SANTA CRUZ — In January, deputies answered 293 calls for “emotionally distressed people.” The total, which is rising steadily, is drastically higher than the days when Sheriff Jim Hart started patrols.

“When I started 30 years ago, we weren’t getting this many mental health calls” Hart told the volunteer-based Sheriff’s Advisory Team at a meeting last week. The team addresses Hart monthly to discuss central law-enforcement topics. Substance-use or behavioral health disorders and poverty — mostly relating to homelessness — dominate the concerns. Hart and a team of specially trained sergeants and lieutenants used the meeting to unveil a series of department initiatives and reported the extent of the daily dilemma among the ranks.

“That’s just in unincorporated Santa Cruz County. That’s not including the jail. That’s not including the (cities),” Hart said. “It’s a very contemporary issue we’re dealing with.”

He said drug and alcohol abuse are so interwoven with behavioral health cases, there is no easy distinction for deputies.

Are people self-medicating? Hart asked.

“Have they used so much substance that it’s created a mental health problem?” Hart asked. “Do they have “co-occurring” disorders? And on top of that, most of them are homeless. Sometimes, you have all three at once.”

Three decades ago, the sheriff’s office had a few behavioral health-related calls a week. Now, the agencies reports about 10 per day, Hart said.

“Much of what police work has turned into is social work,” Hart said.

There were 3,651 county 911 calls regarding emotionally distressed people in 2018. That total increased 217 cases from 2017, Chief Deputy Mitch Medina said during the team meeting last week.

Those calls reflect 407 involuntary psychiatric holds in 2018; about 34 calls per month, Medina said.

Not enough

Behavioral health services advocate Michael Fitzgerald said the dilemma was not originally a law-enforcement problem; it stems from a lack of incentives for California counties to use resources for behavioral health hospitalizations.

With only 16 inpatient psychiatric beds in Santa Cruz County, many residents at Santa Cruz County Behavioral Health Advisory Board meetings have decried the resource shortage that, they say, has not been clearly explained.

The advisory board meets monthly and submits recommendations to the Santa Cruz County Board of Supervisors and the county’s mental health director.

Director Erik Riera last year offered examples of declining revenues affecting a variety of services amid calls for an increase in beds for psychiatric holds. Among the shortfalls: declining revenues from the “millionaire’s tax” generated through the Mental Health Services Act, Riera has said.

The same explanation justified the expected closure of the peer-operated 2nd Story adult respite program at Estates Drive in Aptos. The program exhausted the original revenue supplied by Substance Abuse and Mental Health Services Administration, Riera has said. Private donors — with a gift to Community Foundation of Santa Cruz County — revived the home-based program in October.

Telecare, a contracted company, operates the Santa Cruz Psychiatric Facility on the 2000 block of Soquel Avenue. It is the only county-supported inpatient treatment facility for people enduring behavioral health problems.

Looking back

A 2011 publication by nonpartisan group, Insure the Uninsured Project, shows the evolution of California’s mental health system: from pre-1960s state institutions for severe cases to the California Realignment Act of 1991, which officially shifted responsibility to counties.

The Bronzan-McCorquodale Act, as the act was known, dedicated money for community mental health programs and bestowed counties considerable autonomy in managing the services, according to the 2011 publication.

“At the same time, realignment funding for mental health did not take into account prior inadequacy of mental health funding; it has not kept pace with population or cost of treatment growth and is vulnerable to economic recessions,” according to the 2011 publication. Even through the early 2000s, rising demand for services strained the system throughout the state.

Lack of incentives

And hospitalization has been considered a waste of money regarding behavioral health cases, Fitzgerald said. With alignment came a reluctance to hospitalize — a greater expense — than providing outpatient care, he said.

“They gave counties a pot of money and said manage those dollars and instead of hospitalizing people, build more crisis centers,” Fitzgerald said. “The incentive is to put mentally ill people in jail as opposed to hospital treatment.”

That leaves behavioral emergencies in the hands of law enforcement.

Santa Cruz County Jail is the default housing unit for many behavioral health cases, Hart has said. Meanwhile, the jail has undergone its own realignment, taking on an average of 70 inmates serving up to 12 years for low-level felonies. That has crowded the jail, too.

Mental illness accounts for roughly a third of the people booked at the local jail, Hart has said.

In response, deputies undergo training for crisis intervention, communications and tactics — especially calming techniques known as verbal judo.

“They have to be trained to understand the behaviors that are being displayed in front of them what those behaviors really mean,” Hart said.