A Santa Barbara County resident is dealing with mental illness and homelessness. She frequents local emergency rooms, to the point where staff there know her by name. She’s had her share of run-ins with law enforcement, as well—police have booked her a couple of times for low-level crimes, like disorderly conduct or urinating in public.
She cycles through these systems again and again, never seeking treatment. She doesn’t want to be treated. And even if she did, she wouldn’t know where to start.
This particular story doesn’t belong to a specific person—it represents many residents throughout Santa Barbara County who struggle with mental illnesses, and often homelessness. And until January, the county lacked an outreach program to serve these individuals.
The county’s Behavioral Wellness Department implemented a three-year pilot program for assisted outpatient treatment, or AOT, at the beginning of this year. The program was modeled after state legislation known as Laura’s Law, which came into effect in 2002 to provide outreach programs to people who wouldn’t otherwise seek treatment for their mental illnesses. The Santa Barbara County Board of Supervisors didn’t agree to fund the local implementation of Laura’s Law until 2016, and shortly thereafter—only four months into the pilot program—AOT sat on the chopping block.
Behavioral Wellness Director Alice Gleghorn, who must trim more than $4 million from her budget in the face of massive funding cuts countywide earlier this year, suggested eliminating AOT. But according to Behavioral Wellness Commission member Jan Winter, Gleghorn’s idea didn’t sit well with the public.
“There was a huge public outcry in support of keeping Laura’s Law on,” Winter told the Sun. “The program itself, in the four months it’s been going, has demonstrated its worth. Some people said four months isn’t very long to be able to tell if it’s a worthwhile program, but the results have been pretty stunning.”
According to AOT Program Manager Tammy Summers, 10 of the first 14 people referred to the program have agreed to mental health services. Those numbers, combined with outspoken public support for AOT, were enough to convince the Board of Supervisors at its May 16 meeting to sustain the program. The supervisors agreed at the meeting to provide another 12 months of funding to AOT.
Summers explained that AOT is able to achieve such success because it focuses on human-to-human contact. The process begins when someone—a friend or family member, or perhaps a law enforcement officer or emergency room staff member—refers an individual to AOT. One of the county’s three AOT teams (based in Santa Maria, Lompoc, and Santa Barbara) then does everything it can over a 90-day period to engage with the referred person, usually starting small by bringing the person a warm jacket or a cup of coffee.
“You never start out saying, ‘We want you to take part in our services,’” Summers told the Sun. “What we’re trying to do is go out there and get them to trust us, work with us.”
When the team members find the person, they assess them to ensure they meet the requirements for Laura’s Law. If so, they proceed with trying to engage them, with the ultimate goal of finding treatment.
Usually, referrals respond well to AOT team efforts, Summers said. “But sometimes, there’s a gap between people wanting our services and learning to trust us.”
If a referral still refuses offers of treatment after 90 days of AOT engagement, the person can end up in court, where a judge might order them to receive treatment. But Summers said the county’s AOT program hasn’t yet encountered that situation. She chalks up the success to the power of human interaction.
“People respond to human beings coming out and asking them how they’re doing,” Summers said. “Anything like that’s just the human element, offering them clothes or shoes or jackets or food.”
Winter described Santa Barbara County’s AOT program as “constantly refreshing.” It has a somewhat-flexible 10-client limit, where the treatment teams engage with 10 individuals at a time. Once a referral accepts treatment, that person moves out of AOT and their slot open.
“They’re finding that that’s working really beautifully and smoothly, for the most part,” Winter said.
The program’s pilot phase is slated to last for three years, though it’s only secured funding for the first year and a half—including the funding clinched at the May 16 Board of Supervisors meeting. Those funds will start in July and extend through the next year.
Winter said AOT would save the county money in the long run by keeping some of its mentally ill residents out of expensive emergency rooms or jail cells.
“Quite often, they become so ill that they end up in state hospitals and locked units where the costs are huge,” she said. “If they could be picked up and got into the system for outpatient treatment before they descend into such severe illness and such severe symptoms that they have to be hospitalized in locked units, it’s better for them. It’s humanely better for them, but it’s also better for the funding of the system for the taxpayer.”
Still, Laura’s Law doesn’t solve Behavioral Wellness’ biggest problem, which Winter and Summers agreed is a lack of inpatient treatment facilities. When the county’s psychiatric unit health facility’s 12 beds fill up, people requiring inpatient treatment need to find it elsewhere.
“When that’s full, we can’t hospitalize anyone in the county, so people who need inpatient care need to be sent outside the county,” Winter said. “That’s extremely expensive and just about breaks the back of the mental health budget. We desperately need some inpatient care beds in our county, and we need some residential care.”
Summers said she’s prioritizing residential treatment facilities for the near future. She said she’ll be connecting with Behavioral Wellness partners to expand local housing programs.
But until then, Summers said she’s proud of the work her AOT teams have done, and she’s glad to secure another year of funding.
“We’ve got some really good people who are doing some really good outreach for us, and I think that’s what we’re here for,” she said. “We’re here to help the clients who have the most serious need. I’d hope somebody would do that for my family.”
Staff Writer Brenna Swanston can be reached at bswanston@santamariasun.com.
This article appears in May 25 – Jun 1, 2017.