Tommy Zamarripa and Chris Stepp were sharing a midday smoke in a well-tended Rio Linda backyard, the clucking of roosters a backdrop to their quiet conversation.
Between them was the deck of cards that Zamarripa said helps get them through the day at Turning Point, a mental health treatment program where they’ve been living since early August. They spoke about the strangeness of the new facility – where room checks are conducted daily and razors are stored in a locked closet – and how it’s the first time in years they have felt hopeful about their battles against anxiety and depression.
“There’s this feeling of emptiness that happened many years ago that never went away,” said Zamarripa, 36, who two weeks before was being held at Sacramento County’s psychiatric hospital for threatening to harm himself. “I’m here to try and cope with that. I just want to feel happy.”
The treatment center opened Aug. 1 in a gray stucco building that looks more like a home than a medical institution. It marks the county’s latest effort to expand its mental health treatment options to provide midlevel services that span the gap between outpatient counseling and hospitalization. Called a crisis residential program, the center gives people with dire mental health needs a place to live for 30 days while getting services.
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This level of care has been lacking in Sacramento, county officials said, leading people in the throes of anxiety attacks and suicidal impulses to show up in crowded emergency rooms.
The county is contracting with Turning Point Community Programs to operate the new 15-bed facility in Rio Linda, and has committed $1.7 million annually for treatment services. Turning Point also runs the county’s only other crisis residential program, a 12-bed facility in south Sacramento that has been operating for 25 years.
Over the next year and a half, the county will use $5.7 million in state funding to build three similar facilities, increasing crisis residential capacity to 72 beds. That’s enough to serve about 1,100 people annually, said Uma Zykofsky, director of Behavioral Health Services for the county.
“We’re trying to create focused programs to try to relieve the pressure on the ER for multiple types of populations,” she said. “You have people who are in outpatient who became acute but don’t need to be in inpatient psychiatric hospitals. We’re creating that middle level on our continuum.”
JoAnne Miller said she arrived at the new Turning Point facility on Aug. 3, and was taken to a small, clean bedroom and told to make herself at home. A sign on the wall above her twin bed reads, “Simply become who you are.”
It was a bit of a shock, said Miller, who is 50. Just days before, she had been living on the streets in an industrial section of Sacramento around Richards Boulevard, lining up with other homeless people for food and showers at Loaves & Fishes. She got medications at the county’s Guest House Homeless Clinic, but her bipolar disorder nevertheless pulled her into debilitating bouts of depression and mania, she said.
Miller said her illness has made it difficult to find work. Caseworkers at Pathways to Success After Homelessness, a drop-in program that Miller was attending, referred her to Turning Point so she could get back on her feet.
Since checking in at the Rio Linda house, Miller said she feels more stable. Still, her anxiety about the new environment keeps her up at night.
“I struggle sometimes, we all struggle,” she said. “But this is the new me. I’m picking up new habits. I’m motivating myself, respecting myself. I’m giving myself permission to be selfish.”
A typical morning at the facility starts with breakfast, prepared by whichever residents are on the first meal shift. All residents are required to help with meal planning, cooking, vacuuming and laundry, among other tasks. Assignments are listed on a chore chart in the dining room, which doubles as a group therapy space.
“When folks feel like they can care for themselves and for other people, it gives them a reason to try,” said John Buck, vice president of operations for Turning Point. “Nobody wants to have somebody do everything for them.”
There’s this feeling of emptiness that happened many years ago that never went away. I’m here to try and cope with that. I just want to feel happy.
Tommy Zamarripa, patient at Turning Point’s crisis residential program
Stepp, a father of two, said his PTSD and depression trace back to an abusive childhood and leg-shattering car accident. He’s been in and out of the county psychiatric hospital at least a dozen times in the past decade. When he felt suicidal thoughts coming on, he said, he would head to an emergency room, where staff would transfer him to a mental hospital. But he never felt like he was moving toward anything.
“That was a Band-Aid,” he said. “They pack you full of drugs and let you walk around like zombies ... There’s nothing to help you get past whatever problem you have.”
At Turning Point, residents are required to attend three group therapy sessions a day. A caseworker helps connect them to services such as housing, food stamps and employment.
Patients can leave the property during the day as long as they aren’t missing group sessions or staying out past 7 p.m. They can’t have a car on site, but staff will take them to appointments and other locations such as clothing drives and farmers markets.
“We mandate the schedule, but it’s not rigid,” said Val Ruszovan, program director for Turning Point. “This is their home for 30 days, so we try to be flexible about the rules. That helps to build a community, instead of it being an environment that’s restrictive.”
Having a sense of control during the recovery process can make a difference in how well someone reintegrates into society after a mental health crisis, said Jonathan Porteus, CEO of WellSpace Health, a network of clinics offering outpatient mental health services throughout the Sacramento area.
“When you go to the hospital you’re handing yourself over to others, but when you go to a crisis respite environment you’re asking for support,” he said. “Patients help themselves through a crisis, versus putting themselves in a barrel and going over Niagara Falls.”
The county says crisis residential programs have a successful track record, both nationally and locally. During the 2013-14 fiscal year, 13 percent of the people who stayed at the county’s crisis residential program ended up in a hospital within 30 days of leaving the program, Zykofsky said. The other 87 percent remained stable, she said, often with the help of programs they were connected to through their case workers at Turning Point.
On a recent weekday, while Miller cleaned up after lunch, she talked excitedly about applying to low-income housing with help from staff. In the meantime, she said, she was looking forward to whipping up a special meal to share with her Turning Point housemates, a favorite beef stroganoff recipe.
“I’m a person; I’m still a human,” she said. “I’m not proud. I’m trying to get better.”
We mandate the schedule, but it’s not rigid. This is their home for 30 days, so we try to be flexible about the rules. That helps to build a community, instead of it being an environment that’s restrictive.
Val Ruszovan, Turning Point program director
Every month, more than 1,600 children and adults land in a hospital emergency room in the Sacramento region because of mental health issues, according to the Sierra Sacramento Valley Medical Society. The number of people turning to emergency rooms for mental health crises has been on the rise since the state and county slashed mental health beds in 2009. That gap, combined with the general increase in people using hospitals since the Affordable Care Act took effect, has compounded the crowding problem in ERs, said Brian Jensen, regional vice president for the Hospital Council of Northern and Central California.
In 2014, a coalition that includes the hospital council, Sacramento Metro Fire, Sierra Health Foundation and leaders from the region’s health systems began brainstorming ways of improving mental health care. Ideas included opening crisis stabilization units, sending out mobile mental health teams and increasing crisis residential beds like the ones Sacramento County is making available through Turning Point.
Porteus with WellSpace Health said his clinics and others that serve large numbers of homeless and low-income patients have been in grave need of more mental health beds. They often refer people to the original Turning Point facility in south Sacramento but the slots fill up quickly, he said. He agreed that the emergency room is not the place for mental health treatment, and called the opening of the Rio Linda facility a “dream come true.”
“When you’re feeling really paranoid, if you’re around people who get that and have that lived experience, in a very natural setting with couches and lounge chairs and a cup of tea, it’s very different from being in an ED, where parents of kids with broken arms are looking at you with fear, which only reinforces the idea that there’s something wrong with you,” he said. “It’s not a dignified place for a person in a mental health crisis.”
Stepp said he knows there aren’t enough services, and feels lucky to be in a residential program. He talks to his children, ages 7 and 15, on the phone every day, and contemplates life after Turning Point. He hopes it won’t include more emergency-room visits.
“This program is a start,” he said. “In 30 days, you’re going to have tools and you’re going to start to work on it. But depending on how bad you have whatever it is that you have, it takes a very long time to get past that.”