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.

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.

NO SURE BED

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.”

SEEKING COVERAGE

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.

REASON FOR HOPE

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.”