Recently, Governor Gavin Newsom expressed support for housing up to 200 persons with serious mental illness at the Fairview Developmental Center site in Costa Mesa. As the author of the original plan for the use of a part of the Fairview site for mental health care, I applaud this leadership.
Several members of our legislative delegation have also announced their support for mental health and wellness on the Fairview site. Mayor Katrina Foley in Costa Mesa has expressed support. There is a common willingness to do something.
What that something is…is now the question.
My original proposal envisioned a world class 240 bed wrap-around behavioral health campus with crisis stabilization, acute care, post-acute care, transitional housing and permanent supportive housing. It was ambitious and it was meant to be. In the mental health arena, we have for too long abdicated our responsibility to the most vulnerable members of our society. Our neglect has had us waste billions of dollars in our emergency rooms and jails with no impact in improved lives. It has gotten worse and is incredibly expensive. Now we have the chance to change that. We need to think carefully about the future.
As much as 90% of the mental health beds we had in the United States in 1955 are gone. The institutions closed and community health centers were supposed to take their place. They didn’t. The situation worsened. We see it on our streets and in our jails every day.
Orange County is unique in the nation, and maybe the world. The Be Well Orange County coalition began to take shape soon after that proposal. Others were as upset as I was at a system that had let families and individuals down so badly. Be Well OC is meant to bring all stakeholders together; our faith communities, our governments, our law enforcement agencies, our schools, our non-profits; everyone, to build the best behavioral health care system in the country. Fairview is the gem in the crown.
Already, the county, our hospitals and CalOptima have stepped up to build the 235 Anita Wellness Center. It will be a state-of-the-art short-term crisis stabilization and recovery center (CSU). More are planned around the county.
But recovery comes in different stages. There are the CSU’s, from which 80% of the visitors go home within 24 hours. Then there is acute care, the psychiatric units in our hospitals. After that we are missing a link, post-acute care. Individuals typically spend from 1-14 days in the hospital, sometimes longer. They are then released either to family or the street, but are not yet stable in their recovery. We need a step down from acute care.
At the same time, some individuals need long term care for up to 6 months. These are sometimes locked facilities with attendant security and restriction of movement. Sometimes individuals don’t get treatment in the locked facilities because of our arcane regulatory system.
Then it steps down to group homes and Adult Residential Facilities (ARF’s). These are medium to long term residential settings where individuals return to the community and maintain their recovery with caregivers, medication, good food, activities and freedom. They are typically for those who cannot completely care for themselves.
Permanent supportive housing is what it says it is. In most cases, as with group homes an ARF’s, you wouldn’t even know they are there. It is incorporated into apartment complexes and other residential settings. Wraparound services include medication management, life skills training, job training and other services. This is the highest level of autonomy in a mental health setting and serves best the homeless with mental illnesses who, if supported, do well.
So there are many way stations along the road to recovery. We need more of all of them. Currently, when one gets backed up, all get backed up. Individuals can sit waiting for a bed to open for days or weeks or months. Sometimes, their medical status dictates that they stay longer in one level of care longer than expected. This has a significant impact on the system. We just don’t have enough beds at all levels.
Our homelessness problem is in the national news and people are dying. This is no exaggeration. Over 240 people died with no known address in Orange County last year many if not most who suffered from mental illnesses.
We have a unique combination of opportunity, will, and the resources necessary to truly change our mental health system and build a more compassionate, more effective, and more efficient system of care.
The Fairview site has the greatest resource of all; space. We can use some of the current residential housing for housing, but what then? How will people be fed and cared for? What services will be offered? What levels of care will be offered?
I wrote a plan as a starting point. Now we need the wisdom to do the right thing. I have a feeling that we will.
Matt Holzmann, Chair – Government Relations, National Alliance on Mental Illness – Orange County Affiliate
Opinions expressed in editorials belong to the authors and not Voice of OC.
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