The mother of the man accused of making a bomb threat that closed down the county courthouse made an impassioned public plea for better services for people who have a “dual diagnosis.”
Tracy Howson told a horror story in which her son sought help but instead fell through the proverbial cracks, a tale that a gathered group of families of the mentally ill and local nonprofit leaders found all too familiar.
“My son is in jail for the bomb scare right now because he didn”t have anyone who would listen to his pleas for help. [Mendocino County Department of] Mental Health said he wasn”t a client anymore. This is a person who is mentally ill who can”t go to Mental Health for help,” Howson said.
Howson”s example of the difficulties facing those who have been diagnosed with mental illness and drug or alcohol abuse was picked as the top problem facing the giant new county agency that covers both public health and mental health.
For Health and Human Services (HHS) Director Ana Mahoney, last Thursday”s gathering at the Department of Social Services” Fort Bragg office was the 14th community meeting in a traveling roadshow designed to help the county partner with communities on solutions Mahoney promised to be “transparent and inclusive.” Potter Valley, Round Valley and the Anderson Valley were recent stops.
The meeting input is expected to be formed into priorities by the end of the month with action groups then being formed and Mahoney using that input to influence the county budgeting process.
The local event was co-sponsored by HHS, Mendocino Coast Clinics, Inc. and the National Alliance for the Mentally Ill (NAMI) of which Sonya Nesch is the local head.
Change needed
Nesch has high hopes for positive change from the process in which employees, family members, nonprofit leaders and the county health boss sit down and hear about breaks in the system.
On Jan. 5, Howson and her son asked for help, but couldn”t find any, documents she presented show.
“We went to Mental Health because my son was schizophrenic and delusional. And he was told from Mental Health to go to the police department.”
From there he went to the hospital. When it was determined by tests that he was on drugs he was released.
“I don”t know why they didn”t violate his probation and throw him in jail for under the influence.” We begged for help,” Howson said.
About 10 days later, on Jan. 16, her son allegedly left a suspicious looking package on the counter at Ten Mile Justice Center, which resulted in his being arrested. Serious felony charges were filed against him.
“He has tried to get help, but nobody has any patience with him. All they ever say to me is He”s on drugs,”” said Howson. “Drugs only stay in your system for three days. Schizophrenia is forever.”
A crowd of 22 women and four men (including this reporter) were on hand last Thursday. Leaders of local nonprofit agencies, county workers and family members of mentally ill people composed most of the crowd. Other than Meredith Lintott, candidate for district attorney, no law enforcement representatives were on hand.
Rules of confidentiality
I should disclose that I have a personal background in this issue, having been an emergency driver for the Department of Mental Health. Until this point, I have never written anything in the paper about that job, despite some understanding of the tremendous challenges law enforcement and Mental Health employees face on behalf of a society that mostly doesn”t seem to care.
I am bound by confidentiality on any cases I have been involved with. Howson”s son”s case was not one of those, but her issues were not unusual. When asked about whether she wanted her name used, she pointed out that confidentiality rules have been an enemy, not a friend of her family.
Confidentiality regulations were cited by much of the crowd as one of the blocks to effective treatment. Anyone dealing with mental illness, substance abuse or developmental disability must sign a dozen or more releases to cover confidentiality laws such as HIPPA. Until those are signed, the agency cannot even confirm they know the person. Those forms, often presented to people who do not read or write or are in extremely emotional states, must be updated yearly. And if someone new becomes involved in treatment, nobody can legally talk to that person until he or she has signed those forms with each and every agency.
Howson described a too typical experience of how the forms kept her from talking to those who could have helped her son.
“I think his rights have been violated when nobody can speak for him because they let the papers lapse that you have to sign that says his family can talk about it to the people [who are] supposed to be helping him,” she said.
Consumers need a roadmap
The crowd was asked to vote for the most serious problem with the agencies that now comprise HHS. The overwhelming winner was dual diagnosis. Finishing a distant second in a three-way tie were three other local problems — services for older adults, homelessness and services for children and families.
Both confidentiality forms and the disjointed, confusing nature of the system were identified as major obstacles to anyone who has a family member diagnosed as mentally ill, whether or not that person uses illegal drugs.
“After a year I still have no clear picture of what is available,” said Leslie Hall.
“When [my daughter] ended up in the hospital the first time, I wish someone could have handed me a brochure that would say if you are exhibiting these types of problems, this is what you can do, this is who can direct you,”” Hall said.
“We have been going through horrific circumstances as a family ? I would like to see a roadmap,” she added.
Carol Mordhorst, long time head of Public Health, facilitated the meeting and is in charge of the effort to fix as many identified problems as possible. She said different meanings and misunderstandings of terminology, including confusing acronymns don”t make a bewildering system any easier. For example, she explained, “dual diagnosis” is unfortunately a term with dual definitions. It can mean a person who is developmentally disabled who also suffers from a mental illness. A slightly more common usage is to describe a person who is mentally ill who abuses drugs or alcohol.
Throughout history, mentally ill people have done what is called “self medicating” with drugs and alcohol. The Department of Mental Health has psychiatrists who seek to give modern, safe medications to patients. Counselors help the consumers work through barriers.
5150” situations
The big cracks in the system emerge when a person goes into crisis. Under section 5150 of the California Welfare and Institutions Code, when people are deemed a threat to themselves or others or gravely disabled, they are held — against their will — for up to 72 hours.
As with Howson”s son, who is said to be a frightening man when on drugs, the situation often begins with an encounter with the police. The decision on whether to deem someone a threat to themselves or others, and to take away their rights, is a difficult one, confusing to the consumer and his or her family. Local police often try to avoid arrest and jail for someone in obvious need of treatment they won”t get in jail.
Where possible, they take the person to the Mendocino Coast District Hospital emergency room, where a Mental Health crisis worker decides if they are truly a threat. Because Mendocino County, like many rural counties, has no locked psychiatric unit, the person must be transported to a county that does. The Mental Health crisis worker begins calling these hospitals, which are located in Sacramento, St. Helena, Vallejo, Santa Rosa, Yuba City and Fremont.
Often during my tenure, there have been times when no beds were available anywhere. No local system exists to confine the person awaiting treatment. None of the above hospitals accepts mentally ill people who are in any way intoxicated.
“It doesn”t matter whether you are dual diagnosis or not, there is no inpatient treatment for alcohol and drug problems,” said Barbara Durigan, who has been involved in all aspects of the process for many years. “There is no treatment available unless you have $10,000 to go to Singing Trees [a recovery center in Garberville].”
For people with dual diagnosis, this leaves the agencies with the difficult choices of arrest, unconditional release, or sitting and waiting for the person”s intoxication to leave their system.
While employed as a driver, I often waited all night with a Mental Health worker for a bed to open up at one of those far away hospitals, or waiting for the patient”s blood alcohol content to go down. These waits are usually uneventful but can be nerve-wracking experiences with impacts on other patients in the unlocked emergency room.
Quality of service varies
Another issue is that the quality of service varies widely between those hospitals, something that no roadmap could tell. I asked some consumers to evaluate the hospital for me and report back later, which they did. Although this information is confidential, it is strikingly uniform.
When a bed does open up at one of the hospitals listed above, the person is put into the locked back of a car and driven as much as five hours to the hospital, with little provision for stopping anywhere along the way.
I”ve often had mental health consumers ask me to explain the system to them on the way to the hospital. It takes a while and they generally say, “That makes no sense.”
Many mental patients know they need hospitalization but the county cannot provide it for them unless they have degenerated to truly being dangerous. They learn to say the right words to get sent to the hospital, but even then it isn”t on their terms.
By definition a person on 5150 hold is “crazy,” but, as the old joke revealed, these people are not stupid,.
“This is what they have had to learn,” said Nesch. “There should be no threshold for crisis and non-crisis help.”
When Hall asked for creation of a roadmap, someone said just such a brochure is now being released to the high school program.
“It should be everywhere, every doctor”s office, every hospital, every police station,” Hall said.
Hopes for improvement
The county”s new Health and Human Services Agency is seen by all as good news at this point, as are the appointments of Noel O”Neill as head of Mental Health and Aaron Goertzen as head of Mental Health on the coast.
Mahoney described a new program where mental health consumers in Ukiah will ride along with Ukiah police officers, so each can learn about the other”s issues.
While real change seems afoot in Ukiah, the problems are not confined to this county. Many rural counties lack a locked psychiatric unit and consumers in many areas are less cared for than here, facts I have found in my drives and encounters with drivers from other counties. And there appears to be very little thought given in Sacramento to the statewide problem of mental health, much less dual diagnosis.
Howson said drug dealers know when her son gets his disability check every month.
“People in Fort Bragg know the cranksters that come and take the mentally disableds” money, when they have money. They know when the checks arrive,” she said.
“I would give the first $100 to bust the first crank dealer. We can”t have these people here. We have a lot of mentally ill people and a lot of developmentally disabled people here in Fort Bragg that these meth dealers try to prey on.”
Two women at the meeting described a well-known mentally ill man who has been using drugs recently.
“I saw him last night covered in scratches from head to toe wandering the streets, a danger to himself and others, and no place for him to get help except for jail,” one said.
While some complaints were made about local police being insensitive, my own experience and that of Nesch is the opposite.
“My impression is they are very sensitive and kind to clients, who may be suicidal and difficult. The police are respectful,” she said. “I remember many occasions when Fort Bragg police have successfully calmed consumers and dealt with crises I faced without panic or force.”
Nesch said that new Sheriff Tom Allman wants to meet with her and find better ways to deal with the mentally ill. She said Allman sees that using the jail to deal with mentally ill people is costing the county a lot of money. Doing things in a better way could also result in savings for the county.
Lintott explained she was at the meeting to get a perspective beyond her potential role as the top law officer in the county.
“The persons that take advantage of what is happening here are sometimes victims and sometimes defendants,” she said. “I have a big interest in making sure that I have a good understanding of the different groups involved and what is happening with the new county agency.”
Ideas exchanged
A popular solution suggested was setting up something for the mentally ill that works as well as the Redwood Coast Regional Center, which serves the developmentally disabled for the State Department of Habilitation.
“I always say, in a perfect world, I would wish that mentally ill clients had the same kind of services that are available to Regional Center clients,” said Kathy Larkin. She works in the transition partnership program through the Mendocino County Office of Education.
Local services for the developmentally disabled and other disabled people work together to avoid lapses in services due to such partnerships and the Department of Rehabilitation, an efficient agency that runs its partnerships with non-profits in the way the new county superagency hopes to.
Nesch said another idea is for people with dual diagnosis to have one case manager, one plan and one chart for one person, leading to better communication.
Joe Curren, head of the Redwood Coast Senior Center, also recommended a shift away from criminalizing the mentally ill to “treat” them toward a new court for dual diagnosis modeled on drug courts, where offenders get a chance for positive treatment options.
“If you break the law and end up in the criminal justice system, it is expensive and not really a good form of treatment ? If there were some kind of way to divert funds so that somebody who would be put into the jail could be diverted to a psychiatric inpatient treatment program, that would be huge,” Curren said.
Age-related issues
Curren was thrilled with the possibility that the new Health and Human Services agency can create more opportunities for integration of services that have been separate in the past and the possibility of working more closely with non-profits.
“Lots of people don”t realize that people over 60 are at the highest risk of depression of any age,” he said.
People with dementia are deemed to have a physical, not mental, problem and don”t qualify for mental health services even when their brain makes them unable to care for themselves. Depression is likely for someone diagnosed with Alzheimer”s, as they observe their own slow deterioration.
“Here on the coast, the over-60 population comprises over 22 percent of the total … This population is expected to continue to rise through 2020. We are in a cycle of aging … This is a really magnificent opportunity to better integrate and highlight services for older adults, social services and mental health,” Curren said.
He also worried about “Ukiah-centric” planning in the reorganization, a problem that is quite familiar to Fort Bragg. A study commissioned by the senior center showed a disparity of services, favoring Ukiah. He hoped that the new agency wouldn”t turn into a bigger bureaucracy in trying to make change and would utilize more community partnerships. Curren said the local nonprofits represented at the meeting, which included Safe Passage and the Fort Bragg Food Bank as well as the senior center, have existing infrastructure the new superagency can integrate and utilize, rather than duplicate.
County management”s view
Mordhorst, director of Public Health, is running the transition effort. She pointed out the Website www.mendocinoresources.com as a source of information.
Another idea is for a 211 phone system, much like 411, except it will come with an operator trained to help people find the right county service, she said.
Mordhorst said the idea of a single case manager, improved systems of referrals and other issues brought up have been heard at the other 13 meetings and would end up on a list of priorities and in the hands of work groups.
Mahoney has a photo in her office of a mother tiger nursing baby piglets it adopted inscribed below with what she says is her motto “Anything is possible.”
Her other mantra is “Why not?”
Mahoney didn”t try to sugar coat the situation she faces. She admitted the county departments had been siloed financially as well as in their thinking.
“I”m not one to shirk or diminish truth. That is where we are trying to lead all our leadership team and all our staff,” she said.
She described the history of a department that now has 700 employees.
“That is 51 to 53 percent of the county workforce. In some ways we are the big gorilla in the room now, which is to our advantage.”
Former County CEO John Ball, who was fired by the Board of Supervisors, envisioned the changes now under way. He came from Portland where there were only nine departments for thousands of workers to Mendocino where there were 28 departments that he called fiefdoms.
“We started off in kind of a bumpy way,” Mahoney said. “We were created by fiat, if you will, by John Ball. It wasn”t that it was a bad idea. There are a lot of possibilities, different leadership, better communication. For that it is a worthy endeavor.”
Mahoney came out of retirement to help the county make change she saw as needed, and she is still trying to retire.
She said the county hopes to hire a new, permanent director in the next three months.
“We hope to get somebody who has the vim and vigor and expertise to carry forward the changes we have already begun ?, to work off the foundation we have created, involving our communities and staff,” she said.
She encouraged people to stay involved. An email list is being made from meeting attendees and other opportunities will be announced.
Mahoney said, “It is absolutely important that the community have participation in a long transformative process. We are government. It takes a long time. We really are committed to changing the way we do business so that people can get the services they need.”
