The Mental Health Game

Several weeks ago, a reader sent me an email: “Thank you so much for the very thorough article (“Who Closed Mental Health Hospitals In California?”) about the history of mental health issues in California. I am wondering if you might offer another follow up article on possible real life solutions to the issues?”

While I definitely have a few potential solutions to the mental health crisis in our state and right here in Mendocino County, I’d first like to briefly review over the next couple of weeks a bit of the relevant history surrounding the issue.

What follows are excerpts from pieces I wrote back in the early 2000s when certain irreversible decisions were made regarding the direction and scope of mental health services in Mendocino County. This is a rudimentary timeline tracing the beginnings of big trouble in Mendocino County Mental Health policy, or the absence thereof.

Early November 1999 — Colfax Doesn’t Buy Mental Health “Crisis”

It was literally a tear-jerker at the Supes weekly conclave (Tuesday, Nov. 2).

County Mental Health Director Kristy Kelly broke down in the midst of informing the Supes that it’s a full-scale crisis at the Psychiatric Health Facility (PHF). Attempting to regain control, Kelly apologized for crying but was told by a choked-up Patti Campbell, “You never have to apologize to me for tears …” Campbell has been known to shed a tear or two herself during her BOS tenure, including occasions when general assistance payments have been at issue, as well as those times when recovering-addict single mothers have testified to the merits of the Drug Court. While Richard Shoemaker offered Kelly a box of tissues, 5th District Supe David Colfax appeared unmoved by the waterworks display and more concerned with probing the cause of the “crisis.” Here’s the story.

Colfax wasn’t buying the crisis argument. He prefaced his remarks by referring to the Ukiah Police Department’s killing of DMH patient Marvin Noble, plus two other recent jail suicides of DMH clients. “Given the history of the agency you’re responsible for” he said, “and all the potential impacts on other departments, like the Sheriff, Jail, DA, Courts and Public Defender, I want something in writing, on paper, from all those affected by this (closing the PHF) before we make a decision.”

Early January 2001 — Psychiatric Unit Still Closed

Since we’re on the subject of how government treats humans, the situation with the County’s Psychiatric Health Facility is truly criminal. The PHF (pronounced “puff”) unit has been shut down since last December. The PHF unit deals with the very, very mentally ill, some of whom are violent, suicidal and/or criminal offenders. Oftentimes they are dually diagnosed as mentally ill and addicted to alcohol and/or drugs. These folks require 24-hour attention in the special facility. The County Jail is neither equipped nor does it have the qualified staff to care for people who are charged with crimes but are also mentally ill. Likewise, harmless but mentally ill folks who wander the streets getting into mischief don’t belong in jail. They need care and treatment. But when the county’s Mental Health Department closes the only facility that offers specialized treatment, there are no good alternatives.

According to MH Director Kristy Kelley, her PHF staff is burned out and can’t handle the stress of their jobs. One has to presume they went into their chosen profession with their eyes wide open. If they no longer can perform their jobs, they need to get off the County’s payroll and find something else to do. At Tuesday’s BOS meeting, Kelley spoke as if the PHF unit would not be reopening anytime soon, if at all. County Administrative Officer Jim Anderson, to his credit, told the Supes it was “premature” to be exploring such a drastic option.

Needless to say, there are serious questions about Kelley’s performance as head of one of the County’s most critical services. Granted, her staff may be stressed out, but closing the PHF is no solution. Her five bosses on the Board of Supervisors need to take decisive action — this dire situation has been allowed to fester far too long. Cops have a hard enough time dealing with the run-of-the-mill, garden-variety types of criminals and assorted low-lifes who operate in Mendoland. Mentally ill folks need to be cared for by professionals. When there’s no place to put them, the cops are forced to deal with them. This requires deputies to hold them pending finding a suitable, oftentimes out-of-county mental facility to house them. This breakdown in mental health services is both a burden on law enforcement and an extra expense to taxpayers. It’s also unfair to people who aren’t lawbreakers but just sick mentally.

Late January 2001 — Time For MH Director To Be “Relieved”

A couple of weeks ago, I reported to you that the Supes — with the exception of Mike Delbar — caved in to Mental Health Director Kristy Kelley’s demand to permanently shut down the county’s Psychiatric Health Facility (PHF). I’ve said time and time again, the Board just doesn’t have the political will to tell the Mental Health Department to do its job: Provide acute psychiatric care for folks — some of whom are also caught up in the criminal justice system. The Supes swallowed hook, line and sinker, Kelley’s pitch that the Board could utilize $900,000 in purported savings from the PHF’s closure “towards the development of a comprehensive and effective mental health system of care.”

How’s that new system working?

Several days ago, mental health “providers” locked a troubled soul in a DMH vehicle for three hours on a sweltering day. The abandoned troubled soul kicked out the car’s window in order to relieve himself. It’s also way past time for the Supes to relieve Kelley — permanently — from her post.

August 2001 — White Flag Hoisted

It was painful to witness, but at Tuesday’s Supes’ confab, the criminal justice types reluctantly threw in the towel. We’re speaking of the Board’s decision to permanently close the county’s Psychiatric Health Facility. You can’t blame the Sheriff, Public Defender, Probation Department, DA, or the Courts for running up the white flag. They all saw the handwriting on the wall months ago. With the exception of Mike Delbar, who voted against locking the doors of the PHF unit, the rest of Board just didn’t have the political will to tell the Mental Health Department to do its job: Provide acute psychiatric care for folks caught up in the criminal justice system, many of whom are also dually diagnosed with substance abuse problems and mental health illness.

Instead, the county will utilize $900,000 in purported savings from the PHF’s closure “towards the development of a comprehensive and effective mental health system of care.” Why must the PHF unit be closed in order to attain that lofty goal? Isn’t that what the Mental Health Department has been doing all along?

Anyway, these new, enhanced services don’t include local critical care for those whose severe mental health problems lead them into conflicts with the law or who pose a threat to themselves, as in suicidal tendencies. As a recent letter-writer opined, Mendocino County is becoming something of a haven for those who want to end it all, but that’s a subject best left closed, just like the PHF unit.

The problem with most of these folks is there’s no place to care for them in a Mendocino County sans a PHF. So, as has been the case since last year (when the PHF’s doors were “temporarily” closed), those individuals will be transported to out-of-county mental health hospitals. As you can imagine, that situation makes things a bit difficult for an already short-staffed Sheriff’s Office, which provides the out-of-county transportation for mentally ill inmates from the hospital to the courts. Likewise, defense attorneys are burdened with literally going the extra mile to meet with clients who may be in an Alameda County or San Mateo County facility. Needless to say, family and friends of the mentally ill encounter the same sorts of difficulties.

But those are the prices that everybody pays when the county is working “towards the development of a comprehensive and effective mental health system of care.” Any bets on when that will occur?

When you think about it, closing the PHF is somewhat similar to the Supes’ decision to close all of the county’s landfills. Back then the Supes didn’t have the political will to deal with the dump issue on a local basis: There’s got to be a county site where a modern, regulatory-compliant landfill can be located. I’ve always said the problem with garbage is everybody wants you to pick it up but nobody wants you to put it down. Now, we just ship the garbage out-of-here, out-of-sight, out-of-mind — it’s somebody else’s problem.

Now we’re doing the very same thing with Mental Health patients.

Oh well, garbage in, garbage out.

(Jim Shields is the Mendocino County Observer’s editor and publisher, observer@pacific.net, the long-time district manager of the Laytonville County Water District, and is also chairman of the Laytonville Area Municipal Advisory Council. Listen to his radio program “This and That” every Saturday at 12 noon on KPFN 105.1 FM, also streamed live: http://www.kpfn.org)