.County’s Health Services Agency Under Fire

Michael Fitzgerald was homeless for four years in the late 1970s and into the early ’80s in Santa Cruz, while struggling with mental health challenges.


After recovering, he entered the mental health care industry, and he now serves as technical advisor for the National Alliance on Mental Illness of Santa Cruz County (NAMI). He says county government leaders need to do a better job of handling mental health crises.


“Looking at other counties, we could learn from some of their approaches. Santa Cruz is, unfortunately, an outlier,” Fitzgerald says.

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He isn’t the only one with concerns.


Santa Cruz Mayor David Terrazas says that mental health struggles of people on the streets have created “the number one issue” facing downtown. Folks in need of psychological support, he says, can create a visible—and often noisy—impact. Since Terrazas’ term began late last year, he has repeatedly pushed for more collaboration on mental health issues, starting with his Dec. 20 column in the Santa Cruz Sentinel titled “We Can’t Do It Alone.”


“A well-run and effective mental health services response in our region is something in all of our interests,” Terrazas tells GT, “and especially for the city of Santa Cruz.”


The county’s Health Services Agency—particularly the portions dealing with mental health—have been taking heat from multiple sides lately.


Homeless advocates Sibley Simon and John Deitz say the agency can be an inadequate partner, one that does a poor job managing the intersection of homelessness and various kinds of illness. A Santa Cruz County Grand Jury report, released in May, called for county behavioral health professionals to accompany law enforcement on more calls. A few weeks prior to that, Santa Cruz’s Greg Larson, former town manager for Los Gatos, filed an online petition that gained 2,668 signatures calling for increased transparency with mental health funding, after local woman Sarah Shinsky was attacked near the clock tower by a mentally ill man. The petition accused the county of sitting on $15 million in tax revenues. Essentially, he says he wanted to call for more accountability on how the HSA, the county’s largest department, spends its mental health money.


County officials pushed back on the details, and Larson quickly modified the petition’s wording.


“Our unspent funds are less than $3 million,” says Pam Rogers-Wyman, the HSA’s adult services director. “That’s been really a misnomer that we’re sitting on millions of dollars. I think we’ve tried to correct it several times.”


State law, she adds, requires the agency to keep a certain amount of funding in its reserves.


Other local activists, from both the left and the right—including the public safety group Take Back Santa Cruz—have lined up with criticisms of their own. And a NAMI report  from this past fall identified key areas where the HSA needs to improve, calling for better oversight of the contracted mental health care provider Telecare. The report noted that the number of beds available for people experiencing a mental health crisis is critically low in Santa Cruz County. It showed that the discrepancy impacts everything from emergency room treatment times to an increased presence of people on the street who would normally be hospitalized.


In a California State Auditor’s report, Santa Cruz County was one of 12 mental health agencies statewide that did not submit their fiscal year report by the December 2017 deadline. The agency was one of six that didn’t submit reports for either of the past two years.


“We’re behind, and we do expect to file those reports quickly,” says county spokesperson Jason Hoppin, who says the problem stemmed from a software switchover. “It was internal. It doesn’t excuse us.”


At the end of May, Health Services Agency Director Giang Nguyen left her post at the county, but officials said they couldn’t discuss the reasons for her departure.


Rogers-Wyman says the biggest problems Santa Cruz County faces are not unique to this area.


“I think it feels for every community from San Diego to Crescent City, anyone along the coast, that we’re dealing with an issue around lack of low-income housing, poverty, and behavioral health system that is not adequately funded for the need. We spend every penny we get, and we leverage it as far as we can, but it’s not that much money,” she says.



Santa Cruz County has less than a fourth of the number of inpatient offerings recommended by Treatment Advocacy Center, which advocates for 50 beds per 100,000 residents. With a total of 16 beds, Santa Cruz County has only six beds per 100,000 residents. That is half of California’s average, as noted in the NAMI report. That report was dedicated in part to the memory of Sean Arlt, who was shot and killed by Santa Cruz Police officers shortly after he was released from a brief stay at the Behavioral Health Center without stabilizing from a psychotic episode.


Progressive activist Denise Elerick feels that local hospitals aren’t doing their share when it comes to mental health, either, further compounding problems at the HSA. She’s also frustrated with a local perception that mental health issues pose a serious safety hazard to the entire community.


Rogers-Wyman says she and her colleagues are aware of the inpatient issue and are working toward a solution.


“We are not necessarily looking at additional inpatient beds within the county. We are working on a contract with an inpatient unit over the hill as an overflow, but we are working with Telecare on developing more of a continuum where we can best utilize our inpatient beds,” she says, noting that Encompass is also a crisis residential facility geared toward patients who no longer need a locked-down setting. “That is a continuous discussion.”



Affordable housing entrepreneur Sibley Simon says that when someone’s homeless, it’s impossible to solve their mental health difficulties without also addressing their need for housing.


“You can spend all these resources in the hospital, on medication, and it does not help at all for many different major medical issues,” Simon says. “People die when they’re homeless of things that wouldn’t kill anyone else.”


Around the county, nonprofits on the front lines of this issue are increasingly using the Homeless Management Information System (HMIS) to make sure everyone is on the same page when it comes to tracking the county’s neediest people. Simon lauds the Homeless Persons Health Project, a county HSA program, for using HMIS and for its work with people living on the streets, more generally. But he notes that the rest of the Health Services Agency doesn’t use the system.


He compares the situation to a doctor who isn’t interested in looking at a patient’s medical records or sharing information with other doctors.

“It’s the equivalent, in case management, of medical records,” he says. “It’s information about what programs they’ve been a part of, what challenges they’ve had, how long have they been homeless here, what ailments and characteristics have been diagnosed, what services they’re getting from other partners, comments on what’s been effective, what hasn’t, their history.”


John Dietz, one of the founders of the 180/2020 program to end chronic homelessness, says he’s seen a high percentage of people return to homelessness, often after receiving one year of services through the county. And the county, he feels, does a poor job of following up with people. The needs of a recently housed person often develop into a mental health crisis that spirals until they get evicted.


“The problem they’re having is loneliness,” he says. “The client doesn’t have anyone to talk to. No one is checking in on them. They’re falling back on bad habits.”


Hoppin says the county officials know there are some holes in the safety net, and they’re working to patch them with new solutions like Whole Person Care, the new tech-driven program aimed at aiding the neediest county residents.


“While we have services available for people in crisis and those who suffer from severe mental illness, it’s true that more can be done for mild and moderate cases,” he says. “We expect to develop these services once Whole Person Care is fully operational, and we also now have follow-up care available for those being treated for substance-use disorder through the recent expansion of those services under Medi-Cal, which the county is helping to fund.”


City Councilmember Cynthia Chase says that while she understands many of the critiques lobbed at county health, she has seen that frustration can go too far at times.


Chase, who also works as the inmate program manager at the Santa Cruz County Sheriff’s Office, says the community needs to remember that the county is a partner and not an enemy—especially if it wants to get positive results. “You can go down a rabbit hole of misinformation, and end up creating adversaries where we should be creating partnerships,” she says.



While it is uncommon to see one county agency garner so much criticism from so many different camps, that doesn’t mean there’s consensus on everything that should be done better.


For their part, public safety activists from Take Back Santa Cruz (TBSC) feel that the HSA could be more proactive about referring addicts to treatment options and improving the Santa Cruz County Syringe Services Program, commonly known as the needle exchange.


The program is designed to stop the spread of disease among intravenous drug users. David Giannini, a member of TBSC’s executive committee, suggests the program try doing a one-for-one exchange—so that a user may only receive one syringe for every dirty one they bring in—or some other mechanism to incentivize users to bring back each syringe, instead of littering them about.


“If you could find some way to make used syringes valuable,” says Giannini, whose 18 years sober from addictions of his own, “then my brothers and sisters who are still out there using, would gather them up and find them a way to give them back.”


Other activists, including Elerick, have long held that stricter exchanges will do a poorer job of reducing the spread of disease and may do nothing to curb littering. She notes that many homeless people often have their belongings—including clean syringes—stolen or sometimes swept up in camp clean-ups. She says more syringe disposal sites would be a more rational solution.


In general, Fitzgerald says the most important step for the HSA to take is to start a dialogue and better involve the community.


He compares the Santa Cruz region to San Luis Obispo County, a similarly sized coastal community that also grapples with homelessness. “According to their MHSA plan, they have a very robust engagement with their community compared with Santa Cruz, where there was virtually none. It’s an opportunity for us to improve,” says, Fitzgerald, who’s also executive director of behavioral health services at El Camino Hospital in Mountain View. “The mental health director needs to lead this, but the community must accept the challenge and become engaged.”


Faith leaders and business owners are beginning to step up.


Father Milutin Janjic, of the Prophet Elias Church, says his congregants asked him to call a meeting with Mayor Terrazas, Police Chief Andy Mills, and county health leaders for members of the church to learn about services available for mental health.


At the meeting, Rogers-Wyman shared information about the new program HOPES, which allows community members to make referrals for mental health through the website santacruzhealth.org/hopesteam. She made a similar presentation at the Downtown Association meeting a few days later.


Since its unpublicized launch in mid-March, the county has received 90 referrals, and Rogers-Wyman says the county is actively managing about 30 of those individuals, 10 of which they’ve gotten off the street and into residential treatment for either substance disorder or mental health.


Janjic says his church, which is located across the street from the library and Santa Cruz City Hall, has outreach programs to help people in need, including the homeless.


“We’ve developed some kind of relationship with them, and then we see how desperate they are for help, especially those with mental health issues,” he says. “We would like to see how we, as a part of the Santa Cruz community, could help, but we would also like to see what the city, county and state, are doing to help those people.”


  1. This story is great but leaves out the fact that it was the County’s own report to the State that showed $15 million of “unspent” funds, as they’re called by the State. When the County filed their next report, still over 2 years late, it was down to $11 m of “unspent” funds. I only changed the petition language to give the county the benefit of a doubt about their claims that the other late reports would show less “unspent” funds. We’ll see. But at least now more and more of us are starting to hold the County accountable for its $80 million per year behavioral health budget, which is 150% more than all the police department budgets in our County.

  2. This article is great and focuses much needed attention on the County’s use of $80 million per year to meet, or not meet, the rapidly growing mental health and addiction crisis on our streets and in our neighborhoods. To put it in perspective, the County’s $80 million per year budget for behavioral health (addictions and mental health) is 150% more than the combined budgets of all 4 police departments in the County. We have the right to ask if we’re getting the services we need. How much of those funds go to County, department and non-profit overheand and administration?

    However, the article neglects to mention that the petition’s initial claim of $15 million of “unspent funds” came from the County’s own report to the State. The number was reduced to $11 million of “unspent funds” when the County submitted an updated report over 2 years late. The petition language was only changed to give the benefit of a doubt to the County’s as yet unproven claim that there are no unspent funds. The County is still 1 of only 5 counties (out of 58) that have not yet submitted the late reports that will prove them right or wrong. We’ll see.

  3. My son was arrested in Telecare our local psych hospital in September of this year. He was in a drug induced psychosis deemed “gravely disabled” and also on top of that they had himon 10-12 psych meds and two major psych diagnosis’ yet when he threw a chair they called the cops and he got charged with assault with a deadly weapon vs getting the help he needed. My young son who was born with special needs is now as of April at San Quinton Prison and they tried to give him a strike for this chair “deadly weapon.”
    My son also has gone without Medi-cal since he was 18 when his SSI ended and his Ecnompass payee he paid for out of his monthly check let his SSI end and did not look into the error of his Medi-cal ending. He now is in debt way over $20k and has bad credit. My son has been found passed out on the street many times almost dead and robbed many times. The negligence by the people in our town who are PAID to supposedly help is outrageous and scary. They not only do not help but ruin lives. It is incestious here in this town from social services to the government itself. There is no way to get help. I have tried for over 2 decades to get my son help. I am the last to cry racism but…it is very hard to not think that is at play with my biracial son. At least in part. I am pretty sure they would not have called the cops on just anyone at Telecare. I know another black male that was arrested there too.
    My son’s first time being arrested as an adult was at our local “Dignity” health emergency room aka once known as Dominican Hospital. But once they changed their name and I think ownership they began having the opposite of dignity towards anyone seen as not “normal.” They have utter disdain toward people with alcohol & or drug problems. And said to my and my son’s faces “He chose to do this…” when he was almost dead. and left him on the ambulance gurny in the hallway & falling off. Rolling their eyes at me. My son was a bother to them. And not worthy of their time. The time they arrested him he had gone in on his own thinking he was having a heart attack. With reason being two days before he had almost over dosed on cold meds. He has been on the cardiac unit more than once in his life. Even as a teen for over doses. But they do not bother to look at your records if you are a low-life like my son in their opinion. Homeless and addicts do not get their attention.
    The county jail, the court, the juvenile hall, the judges, the probation, cps… all of it here. All exactly the same. They do not care about the family. They only seem to care about getting a paycheck. Honestly, that is all I have seen. People that act like high school kids who are immature and gossip. Have no interest in looking into the truth. I have boxes and boxes of my son’s history and not one person in 2 decades has been willing in ANY branch of government or social services to actually KNOW who my son or my family really is. That is the direct result of why my son has almost died and why he is where he is now. At San Quinton Prison. And I see no reason why he won’t just come back here and do it all again and die. I see no reason for it to change. I know people who have died. I can not understand and never will fathom how not even ONE person has whistle blown in any of these branches. NOT ONE. There has to be one person that knows they are not doing right. There has to be ONE person that knows they lied. That knows they were negligent to the point of ruining a life. But…they do nothing. Is it really for money? Or for another promotion? Or are they really just that passive? I will never understand. I do know the very people paid to help and paid to be in power have ruined my and my son’s life here in Santa Cruz, CA and no one has tried to fix it and I suspect they never will.
    Every adult that has screwed up royally with my son when he was a kid? Ends up promoted to then work with adults. That is the town we live in. Judge guy was the family court judge as a kid and is now an adult judge. So, the kids who’s lives were ruined by her rubbing stamping their lives away get to see her as an adult. Judge Morse the juvenile hall judge who let my son be in 23 hr solitary confinement as a juvenile.. where he was sentenced thru his 18th bday? Ended up becoming an adult judge in MENTAL HEALTH COURT! and yes my son saw her in that court. AND THEY DO NOT MAKE THE CONNECTION DO THEY? Why is my adult son and others in mental health court? hmmm?
    My son’s probation officer Duc was the same one he had when he was a juvenile. Conflict of interest? oh no! Not here in Santa Cruz. Even tho he did a bad job then. They think it is a great idea to have him again as an adult. and keep having him. And he was the main one pushing for my son to go to prison and have a strike. His Children’s Mental Health therapist ends up being a county therapist in the jail and he never even had a degree of any sort… he only had a certificate in alcohol something or other. And he never looked at any of my son’s records that I tried to give him. So, he was totally biased then. As he more so is now. So, once again my son has someone against him … years and years built up. How can you get a fair anything in an environment like that? You can not.
    Real life Twilight zone; That is Santa Cruz Social Services and Courts and psych hospt etc.


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