Double Trouble

Money, beds, case managers, a bigger jail-they would all help fill the gap in services for those suffering the simultaneous effects of mental illness and substance abuse problems, or dual diagnosis. But as of now-and without creative thinking in the future-those won’t be a reality, according to a panel of 23 law enforcement officers, experts, and public officials gathered at the Faulkner Gallery on Tuesday, along with a standing-room crowd of about 140 community members.

The county has programs for both the mentally ill and substance abusers but for years has been unable to adequately serve people whose substance abuse and mental illness co-exist. But fairly recently, an organized group called FACT (Families Advocating for Compassionate Treatment) has been talking about changing the system to support the dually diagnosed. “There just aren’t any options to get someone back on track,” said Suzanne Riordan, who helped found FACT after her son Ian Bezman, who had bipolar disorder, died from a drug overdose.

Mental illness and drug abuse impact thousands of families in the U.S. In Santa Barbara County, more than 70 deaths related to drug and alcohol overdose or suicide occurred in 2006. The Santa Barbara County Jail-the de facto mental health facility in the county, according to Sheriff Bill Brown-is critically overcrowded. Furthermore, an estimated 120 inmates are taking medication for mental illness, according to a recent civil grand jury report. “In out, in out, in out” is how one mother described her dually diagnosed son’s time going through the revolving door of the county jail.

On a journey through a dually diagnosed person’s interactions, the first stop is often with law enforcement. Police often contact the same mentally ill people repeatedly, and jail is sometimes the easiest-and cheapest-place to take them. But through a restorative policing program, Santa Barbara cops are trying to take a specialized interest in the individuals. Instead of automatically arresting a person, officers can take into account the subject’s history, along with potential drug or mental health problems, and find appropriate help. One man, according to Capt. Frank Mannix, had 400 contacts and arrests by police in a two-year period. Through restorative policing, the number was cut to just a handful.

Because of the state’s 1972 Lanterman-Petris-Short (LPS) Act, dually diagnosed patients have been left out to dry, according to some of the members of FACT. The law was designed to protect the rights of people with mental illness but often only makes treatment difficult because of restrictions placed on the caregiver.

One of the first steps to change, according to FACT, is a reversal in how people see the dually diagnosed. “This is somebody’s brother or sister, someone’s son or daughter,” said FACT’s Anna Campbell. Beyond that, the biggest problem, according to county public defender Gregory Paraskou and many others, is the lack of bed space in the county and in residential facilities. “The reality is people can’t function on the street,” he said. The county has only 16 beds dedicated to dually diagnosed patients. Expanding the number of involuntary beds was an option presented at the meeting, as well as increasing the number of residential treatment centers.

At the core, said J.T. Turner-manager of Phoenix House, a long-term care facility for people with mental illness-is not necessarily increasing the number of beds in the county, but having people move through the system more effectively. Turner said the client-to-staff ratio at places throughout the county needs to be lowered. “The work we do in mental health is about relationships,” Turner said. “We’re only going to succeed with relationships.”

The meeting was only a kickoff for ideas to come, as FACT is assembling a task force which will continue to look at how dually diagnosed patients can be helped. “It’s our hope that from this moment will come momentous change with momentous results,” Campbell said.