Mad Dogs on the Loose

HUFFING AND PUFFING: It was at the height of the last great drought that my crazy cousin experienced what’s delicately described as an “incident.” He was living in Ventura at the time and absentmindedly lit a drinking straw on fire. The straw, it turns out, was attached to one of those wax-paper, takeout soft-drink cups some litterbug had dropped under a pine tree. The pine tree happened to be located under the eaves of a Chinese restaurant. It’s the sort of thing you do if halfway through your adolescence you find yourself suddenly stark raving schizophrenic. It’s what you do if none of the drugs in your system match those prescribed by your shrink. The restaurant caught fire, though the flames were put out before much damage was done. My cousin, dressed in spectacularly tutti-fruiti garb, was positively identified by scores of witnesses. Besides, he’d made no effort to flee the scene of the crime. I remember visiting him at Ventura County Jail. His brain was revving fast and furious. He should have been a genius. Maybe he was. But even through the six-inch Plexiglas partition, I could smell the smoke.

He got lucky. His parents could afford a good lawyer, and he wound up getting the best deal possible. At any given time, about 150 people in Santa Barbara County Jail are not so fortunate, placed behind bars for relatively minor offenses stemming from mental illness, not criminal inclination. According to a recent study, we could save about $12 million a year by putting these people in treatment instead. Of course, that presumes such treatment exists. In most cases, it does not. I was thinking about my cousin this week as the county supervisors received a lengthy update on the state of the county’s troubled Psychiatric Health Facility (PHF), better known as “County Puff.” PHF is where mentally ill people are held against their will if it’s deemed they pose an imminent threat to themselves or to others. The good news about the PHF is that it wasn’t worse. Two years ago, federal regulators nearly shut the PHF down, citing wholesale deficiencies discovered during two audits after Clifford Detty, a mentally ill 46-year-old with a taste for meth, died in custody there. Back then, the PHF was very big into secluding and restraining difficult patients. They failed to check the heavily medicated Detty’s vital signs according to their own established protocol. The county just settled with Detty’s father for $1.5 million. That’s a lot of money. The PHF has since gotten new administrators who appear to be running a much tighter and much more compassionate ship. There’s more therapy for the clients, more staff to deliver it, more training for the staff.

The problem remains that there are only 16 beds for all of Santa Barbara County. For a county our size, PHF administrator Leslie Lundt told the supervisors, we need 30 to 60 beds. Lundt provided the supes a vivid snapshot. The PHF, she said, was currently full. In addition, the county had sent 14 patients to acute mental health care facilities in Ventura County, both of which, she noted, were also full. Cottage Hospital had three people in its ERs that were waiting for a PHF vacancy. Marian Regional Medical Center in Santa Maria had two. Cottage Hospital, she noted, diagnosed 604 ER patients PHF-eligible last year. The year before that, the number was 288. It costs $800 a night to send people to out-of-county facilities. Mental health administrators had budgeted for 709 beds for this year. Lundt said we’re already on a pace to exceed 3,000. That’s $1.7 million worth of budget deficit. PHF has gotten better at doing more with less, increasing the number of patients it discharges by 27 percent. That creates more bed space, but not nearly enough. The big problem is that patients stay at PHF far longer than the state average of eight days, some for months. The big problem is there are few places to put them, no “step-down” facilities for fragile souls just recently stabilized. Hell, Santa Barbara County doesn’t have a medical detox facility to send such people. As Lundt noted, she’s disinclined to dump such patients on the streets. They have a habit of coming back. There’s lots of talk ​— ​and even some real plans ​— ​to build licensed step-down residential treatment for those getting out of PHF, but even the most concrete plan remains years off.

In a factoid-rich presentation, I was most astonished by Lundt’s revelation that fully one-half of the PHF’s current caseload are defendants charged with misdemeanors whose psychological sunspots are so serious that the court system has deemed them incompetent to stand trial.

One half?!

Misdemeanors?!

This brought me back to my crazy cousin and the 150 people in county jail at any given time who should be some place else. And it brought me to the $80 million in grants Sheriff Bill Brown has secured to build a new North County Jail that seems to get bigger every time you turn around. It reminded me of the $17 million a year that it will cost county taxpayers to run that jail. To date, no one has figured out where that money will come from. But one way or another, it has to come out of the General Fund. Inevitably, it will come at the expense of programs serving the mentally ill. I know it’s heresy to express doubt about the new jail. It is, after all, needed. But somehow I can’t help wondering, if we spent a few of those millions on people like my cousin, maybe we wouldn’t have to spend so many millions locking people up. I don’t think it should take a crazy person or even a genius to figure that out. Little wonder that on the way out of supervisors’ chambers, the only thing I could smell was smoke.