The news that the Sonoma County Board of Supervisors is proposing to eliminate 76 staff mental health workers at the Behavioral Health Division in the Sonoma County Department of Health Services sent chills through me (“Lifeline for addicts about to be cut short,” Tuesday).
The county behavioral health team is responsible for taking care of the sickest psychiatric patients, along with patients in times of a psychiatric crisis. As a resident physician at Sutter Santa Rosa Medical Center, I am often forced to discharge a hospitalized patient suffering from severe mental illness directly to jail. I am unable to send such a patient to an inpatient psychiatric hospital for the higher level of care needed due to lack of such psychiatric facilities in Santa Rosa. In fact, the largest psychiatric facility in our county is now the Sonoma County jail, a facility that is not designed to provide comprehensive mental health treatment. Still, every year larger numbers of people with mental illness end up there.
This speaks to the already overwhelmed network of mental health providers and community support programs in Sonoma County. Further reducing this capacity is neither medically sound nor cost-effective for taxpayers, as former District Attorney Mike Mullins recently pointed out in his letter to the editor.
The proposal includes cutting about 40 percent of mental health staff positions and reducing contracts with community nonprofit groups. Hence, these layoffs include not only community psychiatrists but also integral support staff such as social workers and case managers.
According to the recent Press Democrat article, the cuts to outside contracts will likely include nonprofit organizations that provide suicide prevention counseling, wellness programs, peer support and recovery services, supportive housing, jail diversion programs and therapy services. Right now there is no system in place to replace this level of care. It would be unsafe to scale back further.
Why is provision of mental health services to this population so tenuous in the first place?
It is part of a trend that has been building for decades, and I fear we are approaching a breaking point. Beginning in the 1970s, there was a well-intentioned trend away from long-term psychiatric custodial care facilities and toward integrating people who suffer from mental illness into society. Key to this “deinstitutionalization” was building a strong network of outpatient psychiatric care, community integration programs, housing assistance, job support, etc. Unfortunately, the second half of this plan was never realized.
In Sonoma County, we closed our two psychiatric units (part of two different hospitals) almost a decade ago. Yet our outpatient mental health services have not been sufficiently bolstered to fill that gap. Consequently, when our neighbors with mental illness go untreated and find themselves in psychiatric crisis, the police are often called upon. Oftentimes they are charged with non-violent crimes like trespassing, disorderly conduct, loitering, public intoxication or drug use, which is a common method of self-medication for an otherwise undertreated underlying disease.
This is a vicious cycle, as studies show that spending time in jail results in increased recidivism rates for those with mental illness. They also have higher rates of suicide while in custody and on average spend more time behind bars for the same crime.
We cannot treat mental illness as a crime. It will never get better that way. We must instead commit resources to treatment and community integration. This is not only more cost-effective but safer for our community.