Even More Mental-Health Treatment Exported

Before this week’s vote, the newly named Department of Behavioral Wellness had been authorized to spend up to $7.5 million to send these 110 long-term mental-health patients to three “secured” facilities, two of which are locked down. Five years ago, that number was 89. Typically these beds are set aside for patients with problems of such intensity that they’re beyond the interventive reach of the county’s 16-bed acute care Psychiatric Health Facility (PHF), itself overwhelmed by an ever-growing demand.

Many of these patients suffer from mental illnesses sufficiently serious to have warranted the imposition of court-ordered conservatorships. Two weeks ago, the supervisors approved a separate request by the Department of Behavioral Wellness for an additional $2 million to cover costs associated with sending Santa Barbara’s mentally ill to shorter-term acute-care psychiatric facilities, bringing the county’s total expenditure for such short-term treatment to $4 million.

Behavioral Wellness spokesperson Suzanne Grimmesey suggested that statewide prison-reform measures like Proposition 47 ​— ​which released low-level nonviolent offenders from state incarceration back to their communities of origin ​— ​has helped drive up demand on limited IMD bed space. Santa Barbara County has no such facilities. In addition, Grimmesey suggested that many skilled nursing-home patients have found themselves ineligible to stay in such facilities because of new state regulations.

Longtime mental-health advocate Lynne Gibbs argued if Santa Barbara County adopted a Laura’s Law program ​— ​giving judges legal authority to order service-resistant mental-health patients into mandatory outpatient treatment ​— ​the need for such expensive out-of-county programs would not be so acute. Laura’s Law has been adopted by 13 California counties since the State Legislature approved the measure ​— ​a voluntary opt-in program counties could take or leave —in 2003. Gibbs stated that psychiatric hospitalizations dropped in Los Angeles County by 86 percent since L.A. adopted Laura’s Law, and incarcerations by 78 percent.

“As long as we ignore those with the most serious illness,” she wrote, “these persons will continue to fill the jails, hospitals and IMDs at a much more expensive rate than out-patient treatment.” In the past week, supervisors for both Ventura and San Luis Obispo counties voted to adopt Laura’s Law. San Luis will spend $442,000 to create a program with the capacity to treat up to 12 patients at a time; Ventura voted to spend $600,000 to start a program with a capacity to treat 20 patients. “All I can gather is someone’s decided we are so unique we have nothing to learn from other counties,” Gibbs stated.

Laura’s Law is not without significant controversy. Civil libertarians and some mental-health advocates argue its coercive features constitute a civil-liberties infringement and question how much impact such programs actually have had. Behavioral Wellness spokesperson Grimmesey cautioned that the dramatic statistical improvement posted by Los Angeles County under Laura’s Law only applied to the relatively small number of patients whom judges ordered into outpatient treatment, not the entire county.

Efforts to pass a variant of Laura’s Law in Santa Barbara County have met with stiff resistance from county mental health administrators, who find themselves still in the throes of a top-to-bottom restructuring of the department initiated three years ago ​— ​an expansive effort dubbed “system change.” Department brass have argued that implementing Laura’s Law now would interfere with this broader departmental reform. This resistance has, in turn, generated significant heartburn among at least three county supervisors who voted last summer to go ahead with a small-scale pilot program anyway, authorizing the expenditure of up to $121,000. Preliminary plans for this program are slated for presentation before the county supervisors as early as April 19, but more likely sometime in May.