High Price for Neglect

In a toughly worded nine-page report, the Santa Barbara County Grand Jury took elected officials and administrators to task for failing to seriously enough consider the needs of the mentally ill. “The Grand Jury believes that the mental health needs of the county have been given a low priority,” the report concluded. “The 1997-98 Grand Jury noted that there were insufficient psychiatric inpatient beds in Santa Barbara County and urged the Board of Supervisors to find more facilities. Ten years and several department heads later, the county has not only not added but has lost psychiatric beds so that today there are only 16 locked beds in the county.”

The report will be seized upon in the weeks ahead as the county supervisors wrestle with the chronic budget problems afflicting County Mental Health, or more precisely, the county’s Department of Alcohol, Drug & Mental Health Services. County administrators have proposed cutting the beleaguered department by $8.4 million. Mental health advocates have vigorously opposed such cuts and have been gathering their forces to wage a full-scale counterattack.

The Grand Jury noted that while most California counties are far more generous than Santa Barbara in funding their mental health programs, Santa Barbara ultimately pays a high price for its cheapness. Only 2.4 percent of the county’s Alcohol, Drug & Mental Health budget comes from the general fund; in most counties, the Grand Jury concluded, that amount is 6 percent. The Grand Jury recommended that Santa Barbara increase its contribution to County Mental Health to be on par with that made by most counties in the state. The Grand Jury also observed that if the county were less tightfisted, it might actually save money. “Due to lack of adequate bed space, approximately 400 patients per year are sent to Ventura’s Vista del Mar hospital at a cost of over a million dollars,” the Grand Jury found. That figure does not count the cost of transporting these patients via ambulance to Vista del Mar. The Grand Jury estimated the transportation costs alone were $500,000, but they cautioned that figure might not be precise.

The psychiatric beds the Grand Jury alludes to are “lockdown” beds for patients who pose an imminent threat to themselves or to others and are the subject of court-ordered involuntary stays. The only such beds that now exist in Santa Barbara County are located at the Psychiatric Health Facility (PHF), otherwise known as the “Puff Unit,” located near the county jail. Because the PHF is almost always full, the county is forced to send other patients to Vista del Mar or other facilities outside county lines. Additionally, the Grand Jury estimated that at any time, the jail housed 25 prisoners who more appropriately should be kept in a psychiatric hospital. The Grand Jury found that state and federal compensation rules render the county ineligible for any reimbursement of funds spent sending patients to psychiatric facilities outside Santa Barbara County. Were these facilities located within the county, the Grand Jury found, the same state and federal rules would allow the county to be reimbursed for 50 percent of costs.

When the Grand Jury visited this issue 10 years ago, there were 24 lockdown beds in Santa Barbara County. In fact, the PHF unit has a capacity of 25 beds but keeps nine unused because Medi-Cal rules provide inadequate compensation for any beds beyond 16. Since the first report, St. Francis Hospital closed its doors (in 2003), and with it went its psychiatric wing, which provided specialized care for older adults suffering dementia and other psychiatric ailments. Cottage Hospital declined to assume that burden, arguing that federal reimbursement formulas would not allow it to recoup the costs of service. For a brief period, older psychiatric patients from Santa Barbara were shipped to St. John’s Hospital in Oxnard, in a neighborhood plagued by gang activity. But St. John’s likewise has ceased providing geriatric psychiatric services. For many years, Cottage contracted with Santa Barbara County to accept involuntary psychiatric patients, but in 2002, Cottage declined to renew that contract. There weren’t enough local psychiatrists willing to work for what the county could afford to pay. And, meanwhile, there are no acute care psychiatric beds anywhere in North County.

In addition, the Grand Jury found that the county was contributing to County Mental Health’s budget woes by charging the cash-strapped department $400,000 in interest this past year, when the supervisors agreed to dip into reserves to keep the department budget whole. The Grand Jury said the interest payment-which is projected to hit $800,000 this coming year-only exacerbates the fiscal woes plaguing the department and should be forgiven.

In 1997, the Grand Jury found “there continues to be an overwhelming need for a short-term holding facility for patients whose failure to take medications causes disruptive behavior.” The Grand Jury also urged the supervisors to “seek funding from all available sources, including a possible bond issue, to fund new facilities.” At that time, the Grand Jury concluded that 10-15 percent of the jail population belonged in such a lockdown facility. As urgently as that report was written, fewer patients were being shipped south to Ventura than they are now-only 280 a year.

County media spokesperson William Boyer said the county would not issue an immediate response to the Grand Jury report, saying county administrators would save their powder until they formally responded to the Grand Jury, as they are required to do by law.

In the past two years, the county has opened two Crisis and Recovery Emergency Services units, one in Santa Barbara and one in Santa Maria. While these facilities do not fill the breach identified by the Grand Jury-acute care beds in a psychiatric lockdown facility-they are designed to address the needs of people suffering from escalating psychiatric problems before an involuntary hold becomes appropriate.