Crisis Respite, Fort Bragg

On August 25th, Mendocino County's Mental Health Treatment Act Citizens Oversight Committee, commonly known as the Measure B Committee, held their most recent meeting. Item 3d on the agenda was a “Request for Supplemental funding for a Crisis Respite in the City of Fort
Bragg.”

Committee member Mark Mertle made the case for $244,000 in annual funding over a four year period. The funding is needed to pay for those costs of operation not covered by Medi-Cal. Reading from a statement put together by Fort Bragg Mayor Bernie Norvell and City Manager Tabatha Miller (signed by Norvell, Miller, Vice Mayor Jessica Morsell-Haye, and Police Chief John Naulty), Mertle pointed out the pluses associated with crisis respite facilities. “Crisis Respite offers a safe, comforting environment for those who are experiencing a temporary mental health crisis that may be severe, but is not life threatening and would not require the individual be placed in a psychiatric hospital, if a crisis placement option existed. Crisis Respite is available 24 hours a day, seven days a week, and provides an immediate opportunity to take a time-out and receive support. The inland Crisis Respite program 'Madrone House' has demonstrated the benefits of a Crisis Respite program for inland Mendocino County residents.”

As Mertle noted, the coastal part of the county has been lacking in any sort of similar service for a long time. The germ of the August 25th presentation began anew in 2019 when a coastal citizen asked a county supervisor Ted Williams just what it might take to get the coast, and specifically its hub municipality, Fort Bragg, something realistic in the way of mental health services. Williams had met the son of Steve Fields, a prime force behind the Project Foundation, which runs several crisis residential treatment facilities across six Bay Area counties. The supervisor suggested that Fields' knowledge and experience might serve as a catalyst.

The citizen contacted a friend who is a long time employee of Social Advocates for Youth (SAY) in Sonoma County. In turn that leader within SAY put our coastal citizen in touch with another SAY employee who offered up an introduction to Steve Fields. The citizen organized an early February, 2020 meeting at 516 Cypress Street in Fort Bragg. At that get together, Steve Fields shared his decades long experiences in crisis residential treatment with a group that included Fort Bragg City Council members Norvell and Morsell-Haye, Supervisor Williams, the chair of the coast healthcare district (which owns the property at 516 Cypress St.), Adventist Health (AH) administrators Jason Wells and Judson Howe, and Dr. Ace Barash, from AH's Howard Hospital as well as a member of the Measure B Committee.

In part due to the encouragement Fields inspired at this meeting, Fort Bragg Mayor Norvell has taken the ball and run forward with it in meeting after meeting with the involved parties. He pushed for the involvement of Redwood Community Services (RCS) as the service provider, ultimately agreeing with the decision to start with a crisis respite program which could build to a fuller scale crisis residential treatment facility in a few years.

Mertle's presentation pointed out the advantages of crisis respite, first citing inland access to similar treatment at Madrone House. “In fiscal year 2019-2020, 128 clients were admitted to Madrone House, allowing them to stay within the community for treatment services resulting in a 14% reduction in Mendocino County residents needing to leave the county for services. In addition to providing the ability for individuals to stay within the community for treatment and staying connected with family, the program also benefited the local emergency rooms with a 12% reduction in the average number of days patients waited for placement in the hospital emergency rooms.”

Mertle went on to the crux of the matter on the coast. “During the same fiscal year of 2019-2020, the Coast Mental Health Crisis Program assessed 479 patients. Of those patients, 319 were opened to Mental Health services and 112 of these clients were hospitalized due to the need for a high level of care and the lack of a Crisis Respite or Residential treatment program on the coast. Very few of them
were able to participate in the preventative or transitional services available through a Crisis Respite program because the only program is located in Ukiah. A Crisis Respite program on the coast would allow coastal residents to be served locally and within the community. It would also provide relief to the local hospital and law enforcement, by allowing a viable and beneficial alternative for individuals experiencing a mental health crisis.”

The coastal crisis respite at 516 Cypress Street would be located on the hospital campus now run as Adventist Health Mendocino Coast. As such it is only a few hundred feet from the emergency room (ER). In the past it has served as an office for orthopedic surgeons, a human resources (HR) office, and in 2010 it was re-zoned to also accommodate the housing of ambulance crew members on multi-day shifts. As such, no change in zoning regulations will be needed to convert to a crisis respite facility. Adventist Health has promised a new home for the ambulance crew. This past week the healthcare district board of directors approved a sublease between Adventist Health and RCS for the 516 Cypress property.

A particular selling point at the healthcare district level was the statement made by Fort Bragg Police Chief John Naulty. The Chief told both the healthcare district and the Measure B Committee that a majority of the calls his officers receive involve mental health services. Though the officers are not nearly fully educated in mental health services it is they who must diagnose how serious each situation is. Naulty pointed to another stumbling block in each individual case, what sort of insurance the person possesses. This new Fort Bragg crisis respite program will be accessible to all clients regardless of type of insurance. Chief Naulty also noted the seemingly obvious positive impact a coastal crisis program would have on freeing up law enforcement time to more traditional duties.

In his statement, Mertle told the Measure B Committee that the overall annual operating cost for the 24/7/365 crisis respite program is projected at $600,000. The $244,000 from Measure B would cover “the cost of Medi-Cal Match, non-billable services, those with commercial insurance or Medicare, and those with no insurance.”

Mertle's presentation also “projected that Medi-Cal or other funding sources would pay the remaining annual operating cost of $360,000. Over the next four years, additional funding streams will be explored, including grants, to sustain the program long term.”

The Measure B Committee approved the funding expenditure for the coastal crisis respite project by an 8-0 vote. Chair Donna Moschetti abstained because of her role as a member of the RCS board. Next up, a hoped for approval by the Mendocino County Board of Supervisors.