In Wake of Patient Death, ADMHS Proposes Pilot Treatment Program for Mentally Ill
In April, Cliff Detty, 47, of Santa Maria, died after spending hours in a restraint that held his limbs and torso down inside the county Psychiatric Health Facility in Santa Barbara. The younger Detty had struggled with paranoid schizophrenia for nearly a decade, and was homeless much of the time, or in jail.
The meeting was also the first time Rich Detty has been able to talk with mental health officials about what happened to his son, and to express his frustration with their inaction. Santa Barbara County Sheriff’s Department officials still haven’t given Detty an official cause of death, and no one has told him exactly how his son died.
Since Cliff Detty’s plight was uncovered, discussion has been under way about how to reform existing law and better serve patients and their families. Under current law, patients must present a danger to themselves or others, or be deemed gravely disabled, to be taken in for emergency treatment involuntarily. It was under such circumstances that Rich Detty was repeatedly denied the mental health assistance he sought for Cliff, who would have had to come in on his own terms to receive it.
But California counties can opt in to a provision called Laura’s Law that would require outpatient treatment for people who are unable — or won’t — access mental health services voluntarily. Any adult with whom the person resides, as well as a set of other qualified people, can petition the local Superior Court for treatment for the person with mental illness. The county mental health director then must conduct an investigation to determine whether the person qualifies, and if so, the person is placed in a six-month outpatient treatment program. Patients remain in the community and receive treatment, with less disruption to their lives than being locked away in a facility, according to advocates.
The commission discussed Laura’s Law at its October meeting, and directed ADMHS to examine the law and possible alternatives. This isn’t Santa Barbara County’s first brush with Laura’s Law. In 2003, a study group was formed to look at the issue, but recommended that the county not participate because of the cost.
Fifth District Supervisor Joe Centeno was at Friday’s meeting, and was a member of the Board of Supervisors in 2003 when the study group made its recommendation. Dismissing Laura’s Law without an alternative was a “terrible mistake,” he told commissioners and staff.
With the new pilot project, patients would be brought into the already existing Assertive Community Treatment program, which reaches out to people with mental illness who haven’t been treated traditionally, like those on the streets. But the program that ADMHS is proposing would bring in just 10 people, only five of whom would meet Laura’s Law criteria. The other five patients wouldn’t qualify, but might be withdrawing, said ADMHS medical director Edwin Feliciano. Further, the pilot program leaves out what’s possibly the most crucial component of Laura’s Law: there would be no court involvement in the plan the department is proposing.
Because the program lacks the teeth of Laura’s Law, in terms of enforcement, it raised concern among several commissioners, including Ann Eldridge.
“I’m very concerned about people who have very poor insight about what their needs are,” she said.
People who are in denial about the fact that they need treatment are a concern, said Eldridge, who added that she hopes the ACT team can break through that obstacle.
The small percentage of people with mental illness who don’t seek treatment perpetuate the stigma of the illness, Eldridge said. In the past, she added, her own son had only sought treatment while he was on probation and ordered to be treated.
“A lot of people with schizophrenia have their insight totally skewed,” she said.
Of the program, Eldridge cast a wary eye.
“I’m going to be looking at it very carefully,” she said.
Responding to Eldridge’s concern about the lack of court oversight in the pilot project, Feliciano said the county already promotes a conservatorship program. But some argue that the conservatorship process is more intrusive than the role of the court within Laura’s Law. A person must be a danger to himself or others to qualify for conservatorship, excluding many people from treatment. Still, the ADMHS is hesitant to employ the law.
“Engaging consumers in a voluntary situation is very important to us,” Feliciano said.
Eldridge and fellow Commissioners Jim Rhodes and Jan Winter offered to be a part of the subcommittee to oversee the pilot program, which would begin in Santa Barbara and then expand countywide.
After initially talking about the pilot program, commissioners then spent the next three laborious hours going through other items, mundanely congratulating program directors for a job well done before allowing Rich Detty to speak during public comment. Detty eloquently recounted his story, about seeking out help from law enforcement and mental health officials, and repeatedly hearing that no one could give him information because Cliff was an adult. Detty was never informed about his son’s official diagnosis, and Santa Maria police even told Detty that he needed to use “tough love” on him.
It would never be enough for Cliff Detty, however, and it ultimately led to his death.
“Tough love doesn’t work on someone who is mentally ill,” said Detty, garnering nods of agreement from those on the commission.
The difficulty of getting help as a parent of a child with mental illness is a glaring shortcoming of Santa Barbara County’s system, and Detty suggested the need for more education to be offered to parents, for example, when their adult children are released from jail.
The idea seemed to resonate with commissioners, and staff.
“I could see this leading to a wider educational effort,” Feliciano said.
» Click here for the first story in Noozhawk’s series on the Cliff Detty case: While Son Struggled with Mental Illness, Father Fought His Own Battle
» Click here for the second story in Noozhawk’s series: Seclusion, Restraints and Screams Marked Man’s Final Hours at Psychiatric Unit
» Click here for the third story in Noozhawk’s series: Seclusion and Restraint Practice Poses Risks, Prompts Questions
» Click here for a related commentary: Brian Stettin: Laura’s Law Might Have Saved Cliff Detty
» Click here for a Noozhawk slide show.
» Click here for mental health care resources that are available 24 hours a day.
— Noozhawk staff writer Lara Cooper can be reached at email@example.com. Follow Noozhawk on Twitter: @noozhawk or @NoozhawkNews. Become a fan of Noozhawk on Facebook.