Jo Ann Rebane: Counties face staggering costs assisting mentally ill homeless people
May 7, 2018
Editor's note: This is the second in a series of columns discussing the impact of mental illness on the issue of homelessness in western Nevada County.
Funding California's local mental health systems depend on a complex, shifting, and unpredictable web of federal, state, grants, and local monies.
Counties rely on a mishmash of sources and program requirements like Medi-Cal, Bridge to Recovery, HUD grants and programs, Housing First, Prop 63 Mental Health Services Act, Continuum of Care, No Place Like Home, Affordable Care Act, Wellstone-Domenici Mental Health Parity Act and others.
Critically, the costs counties face for care of the most vulnerable, most severely mentally ill homeless is staggering. Data published this March by the research firm Economic Roundtable for the League of California Cities and the California Association of Counties Report on Homelessness is based on comprehensive collection of costs from a potpourri of law enforcement, jails, homeless services, general relief, food stamps, paramedics, public health, mental health, private hospitals, emergency departments, out-patient clinics, etc.
... despite our high taxes, California ranks worst in the nation with one psychiatric bed for every 5,651 people.
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They found that it costs Los Angeles County between $67,000 and $78,348 annually to care for a single homeless person with serious mental and physical problems. Santa Clara County reports 47 percent of all costs of homeless programs is spent on the mentally ill which average cost per year per individual is over $100,000. San Diego spends between $40,000 and $125,000 per mentally ill homeless person annually. The San Francisco Chronicle reports that for each severely mentally ill homeless person left on the streets, it costs the city about $150,000 a year in emergency room visits, police calls and other services.
Full scope of the problem?
Locally, our jail does not currently have figures regarding the number of homeless in its population. A new effort using the Stepping Up protocol will collect statistics with the aim of identifying the mentally ill in jail, route them to services, and hopefully keep the mentally ill out of the justice system or falling into homelessness. Nevada County's Health and Human Services Director Michael Heggarty said the county doesn't keep data on the cost of treating the mentally ill homeless population for privacy reasons. Figures for police and fire responses are not collected either. The true scope of the problem, total cost of dealing with our mentally ill homeless segment is not known.
Our Sierra Nevada Memorial Hospital treats everyone who presents themselves for mental or physical emergencies or treatment. The costs our mentally ill homeless put on the hospital are undoubtedly substantial. But the hospital's confidentiality policy, according to Dignity Health Director of External Communications William Hodges makes it impossible to release even aggregate numbers or costs.
Unlike the metropolitan counties mentioned above, we in Nevada County do not actually know the extent of the problem the mentally ill homeless pose here or have any way of assessing the total of the actual costs carried by all entities serving this segment of the homeless population.
Nevada County does provide crisis services to about 166 people each month and serves roughly 32 clients each month at the Crisis Stabilization Unit, however the status as homeless or not is not recorded. On average a client spends 17 hours in the unit at a cost of $2,400 per visit. With or without clients, to keep the unit costs about $115,359 per month. To estimate the hospital's burden when a mentally ill homeless person requires hospitalization, according to Kevin Fagan, staff writer for the SF Chronicle, "the daily stay in an intensive-care hospital bed, which is where patients can end up if there is no lockdown bed available, costs $2,000."
The Nevada County's Adult Behavioral Health agency supports 136 individuals through a variety of housing programs tailored for the mentally ill. According to Heggarty, "It is likely all or the vast majority would be homeless without the agency's support." The direct housing programs are funded by several renewable grants and programs totaling $670,000 per year.
If our total costs to care for the homeless who are severely mentally ill mirror that of Los Angeles County, we, as a community, could be spending a big number and not even know its magnitude.
OUTSOURCING ASSESSMENT, TREATMENT
Another hurdle facing our county, besides the cost of care available here, is the lack of a local, designated, inpatient facility where an involuntary assessment or treatment can take place. Heggarty says, "consequently, patients must be treated out of county where access is very limited, transportation is difficult, family involvement is limited, and discharge planning is inefficient."
The cry most often heard is that there are no beds, no place, public or private to treat the severely mentally ill homeless, and no place to house or programs to adequately support them when they are discharged.
A panel of experts retained by the California Hospital Association looked at the problem and concluded that 50 public psychiatric beds per 100,000 residents or 1:2,000 "is the absolute minimum number required to meet current needs [in 2010]." That figure was contingent upon the availability of appropriate outpatient services in the community. According to the same study, and despite our high taxes, California ranks worst in the nation with one psychiatric bed for every 5,651 people.
Of course people released from treatment can't be dumped back into homelessness without the expectation that their mental illness will "decompose" or get worse, and thereby, once again require stabilizing treatment. What is needed are treatment beds, long term community housing and continuous supportive attention.
Next week we will seek to understand the scope of the problems (financial and human) the mentally ill homeless present to California and Nevada County and identify some remedies.
Jo Ann Rebane is a member of The Union Editorial Board. Her views are her own and do not represent the views of The Union or its editorial board members. Contact her at firstname.lastname@example.org.