To the Editor:
“Nowhere to Go: The Tragic Odyssey of the Homeless Mentally Ill” by E. Fuller Torrey MD offers a comprehensive look at the essential components of a mental health system. We can see how Mendocino County measures up to his 9-part plan. Something startling for us to think about is our two new facilities – a 90-bed Mental Health Wing of the Jail (opens 2026) and a 16-bed Psychiatric Health Facility (opens 2025). We can also think about how to expand mental health supports, within the limited resources, perhaps with more education about mental illness in community forums and the schools.
E. Fuller Torrey MD is a clinical and research psychiatrist specializing in schizophrenia and bipolar disorder. He has authored or co-authored 21 books. This book is offered free in a downloadable pdf and is well worth your read, even if you only read the Prologue and Epilogue. There is also a lot more detail on his excellent 9-Part Plan to fix the mental illness treatment system.
link.springer.com/book/10.1007/978-3-031-84685-4
I am looking at how Mendocino County measures up after following this topic closely since 1992 when I was appointed as a “Family Member” to the County Mental Health Board by the 5th District Supervisor. I have provided mental health trainings to the County and four communities, held leadership positions in Mendocino County’s NAMI (National Alliance on Mental Illness), am author of Advocating for Someone with a Mental Illness, and teach Healthy Living classes on the Coast to some Redwood Community Services (RCS) clients.
Mendocino County provided all mental health services until the non-profit organization Redwood Community Services (RCS) started providing mental health services to children and their families in 2002. From 2013 to 2016, the County hired a private-for-profit medical corporation to provide adult services. In 2016, RCS began providing adult mental health services in addition to children’s mental health services.
RCS offers specialized therapeutic and behavioral services to youth, adults, and families across the lifespan. Clinicians use evidence-based practices in their treatment modalities, including Trauma-Informed Therapy, Cognitive Behavioral Therapy, and Motivational Interviewing, among others. Clinical services are fully integrated with RCS residential treatment, emergency shelter, and crisis care services. RCS provides a comprehensive range of community-based services to address substance use treatment, prevention, counseling, and recovery.
RCS provides 24/7 crisis intervention services to everyone, regardless of insurance. This includes emergency mental health, evaluation, assessments, intervention, aftercare and follow-up services.
9-Part Plan to Fix the U.S. Mental Health Treatment System, E. Fuller Torrey MD
1. A Sufficient Number of Public Psychiatric Beds – The Mendocino County 16-bed PHF is scheduled to open in 2025. Dr. Torrey writes about the model recovery treatment program at Indiana State Psychiatric Hospital that includes integration of Trauma-Informed Care. This is a patient-centered model of care that combines conventional psychiatric treatments with evidence-based therapies to promote whole person healing and long-term wellbeing. Their foundational model treats the: physical, emotional, spiritual and mental bodies with classes such as yoga, sound healing, Reiki, light therapy and neurofeedback. Mendocino County could study and incorporate as much as possible of the successful program at Indiana State Psychiatric Hospital.
Redwood Community Services (RCS) operates Crisis Residential Treatment facilities on the coast and inland to provide early intervention crisis support that is an alternative to hospitalization, when that is possible. This includes whole person healing.
2. The Availability of Evidence-Based Psychiatric Treatment – Mendocino County does provide evidence-based state of the art treatment from Anchor Health Management (AHM) that includes the use of clozapine as well as long-acting injectable antipsychotics. AHM uses a team-based approach anchored in strong collaborative local partnerships
3. Provision for Involuntary Treatment – Mendocino County provides this to reduce: rehospitalizations, arrests, homelessness, drug use, violent behavior and suicidal thoughts. Some patients with severe mental illness have damage to the parts of the brain that we use to think about ourselves, and are unable to understand that they are sick – a condition called anosognosia which is biological in origin. The denial of illness is psychological in origin. Some of these individuals refuse to take medication to control their psychotic symptoms. They may be treated involuntarily to protect them and/or the community. This requires a court order and Assisted Outpatient Treatment.
4. Continuity of Care and Caregivers – Dr. Torrey says Assertive Community Treatment (ACT) teams are one of the most important treatment elements. Our Mendocino County version of ACT with RCS and AHM includes: a Psychiatric Medical Provider, Counselor, Case Manager, Crisis Support with a 24/7 Crisis Line (855-838-0404), and short-term residential support. Dr. Torrey says the “disordered funding system involving Medicaid and other federal funds is a problem.”
5. Housing, Rehabilitation, and the Clubhouse Model – People need access to decent housing, social opportunities, and vocational opportunities. Fort Bragg and Ukiah have successfully provided some housing but more low-income housing with supportive services is needed. We also need more support groups for clients and family member/friends, and opportunities for people to find a meaningful role in life.
6. Jail Diversion Programs – The Mendocino County Sheriff’s Office has a Crisis Response Unit (CRU) that collaborates with Redwood Community Services and Mendocino County Behavioral Health & Recovery Services to provide comprehensive crisis response services.
Fort Bragg Police Department has a Crisis Response Unit (CRU) team that is designed to: reduce recidivism, improve mental health and substance use treatment, and enhance community safety. Police Chief Neil Cervenka says, “The CRU team work has cut homeless arrests in Fort Bragg by 47% and the biggest problem is finding long-term, sustainable funding.”
Some County and city law enforcement officers have had the excellent Crisis Intervention Training (CIT). Judges can order evaluation and treatment under our Assisted Outpatient Treatment (AOT) program. Non-compliance can mean jail time.
The Mendocino County Sheriff’s Office is building a 90-bed Mental Health Wing to the Jail scheduled to open in early 2026.
7. Protection of the Vulnerable – Many individuals with severe mental illness, especially women, are vulnerable to abuse and victimization because of their mental disorder. RCS collaborates with homeless shelters and others to provide treatment. The continuity in these sometimes long-term relationships is important.
8. Prioritization of the Target Population – Some people are repeatedly hospitalized and incarcerated. Some of their common characteristics are: violence, concurrent substance abuse, anosognosia with medication noncompliance, antisocial personality traits, paranoid symptoms, neurological impairment, and male gender. RCS, law enforcement CRUs and others collaborate to help people in this situation.
9. Single-Source Funding and Accountability – Federal Medicaid can be used to support the hospitalization of a mentally ill person in the psychiatric ward of a general hospital but not in a state hospital. Most general hospitals are not staffed to provide adequate care for people with severe mental illness. Dr. Torrey says the fix for this is to return the funding and accountability to the states using block grants. Large states may choose to shift the funding and accountability to the county level.
Mendocino County Mental Health Services are available inland and on the coast. There are good websites that provide information about entry to the locally available mental health services for Redwood Community Services, Mendocino County Behavioral Health and Recovery Services, and the federally funded Health Clinics.
For family member/friend support, there are helpful local, state and national websites for NAMI (National Alliance on Mental Illness).
-Sonya Nesch, Ukiah
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