committed serious crimes; those individuals who have committed serious offenses do not fit the program criteria. In addition, the program is both very strict and voluntary. Not all jailed mentally ill individuals will voluntarily enroll in such a program, nor will their public defenders encourage them to do so, nor will the courts always order them into such a program. Participation in such programs is contingent upon multiple factors, and the agreement of multiple parties, and not within the control of either the Sheriff or ADMHS.

 

 

Recommendation 6: The Director of Mental Health should find and hire competent managers in order to be relieved of some of the burdens of increased departmental responsibilities. In addition the director should:

 

a) Investigate ways to promote increased cooperation between county jail staff and the Mental health Department, particularly with regard to housing and handling the jailed mentally ill.

 

b) Improve morale by visiting all facilities and conferring with staff throughout the department.

 

c) Publicize the need and encourage public support for facilities to house the mentally ill and addicted members of our county.

 

Alcohol, Drug & Mental Health Services Director’s Response:

 

The recommendation to hire competent managers has already been partially accomplished. ADMHS has recruited a highly experienced and competent Alcohol and Drug Programs Manager, Al Rodriguez, who began employment in April, 1998. Interviews are in process at this time for the Assistant Director, Administration position which was vacated in October, 1997. The department has not been successful in two recruitments for the Medical Director position, open since December 15, 1997, and is reviewing the position’s responsibilities for possible reconfiguration of departmental structure; such a reconfiguration would require Personnel and County Administrator’s approval.

 

a) The department will continue to work with the Sheriff and other interested and responsible entities to reduce the numbers of seriously mentally ill individuals in the jail. Arnie Schildhaus, Mental Health Program Manager responsible for jail mental health services, meets regularly with the Sheriff’s managers to coordinate jail mental health services. Mr. Schildhaus has also participated in the Jail Overcrowding Task Force to review multiple alternatives to reduce jail overcrowding, among them alternatives for the seriously mentally ill. The Sheriff has expressed his willingness for his department to work with ADMHS to submit a grant proposal for alternatives if SB 1485 is passed by the state legislature and approved by the governor.

 

b) The Director will renew regular meetings with all departmental teams once full executive staffing is reached. Until that time, the director’s schedule will not allow for visits to all teams as often as in the past.

 

c) The department has and will continue to advocate for increased affordable housing for the mentally ill, to inform local housing authorities of the needs of these individuals, and to work collaboratively on joint projects to expand supported housing. The department has assigned adult program managers to work collaboratively in each area of the county to inform themselves of the local housing authority process and to provide local input. ADMHS does not have a Public Information Officer or a funded Public Education function or unit. The department does have a unfilled Project Management position; when filled, this individual will be assigned responsibility to expand housing supports throughout the county. The department is also presently negotiating for training and consultation in supported housing development from a nationally known expert in specialized housing development for the seriously mentally ill.

 

 

CONCLUSION

 

 

The department thanks the Grand Jury for its many hours of work on reviewing the extremely complicated and difficult issues regarding housing and crisis services for the seriously mentally ill. We believe the public is better informed as a result of their efforts.

 

Sincerely,

 

 

 

Fran Ruddick, L.C.S.W.

Director

 

c: Tim Putz, Foreman, Grand Jury (hard copy and on disk)

Michael F. Brown, County Administrator

Jerry Burton, Chairman, Mental Health Commission