Leonard Marcus came home to his son lying in a pool of his own vomit about 13 years ago.
“He abused substances because of his mental illness. He was 15 or 16 at the time—still quite young—and it was a real shocker to see how drunk he was. I knew he was drinking, but I had no idea to [what] extent he was drinking,” the Santa Barbara County resident recalled.
That was the first time Marcus called 911 to get help for his son’s mental illness, and the response “got ugly,” he said.
“My son was incoherent, and the sheriff’s [deputies] were aggressive about it. My son did not want to go to the hospital,” Marcus said. “They were saying things to him like, ‘We’re going to take you to jail,’ and, ‘You need to shut up,’ and he was screaming at the top of his lungs.”
Since then, Marcus said the family has seen improvement in responses to their crisis calls as deputies received Crisis Intervention Team (CIT) training through a collaboration between the Department of Behavioral Wellness and the Sheriff’s Office. CIT training helps ensure people in mental health crises get diverted from the criminal justice system to treatment facilities, but advocates say inadequate funding continues to cause a shortage in mental health services.
In 2018, the two departments launched the co-response team—a program deploying intervention-trained deputies with a behavioral wellness clinician—with two based in South County and one in North County, said Dr. Cherylynn Lee, behavioral sciences manager and co-response team founder.
“We started going to different meetings and understanding the lack of connection between Behavioral Health and law enforcement being part of the problem,” Lee said. “We got creative with one deputy and one case worker who saw the value of thinking outside the box.”
The program gets mental health providers on the scene right away, Lee said during an Oct. 19 presentation to the Santa Barbara County Board of Supervisors.
“Typically, a call from 911 would have dispatched deputies to the scene; once they gather enough information, they call the mobile crisis team, and then they look up information about the patient,” Lee said during the meeting. “All of these processes take time. It can add an hour or an hour and a half to the call.”
By pairing the two together, a mental health clinician gets to the scene right away and quickly addresses the situation. Co-response spends about one-third of the time that patrol does—about 43 minutes compared to 126 minutes—Lee said in her presentation.
“Time delay can cause escalation, and our data is showing us after any response encounter, persons trend less jail days after the incident and more time in treatment,” Lee said.
In 2020, the Sheriff’s Office received about 3,000 mental health crisis calls, and a co-response team showed up to about 1,600 of those. Only 11 people went to jail and the rest found safety plans, clinicians, or hospitalization, Lee stated. In July 2021 alone, the department had 365 documented crisis calls, the largest number they’ve had in a single month.
“It tells us that our community is hurting in a way that can be considered unique. We as caretakers need to listen to those unique needs, which in this case is mental health help,” Lee said.
Barriers to care
Mental health services challenge the county—and the nation—due to a lack of funding, resources, and mental health service providers as well as a complex service navigation system, said county National Alliance on Mental Illness (NAMI) President George Kaufmann.
“Part of it goes way back to history in the early 1980s with a movement to close mental hospitals across the country. It was a good thing because people were incarcerated and did not have human rights,” Kaufmann said. “The idea was that as hospitals closed, there was supposed to be a shift in funding to community resources from the funding used at the hospitals. The hospitals shut down, and the funds did not go to the community.”
In 1981, the Reagan administration repealed a community mental health initiative spearheaded by President Jimmy Carter, blocking grants for states and ending the federal government’s role in providing mental health-related services, according to Mother Jones.
NAMI’s top advocacy priorities, Kaufmann said, are crisis services and in-patient care expansion. He added that Lee’s co-response team and crisis intervention training are major benefits to county services.
“This is evidence-based practice and the best way to handle mental health crises. … The deputies are specifically trained in how to de-escalate mental health crises,” Kaufmann said. “Our relatives aren’t going to jail; they’re referred to treatment, which is huge.”
However, the county and state are experiencing chronic resourcing problems—like the low number of psychiatric health facility (PHF) beds for in-patient care—due to budget cuts. When there’s a 5150—a call for a 72-hour involuntary psychiatric commitment—referred during a mental health related response, the individual goes to a general hospital to get medically cleared. In Santa Barbara County, that would be at Marian Regional Medical Center or Cottage Hospital.
After 72 hours the hospital is required to release the patient if they can’t be redirected to an in-patient, locked facility.
“The problem is we are among the worst counties in terms of the number of beds available per unit,” Kaufmann said.
There’s one facility with 16 PHF beds, he said, adding that with a population of 440,000 people, it works out to three or four beds per 100,000 people.
“What’s happening is people are walking away without any plan or forced to be discharged with a safety plan. If people weren’t getting help before, they aren’t going to seek it when they are discharged,” Kaufmann added.
David Ketelaar, an emergency room physician at Marian, is working on improving treatment for people experiencing acute mental health crises, such as suicidal thoughts or thinking about hurting themselves or others.
“We are in the process of opening a crisis stabilization unit that’ll be separate from the emergency room. It’s a place to treat persons with an acute mental health crisis in a collaborative, open setting,” he said.
Until that happens, the shortage of acute in-patient beds is a growing problem for the hospital as mental health conditions become more prevalent, Ketelaar said.
When the 72-hour period ends, it’s easy for the patient to reenter the community and be in a “vicious cycle” of returning to the emergency room, he said.
“What frustrates us is the lack of outpatient care and barriers that come up,” Ketelaar said. “It’s difficult as emergency room physicians that we cannot do the follow-up.”
He added, though, that the co-response team checks in on previous patients as part of a proactive engagement element to the program, which helps the hospitals.
“The situations in the hospital are much less severe because of [their] work in the field, which is so much better for the patient,” he said.
‘A totally different response’
Santa Barbara County resident Marcus said he remembers calling 911 and being able to ask for a CIT co-response team to respond to his son.
“He was hearing voices, beating holes in the walls, broke a hole in the door, and talked about suicide. I called 911, and it was a totally different response,” Marcus said.
The officers who arrived on the scene diffused the situation and took his son to the hospital.
“This training is really crucial for helping the police, and it’s actually helping people,” Marcus said. “The bottom line is the CIT and co-response teams make a huge difference. I think it’s money well spent and saves the county money by keeping people out of jail.”
His son’s treatment remains challenging; he went under a 5150 for seven days, and he saw three different psychiatrists over three different days. Other times, he’s seen doctors he hasn’t liked and a registered nurse working with a psychiatrist due to staff shortages. The family is still looking for answers on the mental health issues their son faces.
“At the PHF, [they said] he had major depressive disorder, but we think my son suffers from borderline personality disorder or schizophrenia, but we don’t know,” he said. “It’s a sad situation; the stress is watching his life go by while he sits in his room and is miserable. … I just want my kid to be happy, he’s a really sharp young man.”
Reach Staff Writer Taylor O’Connor at toconnor@santamariasun.com.
This article appears in Nov 4-10, 2021.
