Wednesday, July 6, 2016
[Shasta County] Grand jury report findings on mental illness no surprise for those in field
It was no surprise to anyone familiar with mental health in Shasta County when a grand jury report said officials should look into expanding services across the board to help overcrowded emergency rooms.
It certainly wasn't a surprise to Adult Services Director Dean True, because most of the report read like a list of goals for his department — some in progress and others that have not materialized.
When the report said the county should look into funding a mobile crisis unit to meet people at their homes, True knew why that hasn't taken off yet and it hasn't been for a lack of trying.
"The challenge is funding," he said. "Mobile crisis teams are common in large urban centers. Here it becomes a matter in economy of scale — what would the Shasta County team be responding to?"
In 2013, Shasta County applied for a grant to sponsor a mobile team and psychiatric beds, but the county lost out as most of the state funding went to larger counties with dense populations.
A 2015 update on Senate Bill 82 showed most of the funding went to Southern California, while Shasta, Tehama, Modoc, Trinity, Siskiyou and Lassen counties were skipped.
"It's a matter of numbers," said True. Smaller counties have the burden to show there is a demand for these services.
On Tuesday the Shasta County Board of Supervisors responded to the grand jury report, saying they will have a better idea later this year about what can be done to create a mobile unit.
Last year the grand jury made the same recommendation and county officials said it was in the process of securing that money, which it ultimately lost out on.
About $1.36 million went to Butte and Mendocino counties for 20 residential beds and $35 million went to Los Angeles County for 560 beds.
"It's one of those tricky things," True said. "You've got L.A. County and you can imagine their budget, but they also have a large population and so one can say a mobile crisis team and bed space would be (used more) versus Shasta County. That's not lost on those determining the grant outcomes."
The grand jury also recommended all local law enforcement officers receive training every two years to de-escalate potentially dangerous situations when someone is having a mental health crisis.
About two-thirds of deputies in the Shasta County Sheriff's Office have received the crisis intervention training, according to Sheriff Tom Bosenko.
That's not to say deputies and personnel are not familiar with speaking with someone having a mental crisis, because they receive other training that includes de-escalation and communicating with someone to avoid the officer or the person getting injured.
But sending officers to crisis intervention training can be costly, Bosenko said. Deputies receive de-escalation training in the academy before they come to work for the Sheriff's Office. All jail staff take a refresher course each year that includes communicating with people who are mentally ill and how to de-escalate a volatile situation, he said.
"I recognize the value of CIT," Bosenko said about crisis intervention training. "But we also have to balance that with the rest of our training needs and priorities. I will not be making it mandated to have officers take it every two years."
Another option is to certify officers in crisis intervention training so they instruct other local officers, as opposed to the off-site 32- to 40-hour course.
Knowing how to de-escalate a mental health crisis benefits patients and their families — as Susan Power knows firsthand.
Power said she's grateful sheriff's deputies were able to speak to her 17-year-old son when he experienced a mental health emergency last week. He was released from a residential treatment facility six months ago. Since he returned home, Power has called 911 twice as her son posed threats to himself and others. Deputies each time have been able to communicate and calm her son.
"To have that both times, with officers who are trained with the right training — it was beautifully handled," said Power, president of the Shasta County chapter of the National Alliance on Mental Illness. "We all have to respond to these crises and if it can be handled at home then that's what you want. That's the ultimate goal, isn't it?"
When mentally ill patients need more intensive help that can only be found in an inpatient setting, there is little available for them in Shasta County, the grand jury found. The grand jury reported that a patient waited about 45 days in a Shasta County hospital room while Health and Human Services officials tried to find a psychiatric inpatient bed. This highlights the need for more psychiatric bed space in the county and while the county's official response said it has been working at this, True said it is a complex process.
"There's a reason why a lot of people are not lining up to take on building these institutions," he said.
"They're expensive and the resources to get them in place are complicated," including finding a location, securing permits with the state and then waiting to find out if the resources are in place.
For a time Shasta County was in talks with Restpadd Inc. The county's provider for psychiatric bed space currently has 16 adult beds in Redding. Plans to increase the number of beds in the county and include beds for children were in the works but ultimately fell through.
Now it looks like that facility will be setting up in Tehama County.
Last year Shasta County sent 595 adults to psychiatric hospital facilities and 89 children out of county. The county has no bed space for children. Restpadd is the first place the county looks to when it places an adult, said True.
The Health and Human Services budget is a quilt work of various funding sources, including the Mental Health Services Act, or sometimes called the Millionaire's Tax.
Shasta County is in the process of developing a center through MHSA funding where people in the county can get access to mental health services after business hours and during the weekend.
The grand jury report said the county should expand the hours of its existing mental health clinic until that new center opens. But again, it comes down to money.
"We'll continue to analyze funding," said True on extending hours at its existing clinic.
One program the county initiated this year places workers in local emergency rooms to assess mentally ill people. It's not quite the same as a mobile crisis response team, which would send health professionals and law enforcement officers to people's homes to help.
But the workers now helping in the hospitals could be pegged to help with a future mobile response team.
"We're trying to see if these workers make sense — if they have enough work in the hospitals," True said.
"If we decide they're not as busy as they could be, those people could on occasion join law enforcement in the field. It's still something we're reviewing."
July 2, 2016
Redding Record Searchlight
By Nathan Solis