Ventura CountyBehavioralHealth Age-ncy Housing forAdults with Severe and PersistentMental Iflness

According to the Ventura County Sheriffs Department Program Managerforthe Mentally 111, Directorfor Psychiatric Medications, in December 2002, 37% ofthe adult female inmates and 14% ofthe adult male inmates in Ventura Countyjails were 300 HillmamtAvenue Ventura, CA 93003 ,(805) 652-6737 Fax (805) 652-6160 - " , www.vchca.org 1. Honorable Bruce A. Clark 2 administered psychiatric medications while incarcerated. An additional number of inmates refused psychiatric medications. (See Addendum A) Unable to comment

The Countyjails the largest single provider of housing for the mentally ill in are Ventura County. (See Addendum A) Parlia//y concur. County jails provide place of safety both to inmates and for the generally a community. People in jail because they have commined crimes; sometimes are people commit crimes result oftheirmentalillness. as a Jails acknowledged to be institutional seffings and generally understood are are as group quarters, not housing. F=4 Command, management and rank-and-file law enforcement personnel discussed the change law enforcement's role in terms ofthe closure of most California State in Mental Hospitals and the lack of other housing forthe mentally ill. Unable to comment F-S Sheriffs deputies do their best but not all trained to be the caretakers of the are mentally ill. The Sheriffs department also coordinates with the Cisis Intervention Team to apprehend mentally ill adults who possible threats to themselves another. are or Concur

There policies forjail release andjail diversion for laentally ill adults, but they are not always applied due to constraints oftime and are resources. Unable to comment

Statistics gathered by the 2001-2002 Grand Juryfrom the Ventura County DistrictAttorney, indicate about halfof all officer-involved shootings in Ventura County in recent years involved a mentally ill adult. Unable to comment

Ventura County mentally ill adults frequently released from the In-Patient are Psychiatric Unitwith onlythe address of homeless sheltergiven to them by Behavioral a HeaEh "housing." (See Addendum A) as Disagree. In response to the core hnding, the VCMC Psychiatric Unit consistentlyattempts to provide for and arrange transporlation for all hospitalizedpatients. During their hospitalizaton patients may need transportation services to specialty clinic appointments, for outside medical procedures, Superior Couri, etc. After discharge patients typicallyneed assistance with transportation to otherfacilities, their homes, placements, outpatient clinics, and homeless shelters. At new discharge each patient needing assistance wlh transportation is assessed to determine the most appropriate mode oftransporfation. Unit staffmay personally drive the patients in County vehicle, alternatively, patients given bus a or are a voucher bus token at cost. The staff will also coordinate the schedule, or no provide written instructions for patient, and if needed, transporf the patient directlyto the bus stop in downtown Oxnard LosAngeles Union Station. or Each time the Unit staff transporfs patient s7ransporfation Worksheet" is a a completed and logged into binder. Over the past six months the staff h4ve a logged total of 549 patient transporlation episodes including 47 direct pafient a transporls to homeless shelters. Patients have been transporfed to placements as farawayas Long Beach, GA andBakersfield, CA. Patients, who have /acal disGharge destination and who able to local are use public transporlation, given bus foken at cost to them. The Unit has are a no spentapproxin~ately$800 in Greyhoundbus tokens over the past year. For patients needing extended transporlaton (for example, out ef state), Greyhound bus vouchers issued. Overthe ofthe past six months the are course Unit has issued $2,602.75 worth bus vouchers. in

Many mentally ill adults released from the In-Patient Psychiatric Unit, never arrive at the shelter. Partially Concur. Despite the Units best efforls, it is acknowledged that some cfients do not end vp at theirdischargedplanning /ocation.

Severe and persistent mental illness condition with periods of and is a crisis Ventura County has no crisis or respite facility where a mentally ill adult may come for temporary residential when they below the legal threshold for 72-hour care are a voluntary involuntary hold at the In Patient Psychiatric Unit, Hillmont Hospital. (See or Addendum A) Agree. There is definite ongoing need for sub-acute facilityin this County order to a a in `step down"sub acute hospitalizedpatients and to admit sub-acute clients as an I 4 alternative to hospitalization. [See F-26 response; one is currently in developmentl

According to the Chief Mental Health Services Administratorfor Adults and the subordinateAdministrators for Adult Mental Health Services, Ventura County in between 30% and 70% of middle-aged mentally ill adults live with elderly parent. an These figures vary depending on the community. (See Addendum A) Disagree. The ChiefMentalHealth ServicesAdministratorforAdults andthe subordinate Administrators forAdult Mental Health Services notinterviewed. were

The Behavioral Health Adult Clinics stated to the Grand Jury thatveryfew mentally ill adults between ages 18 and 6i) years in Ventura County are transitioned to the mentally ill senios programs at 65. Disagree. The BehavioralHealthAdult Clinics notinterviewed. were

Ventura County has estimated 11,960 adults with and persistent an a severe mental illness. Parfia//y concur. The California Mental Health Planning Council in March 2003 published the California Mental Health Master Plan: A Vision for California. The Unmet Need Estimate Based CMHS [Center for Mental Heafth Servicesl Prevalence Rate on forpersons in Ventura County between the ages of 21-59 is 5,388 at the lower limit and 17,435 at the upperlimit. '7hese unmet need calculations were made fn fiscalyear 1999-2000. At that time, the mostrecent data available on the number ofclients servedin the mentafhealth system was forfiscalyear 1997-98."

The Housing Gaps Analysis 2000 led to the developmentof the Five Year Plan. Concur

The Five Year Plan designed to develop 500 licensed/approved was new housing opportunities by the year 2006 and close a housing gap that was estimated to be at least 1,000 and growing. Partially concur. The Five Year Plan states: `7he identified need for permanent housing in Ventura County forpersons with psychiatric disabilities is ai Ieast 500 units."[l.2 Goals and Objectives, ] * July 15, 2003 5

The Five Year Plan presents milestones for each ofthe five years. The County is now in the third yearofthe Five Year Plan. None ofthe overall numeical goals for additional ready-to-occupy housing have been met. Disagree. While the Five Year Strategic Housing Plan, prepared with valued stakeholder input may have been unrealistically optimistic in the timeframes set forlh, significantprogress is being made in achieving the statedgoals. Relative to Homeless Services, permanent housing in Oxnard for six homeless mentally adults (AB2034) has been secured in partnership with Cabrillo Economic Development Corporation. BHD has obtained approva/ for 11 Section 8 Shelter Plus Care tenant-based housing vouchers through the Oxnard Continuum ofCare. This willprovide rental subsidies forup to 11 mentallyill households for an initialterm of5years. BHD in collaboration with Ventura County Public Health, Turning Point Foundation and the Deparlment of Veterans Affairs, Greater Los Angeles Healthcare System submiffed application April 14, 2003 for funding an on through the Collaborative Initiative to Help End Chronic Homelessness requesting nearly $2.6 million in funding. The application requests funding from the Department ofHousing and Urban Devefopment for Safe Haven in Oxnard a (to be operatedby Turning Point Foundation) and funding from SubstanceAbuse and Menfal Health Services Administration for management and intensive case mental health and substance abuse services to project parficipants. It also requests funding from the Health Resources and Services Administraton for case management nd primary health care services to program participants and funding from the Deparlment of Veterans Affairs for a case manager at its contract clinic to homeless veterans with mentalillness and evafuator. serve an In transitional housing, the renovation of the former Inpatient Unit to 15 serve mentally ill adults is going forward with construction to starf in fhe third quarferof 2003 and occupancyin the second quarlerof2004. Most of the activity has been in the permanent housing though fhe arena even keystone piece of the strategy California Supportive Housing Initiative Act funding-has been eliminated. - In addition to the permanent housing noted above, Many Mansions, loGai a nonprohthousing deve/oper, completed renovation ofCasa de Paz Supporfed as Housing for Persons with Disabilities (mentally ill) that provides 13 now affordable housing units. The Warwick Aparlments currently undergoing are renovation and 13 ofthe 27 units are expected to be available for occupancy by 6 adults oflow income with mentalillness in September2003. BHD regularlyrefers clients to EsseffVillage Apartments, anotherManyMansions managedproperly. SHD secured 32 "special needs" Section 8 vouchers from the Ventura Housing Authorityforclients. BHD has taken active role in recruitng /icensed Board and Care operators an with the result that since March 2000, in spite ofthe /oss of 7 facilities with total a of53 beds, three facilities with total of54 beds have been added. Another new a 4 facilities with a total of 24 additional beds are in the process ofsecuring their licensure and will be serving mentally disabled clientele. The licensing process from first inquiry to hrst occupant easily take 6 12 months, sometimes can longer. - The p/anning, in conjunction with the Area Housing Authority, for the development of housing at Lewis Road is now able fo go forward in eamest, following passage of the Housing Bond Act of 2002 in November 2002, making capital development funding available. The capital funding just being is now made available through periodic issuance ofRequests forApplications. The County Executive Office, at the direction of the Board of Supervisors, is currentlyevaluating converting the HonorFarm facilityinto locked facilityforthe a mentally ill. The forthcoming reporf will list the advantages and disadvantages of such conversion, and provide the staVs professional estimates the a on feasibility, initialand long-term cost, overall budgetimpacts andpotential sources offunding formaking fhe conversion. The report willprovide suMcientinformation to enable the Board ofSupervisors to determine whetherthe issue merits furfher, refinedanalysis. more

Santa Barbara and Kern Counties have over 150 beds per 100,000 of population for mentally ill adults compared to Ventura County's less than 40 beds per 100,000 of population. Disagree. Ventura Countyhas 212 licensedBoardand Care beds formentallydisabled individuals; Santa Barbara Countyreporfs 144 and Kern reporfs 285. As ratio a oflicensedBoardand Care (B&C) beds to open enroJledaduJt cases, Ventura Countyhas 1 bed forevery 14 aduK clients; Santa Barbara Countyhas 1 B&C bedforevery23 adult clients andKern Countyhas 1 B&Cbedforeve~y 18 adult clients. 7

Santa Barbara County's median household 46,677, and Kern County's income, median household income, $35,446 far below Ventura county's median household are $59,666. income, Parfially COnCUT. The FY2003 median householdincome forSanta Barbara Countyis $60,600; for Kern Countythe FY2003 median householdincome is $42,800; andfor Ventura Countythe FY2003 median householdincome is $73,600.

Santa Barbara and Kern Counties provide substantially housing and more residential for mentally ill adults than Ventura County. care Disagree. Referto Response to Finding F-l7. I In addition, Ventura Countyprovides residential care (e.g., Institute forMental Disease, MentalHealth Rehabilitation Center) at ratio of lbedto 40 adult a clients compared to Santa Barbara County with 1 bed fo 59 adultclients and as Kern County with 1 bed to 137adult clients. I

An unknown number of mentally ill adults live motel rented etc. in rooms, rooms, and intermiftently homeless. are Partially COnCUT. The BHD through its EmergencyShelferProgram (ESP) safelyhouses an average of8 individuals at anypointin time in local motels while exlending services andlinking to mainstream services. Forfhe fiscalyearendedJune 30, 2003 ESP served 151 clients for totalof793 "bed-nights' a Lack ofhousing availabilityand affordabilitycontinues to challenge renters and homebuyers alike in Ventura CountyandofherCalifornia coastalcommunities. According to the National Low Income Housing Coalition (NLIHC), California ranks second the nation, behind Massachusetts, "leastaffordable"forrental in as housing. "In California, extremelylowincome household (earning $18,303, an 30% ofthe Area Median Income of$61,010) affordmonthlyrent of can no more than $458, while the FairMarket Rent for two bedroom uniis $1,024."[Outof a Reach 2002-NLIHC] The surveyofhomelesspersons in Ventura shelteredin cold weathershelters andtransitonalhousing facilities February27,2003 found 51% on over were women and children. This seventh annualpoint-in-time survey, sponsoredbythe Ventura CountyHomeless and Housing Coalifion found the ranks ofthe homelesspopulation growing. people remaininghomeJess longer, and are are those sheltered Iong time Countyresidents. are 8

Other adults with and persistent mental illness continually homeless a severe are and employ strategies such living abandoned buildings covered bins. as in or Concur. The American PlanningAssociation (APA) releasedin May 2003 "Policy Guide a on Homelessness"thatstates 800,000people are homeless across the United States. TheAPA papers notes severaffactors thathave contributedto the rise of homelessness: Escalating housing costs which have outstrippedpersonalincome growlh; Acceleratedloss ofaffordable housing stockand declining rental assistance; Decreasedaffordabiiityand availabilityoffamilysupporf services such as childcare. Theyremind thatplanners play significantrole in reducing us can a hon~elessnessbydetermininglocalhousing needs through theircomprehensive plans, removingregulatoryandlegalbarriers to the developmentofaffordable and supporfive housing, and fostering communitysupporf forpermanenthousing I forthe homeless.

Most ofthese strategies bring the mentally ill adult into frequent police contact and possible incarcerations. Concur. When individuals, homeless ornot, having mentalillness ornot, a are frespassing private orpublicproperty engagedin high-riskbehaviors on or or criminalactivity, there is reasonable expectafion ofpolice contacf andpossible a incarceration. Evidence from aroundthe countryshows thatsupporfive housing typicallyresults in decreased use ofemergencymedicalservice and incarceration, reducedrecidivism among substance abusers andincreased employmentrates.

Presentlythere fewer licensed board and homes and board and are care care placements for mentally ill adults than when the Five Year Plan prepared. (See was Addendum A) Disagree. There has been substantialactivityin this between the ofMarch arena census 29, 2000 appearing in the Five YearPlan andthe most current ofMay census 20, 2003. Af March 29, 2000 in Ventura Countythere totalof211 beds for were a mentallydisabledadulfs in 18/icensedadultresidentalfacilities. AtMay20, 2003 in Ventura County there total of212 beds formentallydisabledadults are a in 13 licensedadult residentialfacilities. In the interim, 7 facilities eiher terminatedoperations serving differentpopulation and 3 facilities orare a new added. BHDAdult ResidentialServices has staffperson actively working were a 9 to recruit andliaison with licensees serving menta/lydisabled adults in Ventura County. The followinghypotheticaltimeline isprovided to betterunderstandthe process I ofbecoming licensedBoard and Care (S&C) facility, arbitrarilysetting July3, a 2003, the date ofiniialinquiry' 1 as Date Activit Jul 3, 2003 Prospective B&C eratormakes inqui o Aug. 6, 2003 Attend Community Care Licensing (CCL) Orientafion in Santa Barbara Aug.7, 2003 Mailrequest forApplication Packet Sept. 6-10, Enroll forAdministratorCerfification Program-SDaytraining- I 2003 Costis $239 where available Sept. 24, 2003 A plicanttakes uired test re Sept. 25, 2003 Requiredfinger rintin takesplace Oct. 23, 2003 Results ofcerfihcation examination Oct. 31, 2003 Submit application to CCL Nov. 15, 2003 CCL willcallaboutitems missin in application Nov. 30, 2003 CCL Component 11 Interview- face-to-face InitialFire MarshallInspection Dec. 15, 2003 CCL Component111Meetin forms & uiations re FinalFire MarshaJIIns ection- Dec. 28, 2003 CCL pre-licensin visit to the facilit Jan. 15, 2004 CCL issues license-residents be in moving in 'The timeline setforth above the applicanthas priorconvictions, is knowledgeable assumes no aboutthe program andmission ofB&C facilities (Adult ResidentialFacilities), andthe house is clearedbythe Fire Marshallin timely CCL endeavorsto complete theirprocessing a manner. within 90 days from receipt ofthe complete application. In reality, due to holidays, staffing shorfages, andapplicantsnotbeingfullyprepared, the processisprolonged. The lead time to the creation and establishmentoflicensedBoardand Care facilities is typicallysix to nine months afteraprospective applicanthas been identified through self-selection recruited and suitable building has been or a secured. The lead time forceasing operations /icensed Boardand Care, either as a voluntarilyorbyfailing to be in compliance wih licensingregulations be can immediate but typically wouldbe within 30 days. more 1 July 15, 2003 10

Ventura County has 27 fewer board and care placements than three years ago occupied by adufts with and persistent mental illness. (See Addendum A) severe Disagree. There has been subsfantialactivityin this between the ofMarch arena census I 29, 2000 appearingin the Five YearPlan andthe most current census ofJune i I 24, 2003. At March 29, 2000 in Ventura Countythere were a total of211 beds for mentallydisabled adults in 18 licensedadult residentialfacilities. AtJune 24, 2003 in Ventura Countythere tota/ of212 beds formentallydisabled adults are a in 13 licensedadult residentialfacilities. In the interim, 7 facilities either ferminatedoperations serving differentpopulation and 3 facilities orare a new added. were I I BHDAdult ResidentialServices has designated staffmemberto recruit I one I potentialBoard and Care operators, andto assist andsupporfapplicants through the licensingprocess. Operators receive support as theyembark on operations, broughf togetherperiodicallyto discuss issues ofmutualinterestandto be are acknowledgedforthe valuable role ofBoardand Care facilities in the wide array ofcommunityliving options.

Placements by Behavioral Health for adults behveen the ages of 18 and 64 with and persistent mental illness in semi-independent homes have decreased from severe 17 2000to 11 in 2003. in Concur. Currently 10 individuals reside in 3 semi-independentliving homes. The reduction in BHDleasedproperties is in keeping with the philosophyofthe Deparfment to move away from the dual-roles oflandlordandservice provider. In keeping with bestpracticesindividuals being appropriatelyintegrated are more into the communityby having their aparfments andreceiving clinic based own services and, when appropriate, fieldbasedservices Well. In Semi- 0S independentliving BHD is in the awkwardposition ofbeing in dualroles both as landlordand mentalhealth servicesproviderwhereas in community-based housing the landlordroles andthe supporlive services separate they are as shouldbe and clearlydehned.

The former in-patientfacility at Hillmont Avenue planned to house 15 is now adults in a rehabilitative setting after renovation. The Five Year Plan called for housing 34 adults in the facility. Concur. The Five YearPlan anticipated 27adults living in the formerinpatient unit followingrenovation. The building designed psychiatrichospital with was as a shared anddoes notlenditselfwell to re-design conventiona/housing. rooms as In recognition ofthe need for structuredliving environment with a more a 11 I treatment focus andgiven its proximityto the current /npatient Unit, the current I i design makes the most appropriate andbest use ofthe space. Theplan is to I serve 15 adults with suMcient space forboth housing and the necessary rehabilitation environment to facilitate the movement to independentliving with~n established time period. an

Adults between 18 and 64 years of age have the greatest difficulty obtaining funding and therefore services, housing, medication, etc. Concur. Recommendations: R-l The Ventura County Behavioral Health Department should take strong a leadership role in promoting group homes and reversing the loss of board and care homes that has occurred in Ventura County. The BehavioralHealth Deparfmentpromotes qualitylicensed Boardand Care facilities in Ventura Ceuntyandactivelyrecruits potentialoperators. Board and Care facilities, ie., Adult Residentia/Facilities, licensedby the California are DeparfmentofSocialServices Community Care Licensing Division. Each facility is privatelyowned and operatedenterprise. The Countydoes not operate, own, ormanage liGensed Boardand Care faGilities. Since 2001 BHD mounted focused efforl recruitingindividuals to become a on Board and Care operators specificallyto the mentallydisabledpopulation serve andsupporled these individuals as theynavigate the licensingprocess with Community Care Licensing andhas been successfulin its efforfs. The recruitmentand retention ofquality Board and Care homes is challengedby the fact that licensedoperators receive 2J4 times the rate for andboardand room care andsupervision for a developmentallydisabledperson as comparedto a mentallydisabledperson. This is parityissue to be addressedat the state and a federalleveland challenges anyrecruitmentand retention effort.