A Santa Barbara County Grand Jury report released Thursday looks at recidivism among the mentally ill and what steps county leaders should look at going forward. It focused on a specific “target population” — the mentally ill, possibly substance-abusing, uninsured, indigent, homeless individuals cycling in and out of jail.
“The jury believes the cost of jailing and tending to the medical needs of these individuals on an ad hoc, recurring basis is greater than the cost of a planned and sustained effort that addresses their problems at the outset,” the report stated.
It cites statements from homeless advocate Roger Heroux’s research, which states that the chronic homeless make up about 15 percent of the total homeless population but consume 50 percent of the resources allocated to homelessness. Based on that assumption, the report implies that expenses to deal with the chronically homeless totaled $12 million just this year.
Heroux’s report also analyzed the cost of providing supportive housing. His report was administered in 2006, so costs would be higher now, but the comparison is still interesting.
Heroux estimated that supportive housing costs $28 per day and homeless shelters $16 per day, while jails cost $86 per day, psychiatric facilities $800 and hospitals $1,600.
“The jury is not aware of any studies that compare the current estimated cost of the chronic homeless to the cost savings for Santa Barbara County if these people were diagnosed, treated, housed and monitored from the very beginning,” the report stated.
The jury also calls on the Board of Supervisors to produce a document comparing the current total yearly costs of the incarcerated mentally ill indigent homeless to the estimated total yearly cost of providing housing, medical and psychological services, case management, outpatient care and other needed services to create stability for these particular individuals.
The report also mentions Laura’s Law, a bill that requires outpatient treatment, by court order, for people who are unable — or won’t — access mental health services voluntarily.
It notes discussions entertained by county supervisors in 2003 about the law. Since no funding was dedicated to the bill, officials deemed it too costly to be implemented at the time. The ability to enforce a court order also presented a challenge, but the county Department of Alcohol, Drug and Mental Health Services agreed something needed to be done about the issues raised by the legislation.
The discussion was largely silent until Noozhawk published a series on a patient death at the county’s psychiatric health facility. Those stories prompted discussion among ADMHS’ Mental Health Commission, which proposed that a pilot program be put forward to deal with the problem.
That program, currently under way, seeks to allocate current Assertive Community Treatment Team resources to 15 seriously mentally ill, high-risk individuals who are not receiving treatment. But the program depends on patients accepting help voluntarily, instead of a court-ordered treatment program as provided for under Laura’s Law.
“This jury report notes that some mentally ill people in need of assistance may not be aware of their condition and some resist intervention,” according to the report. “How well ACT can break the resistance to voluntary treatment, or whether or not ACT will utilize legal avenues at its disposal to compel treatment, will be major factors in determining success.”
The report also confirms Sheriff Bill Brown’s statement from earlier this year in which he told county supervisors that the county’s jails have become de facto mental institutions.
“An estimated 25 to 30 percent of those incarcerated at the Main Jail were on psychotropic medication,” the report states.
It also takes on Prison Health Services, the company that the county contracts with to operate medical, and mental health, services within the jail. Concern was expressed for mentally ill inmates who may not be capable of requesting help for mental illness, and many of the jail custody staff aren’t trained to identify those symptoms. The company’s contract expires in June and is subject to renewal.
“The jury found that not only have the promises noted above not been achieved, some of the conditions of the contract have apparently not been met,” the report said. A handful of items were listed, including intake screening by PHS mental health professionals at the time of booking.
Though a part-time jail discharge planner has been hired, the report said it is not equivalent to case management and follow-up.
“Individuals are likely sent back to the streets of the county, homeless and mentally ill, with a high probability that their lives will end prematurely from substance abuse, an undetected/untreated physical ailment, exposure to the elements or a combination of these factors,” according to the report.
The report also calls for the Sheriff’s Department to conduct an audit on Prison Health Services, and calls for more mental health treatment beds in the community, as well as in the jail.