Mental health, homeless crisis need more aid
CHICO >> A local mental health and homelessness crisis is drawing attention to Butte County Behavioral Health’s role in directing people who are unsheltered and vulnerable to services.
However, the department says it cannot be fully relied upon to answer these crises, particularly after years of traumatic incidents straining all county resources, including the Camp Fire.
Butte County Behavioral Health’s director Scott Kennelly said the department is battling “a lot of misinformation” about the services provided and capacity available. The department was recently hit with a request from Chico Mayor Andrew Coolidge to review its budget and spending, and presented to the county’s Board of Supervisors for the same review Tuesday.
Kennelly added he thought the Chico mayor and Chico City Council have been making “some pretty strong statements about what they think we should or shouldn’t do.”
“There’s a tremendous amount of finger pointing going on,” Kennelly said, adding his department cannot be solely responsible for responding to the homelessness crisis, although
pursuing new solutions like a partnership for a new detoxification program.
“Behavioral Health is not supposed to be solving the homeless problem. Behavioral Health is tasked with treatment of the mentally ill.”
Kennelly added there is some limited funding of about $14.5 million for short and long term housing projects — only for users of mental health services — such as the Everhart Village in progress with the Chico Housing Action Team. But he said its funding compared to the current need is “very little,” especially compared to what other local and state organizations have received.
Costs for treating people who agree to services has increased alongside the price of a hospital bed and residential treatment. Residencies in a facility like Skyway House for example can cost on average $3,500 to $4,000 per month per person, he said.
To be fair, he said nearly all of his department’s programs touch homeless individuals in some way, as many are just “one step away” from homelessness, often due to mental health issues. But Behavioral Health’s main way to reach people is through the intensive case management crisis team, which goes out on the streets to connect and develop relationships.
Behavioral Health Clinician Amanda Wilkins is one of the newest crisis team members who has regularly engaged with unsheltered individuals in the past.
“They’re often really intimidated and used to being turned away,” she said. “People just really want someone to connect with and talk to. A lot of people don’t have family members, or anyone.”
Wilkins has worked on conducting the local Point in Time survey and as a grant-funded Projects for Assistance in Transitioning from Homelessness clinician.
“Especially being in mental health services, it’s something I’ve learned… to have that understanding and compassion for a person who has so many things influencing (them),” she said.
The team is greatly affected by Chico’s recent enforcement actions of city ordinances against activities like camping, because clients are displaced and the team is left trying to follow leads in order to not lose contact with someone altogether.
“Especially if you don’t know where people are going, sometimes they disappear entirely,” Kennelly said. His team has to work with the local shelter and the Chico Police Department Target Team to try to prevent that from happening, and depends on notice prior to enforcement operations involving camp sweeps in order to work with people before they are moved.
Wilkins said these people are likely to struggle to get to the services and appointments they need to keep up.
“Because of COVID-19, a lot of processes move a lot more slowly,” she said. “Getting people connected with shelters is also hard
and intimidating.”
And, the department is a voluntary service provider, Kennelly added.
Unless a person must be hospitalized or is court ordered to seek treatment, Kennelly said “getting someone off the street and getting them to services is the biggest challenge.”
“There used to be a requirement for people coming out of jail to court order drug treatment,” Kennelly said.
However, he added California Proposition 47 — which reduced criminal penalties for drug possession, felony drug arrest rates declined and racial disparities among these arrests decreased, according to new research in the American Journal of Public Health — changed everything.
“A lot of people came from prison and that treatment was voluntary, and they then became homeless and stayed addicted,” he said. “If someone doesn’t want help, it doesn’t matter how strong the relationship is, they’re not coming in.”
There’s also a shortage of case workers able to go out on the street for intensive care, as current funding does not support reimbursement from Medicaid for outreach or engagement on the streets until a person agrees to services, he said.
“Our budget includes a 30 to 40 percent expectation that we’ll be drawing down money from the federal government for MediCal,” he said.
“We know we’re not being reimbursed for it, but we know it’s important to do.”
Kennelly said there are some clients who cannot remain stable in housing, or have “burned bridges” because of mental issues or substance use. The team will reach out these people several times a week.
“The hard part is many of the homeless population are heavily addicted, and when you’re addicted at that level your frontal cortex is taken over and impaired significantly by your drug use,” he said.
Kennelly said the critical missing piece is there are no detoxification services
“where you take someone addicted to severe drugs and help them come off drugs in humane way, help them cope with the symptoms and prevent death … transition into drug treatment.”
“People believe Behavioral Health can do this, but we are not carved out to do that. That’s a medical service.”
And he said no medical providers in the county are able or willing; it would be up to the state to encourage a provider to work on detoxification.
The Butte County 2019 Point in Time Survey found 12% of homeless individuals reported substance use and 22% reported mental illness. But Kennelly said he thinks the number of people experiencing substance abuse is significantly greater, possibly approaching 75% of the population of unsheltered individuals.
“Many people underreport their addictions,” he said. “We believe it’s a much more significant issue for people. The drugs on the street now are so much more potent and powerful than they were in the ‘60s.”
Behavioral Health offers medication assisted therapy to people willing to get the service, and has a contract with Aegis Treatment Centers in Chico.
Kennelly said he thinks a reformed drug court system is needed, and added his department is not paid by the state to give out medication on the street without a state certified and approved building available.
“Drug treatment cannot be voluntary,” he said. “We have to require treatment in partnership with housing to have the most success.”
Kennelly added the California Advancing and Innovating MediCal reform which begins in 2022, allowing counties to do more outreach and engagement, will be “a game changer” to shift more resources to provide more field based services.
He also thinks the Lanterman-Petris- Short Act, which defines critical disability and how to place someone on involuntary hold (for individuals determined
to be in mental crisis or gravely disabled) under Sections 5150, 5151 and 5152 of the California Welfare and Institutions Code, must be reformed.
“That law is horribly out of date … created 50 years ago, back when homelessness was not anything like what we see today,” he said, adding in the past there were also more treatment facilities and hospital beds.
“If you expand the definition of grave disability and expand more inpatient beds, we can get a lot of those people off the street,” Kennelly said.
“We need to … get the ability to treat and stabilize more people who need to be treated. People with severe illnesses who are not getting the health care and things they need to survive, they’re falling apart and getting worse and worse. They’re dying on the street.
“Until we force them in, they’re just going to keep getting worse.”
According to Mental Health Services Act Coordinator and Public Information Officer Holli Drobny, Butte County Behavioral Health’s data for inpatient admissions for the time frame from Jan. 1 2020 through Jan. 31 2021 were: • 539 people who experienced at least one inpatient admission
• 130 (24.12%) people who experienced more than one inpatient admission
• 136 (25.23%) who selfidentified as “homeless” at some point
Kennelly added from 2019 to 2020, the department hospitalized 563 for in patient services, or 493 adults and 70 youth. The total number of admissions, which includes people with repeat hospitalizations who are unstable, is 777. That means 214 of admissions yearly are repeat hospitalizations, he said.
In January, the department hospitalized nine youth and 52 adults.
Butte County Behavioral Health is likely to present to the Chico City Council in April.