Ellenberg and Manley: Mental health and substance abuse as a public health crisis
The Santa Clara County Main Jail, located at 150 W Hedding St. in San Jose is pictured in this file photo.

We’ve seen the headlines and news reports, the social media posts and countless podcasts. COVID-19 has shined light on the existing gaps in our systems that have left us all exposed. But for decades before coronavirus was part of our lexicon, these gaps began to manifest on our streets, in our schools, in our neighborhoods and in our homes.

According to this CalMatters piece, one out of every six Californians suffers from some form of mental illness—one out of 24 with such acuity that makes it nearly impossible to function independently, and “a third of adults who received county mental health services for serious mental illnesses had a co-occurring substance use disorder.”

Furthermore, about a third of our homeless population suffers from serious mental illness. In this state, and our nation, the largest psychiatric institutions aren’t even places of care—they are our jails and prisons, with nearly 30% of all those incarcerated receiving treatment.

And according to the National Institute for Mental Health, right here in Santa Clara County more than 50,000 of our 263,500 enrolled students may suffer from a mental illness—and less than half will receive treatment.

COVID-19 spread quickly throughout our community, and it was clear that leaving people without treatment or care was unacceptable, so major steps were taken to ensure this wouldn’t happen. Mental health and substance abuse are much slower moving, having decades to impact our communities, but an equally significant step must be taken to ensure the same results: not leaving people behind without care.

On Tuesday, Supervisor Susan Ellenberg, in partnership with Supervisor Otto Lee, will introduce a resolution to formally name mental health and substance abuse as a public health crisis as the first in what will likely be a series of major steps to get us to a resolution of this crisis.

The current crisis of people with untreated severe mental illness, and its intersections with the housing crisis, substance use and criminalization of mental health with jails as the provider of last resort, have been decades in the making and will require large-scale, innovative and coordinated responses across levels of government, the private sector, community organizations and residents to resolve.

To be clear, there have been herculean efforts across our county and state over the last several decades to solve for this. Judge Stephen Manley spent the better part of his 20+ year career with the creation of one of the nation’s first mental health courts, aimed at creating such partnerships to ensure that defendants in need of support received it outside of our jails.

In the last three years, Santa Clara County added a mobile crisis response team, a crisis stabilization unit, additional contracted treatment beds, embedded providers with law enforcement agencies, allcove youth wellness centers, expanded school-based behavioral health services and intensive outpatient treatment programs. Additional services like assisted outpatient treatment and a community-based mobile response team will be added early this year.

All these efforts, however, have been made as a patchwork of solutions and we must step back and look at the bigger picture—and address the gaps systemwide.

Our county still only has approximately 18 inpatient mental health beds per 100,000 residents, below both the state average of 21 per 100,000 and well below the recommended standard of 50 per 100,000 residents.

Access to drug withdrawal/detox services typically takes more than seven days for placement, and we hear countless stories of people not accommodated at the moment they’re ready to accept help, resulting in relapse and missed opportunities.

To add fuel to this firestorm, substantial workforce shortages exist today for behavioral health workers, especially in publicly funded systems, and forecasts indicate significant future shortages. By 2028, based on current service utilization patterns, California will have 41% fewer psychiatrists than needed.

This work will be hard. It will be expensive. And it will take time. But it is our moral imperative to respond to this crisis that has been at our doorsteps and in our homes for much longer than COVID-19 has existed.

Susan Ellenberg is a Santa Clara County supervisor and Stephen Manley is a county judge.

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