BAD NEWS: It was yet another Zoom meeting. On the line was the mental-health brain trust for pretty much the whole South Coast — high-ranking administrators from Cottage Health and the county’s Department of Behavioral Wellness, a smattering of frontline workers who deal intimately with those in the throes of crisis and despair, and, of course, the usual coterie of mental-health advocates. These advocates are the unsatisfied customers of a system even the most bureaucratically savvy find impossible to navigate. It was one of many such meetings regularly held to ensure that everyone experiencing a psychiatric crisis is enveloped in the comforting embrace of “wrap-around services” — in the lingo of the profession — and that all “hand-offs” are unfailingly “warm.”
The meeting — held about a month ago — started out bumpy enough. Cottage Emergency Room workers were really frustrated and upset. During the pandemic, the ER has been overwhelmed by the high number of involuntary mental-health holds called 5150s — patients deemed a potential danger to themselves or others. They wanted answers to some critical questions. Who was the Behavioral Wellness person they should contact when releasing people whose acuity had subsided just enough to no longer qualify as 5150? What about people who relied on CenCal or MediCal for their insurance — in other words, poor people? What were they supposed to do with people whose 72-hour holds had expired?
The meeting got bumpier still when Isabell Nava joined the meeting. Her 25-year-old grandson had checked himself into the Cottage ER five times in psychiatric distress back in October, she said. He was paralyzed by crippling anxiety. He was hearing voices telling him to hurt himself. He got prescribed medications. On one visit, he was sent to the county’s Crisis Stabilization Unit but then sent back to the ER for medical attention. But what he did not get was placed in a qualified facility treating people needing acute care. There’s not much room in that inn.
Instead, he went home and on October 14 stabbed himself 43 times. Then he cut his throat. “You didn’t do what you were supposed to do,” Nava charged. “If we don’t put him behind bars, you release him,” she said. “And if you put him behind bars, then he is treated like an animal.”
The facts, no doubt, are more complicated. They always are. Some people just can’t or won’t be helped. But one thing is absolutely certain: Nava’s grandson was asking for help. He was pleading.
The real mystery is that such tragedies don’t happen more often. The number of 5150 holds referred to the Cottage ER between last March and October was up 58 percent from the year before. COVID, anyone? The average length of stay for each case increased from 20 hours to almost 29. You try juggling that.
The underlying problem is not one of indifference or incompetence; it’s that there simply are not enough rooms where people experiencing acute distress can be safely placed. The numbers have undeniably improved in the past six years, but not nearly enough to meet the growing demand. This, unfortunately, is nothing new. Generations of grand jury reports have waxed apoplectic on this problem.
The definition of insanity, it turns out, isn’t doing the same thing over and over and expecting different results. It’s not doing the same thing over and expecting different results.
That was the bad news.
The good news, as usual, was the County Sheriff’s co-response program, in which deputy sheriffs trained in the gentle arts of de-escalation accompany clinical case workers out into the field to respond to mental-health-crisis calls. Such calls, typically, are very time-consuming. And they can explode. A disproportionate number of these calls have ended with law enforcement using force, sometimes fatally.
In our current post-George Floyd moment, when everyone claims to want to “reimagine” law enforcement, co-response is the best program we currently have going. In 2020, the Sheriff’s Office fielded 2,989 mental-health-crisis calls. Of those, the co-response team handled 1,606. Of those, fewer than 20 resulted in an arrest.
Co-response may not be perfect, but it helps keep people out of the criminal justice system who should never get into it. It helps prevent deadly eruptions of violence against those in acute distress. And it frees up people who wear badges so they can do other things.
Naturally, there is a fly in the ointment — more than one.
For starters, the guy currently running the county’s crisis response team — which includes the co-response team — just turned in his notice this Wednesday. Conspicuously, he does not have another job lined up. Not a good sign.
Then the psychiatric social worker assigned to the Santa Barbara Police Department’s co-response unit has also just quit. She, I am told, also left without having already secured another job. Another sign of concern.
On top of that, Pam Fisher, the Number Two at Behavioral Wellness, is also leaving, though in her case it is to retire. Fisher happens to be in charge of the guy who’s in charge of the department’s crisis response effort. That’s three levels of crisis response out the door in one fell swoop.
I have, of course, been assured there’s no cause for alarm. I don’t happen to believe that. Nor should the county supervisors.
This coming Monday, April 12, the Board of Supervisors will begin discussing this year’s proposed budget. For the first time, they will seriously consider people can be diverted from the county jail and the entire criminal justice system. This is the time to ask a lot of questions about the co-response program.
Maybe you should show up, too. After all, it’s just another Zoom meeting.