Mental Health Strategies: Back to the Future

Sheriff Allman Makes His Own Case:

Good afternoon. Thanks for discussing the mental health situation, and our initiative. Over the past ten years, I have asked about the possibility of a PHF and have been met with the simple response that there is no money that would cover the reopening of such a facility. Granted, the budget for mental health is $20 million, this money is used as "money out, money in (reimbursed)." There are four parts of the mental health foundation that we should have in our county: 1) A psychiatric health facility (PHF) that allows our citizens to stay local if they suffer from a psychotic episode. Keeping people local means easier follow up and more family involvement. 2) A crisis residential location (voluntary, non-locked) where people can transition from a locked facility to an unlocked facility. This would be for up to 30 days of treatment. 3) A drop in clinic. This would allow clients to drop in for counseling, meds, basic check in and a safe place for clients to visit. 4) An improved location for treatment of clients involved with treatment of alcohol and other drugs.

And Mental Health Veteran Services must be improved in our remote area for the veterans who live too far to frequent the Ukiah VA office.

Whatever we want to call our mentally ill citizens (clients, patients, inmates, victims), we must get to a point in our available services where families can feel comfortable in the diagnosis, treatment and medication. While I have not specifically spoken with Jim Bassler about this initiative, he is a driving force in my desire to see improvement.

Mental illness is not a crime. The treatment of our friends, family members and fellow citizens should improve. I readily offer any other person to put another idea on the table. I listen and learn, but I also want to see law enforcement officers not continue to be the primary responders to these fragile situations. While we (law enforcement) will continue to respond to potential violent situations, these are the exception and not the rule.

This initiative will not solve all of our problems, but this initiative has helped increase the dialogue about a solution. We need to continue to discuss a solution for our citizens who have been declared conserved. This is a huge amount of money which is leaving our county.

Let's keep talking. If I am wrong on the solution, then I am wrong. We need a solution. Mendocino County is a very smart county. We can come up with our solution. If we are going to sit and wait for State or Federal solutions, we will never see a solution.

Tom Allman, Mendocino County Sheriff

Ukiah

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Sheriff’s Ballot Proposal A Good Solution

by K.C. Meadows, Editor, the Ukiah Daily Journal

One of the worst mistakes county supervisors ever made was closing the psychiatric health facility commonly called the PHF, or “puff” in 2000.

There is more than one reason that happened, and the county always likes to say it was just about money, but it was also about trying to cut their losses at a facility that was out of control and no one in county administration at the time had the gumption to make the needed changes. It was just easier to shut the thing down. Supposedly that million or so a year the PHF cost would be spent creating superior out patient services so no one would ever need to be locked up.

What has happened instead is that the growing population of mentally ill patients — many of whom are also addicted to something or other — are running local law enforcement in circles and making a mockery of local emergency rooms.

What Sheriff Allman wants to do is impose a temporary half-cent sales tax to raise $22 million to reinstitute a locked mental ward here in the county where people who are acting out in the streets and are a danger to themselves or others, can be taken to calm down, get their meds if necessary and get back on course. It would also immediately save the county the hundreds of dollars each day we spend on out of county mental wards elsewhere.

Having mentally ill patients cared for here not only is a better economic solution but also better for families of those patients who now have to drive sometimes hundreds of miles to see their loved ones who are hospitalized.

There is a place right here in our own county that would be the perfect solution: the old Howard Memorial Hospital in Willits. With some reconditioning, that former acute care hospital would be the ideal place to have our own psychiatric facility. Allman says he would be all for using that space.

His ballot measure would also take 10% of the money collected and create a mental health training facility for first responders and mental health workers in the latest methods of handling mentally ill patients.

One of the things we like about this proposal is its temporary nature. The sales tax would be in force for five years, at which time it would automatically sunset. All the spending would have to go through a select committee of 11 people from various associated walks of life to watchdog the money and make sure it’s going where it’s supposed to.

We think Sheriff Allman has thought this through, he has a personal connection with the need for serious and quality mental health services and he has made this a priority. We think it’s a good idea and we support it.

(Courtesy, the Ukiah Daily Journal)

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What Ever Happened To In-County Mental Health Sequestration (Blast From the Past)

Colfax Doesn’t Buy Mental Health ‘Crisis’

by Jim Shields

(Tuesday, Nov. 2, 1999) — It was literally a tear-jerker at the Supes weekly conclave County Mental Health last Tuesday.

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 Board 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, Fifth District Supervisor David Colfax appeared unmoved by the waterworks display and was more concerned with probing the cause of the “crisis.” Here’s the story.

Kelly appeared first thing in the morning with an “off-agenda” item requiring the Supes immediate attention. Kelly said an emergency situation necessitated her seeking Board approval to close the PHF unit immediately. The PHF, located at the Low Gap county complex, provides acute psychiatric care and other inpatient services to the seriously mentally ill, including those charged with crimes or being treated against their will (so-called “5150” cases from the penal code section of the same number).

The PHF unit is licensed by the state “which has clear guidelines for the conditions that allow its operation.” One of those conditions causing suspension of its license is “that certain patient/staff ratios are maintained and that a specific array of licensed staff must be working on the unit at all times.”

As Kelly explained it, chronic understaffing at the unit fell to below state standards in the last two weeks when “violent incidents” forced four staff members off the job with work-related injuries. Additionally, 11 PHF employees filed grievances “regarding working conditions due to concerns for their personal safety.” No details were provided about the violent incidents or the unsafe working conditions, but one can imagine that whacked-out mental cases are capable of bodily harm both to others and themselves.

Kelly told the Board that “as of 3pm today, we will not be able to maintain the minimum number of licensed staff on the unit required by our license.” Kelly recommended that the Supes “affirm PHF operations should be suspended until staffing and other problems are resolved.” In the meantime she proposed re-opening the PHF as a “Crisis Stabilization Unit” (CSU) on an interim basis while the county Personnel Department develops “recommendations on incentives and/or other solutions to address chronic problems in recruiting and retaining qualified staff.” However, the CSU could not house “5150” cases for longer than four hours. Likewise, mentally ill offenders would have to be sent elsewhere. She also pointed out that the CSU would use the existing PHF facility and staff. Finally, all services at the CSU would be “billable under Medi-Cal unlike PHF, which is only partially reimbursable.”

On the down side, closing the PHF and opening a CSU would increase various costs, such as case management and transporting mentally ill offenders to far away state institutions such as Atascadero or Patton.

Colfax wasn’t buying the crisis argument. “Given the history of the agency you’re responsible for (Ukiah Police Department’s killing of Mental Health patient Marvin Noble, plus two other jail suicides of Mental Health clients),” 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.” Colfax went on to say that the so-called PHF crisis “has been building for years” but nothing substantive had ever been done to tackle it comprehensively. He also cited chronic understaffing at the jail and with patrol deputies. “I find it difficult to respond to this emergency when it’s been building for three to five years or more. We need to look at why we’re out of compliance and getting qualified people.”

He laid a large part of the blame on a lack of funding and voters who don’t seen concerned about service cuts in those areas. He urged that “the Sheriff and District Attorney should get on the soapbox” and let people know how serious the problems are.

Sheriff Tony Craver, responding to Colfax, likened the situation to “driving a car that runs out of gas — you won’t get there until you pay what a gallon of gas costs. You need to pay for services what they cost.” Captain Gary Hudson, who oversees the jail, told the Supes his facility had failed the last two inspections by the Department of Corrections. He said the jail was out of compliance with one-quarter of the positions vacant. If the PHF unit closes, it would place the entire operation at risk. “We are at our limits also,” Hudson stated. “With the inability of the PHF unit to function as a PHF, the jail could not operate as a jail.”

Hudson was referring to the seriously mentally ill inmates who must be housed at the PHF because the jail is not equipped to deal with them. He told the Supes that transferring inmates from here to facilitates in Patton or Atascadero would require 12 to 14 hours processing and transport time. That cost is multiplied each time the mentally ill offender is returned to Mendocino County for a court appearance. Furthermore, it would result in less street patrols since those deputies would be assigned transport duties.

Kit Elliott, from the Public Defender’s Office, warned the Board that they were “looking at significant costs” if Public Defender staff had to travel out-of-county to represent mentally ill offenders.

“Realistically, the Public Defender’s staff can’t drive back and forth to out-of-county facilities … phone calls (to the mentally ill) don’t work … you need face-to-face contact with them,” she commented.

With Colfax dissenting, his four colleagues voted to give Kelly the discretion to suspend operations at the PHF if she couldn’t find the personnel to maintain state staffing mandates. According to Kelly, if operations are suspended by local officials they can re-open the PHF any time they are once again in compliance without state approval. If and when Kelly closes the PHF, then the CSU would open, which would, in turn, trigger transporting criminal mentally ill offenders out of county.

Meanwhile, the Mental Health Department, the Sheriff, DA, courts and the Public Defender will be meeting to come up with a plan that will hopefully resolve this mess.

Colfax was not happy with the decision. “We keep backing away and backing away. We’re pretending we’re solving something but this is a major policy change. We’re making it (the PHF problems and related issues) out-of-sight, out-of-mind.”

Speaking for the majority, Mike Delbar scolded Colfax: “We’re not here today to grandstand. I have faith that the Mental Health Director and the ‘support’ departments (Sheriff, DA, PD, courts) will work on this problem — they will not let it fall off the table.”

(Jim Shields is the Editor of the Mendocino County Observer out of Laytonville. At the time of this report he was the only reporter in Mendo covering the Board of Supervisors in any depth.)

(Ed note: Besides the four supervisors mentioned in this late 1999 report (Colfax, Campbell, Delbar, Shoemaker), the other Supervisor voting in the 4-1 majority to axe the PHF was Third District Supervisor Tom Lucier, the Willits mortician.)