Sonoma County reshapes approach to mental health care
The man, shirtless, in dark shorts and white athletic socks, laid face down on the sidewalk in front of a Little Caesars Pizza in west Santa Rosa. He held his hands behind his back, as if they were bound by invisible handcuffs.
Clearly in distress, he rocked slightly on his belly from side to side, calling for help. Several people, including children, walked in and out of shops at the Stony Point Plaza strip mall. Nearly all tried to avoid looking at him, or glanced only briefly as they walked by.
A security guard stood nearby until two police officers showed up. The man, craning his head, begged, “Please put cuffs on me, please put cuffs on me.”
He said people were trying to kill him. He gave the name of a doctor at Aurora Santa Rosa Hospital, a secured psychiatric facility.
“Where am I going to take you?” one police officer asked. “You haven't done anything wrong.”
Police, however, did find a place to take the man.
He was booked on charges of public intoxication and taken to jail, the largest psychiatric facility in the county following the closure of Sonoma County's two psychiatric hospitals serving low-income residents.
But the question posed by the police officer during the March 8 encounter illustrates a common dilemma faced by law enforcement officials in Sonoma County and across the nation: What do you do with someone whose mental health crisis does not yet present a major risk of injury or death?
If he had committed a serious crime, police would arrest him without hesitation.
If he were suicidal or threatening to harm someone else, he could be placed on an involuntary psychiatric hold, known as a “5150,” and taken to the local Crisis Stabilization Unit, a psychiatric emergency room in southwest Santa Rosa that provides short-term treatment to people suffering intense mental health crises.
But what about those who are simply scared and need to go somewhere where they feel safe?
“It can be tricky, because if someone hasn't broken a criminal statute we can't take them to jail,” Santa Rosa Police Sgt. Dan Hackett said. “And if they don't meet the 5150 criteria, we can't take them to CSU (the Crisis Stabilization Unit).”
Like the man in west Santa Rosa last March, a growing number of people with severe psychiatric illnesses are winding up in jail and hospital emergency rooms, The Press Democrat found during a six-month review of local mental health services.
As the mental health system shifts further and further away from a centralized model, which historically placed people in large institutions for treatment, county officials, mental health advocates and medical professionals are now trying to bring all the pieces together to serve more than 20,000 people in Sonoma County estimated to suffer from serious mental illnesses.
County officials say they've taken dramatic steps in recent years to fill the gaps between programs, including the expansion of crisis stabilization services and creating more residential housing with support services for people with mental illness.
But county officials agree more programs are needed. And some advocates say a different model of care is needed, one that treats mental health patients with the same dignity afforded to patients with physical illnesses.
“People keep talking about how the system is broke ... but it's not. There never was a system,” said Barbara Bozman-Moss, a retired local attorney whose son suffers from schizophrenia and is being treated at Napa State Hospital.
What's missing, said Bozman-Moss and her husband, Denny, is a place they call CAASI Farm, where people can get a “tuneup” when they're feeling scared, vulnerable or out of control. The facility would be similar to nonprofit treatment centers such as CooperRiis in North Carolina, Gould Farm in Massachusetts and Spring Lake Ranch in Vermont.
The Healdsburg couple said CAASI Farm - which stands for Community Action And Social Integration - would provide a positive healing environment, free of the drab hallways, thick Plexiglas windows and every other dehumanizing and isolating aspect of traditional psychiatric hospitals and mental health units in jail. Some of Sonoma County's bucolic settings would be ideal for such a facility, Bozman-Moss said.
The project is among a number of steps underway to address local mental health issues. It's a countywide effort aimed at enhancing and integrating existing mental health services and patching gaps in mental health care left by de-institutionalization, the decadeslong move toward emptying out government-run psychiatric facilities.
One key pilot program targets so-called “super-utilizers” who often come into contact with law enforcement and medical emergency personnel. The effort, known as Whole Person Care, would bring together various care providers - including law enforcement, fire departments, ambulance providers, health centers, hospitals, outreach workers and counselors - to provide comprehensive and coordinated care.