Los Angeles County is facing a public health crisis: More than one-quarter of its 53,000 homeless residents struggle with mental illness. “When you’re homeless on the street, your life is about survival. It’s hard to be focused on mental health,” said Maria Funk, a county mental health clinic program manager. “We are failing in many ways.” Funk pointed out that the county has been waiting two years for $700 million to build about 3,600 housing units for homeless people with mental illness. The units would come with access to health and social services. So far, not a penny has been distributed.

That’s because the source of the money, a state program called “No Place Like Home,” has been tied up in court with a lawsuit. Under the program, the state would issue $2 billion in bonds, which would be distributed to counties. The bonds would be repaid with proceeds from the state’s Mental Health Services Act, which levies a 1 percent tax on personal incomes of $1 million and above. Opponents argue that’s an illegal use of the money. Rather than waiting for a legal resolution, state lawmakers agreed in their recent state budget deal to let voters decide. The question will be on the ballot in November. “All of the counties that we deal with, from teeny-tiny ones to L.A., were … eager to apply for the funding,” said Farrah McDaid Ting, a legislative representative for the California State Association of Counties.

The Mental Health Services Act, which was approved by voters in 2004, has raised billions for mental health treatment and services. Under the law, the money is distributed to counties, where about 80 percent of the revenue must be spent on treatment of severe mental illnesses and the remaining 20 percent earmarked for early intervention and prevention. If voters approve the No Place Like Home program in November, the state would issue the bonds and repay them later by skimming about 7 percent off counties’ annual MHSA budgets for the next 20 to 30 years.

“You can’t recover if you’re unsafe and you’re homeless,” said Dennis Culhane, a University of Pennsylvania professor who researches homelessness. Culhane published a study in 2002 revealing that people suffering from severe mental illness who live on the streets each use an average of $40,000 in acute care services annually, such as inpatient psychiatric beds. But Mary Ann Bernard, a retired attorney who filed the lawsuit shortly after the program was adopted in 2016, argues that it constitutes an illegal use of MHSA money. She said she believes the law could be interpreted to allow people who don’t have severe mental illnesses, such as those with drug addictions or victims of domestic violence, to move into housing units funded by MHSA dollars. “I truly believe that the severely mentally ill will see very little of this housing, but it will be harder to fund hospital beds or other forms of treatment because they’re taking away the money to house people who aren’t sick,” she said.

The case is pending in Sacramento Superior Court, with its next hearing scheduled for July 23. Craig Cornett, who was the Senate finance director when the bill passed, explained that the program is designed to give counties the large amount of capital needed for expensive housing projects upfront. “It’s like trying to get out of an apartment and into a home. It would take years’ worth of your income to buy a home,” he explained.

Counties are “excited” by the prospect of getting a cash infusion for housing this population, said Maggie Merritt, executive director of the Steinberg Institute, a nonprofit that advocates for policies that help people with mental illness. “There are lots of people who maybe could be in housing receiving services who are languishing on our streets,” Merritt said. Some counties have already made plans to use the money: San Diego County, which has a homeless population of about 8,500, is expecting about $140 million to build housing for those with mental illness, said David Estrella, the county director of Housing and Community Development Services. Santa Clara County, which has a homeless population of more than 7,000, hopes for $100 million to build 1,800 units for the same population, according to Ky Le, director of the county’s Office of Supportive Housing. The program requires the housing units to come with supportive services such as counseling and case management. But residents aren’t required to utilize them, and opponents fear they won’t. Lauren Rettagliata, a mental health advocate in Contra Costa County, worries that people with severe mental illness will shut themselves in their units while their conditions worsen. “It’s much more complicated than ‘Give someone a house and it will make it better,’ ” Rettagliata said. “When you go to San Francisco and see some guy urinating in public and talking about all kinds of paranoid things, putting him in an apartment … isn’t going to work.”

A scathing state audit released earlier this year faulted counties for sitting on $157 million to $274 million worth of MHSA funding. In addition to those reserves, the counties also hoarded $231 million they should return to the state, the audit said. “Why are we doing this when the counties already have the money?” Bernard asked. “Developers in our larger cities are going to get the biggest benefit from this.” But advocates argue that housing is an essential part of treatment — and that it’s needed urgently. If it weren’t for the lawsuit, “we probably would have units coming online already,” said Funk, of Los Angeles County. “Even if it’s on the ballot and is passed in November, we will have lost two and a half years.”

July 3, 2018 Alex Leeds Matthews, California Healthline

When Erratic Teenage Behavior Means More

Mary Rose O’Leary has shepherded three children into adulthood, and teaches art and music to middle-school students. Despite her extensive personal and professional experience with teens, the Eagle Rock, Calif., resident admits she’s often perplexed by their behavior. “Even if you have normal kids, you’re constantly questioning, ‘Is this normal?’” says O’Leary, 61. Teenagers can be volatile and moody. They can test your patience, push your buttons and leave you questioning your sanity — and theirs. I’m not being flip. Mental health challenges are a serious — and growing — problem for teenagers: Teen and young-adult suicide has nearly tripled since the 1940s. The rate of 12- to 17-year-olds who struggled with clinical depression increased by 37 percent in a decade, according to a recent study. And schizophrenia and other psychotic disorders often manifest themselves in adolescence.

In fact, half of all mental health conditions emerge by age 14, and three-quarters by 24, says Dr. Steven Adelsheim, director of the Stanford Center for Youth Mental Health and Wellbeing, part of the university’s psychiatry department. For parents, it’s often hard to separate the warning signs of mental illness from typically erratic teenage behavior.

When O’Leary’s son, Isaac, now 23, was a teen, he had two run-ins with police — once for hosting a wild party while his mom was away, and again when he and a friend climbed up on the roof and challenged each other to shoot BB guns. O’Leary dismissed those incidents as teenage pranks. But she did start to worry when she was in the midst of divorce proceedings with her then-husband and noticed that Isaac started exhibiting some unusual behavior. He complained of stomachaches and racked up absences from school. That’s when she decided it was time for the family to see a therapist. “It’s a question of what’s normal for my kids,” she explains.

O’Leary is right. Mental health experts say the first step in recognizing possible mental illness in your children is to know their habits and patterns — to spot when they deviate from them — and to create an environment in which they feel comfortable talking with you.

Instead of asking your teen to talk, share an activity that will give your child the chance to open up: Cook dinner together, walk the dog, take a drive, says Tara Niendam, an associate professor in psychiatry at the University of California-Davis. “You just want to know how they’re doing as a person. How are things going at school? How are their friends? How are they sleeping?” she explains. As part of getting to know your teen, monitor and limit your child’s social media activity, says Dr. Amy Barnhorst, vice chair for community mental health in the UC-Davis psychiatry department. “Social media gives us this important window into what’s going on in teenagers’ lives,” she says.

Once you know your child’s baseline, you’ll be more attuned to signs of mental illness: persistent changes in your child’s everyday life that last more than a week or two. Be aware of disruptions in sleep, appetite, grades, weight, friendships — even hygiene. Maybe your son is spending even more time alone in his room. Perhaps your daughter, who is particular about her appearance, stops wearing makeup and isn’t showering. “It’s really when you see kids falling off the curve in every sphere of their lives,” Barnhorst says. “They’re having problems with their academics, problems with their family, problems with their friends, problems with their activities.” Essentially, take note when “there’s a lot of shifting and chaos” in their lives, she adds. Remember, you’re looking for changes in many aspects of your child’s life that last for a few weeks, not the typical — but temporary — sadness that comes with a breakup or the unfortunate mouthing off you get when you ask your kid to clean his room. If your child still has the same friends and is participating in the same activities, unpleasant behavior “is not necessarily something to worry about,” Barnhorst says. “That could just be teenagers going through growing pains.”

But some behavioral changes could indicate a deeper problem. For instance, teenagers with depression may be more irritable than usual, Adelsheim says. They might snap at friends or even the family dog, he says. “Young people will talk about their fuse being shorter than normal,” Adelsheim says. “Things that normally wouldn’t bother them do bother them.” When you become worried that your child’s behavior may indicate something more serious, offer your child love and support — and seek help, experts say. And avoid phrases like “What’s wrong with you?” and “Snap out of it” when talking with your kids, Niendam advises.

If your child threatens suicide, or you think he’s in imminent danger, take him to the emergency room. If there’s no immediate danger, start with your child’s pediatrician or primary care physician. In some cases, the pediatrician will be able to address the problem directly — or may refer you to a mental health specialist. This is where it could get tricky.

You may face a long wait for a specialist — especially if you live in a rural area — and may find that many aren’t accepting new patients. Barnhorst suggests calling your health insurance plan and asking for a list of in-network therapists, psychologists and psychiatrists. Then hit the phone and hope for the best. “One of the most serious problems we have in this country on the mental health front is the lack of access to care,” says Dr. Victor Schwartz, chief medical officer of the Jed Foundation, a New York-based organization that works to prevent suicides in teens and young adults. “We haven’t trained enough professionals. They’re not distributed well enough across the country.” Another option, he says, is to check with nearby universities to see if they have mental health clinics that train students and see patients.

While you’re seeking medical help, don’t forget to contact your child’s school, which may be able to make accommodations such as offering your child extra time for testing, Niendam says. She also suggests connecting with your local chapter of NAMI California (namica.org), a grass-roots organization of people whose lives have been affected by serious mental illness. “If you’re struggling, you can meet other parents and ask their advice,” she says.

Emily Bazar, California Healthline

Aurora Vista Del Mar Rebuilds

Aurora Vista Del Mar Modular Office Installation

On the night of Dec. 4, the Thomas Fire razed two key structures at Aurora Vista del Mar Hospital – our sister hospital just north of Ventura. For nearly four months, 75 percent of Ventura County’s psychiatric beds, and a large proportion of its psychiatric outpatient services, were shut down. With the facility offline, area behavioral health directors saw more adolescents in crisis – including cases with serious outcomes. “It’s a delicate matter, but it’s reality,” Aurora Vista del Mar CEO Jenifer Nyhuis said. “This is the reason we moved so fast to reopen. Our motto is, ‘Every day matters.’”

Working with the Hospital Association of Southern California (HASC) and the California Hospital Association, California Assembly member Monique Limón introduced AB 417, which created a temporary exemption in state licensing regulations for the facility. Signed by the governor on March 23, the exemption allowed Aurora Vista del Mar to reopen outpatient services at an offsite location in Ventura, about four miles south of the main campus. (Vista del Mar Outpatient Services can be reached at 805-653-6434.)

Hospital planners had hoped to reopen beds by the end of May, but are now aiming for July due to the realities of construction permits and “getting all the utilities online,” Nyhuis explained. When it reopens, the number of beds onsite will be 55 — compared to the pre-fire number of 87. Outpatient services will remain at the temporary site for two or three more years. Current plans call for additional construction to restore, and perhaps increase, the hospital’s pre-fire capacity. “We plan to rebuild the structures destroyed in the fire to regain, and potentially increase, the number of inpatient beds,” Nyhuis said. “The process is projected to take at least two years.”

May 9, 2018   Audra Strickland astrickland@hasc.org

Aurora Charter Oak and The Jason Foundation Provide Suicide Prevention Education to Local Community

Suicide is a national health problem that is also one of the leading causes of preventable death in our nation. 

In California:

  • Suicide is the third leading cause of death for middle and high school age youth (12 – 18).
  • Suicide is the third leading cause of death for college age youth (18 – 22).

The California Youth Risk Behavioral Survey reported:

  • Over 1 out of 7 young people seriously considered suicide in the past twelve months
  • Almost 1 out of 11 young people attempted suicide in the past twelve months

The Jason Foundation and Aurora Charter Oak Hospital are partners in raising awareness and providing education in our local community about youth suicide. 

The Jason Foundation, Inc. (JFI) is a national leader in youth suicide awareness and prevention programs targeted to address the “Silent Epidemic” of youth suicide.  Aurora Charter Oak Hospital is the affiliate office for JFI in Covina, CA. Affiliate offices serve as a hub where parents, teachers, guidance counselors, students, churches and other community organizations can obtain educational materials and learn about training programs available through JFI.  All programs, services, and materials are available to the public at no cost. 

Todd Smith, CEO of Aurora Charter Oak Hospital, said, “We are proud to be affiliated with The Jason Foundation.  Aurora Charter Oak Hospital recognizes how serious the problem of suicide is among adolescents and young adults. Every day, we work with individuals who are at-risk for suicide.  The Jason Foundation has developed excellent awareness and education materials and we are very pleased to have these additional resources for our community.”

Clark Flatt, President of JFI said, “Awareness and education are the foundation for prevention. We are very proud of our work with Aurora Charter Oak Hospital in helping to provide communities across California with programs and resources to help build this foundation for prevention.”

About JFI

JFI is a non-profit organization dedicated to fighting “The Silent Epidemic” of youth suicide through educational programs and resources for young people, educators, parents, and other community groups.  JFI, headquartered in Hendersonville, TN, was founded in 1997 after the tragic death of Jason Flatt, the 16-year-old son of Clark Flatt. For more information, please visit JFI’s website, www.jasonfoundation.com   

The Jason Foundation representative at Aurora Charter Oak Hospital is Steve Jennings, who may be reached at 626-214-2029 or steve.jennings@aurorabehavioral.com       

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