Seven long years ago the Mendocino County Behavioral Health Advisory Board was called the Mental Health Board. At their October, 2013, meeting its members were concerned with a letter to the editor published throughout the county. In addition to questioning how Ortner won the contract to privatize adult mental health services, of longer range import the letter asked where were the promised Fort Bragg and Ukiah crisis residential treatment (CRT) facilities?
Indeed, where are they? Promised before 2013, but still as non-existent as the psychiatric health facility (PHF) also promised by our votes for Measure B.
On Thursday, October 8 I received an email from someone I have been acquainted with for years. A coastal resident whose mother was a friend of my mother. You get the picture. After the usual salutations, the email stated, “I am hoping to get some help in preparing a report on my personal issues with the broken mental health system that I recall you have been acquainted with. After reading the minutes of a meeting [Measure B Committee] addressing the establishment of a residential crisis center I was once more enraged at the delays, obfuscations and circumventions the committee seemed to employ. When and if you have time, I would like to meet with you online or in person.”
I reminded her that I could relate, having been born into a family possessed of an older sibling with mental illness and a parent who went back to college to pursue a psychiatric social work career. A week or so later I bumped into the email writer while leaving a grocery store in Fort Bragg. Through our face masks we conducted a fairly long talk about her fifty-something year-old daughter's long bout with mental illness and her (the eighty-ish year-old mother's) frustrations with the mental health system as it exists in the 21st Century in seemingly the most well-off country in the world.
The next day, the mother sent this message in an email, “It was so nice to talk to you in person at Harvest yesterday! I am forwarding the info regarding my problems with finding help for my daughter. If there had been a crisis residential center here just imagine how much grief I and my daughter would be spared. I have calmed down somewhat and try and channel my energy more productively, but still believe in the power of the pen which I think you possess.”
At the end of the first week of October, 2020, this elderly woman's daughter, who had started out in Mendocino County's mental health system some years ago, was now in a mental health unit at the San Bernardino County Hospital. Six months prior, the daughter had been 5150'd (legal code for a person who is in a state of mental health crisis as to be a danger to themselves or others) after leaving a skilled nursing facility (SNF) in Pasadena. She had resided at the SNF for six months. Her mother believed that her daughter had come to accept the facility as her “home.”
However, the daughter's “acting out” apparently cost her a more permanent home there. The 5150 led to a stay at a facility in Ingleside, followed by the Broadway Care Center in San Gabriel. A board and care home in San Bernardino refused to admit her, instead driving her to the San Bernardino Community Hospital and dropping her off. She was not admitted there, so she ended up on the streets. Eight hours later, law enforcement found her seven miles away in the middle of a roadway. As a result she was admitted as a 5150 case to the San Bernardino hospital.
The latest news regarding this essentially helpless fifty-three-year-old is that she was taken to Stoney Point Healthcare Center in Chatsworth, Los Angeles County. Her mother said she had to pay more than $1,100 to have her daughter transported from San Bernardino to Chatsworth. That payment was requested in advance.
The mother asked a case worker if there had been an attempt to locate a SNF in Northern California. The case worker is said to have replied in the negative, citing the fact that the daughter had now spent so much time in Southern California that all of her benefits are now provided through Los Angeles County. Something that complicates the fifty-three-year-old's situation is a diagnosis from a year or so ago, a diagnosis for Huntington's Disease. Also known as Huntington's chorea, this inherited illness which usually manifests between ages thirty to fifty results in the death of brain cells. The earliest symptoms are often exhibited in relatively mild mental lapses. Progression into problems with physical coordination follows and the severe symptoms can vary across a broad spectrum. Some sufferers present as if they are fall-down drunk when no alcohol has been consumed. It is a confusing disease to understand for loved ones let alone the victims. There is no cure. Full time attendant care is often necessitated in its later stages. Until the 1990s there was no test available to see if an individual carried the Huntington's gene. Even in this century about 95% of those who might inherit the gene do not bother with testing. The main reason for that is the fear that goes with the knowledge that there is no cure. Nevertheless, there are treatments that reduce the severity of Huntington's. Those should best be discussed with a knowledgeable physician and not speculated upon herein.
Worldwide there are between five and ten cases per 100,000 people. However, numbers spike in certain regions. For instance, in the Lake Maracaibo area of Venezuela, Huntington's Disease (HD) impacts 700 out of every 100,000 people.
The HD diagnosis for the fifty-three-year-old described above provides a further hitch in her case. That diagnosis allows healthcare facilities an out. They can deny mental health treatment and pass off her case as merely a basic medical situation. This is similar to the not so distant past when folks suffering from mental illness and a drug or alcohol problem were skipped over by the mental health system with the drug or alcohol addiction used an excuse.
This fifty-three-year-old is merely one case, but there are hundreds of one-off cases in this county alone. Seven years ago, a mental health advocate asked the then members of the Board of Supervisors, where are the promised CRTs? Where is the PHF, the CRTs, the remainder of the continuum of care for the mentally ill who are all around us? I have passed along the basics of this one case to at least one member of the Measure B Committee, the head of RCS and RQMC, and the countywide President of Adventist Health. I would like to think at least one member of the Board of Supervisors will read this. The response can no longer be a request to be patient (there is an ironic word). Somewhere between the Schraeders, the members of the Measure B Committee, Supervisors Williams, Haschak, Gjerde and two soon-to-be-new supervisors there must be an actionable answer.
If not, then we are all no better off than those afflicted with Huntington's or any other illness, physical or mental.