March 31, 2022 — Ukiah was rocked by two murders in six days, less than a half a mile apart. Both victims and both suspects were mentally ill, homeless, or both.
Now Redwood Quality Management Company, which oversees the county’s mental healthcare contracts, is planning a 16-bed Medi-Cal certified mental health rehabilitation center for the acutely mentally ill, a block from the critical residential treatment facility, which is fully built but not yet serving clients.
Camille Schraeder, the Chief Programs Officer for RQMC, thinks the Medi-Cal funded center, which she hopes to open in late 2024, will free up more money that the county can use for other mental healthcare services.
That’s because the county uses state realignment funds as a 40% match for Medi-Cal payments. So if patients are sent to facilities that are not Medi-Cal certified, the county has to pay the whole cost with realignment money. Schraeder reasons that if patients go to a facility that is Medi-Cal certified, the county will save 60% of its realignment allocation.
She’s applied for a state grant she hopes will cover some of the construction costs. She says she’s building from scratch for a few reasons.
“An MHRC (mental health rehabilitation center) is a 16-bed residential treatment facility that has intensive nursing and psychiatry. That’s what it has,” she explained. “We wanted it to be co-located with the medication, psychiatry, and therapy outpatient clinic as well as intensive substance abuse. So first and foremost, we need to have it do both. The clinic, and the MHRC. Secondly, we didn’t want to do what has previously been highly criticized in our community, which is to put something that is that intensive, with 16 mentally ill clients, on State Street.”
In the meantime, the county psychiatric health facility, the critical residential treatment center, the rehabilitation center, and the new jail for mentally ill inmates are all in some stage of preparation, though none is available yet. They are all in Ukiah, which is in Supervisor Maureen Mulheren’s district. She listed four teams of outreach workers striving to engage mentally ill homeless people. She also pointed to the county’s success in getting people off the streets and into assisted living in Live Oak apartments, the former Best Western hotel, where residents receive a wide variety of social services. But she described an impasse. In spite of what she described as the county and its partners doing “an incredible job” of providing services to people who are ready, she said, “We have people on the streets that are not ready to accept services. And one of the biggest challenges is of course the laws in California. It’s not illegal to be homeless. It’s certainly not illegal to have mental health issues. But there’s not an opportunity then to get people into the services that might help them get out of their situation and off of the streets.”
Schraeder thinks the proposed rehabilitation center could be part of the solution —though housing and staff are key components that will have to come together, too. She foresees referrals from the critical residential treatment facility, where people would stay for short-term crises. But she believes some others may be candidates for a temporary conservatorship — or court-ordered treatment, if Newsom’s proposal for CARE courts meets with the approval of the Legislature.
“They really need longer term treatment to address their mental health disorder or their intensive substance abuse disorder,” she began, describing what she sees as potential clients for the rehabilitation center. “At that point, they would ask for a temporary conservatorship…once they were conserved, the public guardian would consider placing them at Anchor Health Rehab Center,” where residents would receive intensive case management, psychiatry, and board and care supervision. “Engagement is the piece,” she declared. Referring to the stabbing in the parking lot near the county’s Social Services building and Wells Fargo bank in Ukiah, she said, “Clearly everybody must have been trying to engage, must have been trying to get (the suspect) into care, and in America, you have free will.”
If the Governor’s CARE courts proposal becomes law, local courts will be able to compel people who are severely mentally ill into treatment plans. It builds on Newsom’s $12 billion housing investments, but oversight, court costs, and other elements will need new state funding. The laist reported that the ACLU has raised concerns about the possibility of civil rights violations if people are forced into treatment. Mulheren has some local historical context.
“I was just a child when the facility in Talmage was closed,” she recalled, referencing the Mendocino State Asylum for the Insane, now the City of Ten Thousand Buddhas. “I hear a lot of people talking about this pendulum that has swung, especially in the state of California, where we were housing vulnerable individuals, we were not treating them humanely, and we took this initiative where people should not be forced to live in conditions such as that. And they were released and the funding was set aside and used for other things, and I think that what we see as a state, certainly what Governor Newsom has recognized, is that the people that we have the most safety concerns about are not left to the streets. I think it’s time for the pendulum to swing back.”
One thing is sure, Mulheren concluded: “The way that we have been doing things is not working. So we really need to figure out how we work together. How we shift.”