Stepping Up Into Mush

When the Board of Supervisors discussed new expenditures in next year’s County budget on Tuesday, June 16, Supervisor Dan Hamburg said that because County revenues have not fully recovered from the 2008 recession, he would only support programs that are in the pipeline or legally mandated: Laura's Law implementation, road maintenance increases, and information technology upgrades. He said he would not support the Stepping Up Initiative or the Public Safety Enhancement Grant application.

This prompted Supervisor McCowen to inquire about the "Stepping Up Initiative."

But first this item in the Board’s agenda packet:

“AGENDA TITLE: Adoption of a Resolution In Support of the Stepping Up National Initiative to Reduce the Number of People With Mental Illnesses In Jails and Encourage all County Officials, Employees and Residents to Participate in the Initiative

“SUMMARY OF REQUEST: Each year, there are an estimated two million people with serious mental illnesses admitted to jails across the nation. Almost three-quarters of these adults also have drug and alcohol use problems. Once incarcerated, individuals with mental illnesses tend to stay longer in jail and, upon release, are at a higher risk of returning to incarceration than those without these illnesses. Without change, large numbers of people with mental illnesses will continue to cycle through the criminal justice system, often resulting in tragic outcomes for these individuals and their families, missed opportunities for connections to treatment, inefficient use of funding, and a failure to improve public safety. The Stepping Up initiative recognizes the crucial role local and state officials play in supporting change; the National Association of Counties (NACo), the Council of State Governments (CSG) Justice Center, and the American Psychiatric Foundation (APF) are leading an unprecedented national initiative to help advance counties’ efforts to reduce the number of adults with mental illnesses and co-occurring substance use disorders in jails. To build on the foundation of innovative and evidence- based practices already being implemented across the country, and to bring these efforts to scale, NACo, the CSG Justice Center, and APF are working with partner organizations with expertise in the complex issues addressed by the initiative, including those representing sheriffs, jail administrators, judges, community corrections professionals and treatment providers, consumers, advocates, mental health and drug abuse service directors, and other stakeholders.”

The agenda packet also included a lengthy chunk of boilerplate resolution language with about a dozen “WHEREASes” taken directly and without change from the National Association of Counties on-line template.

http://www.naco.org/newsroom/countynews/Current%20Issue/5-4-2015/Pages/The-Stepping-Up-Initiative-.aspx

We looked and looked for specifics of the “initiative” and the closest we got was this from Florida judge Steve Leifman: “Examples of effective problem-solving initiatives include crisis intervention teams that teach law enforcement officers to better recognize and respond to psychiatric emergencies in the community; jail diversion programs and mental health courts that utilize specialized dockets and provide judicial monitoring of treatment linkages and engagement; reentry programs that assist with linkages to treatment and support services upon completion of jail or prison sentences, and community corrections programs.”

In one form or other these programs are already in place in Mendocino County. But nobody knows anything about them nor whether they’re effective, of course. In fact, nobody knows much about any of the County’s mental health programs because Mental Health Director (and former Ortner exec) Tom Pinizzotto makes sure we only get very limited cherry-picked information and the Board never asks for meaningful reports. On the streets and at the County’s booking log, however, the public can certainly draw some (negative) conclusions about whatever they’re doing from what we see every day.

…

Judge Leifman proceeds to lay the helpo-therapeuto lingo on thick: “This is a community problem requiring a community solution. None of us created this crisis alone and none of us will solve it alone. By leveraging resources and working collaboratively across the justice system and the community, stakeholders can develop effective partnerships. In doing so, we can craft more equitable and sustainable policies and legislation that will help to minimize incarceration, reduce recidivism, improve public safety, and promote stronger, healthier communities.” (Our emphasis.)

Yes, that would be nice — but not if all we get is more of the usual buzzwords, clichés and bafflegab.

The National Alliance for the Mentally Ill (NAMI) describes the program as: “The Stepping Up Initiative is a national effort to divert people with mental illness from jails and into treatment. The campaign brings together a powerful coalition of national organizations, including NAMI, the Council of State Governments Justice Center, the National Association of Counties, the American Psychiatric Foundation and numerous law enforcement associations, mental health organizations, and substance abuse organizations. The initiative will challenge counties and local communities to work together to find solutions that work for the local community. The campaign will also support local leaders by providing examples of effective reforms and connecting them with other communities that are successfully reducing the number of people with mental illness in jails. (Our emphasis.)

“See more at: https://www.nami.org/About-NAMI/National-Partners/The-Stepping-Up-Initiative#sthash.ffQOeEct.dpuf”

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Supervisor McCowen wanted at least an idea of what Stepping Up involves: "What's the timeline for the Stepping Up initiative?"

Health & Human Services Director Stacey Cryer seems to have learned a lot from Judge Leifman: “It's an initiative, a movement, it's a new way of thinking, it's stepping out of the box that we are in, it's coming together, it's collaborating, it's something that we have already started. We are bleeding to death in adult mental health. Adult mental health in this county has been an issue for years. It's poorly funded, not well understood, problematic in more ways than one, across the country. Adults are being put in jail who should not be put in jail because they are mentally ill and they are violating some part of the law and they end up incarcerated and they end up with felonies. It's got to stop. Everyone is saying nationally it's got to stop, we have to change. So instead of just asking for general fund to go into the adult mental health system we decided to do something little more proactive and we decided to do something that we are already working on. As public defender Thompson says we are meeting about 5150 [people arrested on mental health grounds: danger to self or others], about services in the jail; we are meeting about the way that people are picked up and the way they are delivered and how they are in the emergency room and how they end up in jail. So we are doing these things already. So instead of asking for general fund for adult mental health, we decided to be a little more proactive and try to do something a little different and support this initiative. This was talked about on the Capitol steps on May 7 in Sacramento. It was a very good conversation, and a lot of great speakers were there of course, and it felt like something we could wrap our arms around and move this county forward in a new way. So it's not really a program, so I can't give you a deadline, but it's something we are already talking about and we will continue to focus on. It's really putting our money where our mouth is, so to speak, on where we want to look and focus in mental health.”

McCowen: “The request refers to a pilot project, and so —”

Cryer: I think what we were referring to in that document is that is about getting the collaboration started, getting the collaboration of groups together and supporting what we think could be some steps to move this forward.”

McCowen: “So then, what specifically is the funding going to? Is it to pay people to go to meetings and talk?”

Instead of just saying, “Yes,” Ms. Cryer replied: “I don't know if I can really answer that right now. It's a new initiative and we estimated $250,000 to go into this project, again to start the conversation and a group really — we don't have the money so we haven't talked about how it would be used. We would use it in different venues to move this item forward, to move this movement forward.” (Our emphasis.)

McCowen: “Is it possible that we would know more by final budget that we would have more of an idea?”

Cryer: “Absolutely.”

Supervisor Woodhouse then suggested that the Board not discuss each new item individually at this time.

Supervisor Carre Brown said she supported the Stepping Up initiative, adding that she expects staff to get together and define the programs. “It's a big initiative. It is going to be all across the nation and working together I think we can at least find some solutions for this problem that has been ongoing. That's where I'm coming from.”

...

Hamburg then backtracked: “I am not opposed to the Stepping Up and you should— I just want more detail. Perhaps I could support it if I understood it as well as you do or other board members do. But $250,000 is a fair sized chunk of change.”

...

McCowen: I do support the Stepping Up Initiative. It's very true we don't have a lot of detail here. The Stepping Up Initiative, we could tentatively allocate $250,000 with the understanding that we would get more detail prior to final budget. I do support allocating funds for this purpose. I could probably go forward with it today without qualification. But if delaying a final action on it to gain additional information builds a greater consensus I can support that too.”

Supervisor Dan Gjerde: “Maybe we could put a placeholder amount for the Stepping Up program, and I will just toss out a figure, $50,000 there to indicate the board wants to move forward with the program but then taking the other $100,000 in the draft proposed budget and placing that in whatever you call it, a second contingency fund, up to $250,000 making it $350,000. It would give the departments time to clarify what the additional expenses for this program would be, because as they generally described it as a better way of working with clients, in some respects it seems that that's what they should be doing anyway if there's a better way. But maybe there are some additional expenses that are not covered in today's system and they can explain that between now and the next budget workshop. So I would support it with the modification that it's $50,000 in this budget for the Stepping Up program and making the second contingency fund $350,000, rather than $250,000.

McCowen: “It wouldn't quite be a contingency fund but an unallocated fund balance from what — okay we have to have to allocate it?”

CEO Carmel Angelo: “You have to put it somewhere.”

Allan Flora, the County’s new young Deputy CEO, just transferred over from Lake County: “Generally something like that would just lie in the contingency fund. If you wanted to not have it in there, another simple solution I can think of right now would be to just leave it as available fund balance and not appropriating it anywhere, and that would result — if you look at page 28, the overall budget chart, you see, down at the very bottom where it says balanced budget, zero, essentially that would be revised to be $350,000 there and your board would come back at a later time and your board would choose to appropriate that.”

McCowen: “So we would simply designate it as unallocated fund balance?”

Flora: “Right.”

McCowen: “Would that be the appropriate title?”

Flora: “Fund balance available.”

McCowen: “Unallocated fund balance available.”

Carre Brown: “We're putting funding elsewhere that should really address our mental health needs in Mendocino County. I feel that $50,000 is a drop in the bucket to the overall problem that we face and I'm not willing to change anything from the regular budget unless the Stepping Up Initiative gets $150,000. Unless we get that for that particular program I'm willing to listen to other county supervisors depending on what they would like to do.”

McCowen finally moved to put $250,000 in unallocated reserve or whatever it’s called. Gjerde insisted that they get more information on Stepping Up before it's actually allocated.

Brown then encouraged her colleagues to read the information that is coming out on the Stepping Up Initiative. "It's very successful. You need to read that information. I'm kind of surprised you haven't because the whole initiative was explained in the last National Association of Counties newsletter as well as highlighting programs that have been quite successful.”

Again we looked for the programs that “have been quite successful,” and all we found was things that sound like what Mendo is either already doing or already should be doing:

“Convene/Draw on a team of county leaders and decision makers from multiple agencies committed to reducing the number of people with mental illnesses in jails that do not pose a public safety risk.

“Obtain prevalence numbers and assess needs to better identify adults entering jails with mental illnesses and their recidivism risk, and use that baseline information to guide decision making. [Anything involving reporting of actual numbers will never happen with Pinizzotto as gatekeeper.] Although there is a high prevalence of substance use disorders in jails, this initiative initially focuses on people with mental illnesses and those with co-occurring substance use disorders.

“Measure treatment and service capacity to determine which policies, programs, and services are available to minimize contact or deeper involvement in the justice system for individuals with mental illnesses.

“Make a plan with measurable outcomes that draws on the assessment of the jail population and community capacity. (Again, nothing “measurable” will ever come out of Mr. Pinizzotto.)

“Implement research-based approaches that advance the plan and ensure that working groups or individuals with assignments feel supported, but also accountable, to the leadership team. (The recent Grand Jury report says the opposite is the case now. So if we can’t do it now, what makes anybody think it’ll happen with an extra $250k?)

“Track progress using data and information systems, and report on successes.

Mendo is allergic to tracking anything.

What’s that one mental health cliché that they failed to mention: “The definition of mental illness is when you keep doing same thing over and over while expecting different outcomes”?

Or as in this case, if you throw more money at the same people over and over with the same meaningless explanations expecting different outcomes…

PS. We have since learned that despite the various numbers mentioned during this Board meeting, the final amount allocated to whatever the Stepping Up program becomes is $150k. The unallocated fund balance of $250,000 was a separate reserve line item not related to Stepping Up.