Groundbreaking Mental Health Report Released

For the past nine years, Linda Orozco has been looking for the impossible in all the wrong places. Tuesday morning, she may have finally found what she’s been looking for.

Since 2007, Orozco has sought help for her son, now 36, afflicted with the twin demons of schizophrenia and methamphetamine addiction. For the past three years, her son has been living on the streets. Orozco estimates he’s been arrested 20 times and committed to the county’s Psychiatric Health Facility (PHF) at least six times, the latter for posing an imminent threat to himself or others. So long as he’s taking his medications, Orozco says, her son does all right. The problem is he tends to go off his meds. In the past year alone, county mental-health and drug workers have ordered Orozco’s son to detox facilities located in Los Angeles’ skid row, Oxnard, and Santa Maria. Each time, he leaves a day after checking in. This puts him behind the eight ball with county probation officers. For one such violation, his mom said, he spent six months in the Wasco State Prison.

What Orozco insists her son has needed is long-term hospitalization in precisely the sort of facility ​— ​known in the parlance as an institution for mental diseases or IMD ​— ​that doesn’t exist in Santa Barbara County. As a result, county mental-health officers are forced to contract with a handful of IMDs as far away as Sacramento to hold Santa Barbara’s chronic and seriously mentally ill. Statewide, there are not many IMDs. The few that exist can afford to be choosey about who they take, and they aren’t eager to accept patients with complicated criminal histories. It hasn’t helped, Orozco said, that county mental-health workers didn’t really believe her son was “gravely disabled,” the clinical finding needed to commit someone to an IMD. Because her son is a meth addict, many of his caregivers believed he lies. And because Orozco is forever rescuing her son, he tends to be better fed and dressed than he would otherwise appear.

Orozco and her family are no strangers to the revolving door linking the mental-health and criminal justice systems. About a month ago, she finally got whiplash. That’s when Santa Maria police shot Javier Gaona, another mentally ill man, who reportedly lunged at officers with a knife after threatening to kill himself. At the time, Orozco’s son had just walked out of a treatment facility in Santa Maria. In fact, Orozco said, her son witnessed Gaona’s shooting. At the time, however, Orozco was convinced it was her son who’d been shot dead. So, too, she claimed, were many of his mental-health case workers. Earlier this year, police were called to Smart & Final on East Gutierrez Street when her son, who regularly shouts back at the voices he hears, pulled out a small knife and started waving it about. He wasn’t arrested then. He would be, however, reported for indecent exposure at Girsh Park in Goleta. Ultimately, Orozco’s son would be transferred to the county PHF unit, where he still is. Charges were not filed.

This is when Linda Orozco, normally soft-spoken and gentle, decided it was time to get noisy. She started showing up at the county mental-health department ​— ​now known as Behavioral Wellness ​— ​demanding to see the director, Alice Gleghorn, without an appointment. She demanded to see the medical director, Dr. Ole Behrendtsen, as well, insisting he initiate the conservatorship proceedings necessary to have her son committed to an IMD. For the past several years, Orozco has been working with a group of mental-health advocates known as Families ACT! This group has never shied away from making noise, and its members were only too happy to help Orozco rattle cages.

Ten o’clock this Tuesday morning, Orozco had an appointment with higher-ups at Behavioral Wellness and all her son’s case managers. This time, they agreed to initiate the conservatorship proceedings. A judge will have to approve. There will be a trial. Orozco has no idea what will happen next. But for the first time in years, she has hope.

Less than an hour after Orozco’s meeting, the Santa Barbara County Supervisors met and deliberated over major policy changes that could drastically expand the options available to mentally ill people like Orozco’s son. For the first time ever, the supervisors were given a menu of all the residential treatment options now available. And for the first time ever, the report ​— ​prepared by Gleghorn and her housing assistant Laura Zeitz ​— ​detailed the most significant gaps in treatment. Most critically, Gleghorn and Zeitz provided a proposal for how those gaps could be plugged.

While this may sound rudimentary in the extreme, none of this information had ever been assembled in one single planning document. Boiled down to the barest of essentials, the report says that the county now has 221 treatment beds for the mentally ill. They say it needs about 300 more. The most glaring gaps in residential treatment involve the most severely mentally ill. As has been reported multiple times before, Santa Barbara County only has 16 involuntary psychiatric inpatient beds. As a result, it must contract out for beds in Ventura and elsewhere at a cost last year of $5.5 million. Gleghorn and Zeitz said the county needs at least 10 more, a number some mental-health advocates insisted was too low by half.

In addition, Gleghorn and Zeitz reported Santa Barbara County lacks even a single medically supervised detox bed. They said the county should have at least four. Currently, Santa Barbara County doesn’t have a single IMD bed, either. As a result, mental-health officials must contract with providers throughout the state. According to Gleghorn and Zeitz, the county needs at least 50 beds. During the Great Recession, the county lost 50 adult residential treatment beds in small group homes. Since then, only 12 beds have been replaced. According to Gleghorn and Zeitz, the county needs at least another 50. And so on.

Because of these shortfalls, mental-health officials are often forced to place clients in alternatives that are both more expensive and less than ideal. In the past year, the department has opened 16 short-term “crisis care” beds. They appear to be having the desired results ​— ​the number of patients Santa Barbara is sending to a psychiatric hospital in Ventura dropped by 13 a day to 10. Just that reduction saves the county about $1 million a year.

For most of the supervisors, Gleghorn’s presentation was cause for jubilation. “I think this is a great step forward,” declared Supervisor Salud Carbajal. “This is music to our ears,” Supervisor Doreen Farr commented. It was left to Supervisor Peter Adam to ask the skeptical questions. “How much money are we going to be spending at the end of the day?” he asked. “If we build it, are they just going to come?” The financing of mental-health care being so intricately complex, Gleghorn replied, there were no simple answers to such questions, which frustrated Adam even further.

Santa Barbara enjoys one of the best credit ratings of any county in the state, meaning it has ample bonding capacity. It also owns considerable real estate. But even Gleghorn acknowledged most of the state and federal funding streams on which her department relies only cover the cost of programs, not housing. Where that money would come from, she frankly admitted, she did not know.

While some mental-health advocates took exception to details of Gleghorn’s report, they were thrilled it finally got prepared. For the past four years, Deborah McCoy has been exhorting the supervisors to do more for the mentally ill. Her own daughter had been homeless for three years because she wouldn’t take her daily medications and because the county refused to spend the extra $150 a month it cost to deliver those meds in injectable form. Eventually, McCoy’s daughter was conserved into an IMD, and she only recently got out. McCoy considers herself a winner and has been involved with Families ACT! She’s worked hard to help Orozco get her son the help he needs. And she remembers Carbajal telling her four years ago to find someone within the system to champion their cause. “We found her. You hired her,” McCoy said, pointing to Gleghorn. “Now listen to her. Just do it.”