Mental health care advocates showed up in force to Santa Barbara County’s budget meeting this week urging the Board of Supervisors to open more treatment beds and keep people with mental illness out of jail custody.
Parents shared heartbreaking stories of their adult children languishing for months in County Jail isolation cells while they waited for an available state psychiatric hospital bed, and being released from emergency room holds without treatment or follow-up care.
Grand juries, individual advocates and community groups — including NAMI, Families ACT!, League of Women Voters and CLUE — have for years called for more inpatient psychiatric beds and step-down services to serve people experiencing a mental health crisis.
Two dozen people urging “beds not cells” spoke during public comment Tuesday after the budget presentation for the Behavioral Wellness Department, which manages the county’s mental health services and its alcohol and drug programs.
The shortage of psychiatric inpatient beds means the jail is sometimes “the only option for people experiencing a mental health crisis,” said George Kaufmann, whose son was diagnosed with schizophrenia decades ago.
Many people in crisis cycle among emergency rooms, jails and the streets, he said.
He cited the co-response program, pretrial release program and holistic defense as recent successes, “but the fact remains today in our jail, one third to more than one half of the inmates are known to be present or former users of Behavioral Wellness services,” he said.
“We also know that every month, 10 to 20 people who are in our emergency departments of our hospitals are released when their 5150 holds expire without ever getting inpatient placement, and that’s just not right,” Kaufmann said.
New state legislation limited the time incompetent-to-stand trial (IST) defendants can be kept in custody on misdemeanor charges, and imposed a “growth cap” for felony IST defendants with fines levied against counties who exceed it, budget director Paul Clementi said.
The county expects to pay $6 million in penalties this year for its population of felony IST defendants in custody, he told the Board of Supervisors Tuesday.
The fines would be paid into a mental health diversion fund, which the county can then use for local programs, according to Clementi.
Suzanne Riordan of Families ACT! asked the supervisors for more acute-care beds, longer-term treatment beds, and more outpatient care and support services.
“We know that persons with serious mental illness on holds at (Santa Barbara Cottage Hospital and Marian Regional Medical Center) who have no insurance or only have Medi-Cal wait more hours and are less likely to get an inpatient treatment bed than those with private insurance and Medi-Care,” Riordan said.
“This is an inexcusable inequity of health care for those in our community with the least means.”
The county needs stepdown services and support for a “warm handoff” between inpatient and outpatient care, she said.
There are “treatment gaps wide enough to lose a person completely,” said Deborah Allen, whose nephew has been diagnosed with schizophrenia.
Her nephew spent two and a half years in a County Jail isolation cell during the pandemic, when no visitors were allowed, she said.
He made a paper doll village to keep his mind occupied, but when he drew on the walls, “they charged him with vandalism and took away his art supplies,” she said.
“It’s inhumane and cruel. They should not be languishing in jail,” said a woman whose son was kept in a jail isolation cell for seven months after being declared incompetent to stand trial.
It means so much for families to share their stories, Lynne Gibbs of NAMI told Noozhawk.
With the impending $6 million fine for felony IST defendants and the Disability Rights California class action lawsuit settlement against the jail, “no one can say we’re saving money” by putting people with mental illness in the jail, Gibbs told the supervisors.
Marian McKenzie’s son hears voices.
“They terrify him,” she told the board.
He sometimes finds refuge in parked cars on the street, and has been arrested and taken to jail for it.
“He doesn’t need punishment, he needs care,” she said.
This problem has gone on so long, McKenzie said, that she’s starting to wonder if people holding the purse strings care enough to change it.
At that, Supervisor Steve Lavagnino responded to say the Behavioral Wellness budget and staff have grown substantially since he joined the board, and his colleagues genuinely care.
Supervisor Das Williams thanked speakers for their “heartbreaking stories,” and said the county’s momentum on mental health care did not carry through the years of the COVID-19 pandemic.
“There’s still work to be done,” he said.
The Sheriff’s Office, which operates the county’s two jails, and its contractor Wellpath recently started a program funded by the Department of State Hospitals to “minimize delays for incarcerated people awaiting competency restoration,” a department representative said during Wednesday’s budget workshop.
There are 21 people enrolled, and 66 people have gone through the Early Access and Stabilization Services program so far, according to the Sheriff’s Office.
The health and human services departments are mostly funded with federal and state money, and make up 7% of the county’s general fund budget.
Behavioral Wellness Director Toni Navarro said the number of beds needed is a matter of good care management, so fewer acute beds are needed.
The Crisis Stabilization Unit has been rehabbed and will reopen as a locked facility, adding much-needed involuntary inpatient beds to the county’s system. The CSU is set to open with four beds but can expand to eight beds with more staffing, Navarro said.
It’s located near the 16-bed Psychiatric Health Facility.
Tecolote House, a 12-bed board and care facility, is being developed by the county for medically fragile patients with persistent mental health issues, she added.
Noozhawk’s 2022 series on mental health care highlighted the shortage of inpatient psychiatric health beds; the underutilization of the crisis stabilization unit; and the collaboration between behavioral health and criminal justice agencies to create the co-response teams, sobering center and other programs to reduce the number of people experiencing a mental health crisis who end up in jail and emergency rooms.