Over 130 people turned out Friday to a hearing on Orange County’s mental health system, with many outlining key gaps in a system they say could be doing a lot better.
The testimony, at times, elicited gasps in the room – such as when a father described repeatedly running into roadblocks in getting help for his schizophrenic son before the son stabbed him in the head and his wife in the neck.
But many also expressed a sense of hope – that Orange County could become a model for an effective mental health system that improves lives, while also saving money spent on crises and other impacts of untreated mental illness.
“We can help change the conversation nationally,” said Matt Holzmann, an advocate for people with mental illnesses whose son took his own life in 2014. “You can’t just medicate someone and put them back on the street again. You have to have long term solutions.”
The hearing was organized and attended by county supervisors Lisa Bartlett and Andrew Do, who have embarked on a months-long review of the sprawling county system with the intention of finding ways to improve it. In California, county supervisors are the main elected officials who oversee public mental health services, much of which are contracted out to nonprofit groups.
Over 70 people testified during the nearly four-hour hearing, in what was an unprecedented public outreach effort by the county. It was the first time in years – if not decades – that any supervisors have organized a session to directly hear public testimony about the mental health system.
The speakers spanned a wide spectrum – from people with mental illnesses, along with their family members and advocates, to hospital and school system representatives.
A common theme was that many important services in Orange County are either missing or far below the need – with two examples being a lack of mental health crisis beds for children and crisis intervention nurses for police responses. The ultimate results of such a situation are far more serious – and expensive – impacts to society down the line, speakers said.
“There’s a growing crisis stemming from constrained access, and in some cases no access at all,” for children in need, said Jena Jensen, chief government relations officer at Children’s Hospital of Orange County (CHOC).
There’s “not even one single [mental health] bed for children under the age of 12,” she said, noting that CHOC is slated to open the first such beds in late 2017 with a mixture of county and private donor funding.
Overall, the number of psychiatric beds for all age groups have dropped significantly – from about 1,200 two decades ago to about 400 today – despite a growth in population and need, noted Holzmann.
“Our first responders are bearing the burden,” as well as hospital emergency rooms, Holzmann said. “Our jail is the 8th largest mental health facility in the country.”
CHOC has helped form a task force on the children’s mental health system in Orange County, with a wide variety of public and private-sector representatives, to inventory the county’s system, identify gaps and find ways to better serve children.
Dr. Heather Houszty, the chief psychologist at CHOC and co-chair of the task force, provided a visualization for the audience.
There are enough children in Orange County with a diagnosed mental health disorder to fill three Anaheim Stadiums, she said. And yet, if you take away two of those stadiums, that’s how many are actually receiving mental health services.
Even “at the best of times our mental health system is very fragmented” and hard to navigate, Houszty said, adding that research shows that the direction of children's’ lives can be changed to help them have more fulfilled and productive lives.
“Our brains are plastic until the age of 25,” Houszty went on to say, referring to the ability of young minds to grow in healthier directions. If mental health issues are detected and treated early, she said, “we can actually make a dent” in the crisis.
Many also spoke against the current use of the criminal justice system to address mental illness, saying it’s both ineffective and unjust.
Kathy Miller, a member of the National Alliance on Mental Illness, said her schizophrenic son received “unbelievable” criminal charges for acting out a psychotic episode when police were called.
“We need to decriminalize mental illness. It is not a crime; it is a disease. Nobody chooses schizophrenia. Nobody chooses psychosis,” Miller said. “A psychotic event is an assault on the brain. It is not a choice to commit a criminal act.”
Miller encouraged the supervisors to study widely reported successes in San Antonio, where officials have set up a mental health unit in the city’s police department and have used data to better coordinate their mental health system. City and county officials there say the changes have saved $50 million over a recent five-year period.
“We do not need to re-invent the wheel – it’s been done,” Miller said.
Much of San Antonio’s efforts are driven by so-called “smart justice,” or “diverting people with serious mental illness out of jail and into treatment instead,” as NPR put it in a story on the approach.
Karyn Mendoza, a member of the county’s mental health board, agreed with that notion, urging supervisors to support diversions out of the jail system and into treatment, to ensure that incarceration is no longer a form of treatment for people with mentally illnesses.
Untreated mental illnesses are also a major factor in the county’s chronically homeless population, advocates say.
“I can honestly say that 99 percent of the homeless people I meet at the [Fullerton] Transportation Center are mentally ill,” said Leigh White, an advocate for homeless people at the center.
“There are gravely disabled schizophrenic people as well as [people with] bipolar I and bipolar II,” she said, with one homeless man with severe mental illness who hasn’t showered for two years.
Others asked for more transparency about where the money is going. The county didn’t have a list of their 200-plus mental health programs, or a breakdown of the county’s annual $320 million mental health budget, until Do asked for it recently.
“Where are all the billions? And how much money do we get?” asked Jean Meller. “All of us are going to rely on the supervisors…to tell us where the money is.”
Both supervisors were appreciative of the comments, and said they’d be taken into account as they work to improve the system.
“This is something that is really important for the County of Orange,” Bartlett said. “We really want to make our system better.”
Bartlett said she took about 20 pages of notes and will compile them into a matrix so that “we can incorporate what you said here today” into her and Do’s review process.
Do said he and Bartlett will now work with data and other stakeholder groups to put together “a comprehensive plan” on mental health that would then be presented to the public.
Nick Gerda covers county government for Voice of OC. He can be reached at firstname.lastname@example.org.