It’s a sadly familiar story. You see someone in the street, at the park, outside a bar, at the gas station, and something seems not quite right. Maybe their voice is too loud and angry. Maybe they’re swinging their arms wildly.
Maybe they’re drinking in public or high on some substance. Maybe they’ve been posting weird or suicidal stuff on social media.
When most people view something that’s not quite right, the first call is to 911 and just like that, law enforcement is involved. But is the person a criminal? Or does the person have unaddressed mental health issues that are crying out for help?
The relatively new Behavioral Health director, Tony Hobson, presented his department’s view on just that at the quarterly 20,000 Lives meeting in January. He emphasized that his department seeks to work with law enforcement in collaboration — which signals a new direction from years past and one in step with the county’s current emphasis on treating addiction and other crises. Many mental health issues and substance abuse go hand in hand.
Behavioral health can reach out, but cannot mandate a person do anything. They can only reach out and encourage people to get the help they need. Sometimes mental health issues are not substance abuse oriented; sometimes they are. Criminal justice gets involved and then behavioral health.
Hobson insists the key to addressing these issues is to collaborate and communicate with all possible agencies involved, which include the court, the DA, probation, public health and social services.The new approach of constant communication “is in its infancy,” but Hobson is confident this is the right approach.
“It’s hard to get folks into care when they are resistant to care,” said Hobson. Hobson speaks passionately about meetings to have all bases covered. Meetings with the sheriff’s office — jail medical staff, for example. He wants services behavioral health delivers in the jail and the sharing of information to help clients stabilize their lives.
There’s a natural reluctance to share information because of privacy laws, but the department is working to coordinate care for the people that need its services and who might be frequent flyers in the justice system.
“There’s a realization, that when it comes to encountering the mentally ill in the community, the sheriff’s department is on the frontline,” said Hobson. “So are the hospitals,” he continued, “We have to understand each other’s responsibilities and roles. For me — being as humble as we can. They have a job to do. We have a job to do. It’s huge.”
He recognizes that different agencies have different “cultures” and that a behavioral health staff member and a deputy can have an entirely opposite approach to dealing with someone. The two cultures sometimes clash.
“The correctional environment has safety and security as their top priority.
“The Sheriff has done a fine job of understanding the roles here. Team effort. This is a team effort. Patrol officers encounter someone instead of straight to jail they take them to a medical facility first for medical clearance then call behavioral health for care,” said Hobson.
“They may or may not be on substances. This works in getting them to care sooner.”
Hobson recognizes the symptoms that land the mentally ill in jail in the first place — collaboration might help keep people out of jail.
His program and his approach have seen some success in the county in the eight months he’s been at the helm. Right now, there are six people in the behavioral health program that are not in jail and before the new approach probably would be.
What does success look like?
Hobson gives a scenario he’s witnessed. One client who’d been unemployed and living with a relative had very little to do and started getting paranoid; then got himself arrested.
The individual agreed to treatment over jail time. Symptoms of mental illness were reduced. He now lives in transitional housing on his own. He started working and is now considering going to school. He’s had no encounters with the law. That’s a success story.
“Supports need to be in place so they can survive an interdependent life. Employment is a huge thing. Housing. Being compliant with care. Those three things reduce recidivism,” Hobson said.
Hobson has been in the position since June 10, 2018. In that time, the department has gone through some shifting of priorities.
He had to take on a budget deficit created prior to his tenure and had to grapple with how to correct the situation. A few structural changes were made.
Much of the department’s revenue comes from medical billing. Billing per minute. Per minute rates are based on cost report. The state is six years behind on cost reports.
“Our rate was based on 2006 figures. We brought it up and adjusted our rate to the 2013-2014 cost report. We are able to draw in more medical dollars,” said Hobson.
The department also decentralized services and established wellness centers in each community — a vital issue for those without transportation, especially in the winter. Telepsychiatry is also getting up and running a cross the county.
But the most important element comes back to collaboration with other departments.
“Law enforcement and other departments know we are here to support them. We now have open, willing partners to make sure the needs of mental illness and safety get met,” said Hobson.
His staff, he said, is happy and now they work on developing positive relationships and fine-tune collaboration with these agency partners.