Released May 11, 1998

BACKGROUND

The Grand Jury received complaints regarding two businesses which house the mentally ill. In addition, the Jury received letters from relatives complaining that mentally ill inmates have received little or no treatment while in jail. Since the Department of Alcohol, Drug and Mental Health Services (Mental Health Department) has not been reported on for 10 years, the Grand Jury decided to see if the complaints were justified.

The Grand Jury interviewed the following:

• Director and staff of the Mental Health Department
• Fifth District Supervisor
• Sheriff’s Department staff
• Mental Health jail staff
• Alliance for the Mentally Ill
• Mental Health Commission of Santa Barbara

Site visits included:

• County Psychiatric Health Facility (PUF)
• Housing agencies which contract with the Mental Health Department to provide board and care and/or room and board.

The Grand Jury had a number of talks with the Director of Mental Health Department and staff. They provided lists of housing facilities that contract with the department to aid the mentally ill. The Grand Jury received copies of the Mental Health Commission meetings documenting decisions which encourage "clients" (patients) to work and live outside of mental health shelters. This development (sometimes called "mainstreaming") is the result of closing former state mental hospitals which did little to rehabilitate the mentally ill and were very expensive to maintain. Camarillo State Hospital closed in 1997 which increased the burden on county treatment facilities. Recently, new drugs have become available which better control the symptoms of mental illness and allow many patients who stay on these medications to live a more self-sufficient life outside of institutions.

There is a countywide shortage of suitable housing for the mentally ill. "Suitable" means not only safe and clean, but a place where counselors are either available on site or welcomed for regular visits with clients.

There are a number of non-profit organizations such as Work Training, the Mental Health Association, and Phoenix House, which can support a dozen or fewer clients in group homes. These organizations run programs to help stabilize clients and get them out of group homes and into the community. In addition there are larger businesses (Telecare in

North County and Sanctuary in South County) which contract with the county to provide greater numbers of clients with similar support.

Only the Psychiatric Health Facility (PUF) is set up specifically to handle mentally ill persons in crisis. The population at PUF fluctuates from 16 (the number that Medi-Cal will pay for) to a maximum 25 patients. Because this hospital must also take clients referred from the jails by a psychiatrist from the Mental Health Department, the PUF facility is frequently overcrowded. This overcrowding necessitates sending mentally ill clients who are not jailed to other facilities, such as the Vista Del Mar psychiatric hospital in Ventura. Help for an additional 20 patients will be provided by Cottage Hospital when the new 5^th floor space for the seriously mentally ill opens in May 1998. At present, Cottage Hospital can take only one or two such cases.

Last year the Mental Health Department was given responsibility for the Drug and Alcohol programs. Several key managers have voluntarily left the department or have been terminated. This reorganization and personnel change has created additional work for department employees. They indicated that morale is low and that these changes are at least partly responsible.

In mid 1998, a state-funded pilot program known as "Mental Health/Probation Program" will also be implemented. Initially, a small group of mentally ill law breakers will be assigned to the program. The Probation Department, Courts, Sheriff’s Department and Mental Health Department will be collaborating to treat and monitor chronic offenders. The objective is to stabilize mentally ill clients, stop their destructive patterns, and allow these people to live safely on their own.

FINDINGS

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 in Santa Barbara, or if it is full, to hospitals in Ventura.
2. During a six month period between July and December 1997, 52 patients were placed in Santa Barbara Cottage Hospital while 280 patients were sent to Ventura. The $600 or more charge per day for these clients is not fully paid for by Medi-Cal. This charge is a significant drain on Santa Barbara County’s meager mental health funds.
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 expenive renovation.
4. While the department has completed its Strategic Planning Study aimed at resolving problems handling mentally ill patients, the placement of the Mental Health/Probation Program and the Drug and Alcohol Program under the umbrella of the Mental Health Department creates additional responsibilities for the department head beyond those spelled out in the county job description.
5. The 1997-98 county budget allocates less than 2% of general funds for support of the mentally ill. The Sheriff’s department received 28% of the general funds last year.
6. Available beds at Cottage Hospital do not solve the need for temporary placement for people in mental crisis especially those in North County.
7. The county jail is overcrowded. According to the Sheriff’s department, approximately 10-15% of the jail population should be hospitalized rather than jailed. Many of the inmates belong in the category of "dual diagnosis," which means they are both addicted and mentally ill.
8. Personnel changes have negatively impacted departmental morale.

CONCLUSIONS

The Grand Jury was astonished by the complexity of the job facing the Mental Health Department, and was favorably impressed by the way the department deals with its thousands of clients. Confidentiality laws which protect the rights of mentally ill persons often work against their best interests by obstructing freer flow of information between county agencies, family members and/or caretakers. There continues to be an overwhelming need for a short term holding facility for patients whose failure to take medication causes disruptive behavior which requires police to put them in jail. This treatment exacerbates their problems and reinforces society’s intolerance toward the mentally ill. There were few complaints about the department from mental health counselors and workers in contracted facilities. Non-profit and larger businesses that house and counsel the mentally ill were well run and competently supervised by the department.

RECOMMENDATIONS

1. The Board of Supervisors should seek funding from all available sources, including a possible Bond issue, to fund new facilities. [Finding 5]
2. The Sheriff’s Department should take more responsibility for safely housing the 10-15% of their mentally ill prisoners. [Finding 7]
3. The Mental Health Department should find space for mentally ill patients in Santa Maria. [Finding 1]
4. The Mental Health department should acquire the county building next door and ask the county to renovate it. [Findings 1, 2 and 3]



REHABILITATION INSTITUTE OF SANTA BARBARA

 

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’s and Mental Health departments. [Findings 4 & 7]

1. 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.
2. Improve morale by visiting all facilities and conferring with staff throughout the department.

AFFECTED AGENCIES: