Many San Franciscans now have the images of Paneez Kosarian fighting off Austin James Vincent in front of her Embarcadero condominium building burned into our collective memories.
This story of a young, severely impaired man, assaulting a woman to save her from what he thought were robots incited widespread fear, as mental illness is highly stigmatized and associated with violence even if the “violent mentally ill” typecast is a well proven fallacy. Since this incident, there has been much discourse on how to address the mental health crisis on our streets, from the misguided call to halt the creation of a new Navigation Center on the Embarcadero to thoughtful calls for solutions.
On the heels of this saga, the proposal to cut 41 long term beds in our only public board and care facility is a mindboggling disaster. The city has stated they will put 13 Navigation Center beds here instead; they are needed, but not nearly as badly as board and care beds. Worse still is the discovery that these golden beds have been held empty and all placements have been halted since September of 2018. Meanwhile, people in dire need were told no beds were available.
After Mr. Vincent was stabilized and responding to medication in a residential facility, he was removed and sent back to jail, where likely he will be in worse shape when he eventually gets out. If a board and care bed is available, he can be stabilized and live out his life with the opportunity for transformation, but more likely, with the loss of these beds he will return to the streets and decompensate again. It makes one want to run screaming down the street.
In the early 80s, many San Franciscans first noticed large numbers of people with mental illnesses wandering the streets. It was right after a little known but hugely tragic move by former President Ronald Reagan to remove all recipients from disability benefits. Untold thousands of people with mental health disabilities lost their placements in board and care facilities that their disability benefits had once paid for. As calamitous as that policy was, at least back then we had capacity in board and care facilities. However, in the years since over 2,300 of those beds have slipped away, as the old Victorians they are housed in are sold off to the next generation.
The loss of Social Security benefits was followed by realignment hitting California cities’ mental health budgets hard in the early 1990s. Between 2007 and 2012 the city enacted recession era austerity measures that cut $40 million more in direct behavioral health services, knocking even more folks to the concrete. Each of the last four decades have seen its own sword slashing deep into the heart of our mental health system, and each decade has lacked corrective action. Today, we are in no position to respond to a massive opioid epidemic, further complicated by a homelessness crisis. For the third of our homeless population impacted by mental illness, having no place to live makes recovery almost impossible, and instead they suffer more frequent and severe psychiatric episodes.
A whopping 4,666 homeless people are brought into Psychiatric Emergency Services at SFGH every year, and 1,786 are released back to the streets without even a referral. As we churn people through our system, we amplify harm, disintegrate trust and waste valuable investments. Meanwhile, our policy makers seem more interested in soundbites and juking stats than substantive change. They have shortened stays, so the city can serve more people, giving handy “success numbers” for press releases. They focus on do-nothing proposals that score political points. A long string of mayors take credit for adding programs, while quietly cutting others. Recently Mayor Breed announced adding mental health beds at St. Mary’s, but cut beds out of county. City officials stopped counting turn-aways and eliminated waitlists, so they can claim there are none. When San Franciscans ask, “why do we force people who are mentally ill to wander our streets?” it is a fantastic question, the same question asked by the people who are living it. We are failing our most vulnerable. We are failing our neighborhoods. Our once flourishing mental health system is now in shambles.
More important than “why?” though, is how. How do we get out of this mess? One of the most important things we can do is ensure there are beds at every level of care, from prevention, to crisis care, to residential treatment to most importantly long term housing for those who simply cannot care for themselves. Our system must be engaging and fluid and responsive on demand. We can’t keep separating substance use treatment from mental health, and we need to be real about our system failures. We must incorporate treatment for psychiatric trauma at every level of care. Alarm bells must sound at the sight of anyone with severe mental illnesses who appears homeless on the streets, and intensive assertive care must surround them. Once in care, that care must continue into housing. Otherwise, all that care, while offering important respite, will not mean much if the person is yet again homeless and churned back out to where they started. That status quo has to stop. These are big goals but with the political will that can only come from citizen pressure, they are achievable.
Luckily, there are measures on the horizon that will get us closer – Our City Our Home, which voters passed last November and is held up in courts, will result in over $70 million each year to build up our mental health system with new innovative approaches, while also creating the requisite housing to stabilize folks post crisis. Voters will also have the opportunity to pass Mental Health SF on the March ballot, that will provide Universal Mental Health care. In the meantime, let’s preserve the beds we have. That means holding onto our only public board and care beds at the Adult Rehabilitation Facility, and rising to address the staffing issues. This is too valuable a resource to walk away from. This also means that the city needs to quickly find somewhere for the navigation shelter beds.
When our hearts are broken in tragedy, all those pieces create more surface area, and somehow there is even more capacity to love. As awful as the Embarcadero incident was, it is an opportunity for change. It is our civic responsibility to ensure that the tragedy on the Embarcadero becomes not another missed opportunity but a moment for transforming our system into one that works for all of us.
Jennifer Friedenbach is excutive director of the Coalition on Homelessness.
Credit: Source link
We all get the opportunity to start over. Take yours.
What If You Got The Opportunity To Start Over? – Motivational Video
Download or Stream the speech now, on iTunes, Spotify, Apple Music, Google Music, Deezer, AmazonMP3 or MP3 Download Anywhere In The World
What If You Got The Opportunity To Start Over? – Motivational Video (Motivational Speech) – Lyrics, Music, Speech: Copyright: Fearless Motivation
Speakers: Chris Ross, Tyrone Stokes
What If You Got The Opportunity To Start Over? – Motivational Video – Motivational Speech by Fearless Motivation – WATCH FREE:
What if you got the opportunity to start over? To go back.
To learn from every mistake, to scrape every lesson from your past, and start with a clean state.
What would you do differently?
What lessons have you learned in your past, and how would you apply them if you could start over?
What if you had another opportunity, to do better, to be better… would you take it?
Well, you get that opportunity every day. We all get that opportunity every day. It’s called WAKING UP. Every day you wake up is a blessing and you should never take that blessing for granted.
YOU CAN CHOOSE TO START OVER.
YOU CAN CHOOSE TODAY, TO DO BETTER.
YOU CAN CHOOSE TO LIVE WITH A CLEAN SLATE.
Which means you let GO of your PAST and FOCUS on NOW. RIGHT NOW. What are you going to do right NOW to create a better FUTURE for yourself?
What PLANS are you going to make NOW, for today and in the future to ensure this NEW VERSION of you is better than the last?
Will your FUTURE self be proud of you? Will your TOMORROW-SELF be proud of you, by the work you do TODAY, by the PERSON you are today?
You have to EARN that future pride. If you’re not putting in the work today, your FUTURE will pay the price.
Let go of WHO YOU WERE if you don’t you’ll never know who you TRULY CAN BE. Let go of WHO YOU WERE and FOCUS on who you WILL BECOME.
Every morning you wake up, remind yourself that you have another opportunity to experience your GREATEST day. Another opportunity to push yourself. Another opportunity to set an example. Another opportunity to LEARN something that will make YOU BETTER. Another opportunity to ENJOY the day, to enjoy other people… to enjoy life.
You are blessed to get the opportunity of LIFE… make the most of it.
Create the BEST VERSION OF YOU.
You are blessed to get the opportunity of LIFE… make the most of it.
Credit: Source link
In mid-July, Chazz David Brazier became the first participant in the newly sanctioned North St. Louis County Mental Health Court, the fourth court of its kind in Minnesota. Sixth Judicial District Judge Michelle Anderson presides over the court, which meets every Thursday afternoon in Hibbing, and uses the models of ones previously opened in Duluth and Hennepin and Ramsey counties.
Brazier, 23, is now several weeks into the court program scheduled to last more than one year. He has been following his supervision rules, attending weekly court hearings in addition to his treatment and mental health therapy and working with the court team to address housing needs, transportation, insurance and medical concerns.
Meanwhile, he takes care of his fiancee and their two small children. “The court is not just there to do things for you,” he told the Hibbing Daily Tribune during several recent interviews. “There’s structure, but you have to work the program. It’s a hell of a lot more productive than jail. I’m not trying to [expletive] it up.”
As a kid growing up in Hibbing, Brazier experienced trouble concentrating and controlling his impulses. At age 8, he was at the center of a family custody battle when he was diagnosed with attention deficit hyperactivity disorder and prescribed Adderall. Two years later, his adopted younger sister died from complications with Chari malformation and meningitis. As a teenager, Brazier attended Mountain Iron-Buhl High School but he never graduated. Instead he drank alcohol, took painkillers, benzodiazepines and LSD and sold marijuana. His mother, Krista Spotts, of Hibbing, remembered “how much of a fight it was to get him to school” and local therapists saying he had depression and post-traumatic-stress-disorder. By age 18, Brazier had moved out of his mother’s house and started using cocaine, heroin, methamphetamine, PCP, DMT and peyote. He suffered from suicidal ideations and slit his wrists after his first arrest for a drug-related offense.
“We always ended up trying to save him,” Spotts explained to the HDT. “I remember the days my husband and I stayed home from work so he would not harm himself. We brought him to so many counselors. It was very hard to find people to get to the bottom of what was wrong with him. And he was very smart and would just play the game and say what they needed to hear. I begged my family practitioner for help before my son killed himself. There was no way I was going to bury another one of my kids.”
That need for help came in the strangest of forms beginning in September 2018. Brazier tried getting rid of a handgun at the Army National Guard in Hibbing, according to district court documents. Local police tracked him down and teamed up with his probation officer in searching his home and finding two 9mm loaded magazines and a backpack containing residue of marijuana and meth, two syringes, a Velcro arm restrictor and one Winchester 9mm luger bullet. “I was going to use the handgun on myself,” Brazier recalled. “I was deep in my addiction and I knew I had mental health issues. I went to the extreme, but this was my cry for help.” He was arrested, charged with a gross misdemeanor crime of fifth-degree possession of methamphetamine and booked into the Hibbing lockup, before being transported several days later some 76 miles south to the St. Louis County Jail in Duluth.
Brazier received medical evaluations at the jail. St. Louis County has a contract with MEnD Correctional Care, a for-profit company based in Sartell, Minn. to provide health services. The staff took him off Adderall and put him on antipsychotic medications called Loxapine and Lamotrigine.
Two weeks later, he was transferred 21 miles west to Northeast Regional Correctional Center, a minimum-security facility in Saginaw. The facility has its own medical staff and contracts with Essentia Health and the Human Development Center of Duluth for medical services. Both Brazier and Spotts said a medical provider there diagnosed him with borderline personality disorder, a condition characterized by unstable moods and behavior, and prescribed him with Seroqul, a brand name of the antipsychotic Quetiapine. He had a bad reaction to the medication. His blood levels plummeted and he had to be treated at a local hospital. After a month of leveling out, he was moved 245 miles northwest to Douglas Place in East Grand Forks, the first addiction treatment center to have beds in the region. Medical staff gave him Bupropion to treat his depression in addition to his daily intake of Lamotrigine. He stayed for nearly a month, before being relocated 183 miles eastbound to the Northland Recovery Center in Grand Rapids. He took Adderall again and was about to graduate from the program when he violated the rules of his intensive supervised release.
In April, a team working to open the Mental Health Court in Hibbing — including probation officers, prosecutors, defense lawyers and mental health experts — screened Brazier according to rules aligned with the National Drug Court Institute and Minnesota Treatment Court Standards. The team, which considered the results of his psychological evaluation and a chemical dependency assessment, determined that he met the court’s requirements for being a person with a significant and persistent mental illness. A judge sentenced him to a stay of adjudication to serve 308 days in the St. Louis County Jail and ordered the probation condition of completing the five-phased court program created for people residing on the Iron Range whose misdemeanors or felonies result from significant mental health and substance abuse issues and directing them to treatment services.
There are currently 80 jails in the 87 counties of Minnesota, which house more than 6,000 people, according to the Vera Institute of Justice. Like elsewhere in the state, the St. Louis County Jail reports that 75 percent of its 6,000 annual bookings are in pre-trial custody, which means they are waiting to go to trial, enter a plea, or make bail if they can afford it.
Two years ago, the U.S. Bureau of Justice Statistics released studies showing that nearly half the people in jails across the nation suffered from mental illness. Last month, Dr. Todd Leonard, a former family medical doctor turned president of MEnD Correctional Care, told the HDT that his company serves 44 jails in South Dakota, Illinois, Iowa and Wisconsin and Minnesota. Thirty-six of those facilities are in Minnesota. At the St. Louis County Jail, Leonard’s staff oversees an average daily population of 181 inmates staying here some 14 days at a stretch, as reported by jail administrators during the first six months of this year. His staff reports show him that “three out of four inmates in St. Louis County will either have a mental health condition, abuse or depend on drugs or alcohol, or both.”
MEnD provides a crew of administrators, four full-time registered nurses and one health technician in Duluth. A non-prescribing mental health professional visits the facility twice a week and provides services via telemed as needed and a prescribing medical provider shows up eight hours a week. The company plans to hire an on-call psychiatrist with the ability to prescribe medication in the upcoming weeks.
As Leonard explained, the correctional staff ask a series of questions and provide a state-mandated medical screening when people are booked into the jail. If there are no immediate concerns, a nurse completes a health assessment and screens for depression and suicide risks. The findings are reviewed by a medical provider. Under state rules, this entire process must be completed within 14 days, but Leonard insisted that 95 percent of the people are seen within 72 hours of being booked.
If there are concerns, a nurse and perhaps other members of the team triage the person in question. Depending on the severity of the situation, they may end up sending them to an emergency department in a nearby hospital. “You can’t force psychotropic meds in this state at this time,” Leonard said. “They have the ability to refuse treatment.”
Staff have several options if they determine that someone has a high-risk of suicidal behavior, including “the most safe special precaution of suicide watch,” Leonard said. Basically, this means removing an individual from general population and their personal belongings — since common ways to commit suicide in jail involves people hanging themselves with linens and sheets and T-shirts — and putting a kevlar smock on them and holding them in isolation for 23-hours per day. “On any given time, we might have zero to four on suicide watch,” Leonard said. “They’re isolated, but only as long as it’s necessary to ensure safety. Seventy-two hours is my mark. The length of isolation is based on our decision-making to try to help them in every angle, but some don’t take to it. It’s rare for someone to be on suicide watch for one week.”
Unless an emergency situation, it usually takes 14 days to diagnose someone and offer them prescribed medications. “If we discover someone is psychotic, we won’t wait and we’ll offer them antipsychotic medication and hope the patient cooperates,” Leonard said. “But most psychotic diagnosis take up to two weeks. We hopefully get them sober and stabilized so we can get really accurate information.” Still, all medication is voluntary.
MEnD has the ability to make “autonomous decisions” on the type of medications prescribed in the jail. “We have the right to do that because they’re our responsibility when they’re in our custody,” Leonard said. “A new client might not have been scrutinized to the level I do and that’s a rude awakening to patients that abuse or sell their medication.” Leonard is not keen on “red-flagged medications,” such as Bupropion brand of Wellbutrin and Gabapentin, a nerve pain killer. “If someone comes in on Wellbutrin and if they’re using it OK and doing well, we won’t stop them. But we’ll warn them.”
If someone has not been diagnosed and does not take medication. “Let’s start over with a new pair of eyes,” Leonard said. “There’s some advantages of correctional health care, because we have eyes on them 24 hours per day.”
St. Louis County Sheriff Ross Litman has estimated that “well over half of the inmates” in the jail have a diagnosed mental illness. While County Attorney Mark Rubin believes the state “is not the answer to addressing every mental health issue,” Sixth Judicial District Chief Public Defender Dan Lew opined that the county “shouldn’t build a system in which the jail is a mental health provider.”
Still, Lew is not alone in saying, “one of the finest mental health providers in the area is our jail.” He continued, “I say that with batted breathe because it’s ill-equipped for people suffering with mental illness.”
As the former counselor turned Jail Administrator Robyn Wojciechowski sees it, “I don’t know if we’re the best. We’re the catchall. So many folks come to us with mental health and chemical dependency issues, plus criminal issues. It’s a wide net of folks here.” She continued, “being in jail can be the best thing for them. It can slow some people down. There’s a captive audience and we start them on medication and make sure they’re OK. Sometimes it’s all a person needs.”
But there is a strain on resources at the jail ranging from correction officers having to spend more time with people suffering from a mental health crisis to the cost of prescription medications which ultimately come down to taxpayers. “Yeah, we’re stabilizing people and returning them to the community better than we found them. But we’re not a mental health hospital. And we’re not trying to be a mental health hospital.”
As a whole, all mentioned officials support the Mental Health Court in Hibbing as being part of the latest nationwide criminal justice movement to find solutions on how to treat people with mental illness who have been accused or convicted of crimes. A main goal here is to reduce recidivism. But most everyone has commented on the need for preventative measures, the need for more mental health resources on the Iron Range that can help people before they interact with law enforcement or step foot in the courtroom.
Brazier’s mother, Spotts, tried hard to recall a history of mental illness in her family. “Nobody talks about it here. They pretend they’re OK.” She cried and her voice cracked over the phone when she shared how she regretted not taking her son to counseling after his sister died. “But you just don’t do it here. I thought I had to be the strong person.” She also remembered struggling to find help when she did try reaching out to mental health experts.
Aside from a handful of private psychiatrists and counselors, the main options for people with mental health issues remains The Range Mental Health Center and Fairview Range Medical Center. Despite their services, such entities continue to battle with turnover and difficulty in recruiting and retaining people to work on the Range.
As the director of Emergency and Behavioral Health Services at Fairview Range, Kelly Lawson oversees a swelling 11-bed emergency department and the booked 28-bed, acute psychiatric inpatient unit — the only one of its kind in the Northland outside of Duluth. She said there is only residential treatment facility on the Range and less than a dozen psychiatrists in a 90-mile radius from Duluth to Bemidji.
One psychiatrist in the hospital sees more than 80 clients. “We have patients booked out for at least three weeks,” Lawson said. “We can have her seeing patients every 10 minutes, but what’s the quality? If they’re a new patient, they’re probably turned away.”
Many of the 60-plus people for this HDT reporting series mention “social-economic factors” when trying to describe the seemingly rapid increase in mental health issues in cities like Hibbing. They discuss the bankruptcies of regional mines resulting in the loss of thousands of jobs, the declining population, the increase of meth and then opioids and then meth again. They also point to a general uptick in education and awareness of such matters.
“It’s likely we were underdiagnosing for several years, but we’re transitioning with a different generation,” Lawson said.
Now, no one knocks the regional health providers. The staff is doing the best they can, as do local law enforcement, who are struggling to keep up with the caseloads. But the issue here remains: How does one best help people with mental health issues who are accused or convicted of a crime? For most, the Mental Health Court in Hibbing is being viewed as one tool to chip way at that big iceberg, an alternative to the old jailhouse routine.
Today Brazier is primarily taking Adderall and Lamotrigine in addition to Fluoxetine, which treats depression and panic disorders. The Mental Health Team is built to help him monitor his medications, as well as his newly prescribed medical marijuana which his mother said calms him down. He remains unemployed, but he has done well making his scheduled appearances in court and counseling and attending his recovery meetings. “I know it bothers him not to work, but he needs to be mentally healthy before he does,” Spotts said. “I think this mental health court program is good for him. The jail isn’t going to help my son. The jail is full of people like Chazz and I don’t feel like putting him in jail is the answer. The court made it possible for him to stay out of jail. Something is clicking. We all see it.”
Brazier spent time with his fiancee and children over the weekend. “If I’m not right, stable, clean, all I have right now doesn’t exist and I can’t be there for myself and then I can’t be there for them,” he said. “I still have my moments of [expletive] everything and everyone. But mental health court is good for me. I feel like a guinea pig sometimes being the first participant here, but it’s helping me get my sh*t together.”
Spotts released a long breath, one that appeared lodged in her chest for some time, before sharing, “His kids are his life. His fiancee, my husband and I know that if we kicked him to the curb, he would be dead. Now, this is the first time I’ve seen Chazz be Chazz in 10 years.”
Credit: Source link
Credit: Source link