State of Being

Affording Mental Health in Santa Barbara

To the world at large, Santa Barbara is the American Riviera
where happy rich folks frolic on fabulous estates and there is no
sorrow or trouble. As Borat would say: “Not!” While there is much
privilege, there is also marital strife, depression, suicide,
eating disorders, acting-out teenagers, and, increasingly, the
streets of Santa Barbara are home to many untreated mentally ill
homeless people.

In our city’s benign and generous environment, you would think
there would be plenty of help for anyone with ailments of the mind.
But, as it is with so many things, the options available depend on
where you hang on the economic ladder. Gary Linker, a therapist and
executive director of New Beginnings Counseling Center, breaks it
down this way: “If you have money, you can get Mercedes service. If
you have insurance, you can get Honda service at least. There are
many good therapists on insurance panels, but it is hit-or-miss. If
you can only afford $40-$80 for therapy, you are really looking
around.”

Most people in the mental health field whom I spoke with agreed
there are plenty of private-practice therapists available for
people with the means to pay for it. Fees range widely from
$75-$250 (see next week’s Healthspan column for more about this),
but where do people go for mental health services when their cash
flow is more limited? Community counseling centers traditionally
fill this need and Santa Barbara has several excellent ones.

Inexpensive Assistance

Only five years old, New Beginnings Counseling
Center
is dedicated to never turning anyone away,
according to Linker. They have an established sliding scale for
individual psychotherapy from $25-$75, but, according to Linker,
“even those who can only pay $1 are taken care of.” New Beginnings
has been expanding its services to include psychologically oriented
life skills training to homeless and low-income persons.

The Community Counseling Center, which has been
around for 23 years, has a similar mission. It also provides
counseling services on a sliding scale — $16-$75 — basing the
individual’s fee on their income and how many people they are
supporting. According to director Patricia Cooper, approximately 35
percent of the center’s clients are Hispanic and it is well staffed
with bilingual counselors. Like New Beginnings, the center does its
best to provide clients with comprehensive services that include
counseling, educational classes in communication, and parenting
skills, as well as a support group for Hispanic parents called
Poeticas de Familias.

Another excellent community counseling clinic is the
Hosford Clinic at UCSB, which isn’t just for
students anymore. Like the other community-based counseling
clinics, Hosford offers a sliding scale ranging from $15-$85; it
also provides therapy by more experienced licensed staff members
from $50-$150. The clinic is not set up to provide emergency
services but it does have a consulting psychiatrist available for
medication.

Recently Hosford added the Psychology Assessment
Center
(PAC). PAC can provide psychological assessment
services for all kinds of disorders that affect psychological,
emotional, academic, and occupational functioning, including ADHD,
learning disabilities, neurocognitive disorders, traumatic brain
injury, and thought and personality disorders. A full battery costs
$500 and a sliding scale is available.

All these centers rely almost exclusively on student therapists
who are supervised by licensed therapists. This system is effective
in that it provides more coverage for the population in need of
services, but it does restrict the scope of practice.

Debra Manchester set out to deal with that issue when she
cofounded the Family Therapy Institute of Santa
Barbara
(FTI) in 1980. Her idea was to combine a nonprofit
model with a good business one, so that higher-fee clients would
supplement the lower-fee clients. Manchester was convinced it was
“theoretically possible to run a counseling agency with a staff so
good we could play Robin Hood.” FTI puts this into effect with a
staff that is comprised of more than half licensed therapists, and
yet maintains a generous sliding scale from $30-$130. One thing
that distinguishes FTI is its dedication to treating all cases “in
context,” working with families, partners, and other social
relationships in almost all cases.

Manchester also made the point that it is a very different story
for those who want and seek therapy as compared to the more
emergent mental health situations, including the severely mentally
ill. “It’s a revolving door; a lot of crazy things have happened as
we have tried to accommodate. Santa Barbara is making its efforts,”
she said.

Emergency Services

Often, “non-elective” cases erupt and need an emergency
response. In Santa Barbara, the first line of defense is the
Cottage Hospital Emergency Room. There is a
licensed therapist on duty 24/7 with a psychiatrist on call.

If you call 9-1-1, it can get complicated. In the good ol’ days,
we had a PET (Psychiatric Evaluation Team) composed of
psychologists who were part of the response team called during
emergencies. This system has been changed to a MAT (Mental Health
Assessment Team). This is often run by paramedics with less
training in psychiatric evaluation. They are oriented toward
involuntary commitment that has a very strict standard — it
requires the approval of the on-call county psychiatrist and is
rarely done. Often, people in crisis are told to call County Mental
Health and enter into that system which, by most reports, can be
dicey.

There are some positive developments in our public mental health
system. The county has opened a crisis clinic called CARES (Crisis
and Recovery Emergency Services). The original intention was to be
a 24-hour emergency walk-in service for Medi-Cal patients and those
with no insurance, but budget cuts have restricted it to a Monday
through Friday, 8 a.m. to 5 p.m. schedule. This is the county’s
attempt to make services accessible before hospitalization is
required.

Santa Barbara no longer has a suicide hotline. However, the
211 Crisis Hotline is up and running and can deal
with all kinds of emergencies, from domestic violence to suicide.
The county also has a Family Stabilization Team,
which goes out to homes and works with eruptions in families or
between parents and children. The CARES program also provides a
24-hour crisis hotline (884-6850).

Much of the mental health services provided to people with
little or no means is provided through Medi-Cal.
Medication help is usually provided along with case management but
according to various sources, the real problem arises because many
of these people are in need of counseling as well but there is
little ability to provide it.

There is a further problem in the system in that many patients
who come in for help don’t have serious enough mental health issues
to qualify. They are therefore turned back to their primary care
physicians. These doctors are often overwhelmed. “They are too sick
for us to manage,” is a complaint often heard.

Mental Health Reality

In California, generally, mental health services in the public
sector have been under-funded. Ever since Ronald Reagan closed the
mental hospitals, things have gone south. Community health centers
were intended to pick up the slack, but funding and energy have
left that camp. The excellent Santa Barbara Neighborhood Clinics,
for example, have no mental health services available, although
they are looking into it. According to Executive Director Dr.
Cynthia Bowers, “Because of the lack of mental health services in
the community, our primary care providers, by default, also become
mental health providers.” This is a problem, as Bowers estimates at
least one in 10 of the adult patients who come to the Neighborhood
Clinics suffer from some form of mental illness.

The mental health professionals with whom I spoke — most of whom
wished to remain anonymous — agreed serious problems exist. “Most
people in the mental health field would say it’s a nightmare,” one
said. Another put it simply: “We have a mental health system that
is broken. [In Santa Barbara County] we have been traditionally
under-funded, which makes our system worse than other counties.

George Kaufmann, former president of the board of the Mental
Health Association of Santa Barbara County, knows about these
problems — not only as a community activist but also as a father of
a mentally ill son. Kaufmann described his son, who was diagnosed
with schizophrenia, as “typical of a young person with this
illness: no insight into his condition, refuses treatment, addicted
to drugs, went missing, and was homeless.”

The family previously lived in Michigan, where there were
excellent services, and in that system, Kaufman’s son attained a
“remarkable recovery.” But all that changed when the family moved
to Santa Barbara. Due to the high cost of real estate, housing was
a problem. The only way he could get his son higher on the housing
list so he could live independently was to move him out, in effect,
making him homeless once again. “The reason I have stayed involved
in this area is that I was shocked that services were so poor even
though there was lots of money available,” Kaufmann said. “In
California we have a ‘make-do’ culture … because mental health
treatment is actually an option here, unlike other states. Ever
since deinstitutionalization, everybody has become resigned to
making do with suboptimal services.” And what about Santa Barbara
County in particular? Like everyone else I talked to who had
criticisms of our public mental health services and policy,
Kaufmann didn’t want his statements to be an indictment of the
county. “With its resources, it is doing a good job.” As an
example, he cited the county’s emergency mental health services.
“Everyone agreed these needed our most immediate attention and, to
their credit, they created CARES even before funding was fully in
place.”

I asked Dr. James Broderick, director of the county’s Alcohol,
Drug, and Mental Health Services, about the mixed reviews his
department has been receiving. “Some of the criticisms I’m sure are
valid,” he said during a phone conversation. “Our county staff has
caseloads of 50 to 60 cases, and we are doing a good job with the
resources we have. People need to see we are in the process of
changing the system.”

For example, Broderick said the county is doing a tremendous
amount for the mentally ill homeless, getting them off the streets
and into treatment. Along with working to provide housing for this
population, the county is involved in an innovative program called
Restorative Policing, wherein teams of mental health workers and
policepersons go out to the streets to more effectively deal with
the homeless. “The public system is a safety net and the primary
responsibility for the seriously mentally ill falls to us,”
Broderick continued. “All the expectations are on the public sector
but where is the private sector? For example, we are supposed to
have parity [insurance companies paying for mental health services
at the same rate as physical health services] but this is not
enforced.”

According to one high-ranking mental health professional in the
private sector who wished to remain anonymous, “There doesn’t seem
to be much leadership around this locally. Let’s face it, this
isn’t a sexy issue. Yet it is surprising this is happening in a
place like Santa Barbara, a place that is politically progressive
and wealthy. You would think it would be different here.”

Resources

Community Counseling Centers

Family Therapy Institute of Santa Barbara, ftisb.org Hosford Clinic, education.ucsb.edu/ccsp/hosford.html
Hosford Psychology Assessment Center, education.ucsb.edu/netshare/ssmith/pac.html
New Beginnings Counseling Center, newbeginningscounselingcenter.org
Family Service Agency, fsacares.org Community Counseling and
Education Center, ccecsb.org

Emergency Services

Cottage Hospital 24-Hour Emergency: Pueblo and Bath sts.;
682-7111 211 Crisis Hotline: Dial 2-1-1 CARES 24-Hour Crisis
Hotline: 884-6850

Private Practice Referrals

Licensed Psychologists: Santa Barbara County Psychological
Association, sbpsychologists.org Licensed
Marriage and Family Therapists: Santa Barbara CAMFT, santabarbaratherapy.org Santa
Barbara Healthsource, sbhealthsource.org/site/directory/16.html

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