Study: Small group of Sonoma County residents use $162 million in social services annually

The study found that 6,600 people accounted for more than a quarter of the county’s jail time and behavioral health costs, and more than half of the total nights in housing or shelters provided to the homeless.|

Barbie Robinson, Sonoma County’s top health and homelessness official, wasn’t surprised when she reviewed the results of a new California Policy Lab study of the crossover between the county’s various safety nets and social systems.

She knew, anecdotally, that people who used county housing programs also wound up in jail or in local hospitals. It’s why Sonoma County launched an initiative three years ago to share data among county agencies in hopes of improving their ability to coordinate services.

But the specifics that came out of the policy lab’s five-year study — the most detailed to date on the county’s social systems — were a shock.

In Sonoma County, 6,600 people accounted for more than a quarter of the county’s jail time and behavioral health costs, and more than half of the total nights in housing or shelters provided to the homeless. All told, these individuals, the hard cases representing just 1.3% of the county’s population, put an annual strain of $162 million on Sonoma County’s systems of care.

The numbers show acute need in the community, but they also show the county is on the right track, Robinson said.

“I think that, one, it proves the concept,” Robinson said of the study. “It’s the data we needed to make the case for why having an integrated system of care is needed.”

The study’s release July 7 came just one week before Robinson would make her pitch to the Sonoma County Board of Supervisors for a quarter-cent sales tax to fund mental health and homelessness services. They agreed unanimously Tuesday to place the proposed tax, which would generate $25 million annually over the next 10 years, on the November ballot.

“There’s no question that this fills such an important role,” Supervisor David Rabbitt said Tuesday during the board’s meeting. “These two topics (homelessness and mental health) have never received the funding they need.”

The report, from Elsa Augustine and Evan White, delved into the impacts of a complex problem.

Working out of the UC Berkeley campus, the California Policy Lab research team focused on five key areas: physical health, behavioral health, housing, human services and criminal justice. It combed through anonymous county- and state-provided data to find the so-called “high utilizers,” or people who were often seen in more than one of the five areas.

The phenomenon is well known in municipalities across the state, at least anecdotally, according to the study, but it has proven difficult to pin down because the highest utilizers of any given system often don’t use other systems. For example, residents who rack up the highest hospital costs rarely find themselves utilizing homelessness or criminal justice systems, according to the study.

“A county analyst looking at one data system might not be able to tell which individuals are shared clients that also access other county systems,” according to the study. “This report is the first time the county has been able to identify and understand this population.”

For Robinson, it’s almost a case of “work smarter, not harder,” where individual departments were putting in herculean efforts in their own silos while potentially missing the bigger picture.

Three years ago, the county contracted with IBM to develop a data hub that would allow county agencies to share information and align their services under a new program dubbed ACCESS Sonoma, or Accessing Coordinated Care and Empowering Self Sufficiency. The initiative, Robinson said, grew out of the county’s Safety Net Collaborative, a group of top county officials, including the district attorney, public defender, human services, health services and more.

The ACCESS initiative has since won several awards, including a health award from the National Association of Counties and another from IBM itself in 2019.

County health workers at the beginning of the year used the shared database while working to clear the Joe Rodota Trail homeless encampment, which grew to nearly 300 people by the end of January, Robinson said.

To date, the county has identified 3,971 individuals through the initiative, with each of those people consenting to their data being shared across systems — a key requirement for the program. They comprise six groups, including high-needs homeless and mentally ill residents that county officials are seeking to divert from the county jail.

“In order for us to achieve success, you have to think about mental health needs, economic needs, medical needs, behavioral health needs — all at the same time,” Robinson said. “Unless you’re able to bring all of the resources together at one time … your success in outcomes is limited.”

That lack of success has real costs for a variety of systems in the county, reaching $27,000 per person among the highest utilizers, according to the study.

Those residents accounted for 26% of county jail time, 28% of the annual costs for behavioral health services and 52% of nights in housing or shelters for the homeless.

Nearly 60% had issues with alcohol, a group that was more likely to seek medical care and have medical diagnoses.

One-quarter of the highest utilizers had behavioral health needs, experienced housing instability and also served jail time, according to the release. A full 87% of this group had a history of alcohol abuse.

“More striking than any one of these vulnerabilities, however, is the fact that many of Sonoma’s high utilizers are experiencing intense needs simultaneously: struggling with a physical illness while living with a mental illness, cycling in and out of jail, and facing challenges accessing stable housing options,” according to the study.

You can reach Staff Writer Tyler Silvy at 707-526-8667 or On Twitter @tylersilvy.

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