Sacramento lacks hundreds of psychiatric beds even after new facility built, grand jury finds
Even after building a new $10 million facility, Sacramento County will still have a whopping shortage of nearly 200 psychiatric beds, a new civil grand jury report found.
That is just one of the findings in the report, released Friday, that serves as a sweeping indictment of the county’s handling of the homelessness crisis, particularly those suffering from severe mental health crises.
Among the findings:
▪ Of the $530 million annually the county spends on behavioral health, the jurors could not find a breakdown or determine how much is spent specifically on homelessness, making it impossible to determine if money is being spent effectively.
▪ There are at least 30 boards, committees, and entities in Sacramento working on the issue, often duplicating efforts and not communicating.
▪ There is no cohesive homelessness plan for the region. The one Sacramento Steps Forward published last year lacks metrics and has not been successful in addressing the mental health and substance abuse needs of the homeless.
Sacramento County has been working to deepen engagement and expand access to behavioral health services for the unhoused, county spokeswoman Kim Nava said.
“Sacramento County boasts an array of programs to care for people on Medi-Cal, for which Sacramento County’s Behavioral Health is responsible to serve,” Nava said in an email. “Programs include CORE Wellness Centers serving neighborhoods where services are most needed, Homeless Engagement and Response Teams (HEART) that provide engagement and services in encampments and shelters, a 24/7 Mental Health Urgent Care Clinic with walk in access for assessment and treatment, a Mobile Crisis Response Team to address immediate crisis needs in the community, and the Substance Use Disorder and Youth System of Care, among others.”
The report heavily criticized the county for its lack of psych beds, especially for homeless people, who are often unable to access mental health services when experiencing severe mental health crises.
“With millions of dollars available to manage the momentous task of appropriate treatment for mentally ill homeless men and women or those locked in the desperate jaws of substance abuse, the county’s approach seems clumsy and inefficient,” the report stated. “As the crisis proliferates, the county’s public response fails to match its intensity.”
Even after the county opens 64 subacute psychiatric beds in its new Mental Health Rehabilitation Center by 2026, it will still be short 189, the report found, using data from a Rand Corporation study released last year. The county is responsible for beds for people without private insurance, which often includes the unhoused.
“It’s clear there’s a shortage of beds needed for the existing population, so when you compound that with the increasing homeless population, it goes even higher,” said Norv Wellsfry, grand jury foreperson.
Of Sacramento’s estimated 9,300 homeless people about 50 to 80 percent likely are suffering from a mental health or substance use issue, the report found.
“The most common afflictions are post-traumatic stress disorder, depression, anxiety, and a small number with psychosis,” the report stated.
While those suffering from psychosis are a small number, they are often the most visible.
“Drive down dozens of busy thoroughfares in Sacramento County, and you can’t miss them,” the report stated. “Men and women, exhausted and defeated, huddled on curbs or jammed into makeshift encampments. With no home and no immediate future, many numb that jarring reality with drugs or drift toward psychosis.”
Psychosis often causes people to break from reality and experience hallucinations, delusions, or talk incoherently. It’s often caused by severe mental illnesses such as schizophrenia, bipolar disorder or drugs such as meth. It’s treated with antipsychotics, but unlike antidepressants, those can only be prescribed by psychiatrists.
Even if someone has private insurance, the typical wait for a psychiatrist in the Sacramento area is about three months. Homeless men and women, who typically don’t have private insurance, often have to wait longer.
That often leaves emergency rooms and jails as the only alternative for those in psychosis.
Sacramento emergency departments, which are not designed for long-term stays, are sometimes housing mental health patients for as long as weeks, the report revealed.
“Hospital emergency departments house homeless mental health patients for days — and sometimes weeks — while they wait for mental health bed capacity to open due to a severe shortage of inpatient and step-down unit beds,” the report stated.
During a visit to a city and county downtown WellSpace sobering center in 2021, a reporter observed a board listing what substance each person was sobering up from. One person was not on drugs or alcohol at all, but was experiencing psychosis. He ended up at the facility because the caller had assumed it was drugs, and there was nowhere else to go.
Sheriff’s deputies are also transporting people, including those in psychosis, to jail for petty misdemeanors, the report found.
“Those who are inebriated or high in public, but pose no other threat, are arrested and jailed,” the report stated, “which results in increased health risk and high cost of incarceration as opposed to these alternatives.”
Meanwhile, there’s at least one location the county could be sending people that’s better than the jail.
“The paltry rates of referral to the Acute Intake Center at the (Sacramento County Mental Health Clinic) is another lost opportunity to manage people with acute mental health and substance abuse with an option besides incarceration to protect the public,” the report stated.
Spending not tracked
Of the roughly $530 million annually the county spends on behavioral health services, the jurors could not find a breakdown or determine how much is spent specifically on homelessness.
“To spend a lot of money and not know what that money is accomplishing is a breach of trust,” Wellsfry said.
By contrast, neighboring Yolo County’s budget includes an itemized breakdown, showing expenditures and funding sources, such as $11,131 to a winter shelter, and $36,521 to an independent living center.
Despite the fact that the county, unlike the city, has a health department, it still contracts out more than 90 percent of its homeless mental health and substance abuse services, the report found.
The report recommended the county start posting public data on homeless spending quarterly to a county website by the end of the year.
Duplicating efforts
The grand jury also found there are too many boards trying to address the substance use and mental health issues among the homeless, often times duplicating efforts.
“The grand jury identified at least 30 boards, committees, agencies, and entities with hundreds of individuals that include staff, elected officials’ appointees and volunteers … If all these entities could put aside their silo thinking, invest in coordination, relate to each other productively in search of solutions, then they can make a difference in mental health for the homeless.”
In addition to the County Board of Supervisors, there is also the Mental Health Services Act Steering Committee, the county Mental Health Board, and the Sacramento Steps Forward board, for example.
The current strategic plan, the Homeless Action Plan published last year by Sacramento Steps Forward, has not been successful in addressing the mental health and substance abuse needs of the homeless, the report stated.
“Goals are not quantified, accountability is not assigned, and performance is not monitored,” the report stated.
In addition, the Sacramento Steps Forward organization’s board does not include any elected officials, Wellsfry noted.
“Where’s the accountability in that?” he said.
The report recommends the county adopt a new strategic plan, modeled after one in Riverside, Calif., by Jan. 1. It also recommends the county appoint a deputy county executive position to handle homelessness, including mental health and substance use. Currently the highest level homeless staffer at the county is Emily Halcon, director of homeless services.
The report criticized the county for its months of delays in opening hundreds of tiny homes in south Sacramento, and also for clearing the longstanding Bannon Island encampment of seniors without moving all of them into permanent housing.
The county and its Sheriff’s Office will be required to formally respond to the report in the coming months.
This story was originally published June 12, 2023 at 5:00 AM.
