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Ballot Item Seeks to Boost County’s Mental Health Spending

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Between Covid-19 and pre-existing economic conditions, reports of anxiety and other conditions have increased. - ENGIN AKYUR/UNSPLASH
  • Engin Akyur/Unsplash
  • Between Covid-19 and pre-existing economic conditions, reports of anxiety and other conditions have increased.

Back in 2006, journalist Malcolm Gladwell wrote about Murray Barr, a man living on the streets of Reno, Nevada for over a decade. Two Reno cops who had interacted with Barr for years contacted local hospitals and government support agencies in an effort to trace how much government agencies had spent on Barr over the past 10 years. 

“It cost us $1 million dollars not to do something about Murray,” one of the officers told Gladwell.

Gladwell’s resulting article for The New Yorker, “Million-Dollar Murray,” argued that it would be more costly for the city of Reno to let Murray and other chronically homeless people remain on the streets than it would be to provide them with housing and rehab. 

In its own way, this argument was resuscitated over the summer as protesters in cities across the country chanted “defund the police,” a slogan which is generally understood to mean “move funds from law enforcement to other government social programs.” Applied broadly, the concept calls for a decrease in law enforcement solutions to societal problems, and an increase in spending on preventative care.

As protests tapered off in August and September, the county Board of Supervisors opted for a middle-of-the-road approach: increasing funding for police alternatives, but not substantially decreasing law-enforcement spending.

During September budget talks, the Board of Supervisors boosted funding for the Mobile Support Team (MST), a mental health crisis response team in the Department of Health Services founded in 2012, but left the budget of the Sheriff’s Office relatively untouched. 

Similarly, an item on the county’s Nov. 3 ballot, Measure O, asks voters to approve a 1/4-cent sales tax expected to raise $250 million over 10 years in order to increase spending on mental health, addiction services and support facilities for vulnerable people.

While Measure O’s supporters are primarily using a moral argument to support the tax increase, they and the initiative’s opponents are also offering economic arguments.

An alliance of business groups, known as the 2020 Tax Moratorium Coalition, has formed to oppose all of the proposed tax increases on the ballot, including Measure O. The group, whose members include the North Bay Builders Exchange, Sonoma County Farm Bureau and Santa Rosa Metro Chamber of Commerce, argue that increasing any tax in the middle of the pandemic is irresponsible. 

Meanwhile, in their ballot argument, Measure O’s supporters, including Congressman Mike Thompson and Supervisor Shirlee Zane, say that the funds generated by Measure O would “provide dedicated funding to ease the burden on emergency services and our healthcare systems, and keep those in need of mental health services out of the jail.” 

Although Sonoma County doesn’t regularly publish the data used to calculate the cost of a local “Million-Dollar Murray,” a recent study commissioned by the county came to a similar conclusion.

Published in July, a county-commissioned report titled “High Utilizers of Multiple Systems in Sonoma County,” offers some insight into the 6,600-or-so people in the county who use a disproportionate number of public resources cost the county each year—though the average cost per person is substantially lower than the $1,000,000 over 10 years estimated for Murray,  the man profiled in Gladwell’s 2006 article, the ongoing cost is still significant.

The report estimates that each of the county’s 6,600 “high utilizers”—defined as an individual who repeatedly interacts with multiple public agencies at an unusually high rate—at about $27,000 per year, for a total estimated cost of $178,200,000 to state and county agencies. 

“The average high utilizer spent 57 days in some sort of publicly subsidized inpatient or residential setting, such as a jail, a hospital, or homeless shelter,” the report states. And, though they made up only one percent of the county’s population, the high utilizers accounted for 28 percent of the behavioral health costs, “52 percent of nights in housing or shelter for the homeless and 26 percent of jail time in Sonoma County.”

The report splits the high utilizers into two general groups: those with behavioral health issues without a stable housing option who repeatedly interact with law enforcement; and “individuals with serious medical conditions.”

Members of the first group, which is estimated at about 1,580 individuals, were likely to have struggled at some time with an addiction to alcohol and to frequently cycle in and out of jail, mostly without facing new charges.

The average member was booked into jail about once a year for an average period of 41 days. That said, the vast majority of the study group—91 percent—was never actually convicted based on the charges they were arrested for during the five-year study period. 

Measure O’s backers argue that the additional resources will “help keep those in need of mental health services out of jail” and replace funding cuts caused by budget shortfalls. 

But, where does the Measure O money actually go?

Measure O’s ballot language does not specify how much money would go towards any particular program. Instead, the estimated $250 million the measure is expected to generate is split into five categories, with a percentage of the pie for each category. 

The largest single chunk of the money—44 percent or an estimated $11 million per year—would go towards the county’s Mobile Support Team and other crisis response services—including the county’s Crisis Stabilization Unit, longer-term residential crisis services and inpatient hospital services for adults. 

The other funds would be allocated to behavioral health facilities (22 percent or $5.5 million), mental health and substance use disorder outpatient services (18 percent or $4.5 million), homeless behavioral health and care coordination (14 percent or $3.5 million) and transitional and permanent supportive housing (2 percent or $500,000).

Still, it’s not clear whether the many mental health programs will have as much backing as some would like, even with the possible boost from Measure O and some additional appropriations in the county’s latest budget. Furthermore, there are structural problems to be addressed.

For instance, on Sept. 11, at the close of their budget talks, the supervisors agreed to set aside $5.5 million to expand the county’s Mobile Support Team (MST). This year, MST’s budget will increase from $1.9 million to $3.4 million. It will be $3.9 million in each of the following years. 

Before the current budget boost, MST had three two-member teams working Monday through Friday from 1–9pm.

In an Aug. 27 staff report sent to the supervisors in response to questions about MST, DHS staff estimated the program would require a $9.3 million annual budget to provide services 20 hours per day, seven days a week throughout the county and that the program’s full potential may be unknown due to the current call model.

“The current model’s design, which relies upon law enforcement to initiate MST services, likely suppresses the number of these encounters. Redesigning the system to enable MST to be dispatched directly to a wider variety of call types, in addition to law enforcement support, would increase services provided by this program,” county staff wrote in the Aug. 27 report.
 

The Department of Health Services and the Sheriff’s Office disagreed on whether or not the county could easily dispatch MST separately from law enforcement officers, according to the report.

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