By Jondi Gumz
With a 31% staff shortage in Santa Cruz County’s mental health division, county supervisors have green-lighted a new approach: Hiring more peer support specialists to work on mobile crisis teams.
The shortage of licensed staff is not just in Santa Cruz County, but throughout California and across the nation.
This is why the county’s mobile emergency response team has only been available during the week, not evenings and not weekends.
Yet 36% of calls between 8 p.m. and 7 a.m. are mental health-related.
With the current licensed staff shortage, the county’s Crisis Stabilization facility often cannot accept people in crisis, so they are directed to hospital emergency departments — Dominican Hospital, 29 per month on average, or Watsonville Community Hospital, 9 per month on average.
The new approach, called “Crisis Now,” aims to have mobile teams available 24 hours by 2026.
Crisis Now is led by the National Association of State Mental Health Program Directors and developed with the National Action Alliance for Suicide Prevention, the National Suicide Prevention Lifeline, the National Council for Mental Wellbeing, and consultant RI International.
With Santa Cruz County’s population of 274,255, it is estimated that 6,852 people would need crisis services beyond a phone call or outpatient service and a need for 43 acute inpatient beds. This is based on national guidelines projecting that 200 people per 100,000 will experience this acute a crisis.
In 2021, the Crisis Stabilization facility tallied 1,397 uses of crisis chairs with the average stay 1.7 days and 67 adult readmissions
Supporters of Crisis Now say not matching people to their care needs is detrimental to the healthcare system at a cost of $2,264 per psychiatric patient.
Mónica Morales, who heads the county Health Services Agency, presented Crisis Now to county supervisors, who gave their approval in June.
Survey
Planning started in February with a community survey that reached 95 participants, a town hall and listening session with 25 people on Feb. 16, five focus groups involving 98 people, 30 days of public comment through April 20, capped by a public hearing.
The top priority was the need to expand mobile emergency response hours to 24/7, then expanding the number of acute care beds.
RI International, formerly Recovery Inc., was hired as a consultant locally.
The cost of Crisis Now is expected to be $5.16 million over the next three years. Funds are coming from federal and state grants.
The budget includes $1.3 million for personnel.
The overall expense includes $450,000 for RI International and $300,000 for a third-party evaluator.
Arizona Model
In Arizona, where crisis centers are open 24 hours, people experiencing a psychiatric crisis get a fast — 3 minute — handoff to a counselor by police officers who can focus their attention on crime. The centers are open to all, regardless of health insurance.
That’s not available in Santa Cruz County now.
And it wasn’t in 2016 when two young men in crisis — Sean Arlt and Luke Smith — were killed by law enforcement, Sean in Santa Cruz and Luke in unincorporated Watsonville.
But RI International is to help develop a better system of mental health crisis lines, mobile crisis response, and short-term crisis care facilities.
Currently people in a mental health crisis can call 911, answered by dispatchers for police and emergency medical services, 988, the 24/7 line which connects to the Suicide Prevention Service or 1-800-952-2335, the tollfree number of the county’s mobile response team, which works weekdays 8 a.m. to 5 p.m.
To hire peer specialists, the county leaders plan to partner with a nonprofit for the hiring and training. This could be 12 to 24 certified peer specialists and emergency medical technicians.
With sufficient staff, dispatchers could send a mobile team at any time, evenings or weekends.
Crisis Now is being funded as an innovation project via the state tax on millionaires for mental health services; long-term funding has yet to be secured.
The Santa Cruz County Grand Jury investigated the county’s Behavioral Health Division and reported the 31% staff vacancies, along with vacancies in staff of Telecare, the nonprofit contracted by the county to run the Crisis Stabilization facility. See the July 1 Aptos Times.
The county is planning to open a crisis facility for youth at 5200 Soquel Drive, next to the Sheriff’s Office, once renovations are complete. The facility could be ready in 2024.
One issue for hiring is that neighboring counties such as Santa Clara and San Mateo in the heart of Silicon Valley offer higher pay. This leads to people driving “over the hill” to boost their income.