Grand jury finds county's mental health services for children lacking

A Santa Barbara County grand jury released a June 13 report on the county’s Department of Behavioral Wellness and its handling of children experiencing mental health crises. The report outlines much of what the county already knew—there isn’t enough space in the county for children, and people in general, who are in need of immediate and critical mental health treatment. 

“Addressing these deficiencies in county crisis services will provide desperately needed care to the youngest among us,” the report reads, “and also provide some relief and assurance to those distraught parents and caregivers who also face these challenges with them.”

In the report, the jury explores the county’s system for treating children experiencing extreme emotional difficulties, dangerous thoughts, and behavior demanding immediate attention. While the jury writes that there are a number of county- and community-based programs and services for kids struggling with mental health issues, many residents are unaware of them, leading families in crisis to call 911 or go to the closest emergency room, both of which are not necessarily equipped to provide adequate mental health treatment.

To better help families in crisis, the county uses 24/7 phone hotlines and mobile crisis intervention teams of staffers that go into patients’ homes to provide emergency counseling and determine if hospitalization is needed. The jury found that while the crisis teams and phone lines are effective, response times are often slow and the necessary follow-up with patients who are hospitalized is lacking. 

The jury also found that delays in on-site treatment often occur because not all crisis team staff have the authority to place children on a 5585 hold, a legal contract that allows hospitals to keep children in an in-patient treatment setting involuntarily for up to 72 hours.

Most pressing, according to the jury, is that when children are put on a 5585 hold, there is nowhere in the county for them to go. There are no available in-patient psychiatric beds for children in Santa Barbara County, according to the report. Kids who are put on holds have to be relocated to facilities in Ventura, San Francisco, and San Diego, a system that the jury says puts unnecessary stress on children and their parents, who often struggle with the distance from home and have difficulties communicating with each other. 

“The Santa Barbara County grand jury posits that all stakeholders in children’s mental health must act to address the need for in-county facilities to avoid out-of-county placements,” the report reads. “Placing children on 5585 holds and sending them to out-of-county psychiatric facilities is restrictive, expensive and stressful for children, parents, families, and mental health care providers.” 

The jury recommends that Behavioral Wellness establish a crisis stabilization unit for adults and children in Santa Maria, explore the possibility of temporary shelter care facilities, improve training for crisis teams, and improve crisis response times. 

Suzanne Grimmesey, chief quality care and strategy officer for the county’s Department of Behavioral Wellness, said that Behavioral Health has long been aware of many of the issues highlighted in the jury’s report, and some have already been addressed. 

In December 2018, Behavioral Wellness launched its new organized delivery system, which allowed the department to refine and improve the system used to track calls and response times to the crisis hotline. To develop that call center, Grimmesey said the department added a number of staff and a supervisor, and since then, call and response tracking and times have both improved. 

Grimmesey said she doesn’t agree with the jury’s finding that the children’s crisis unit, Safe Alternatives for Treating Youth (SAFTY), is consistently slow in responding to emergency situations. 

“That’s not our experience with SAFTY at all,” she told the Sun. 

As mentioned in the grand jury report, Grimmesey noted that Behavioral Wellness was awarded an $800,000 grant in 2018 from the Mental Health Services Oversight and Accountability Commission to create two hospital-based Children’s Triage Program teams in North and South County. 

The team, Grimmesey said, will enable licensed clinicians to go into emergency rooms with children and their parents and help assess and treat their mental health issues. The department is running a pilot model of that program now in Santa Maria. 

In late 2018, the county also developed a co-response team, which consists of a Behavioral Wellness crisis worker and a sheriff’s deputy. Together the team responds to mental health crises in Santa Barbara four days a week for 10 hours a day, and Grimmesey said that program is doing nothing but good. 

“It’s going phenomenally,” she said. 

The program is being expanded in the Santa Barbara area, and while Grimmesey said the county hopes to expand it to North County, it takes significant resources, which is the issue with a number of the grand jury’s recommendations. 

While Grimmesey said that having a crisis stabilization unit or a shelter would be wonderful, they can be expensive to run, especially in a children’s care system. 

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