Whatever it takes

Imagine the K Street Mall, at 6:30 p.m., on a chilly fall Wednesday. Something’s missing. There are remarkably few, if any, homeless residents huddled in the doorways of closed retail shops, curled around dirty blankets and sleeping bags. The steps of the Cathedral of the Blessed Sacrament are empty.

Imagine also, a mental-health system capable of responding to people’s immediate needs and of providing preventive care. A system that, rather than forcing people to wait weeks for an appointment to see a doctor or service coordinator, responds within hours or days. A system that has as its mandate a “whatever it takes” mantra of providing care for the whole person, not just symptom management.

Sounds like fiction, doesn’t it?

For years, in Sacramento County and throughout California, the above scenarios have been just that. Consumers of mental-health services, their families and, ultimately, the public at large, have borne the burden of more than 30 years of unfulfilled promises at the state level to fully fund community-based mental-health care, and few dispute the high cost associated with that neglect.

But on January 17, the county’s board of supervisors moved to change that, approving an ambitious mental-health-services plan that, if approved by the state, would bring almost $30 million to the county over the next three years to overhaul Sacramento’s mental-health system.

The funds would come from the Mental Health Services Act (MHSA), created by the passage of Proposition 63 by voters in November 2004. The county’s plan must pass muster with the Mental Health Services Oversight and Accountability Commission, the 16-member body chaired by former Assemblyman Darrell Steinberg. The state has 90 days to rule on the county’s plan.

Steinberg sits in his downtown law office on the 15th floor of the U.S. Bank Building, a picture of barely controlled energy—at times passionate, at times agitated, always wanting to get to the “big picture.”

He’s got a lot on his plate right now: practicing law at Hanson and Bridgett; running for state Senate to replace termed-out Senator Deborah Ortiz, D-Sacramento, in November; and chairing the oversight and accountability commission.

It’s the last task, Steinberg says, that means the most.

“Most important thing I’ve ever worked on in my life,” Steinberg said, matter-of-factly.

Proposition 63 was Steinberg’s brainchild and the final legislative success he achieved prior to being termed out of the Assembly in which he served for six years. He had two successive wins in the state Legislature, funding pilot programs in 26 counties that provided “wraparound” services to mental-health clients (sometimes called the “whatever it takes” model). His Assembly Bill 34 and Assembly Bill 2034 programs produced results in Sacramento and other counties, substantially reducing the number of hospitalizations, incarcerations and days spent homeless while saving the state tens of millions of dollars for its investment.

Still, mental-health issues continued to be the first programs on the chopping block in a state drowning in red ink.

Steinberg then hit upon a dedicated funding stream for mental-health services outside the reach of the Legislature and its general fund: a 1-percent tax on all taxable personal income over $1 million. Nearly 54 percent of voters agreed, and the Mental Health Services Act was born.

When reviewing county plans, Steinberg said he and other commission members would look for “big plans, big ideas and demonstrable outcomes.”

“Mental health and mental-health advocates have never had this opportunity before,” he said. “You know, they’ve always been last when it comes to budget priorities. But they’re empowered now.”

Among the programs submitted for approval are:

• “Wraparound” services: Mental-health clients would receive “whatever it takes” to support them in recovery, including links to medical treatment, housing, and vocational and social support.

• The Permanent Supportive Housing Program for Homeless Individuals and Families: This program will provide housing subsidies and services, and support clients as they “reintegrate” into the community. The goal here is decreasing hospitalizations, incarcerations and an increase in employment.

• A Transcultural Wellness Center and a Wellness and Recovery Center: The first would provide services to the Asian-Pacific Islander communities. The second would be a neighborhood multi-service center that would provide a “supportive environment offering choice and self-directed guidance for recovery and transition into community life.”

For many people with mental-health issues, there is a deeply ingrained distrust of police—often fostered by repeated jail time for so-called nuisance crimes, forced trips to the county psychiatric hospital, tickets for illegal camping in area parks, or stern warnings to “move along.” Not helping the situation: A 1995 survey of California law-enforcement agencies indicated that the average number of mental-health training hours in police academies is 6.3 hours. Yet, officers themselves, like Sgt. Matt Reali of the Sacramento Sheriff’s Department, estimate that a full 20 percent of an officer’s time in the field is connected in some way to dealing with untreated or under-treated mental-health issues.

Programs like San Diego’s Psychiatric Emergency Response Team (PERT) are radically changing the way law enforcement responds to persons with severe mental illness. The ability of these specially trained teams to conduct on-the-spot psychiatric evaluations, as well as immediately link consumers with appropriate treatment options, has resulted in fewer arrests of mentally ill individuals in crisis, fewer hospitalizations and fewer officer-involved shootings, San Diego officials report.

In Sacramento County, the PERT model has been discussed and debated for years, generally receiving widespread support. Who pays for what, however, has always been the sticking point. Mental-health dollars, consumers and many clinicians say, should fund the mental-health component, while law enforcement should fund officers’ salaries. Both Sheriff Lou Blanas and Sacramento Police Chief Albert Nájera have said their budgets won’t allow for the dedication of officers to a separate program that takes them away from regular patrol duties.

Following more than four hours of heated debate, supervisors, however, decided to include the $1.2 million PERT program—including $500,000 in law-enforcement salaries—saying the initial outlay was needed to show the program’s value in the long run.

“I strongly believe this program will be a success,” said County Supervisor Illa Collin. “And, by the end of the pilot project, I hope the citizens will make it clear to both city officials and to the sheriff that public-safety dollars should fund the law-enforcement end of this. But we have to start it.”

For Nájera, the realization of a PERT program in Sacramento is a long-fought battle won.

“Nothing is more frustrating to me, or [officers] in general, than to go to a situation where someone is in crisis, and we can’t be effective,” Nájera said.

Forced psychiatric hospitalizations, incarcerations, suicides, homicides and officer-involved shootings all take a “horrible toll,” Nájera said, “and it’s because the mental-health resources aren’t there.”

Nájera expects PERT to reverse these outcomes.

“I don’t want to put these people in jail; I don’t want to put them in the hospital,” Nájera said emphatically. “I want them to get their meds on time. I want them to get the resources they need in the community, whatever they may be. The end result of the PERT program should be to reduce the number of interactions people in mental-health crisis have with law enforcement—that would be a good thing. That’s what I want.”

Meghan Stanton, executive director of the nonprofit Consumer Self-Help agency—an organization that supports people in need of mental-health services and helps them navigate the mental-health bureaucracy—spent the better part of 2005 working with stakeholder groups as part of the MHSA steering committee and was, like many consumers, disappointed that mental-health dollars were funding law-enforcement salaries.

“I’m not against [PERT]; I just don’t believe that’s the only model,” Stanton said, adding that she would have preferred to have officers engage in crisis-intervention training instead, but the issue was never discussed. “I just think we would have gotten more bang for our buck.”

Still, Stanton hopes that with law enforcement and mental health working together, the culture of mistrust ingrained from years of negative contact might be able to be changed.

“It’s a unique opportunity for us to do proactive work to focus on consumers’ wellness,” Sacramento County Chief Deputy George Anderson told SN&R. “To check on them, to do follow up—help them improve their quality of life,” he added.

“By helping to reduce those critical points in their life, my expectation is that we’ll see a reduction in incarcerations, a reduction in the negative and potentially violent contacts with law enforcement.”