Sonoma County reshapes approach to mental health care
The Press DemocratAug 20, 2017
Clearly in distress, he rocked slightly on his belly from side to side, calling for help. Several people, including children, walked in and out of shops at the
A security guard stood nearby until two police officers showed up. The man, craning his head, begged, "Please put cuffs on me, please put cuffs on me."
He said people were trying to kill him. He gave the name of a doctor at
"Where am I going to take you?" one police officer asked. "You haven't done anything wrong."
Police, however, did find a place to take the man.
He was booked on charges of public intoxication and taken to jail, the largest psychiatric facility in the county following the closure of
But the question posed by the police officer during the
If he had committed a serious crime, police would arrest him without hesitation.
If he were suicidal or threatening to harm someone else, he could be placed on an involuntary psychiatric hold, known as a "5150," and taken to the local Crisis Stabilization Unit, a psychiatric emergency room in southwest
But what about those who are simply scared and need to go somewhere where they feel safe?
"It can be tricky, because if someone hasn't broken a criminal statute we can't take them to jail,"
Like the man in west
As the mental health system shifts further and further away from a centralized model, which historically placed people in large institutions for treatment, county officials, mental health advocates and medical professionals are now trying to bring all the pieces together to serve more than 20,000 people in
County officials say they've taken dramatic steps in recent years to fill the gaps between programs, including the expansion of crisis stabilization services and creating more residential housing with support services for people with mental illness.
But county officials agree more programs are needed. And some advocates say a different model of care is needed, one that treats mental health patients with the same dignity afforded to patients with physical illnesses.
"People keep talking about how the system is broke ... but it's not. There never was a system," said
What's missing, said Bozman-Moss and her husband, Denny, is a place they call
The
The project is among a number of steps underway to address local mental health issues. It's a countywide effort aimed at enhancing and integrating existing mental health services and patching gaps in mental health care left by de-institutionalization, the decadeslong move toward emptying out government-run psychiatric facilities.
Coordinated care
One key pilot program targets so-called "super-utilizers" who often come into contact with law enforcement and medical emergency personnel. The effort, known as Whole Person Care, would bring together various care providers -- including law enforcement, fire departments, ambulance providers, health centers, hospitals, outreach workers and counselors -- to provide comprehensive and coordinated care.
In June, the county received a
The program will have a special focus on veterans, elderly people and those who are being released from jail. It will enhance outreach services in
"It allows us to partner with health centers in each of these areas and will also allow us to partner with law enforcement, homeless providers and work directly with the hospitals and the ambulances to really serve this difficult and hard-to-reach population," Kennedy said. "It really gives me the staff I need on the ground to almost hold their hands and bring them in."
"This pilot program allows us to really have the resources to test coordination of care and do interventions across the medical and behavioral health system," Robinson said.
Sharing a hospital
Another effort is underway to create a small psychiatric hospital somewhere between
Kennedy and his counterpart in
Kennedy said his office is talking with
At any given moment, the county has 10 to 12 clients in psychiatric hospitals, while
PHFs offer the same services as psychiatric hospitals but qualify for federal funding. Because they have no more than 16 beds, they are not affected by an arcane rule that blocks federal funding to larger facilities.
Outpatient services
There are other promising models emerging in
One program, called Partial Hospital Treatment, is designed for patients who are either transitioning out of inpatient psychiatric care or who need more support than traditional outpatient therapy. It's an all-day program that runs four or five days a week.
A second service, the Intensive Outpatient Program, is for patients who have been a little more stabilized but may need additional therapeutic treatment. It is offered three half-days a week and also includes evening groups.
The programs are "safety-net" services aimed at those whose symptoms are worsening to the point where they can no longer function and their daily life is beginning to diminish, said
"These are evidence-based treatment models that are shown to be very effective for treating mental health issues in a short amount of time," Ledner-Spaulding said.
For one 73-year-old
"It was very helpful for me to have the structure of having a place to go three times a week and to learn very practical ways of identifying the difference between a thought and a feeling," she said. "It's important because so many people believe that thoughts are true and they may not be. Just because you have a thought that you're a bad person, that may not necessarily be true."
Ledner-Spaulding said a large majority of people who are struggling with substance abuse or other addictions have an underlying mental health issue, whether it's PTSD, anxiety or bipolar disorder.
"They are self-medicating their emotional pain in an effort to try to cope," she said. "We try to teach them functional coping skills and how to manage stress in their lives through learning life skills."
Mental health farm
For Barbara and
Bozman-Moss said she first started thinking about the idea of a mental health farm in late 2013 and the following year conducted a great deal of research around the subject. She and her husband then put together an advisory group in spring of 2015 and have been lobbying for local support ever since.
She recently filed for tax-exempt nonprofit status for the
Most of the properties they've looked at in
Bozman-Moss hopes to tap into private insurance as well
The couple envision a place where clients can receive animal and art therapy, where they can work on the farm and make products that can be sold at local stores and markets. But most importantly they see an opportunity to create a supportive community for those with mental illness, and to help integrate them into the larger community.
"It takes community. People need to be interconnected," she said. "One of the things that happens to people with mental health and addiction problems is they isolate, and part of that is because of stigma. They feel the stigma themselves and part of it is because of people's prejudice."
She said she'd like to help people at the farm develop the skills and tools to re-enter society and to put clients on a healing track where they can manage and even overcome their illness in a larger system of care that is free of stigma, just as with other illnesses like diabetes or heart disease.
She said she's gotten nothing but positive feedback from everyone in the county. She's even pitched her idea to former
Insurers play key role
Considered one of the nation's leading mental health advocates, Kennedy recently visited the
While creating more community-based treatment facilities is part of the solution, Kennedy insisted the problem will not be fixed until health insurance companies start covering more treatment. He predicted insurers will not change their approach to mental illness willingly. Instead, he said, they will need to be dragged into court by state attorneys general and sued for violating the Mental Health Parity and Addiction Equity Act, a bill he authored in 2008.
The law requires insurance companies to cover mental health services at the same level they do for physical health care, but it had no enforcement mechanism written into it, he said.
"Insurance companies are constantly putting up roadblocks," he said.
For Kennedy, the fight for better mental health care is a civil rights issue that began more than 50 years ago when his uncle, President
Like so many others who have watched our jails, emergency rooms and streets swell with those suffering severe mental illness, Kennedy said the treatment that was supposed to accompany that transformation has yet to be realized.
"This is no different than diseases like diabetes or cardiovascular disease. We treat them over time and manage them," he said. "Addiction, depression, other mental illnesses are the same. ... How do we build out a health care system that really incorporates mental health and addiction treatment within it?"
This report was produced as a project for the California Health Journalism Fellowship, a program of the
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