MONKEY SEE, MONKEY DON’T: When in doubt, you can always trot out Albert Einstein. Why not? Everybody else does. Not only did Einstein midwife the atom bomb — profoundly redefining the dimension of global fear — but he was also crazy smart, had crazy hair, and left behind more pithy aphorisms than Oscar Wilde and Mark Twain combined. The quotation getting most traction these days has to do with the definition of insanity, which Einstein described as “doing the same thing over and over again and expecting different results.” For the record, I am officially done with this one. It’s invoked in various garbled permutations by fully half the speakers at any government gathering in which the public is allowed to chime in. In that regard, it’s achieved the same level of abuse as, “That’s like trying to nail Jello to a tree,” or worse yet, “A camel is a horse designed by a committee.” I’d suggest this particular old horse has now been kicked to death so many times that if it were a cat, it would have used up all nine lives. More than that, it misses the mark. What’s really crazy is not doing the same thing over and over again and expecting the results to improve.
Calling this to mind was last Tuesday’s county supervisors meeting, which mental-health advocates impressively “hijacked” (to borrow the description used by conservative gadfly and grumpy-pants Andy Caldwell) to talk about springing the nonviolent mentally ill from county jail and putting them in treatment. Because it’s about $20,000 cheaper to treat someone than jail them — at least according to area mental-health advocates — the county could save up to $4 million a year by doing the right thing. And that number may be understating things. A spate of recent studies suggest that those incarcerated with serious mental illnesses tend to stay behind bars far longer than your so-called “average” inmate. At Rikers prison in New York, it’s a difference of 5-to-1, which, according to one study, makes the mentally ill three times more expensive to jail. The number of mentally ill behind bars is only going up. According to a study released by the Treatment Advocacy Committee, there are 356,268 seriously mentally ill inmates locked up in prisons and jails across the country. By contrast, there are 35,000 in state-run psychiatric facilities.
When discussing the mental-health-care crisis, terms like “crazy” and “insane” are undeniably insensitive and loaded. I get it. But who among us doesn’t have the proverbial “crazy uncle in the attic,” or Norman Bates’s mom down in the basement. Far more loaded and insensitive, however, is how egregiously little we’ve done to address the issue in the past 30 years.
In that time, grand juries have come and gone, issuing one urgent report after another, calling into question the wisdom, cost, effectiveness, and humanity of locking mentally ill people — who frequently have co-occurring substance-abuse problems — in county jail. In response, we’ve nodded our heads in dutiful agreement only to keep locking them up. Other than the Psychiatric Health Facility (PHF) — which offers a criminally scant 16 beds reserved for those in the most acute of crises — there’s been a similarly acute shortage of treatment facilities. Mom-n-pop board-n-care facilities that traditionally provided imperfect haven for those in less inflamed distress have all but disappeared, caught in a terminal cross fire between escalating regulatory costs and diminishing reimbursement rates.
In other words, blah, blah, blah, right? Wrong. We’re now in the moment of genuine opportunity. Because of the Affordable Care Act and the new, more expansive MediCal eligibility rules, there are now new and significant funding sources to help pay for treatment. People previously beyond the pale can now get help. County mental-health administrators are scrambling to take maximum advantage of this. Pushing them further than they might want to be pushed is a coalition of mental-health advocates, including Frank Thompson, who brings to the table 35 years of serious wheeling and dealing to imagine, finance, and build multiple affordable housing projects now operating throughout the county. For the past 18 months, Thompson has harnessed his considerable ingenuity on crafting a financially sustainable plan to create 350 units of new housing under the social-rehabilitation model, where those with mental-health and substance-abuse problems could get not just shelter but also a level of treatment not currently available. Thompson has identified 11 parcels of county-owned land where five such housing pods — each with 50 rental units’ and 20 beds’ worth of more intense treatment — could be built at a rate of one every five years. For people just getting out of detox, it would provide a logical, necessary next step. Likewise for the fragile souls just getting out of the PHF unit. Typically, individuals struggling with chronic acute issues get sent to what the state colorfully classifies as “Institutes for Mental Disease,” or what county mental-health planners call “IMDs.” Naturally, no IMDs exist in Santa Barbara County, so we have to ship such patients elsewhere at a cost of $700 a night. We have contracts for 30 such patients at any time. If we had an IMD in county, the county could recover half that cost. Because we don’t, the county pays full freight.
Thompson cites an avalanche of facts and figures to demonstrate his proposal is financially viable if the county donates the land, waives processing costs, and makes an annual contribution of a few hundred thousand dollars. It’s possible, I suppose, Thompson’s smoking woo-woo powder. But I doubt it. When you consider it will cost $17 million to run the new North County Jail — money which we do not have by the way — I’d say the supervisors should give Thompson’s proposal a long, hard look. It can’t hurt. To do otherwise would unhappily call to mind another one of Einstein’s many pithy observations. “Only two things are infinite — the universe and human stupidity,” he said. “And I’m not sure about the former.”