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Where Are the CRTs?

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.


  1. Betsy Cawn October 23, 2020

    In 2010, the last licensed psychiatrist serving as the Chairperson of Lake County’s Mental Health Advisory Board ended her affiliation with it, and since then, the “Board” has had no members with the simple ability to use basic Roberts Rules of Order or comply with the Ralph M. Brown Act, let alone fulfill its mission as defined by the State Welfare & Institutions Code Section 5604 (et sequentia and others cited in those sections).

    In late 2016, the current Director of Lake County’s Behavioral Health Services department (formerly our Mental Health Department) attended his first Mental Health Advisory Board meeting, in which the then-self-appointed Chairperson was unable to identify how many members the MHAB was possessed of, or how many were prescribed by the local enabling resolution, and could not manage to conduct a motion, vote, and report of results to send to the Lake County Board of Supervisors for replacement of a member who had simply not attended for six months. (The then-Chairperson could not even recall the names of absent members.)

    On October 15, 2020, the re-assembled Lake County Mental Health Advisory Board, with legitimate members appointed by our BoS, conducted an interim election to create MHAB officers, as required by its Bylaws (and W&IC Code). Thus the re-activated MHAB was able to approve amendments to those Bylaws primarily effectuating the change in its own nomenclature from “Mental” to “Behavioral” Health Advisory Board and little else of significance. Those changes must be approved by our BoS in the laborious process of securing an agenda item on the BoS public hearing agenda (weeks away), and embarking on a brand new conversation with our highest elected officials who, for almost 10 years, have not questioned the absence of actions taken (under State law) to ensure that the County’s Mental Health Department was in compliance with reporting requirements — such as developing programs funded by the Mental Health Services Act of 2003 (Proposition 64).

    Members of the Board of Supervisors, who created the MHAB as required by the State, appointed every January by the BoS itself, seldom attended MHAB meetings and at no time asked what needed to be done to meet the regulatory mandates.

    The ability of the MHAB to perform its legal functions, including scrutiny of County contracts (from on high, the State’s Medi-Cal funded services for ONLY the “severely mentally ill adults” and “severely emotional disturbed youth,” and internally for a multitude of subcontracted practitioners and residential care facilities) and has no ability to obtain the necessary data from the County department — on which to base an analysis of the county’s MH needs and service capacities.

    Epidemic levels of suicides among Native American populations, largely by “youth,” resulted in the creation of a reformed “Suicide Prevention Committee,” which dubbed itself the “Life is Sacred Alliance” — focusing chiefly on Native American losses of life (and the attendant signs and symptoms present in those lives) — but has not met in over a year. Significant assistance delivered to the Tribal communities from the federal Substance Abuse Mental Health Services Agency helped to create programs to address the needs of Tribal “youth” and their more or less functional families. Murder, rape, incest, infant disorders of alcohol or drug ingestion by their mothers, and elder abuse crimes prevailed in the decades leading to the 21st Century — and meth amphetamine prevalence in the County’s array of counter-cultural substances of choice — emerged in the tragic deaths of young men and women in these close-knit kinships.

    Yet, no data is available to establish for our Board of Supervisors the priorities for serving a “severely economically disadvantaged” county (“served” — if you credence the term — by North Coast Opportunities, which does a bang up job of creating a mini-empire of “parent partners” who are entrained in the system that delivers maleable children into the 12-year system of basic indoctrination otherwise known as “schools”) with nearly one third of its population aged 60 and over. Of our total population (~64,000), ~15,000 are eligible for “Supplementary Nutrition Assistance Program benefits, locally known as “CalFresh.” Of the roughly 15,000 eligible residents, only about two-thirds are actually enrolled. Endless “outreach” and “education” — now helped considerably by the proliferation of Facebook pages and participants — is continuously issued to the same “target audience” without changing the basic constituents of our demographic realities.

    At the Napa State Hospital, a former medical director coined the term “Lake County Syndrome,” for the number of cases sent to the asylum with “co-occurring mental health and substance abuse” manifestations (not ever including natural enhancements of biologically-concurrent “cognitive impairment” from a variety of aging illness — compounding the medically diagnosable “mental” illnesses which, in any case must be proven to be “severe” in order to receive treatment — usually during an “involuntary hold” in a licensed psychiatric facility, which determines the fate of the individual based, we think, mostly on whether they are adequately categorizable in a DSM-defined mental health illness that is “billable”).

    And the general focus of our Board of Supervisors for the last five years has been the endlessly futile “long-term recovery” from devastating fires and floods, for which the BoS embarked on an “economic development strategy” project led by this year’s Chair, District 1’s Supervisor Simon, including “rebranding” the County, and renewed enthusiasms for tourism attraction.

    Pejorative “nicknames” for our county have been beaten back by the recent years of closed-rank insistence on the “successes” created by disaster “recovery” programs and the arrival of “new blood” infusing the merry marketeers, but not a whisper of truth about the real, tragic, and disturbing conditions in which so many of our citizens struggle has been uttered by our most powerful officials.

    We have watched from our dusty remove the flailing and fighting and dithering of Mendocino County’s “Measure B” committee, and feel grateful to have its example to “lead” us. We are appreciative of the “patient” reporting by Messrs. Macdonald and Scaramella, leaving us perpetually aghast that functional and accountable public servants have not done even the most basic work to counter the inadequacy of our tax-payer funded, so-called “services.” It is understandable that many outsiders view our slough of despond as fertile ground for illegal and immoral exploitation of our fragile natural resources and easily plunderable governance systems. The “Peoples Temple” indeed.

  2. George Hollister October 25, 2020

    The Mendocino County Board of Supervisors does not take responsibility and provide oversight of the management of outside money that is a major part of the county budget. A former supervisor one time passed this part of the budget off in a conversation and referred to it as “other people’s money”. Good description. I might add, that means “don’t worry about it, it’s not our money”. The don’t worry about attitude is where we are with money being spent to increase homelessness(no one knows how much), and $25 million being spent annually for mental health services that are unavailable. This raises many questions that never get answers, either. I feel blessed, and I have said it many times, that I don’t have a family member with severe mental illness.

    What we are talking about is the most visible part of the dysfunctional system. What about everything else in this category? Should we assume it is run any better?

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