OUT OF MIND, OUT OF SIGHT: Contrary to popular misconception, insanity is not doing the same thing over and over and expecting different results. Insanity is writing about other people doing the same thing over and over and expecting them to stop.
Another case in point: Before this Tuesday’s Board of Supervisors meeting evolved into a free-flying food fight, there was a measured, clench-jawed, hold-your-nose-and-vote decision to bail out the county’s cataclysmically overwhelmed Psychiatric Health Facility (PHF), otherwise known as “The PUFF Unit.” The PUFF is where people are sent — mostly against their will — when they pose an immediate danger to themselves or others. The PUFF has 16 beds. A county Santa Barbara’s size should have at least 40. The Grand Jury has been writing about this shortage for more than 40 years. In that time, nothing has changed.
That makes the Grand Jury crazy. It turns out I’ve been writing about the Grand Jury writing about this for almost as long. What does that make me?
Santa Barbara has solved the problem with a respectable variant of what’s known as “Greyhound Therapy.” In other words, we ship our dangerously crazy people elsewhere. For years now, we’ve been exporting our acutely mentally ill 50 miles down the road to the Aurora Vista del Mar acute care facility in Ventura. By the boatload. At the start of this fiscal year — July 1 — the supervisors set aside $2.3 million to send Santa Barbarians experiencing psychological meltdown to Vista del Mar. At $700 a night, it’s more expensive than the Bacara or El Encanto. Based on Yelp reviews, I’m guessing it’s not nearly as nice. No matter how overpriced and underwhelming Vista del Mar may be, there’s no dearth of desperate Santa Barbarans scrambling to get in. And the county pays for it all out of its general fund. Only halfway through the fiscal year, the county has already spent all the money slated for Vista del Mar.
This Tuesday, the supervisors were asked to spend an additional $1.7 million to do the same thing it’s doing, but only more so. County coffers are being depleted at a rate of $15,000 a day to warehouse our wretched refuse down the road. If we continue at this pace, the supervisors will be asked to do the same a month from now. I’ll be writing about it. And nothing will change.
On my planet, $4 million is big enough money to raise several bigger questions. Like, why is the PUFF experiencing such a dramatic increase in demand? Or why can’t it be expanded to accommodate more people? And if that’s impossible, why can’t a newer and bigger PUFF be built?
To answer the first, judges are sending more and more criminal defendants — charged with misdemeanors, not felonies — they deem incompetent to stand trial (IST) to the PUFF. The hope is the ISTs will get sufficiently “restored” to understand what’s happening in the courtroom well enough to go to trial or plead guilty. This is happening throughout California. However mentally ill, most ISTs do not pose an immediate threat to themselves or others. That means they don’t belong in a PUFF. And they’re taking up the bed space that could be used by people who do. Worse still, ISTs typically take much longer to get “restored” than it takes to “stabilize” someone seriously on the ledge.
Therapeutically, it makes no sense to export people. It makes it that much harder for family, friends, and loved ones to help. Financially, it’s flat-out nuts. The county recoups half what it costs to pop someone into PUFF from Medi-Cal. But it doesn’t get one red cent when it sends people to Vista del Mar.
Because PUFF is a stand-alone facility disconnected from any adjoining hospital, federal licensing standards limit it to no more than 16 beds. If the county ever hopes to increase PUFF beds, it needs to find a willing partner that happens to be a hospital. Up in Santa Maria, that seems to be happening. For the past two years, Marian Medical has been giving serious consideration to opening such a facility in an old hospital building it abandoned when the new hospital campus was built. After much circling the pool, Marian — I am told — is ready to take the plunge. Cottage Hospital, by contrast, seems deathly afraid of the water. It’s just not interested. Back in 2007, Cottage and county mental health underwent the institutional equivalent of a bitter divorce over acute-care patients. Relations have since improved but not to the extent anyone is willing to broach so indelicate a subject. When I called county supervisors and county mental-health officials to find out the extent to which they’d pressed Cottage to explore a PUFF partnership, I got the Big Vague. In lieu of answers, I heard a lot of wind getting sucked through lots of teeth. Likewise, when I called Cottage, I encountered a level of deflection worthy of a tai chi master. Truly impressive. Cottage, it turns out, had other plans.
Given Cottage’s massive construction program — picture the pyramids, the Great Wall of China, and Stonehenge going up simultaneously — one would have thought some space could have been shoehorned in to accommodate so screaming a public need. I understand acute mental health care is expensive and scary and expensive. But the government gives Cottage its nonprofit tax status to reward such bravery. And in recent years, this nonprofit swallowed whole the Saint Francis Hospital, the Goleta Valley Hospital, the Rehabilitation Institute of Santa Barbara, and the Santa Ynez Hospital. It also tried to fuse with Sansum Medical Clinic and to take over the Cancer Center of Santa Barbara. To the extent there are more helicopters flying around Cottage than the Santa Barbara Airport, it’s because Cottage has emerged as a regional stroke center.
Every day, I see the construction site where Goleta Valley used to be. Every day, I wonder why no PUFF beds are going in. Every day, nothing changes, and I keep saying the same damn thing. Crazy.