Chumash National Marine Sanctuary Rejected by NOAA… For Now

‘We will look at this situation as a temporary setback for them and continue educating the public as to the many problems associated with a National Sanctuary system,” said Jeremiah O’Brien of the MBCFO. ‘We will be interested in the content of the new proposal as the rejection letter described many of its deficiencies in the area of management, which is the area that has many of us here on the Central Coast concerned.’

In a March 6 letter to Fred Collins of the Northern Chumash Tribal Council, promoters of a proposed, new Chumash Heritage National Marine Sanctuary off the Central Coast, Daniel Basta, Director of of the Office of National Marine Sanctuaries, stated: “The nomination, as submitted, is not sufficient to more forward with a more detailed review.”

Mr. Collins submitted the nomination seeking national sanctuary status for the Chumash Marine Sanctuary on February 2.

While the proposal in no longer currently eligible of review, Mr. Basta suggests in his letter that Mr. Collins could resubmit his nomination after responding adequately to all the information, national significance criteria and management considerations required by NOAA to move forward.

Responding to the announcement, Jeremiah O’Brien, Director of the Morro Bay Commercial Fishermen’s Organization, said: “It appears the reasons [for rejecting the nomination] were lack of information and incomplete data on the application. The letter of rejection seems to encourage them to resubmit their proposal.

“Many of us have been trying to educate the public as to why it is not a good idea to turn over our ocean and beaches to federal control,” Mr. O’Brien told The ROCK. “We, therefore, will look at this situation as a temporary setback for them and continue educating the public as to the many problems associated with a National Sanctuary system. We will be interested in the content of the new proposal as the rejection letter described many of its deficiencies in the area of management. This is the area that has many of us here on the Central Coast concerned.”

Concluded Mr. O’Brien, “Losing or giving up control of our resources to federal management would be a shame. We believe our community is the best manager and steward or our coast, and our past performance speaks for itself.  We only have to walk outside our door, take a deep breath, look around, and realize we have done well, and we will continue that tradition on our own.”

The Chumash Sanctuary proposal is supported by the Santa Lucia chapter of the Sierra Club and District 2 Supervisor Bruce Gibson.

For more background on the debate surrounding the Chumash Sanctuary, read The ROCK:
http://www.rockofthecoast.com/2014/07/15/chumash-marine-sanctuary-sailing-for-noaa-nomination-without-fishermen-on-board/

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For more information on NOAA and the sanctuary nomination process, visit: website: http://www.nominate.noaa.gov/nominations/

Morro Bay Surfboard Art Festival Makes Colorful, Creative Waves in November

The First Annual Surfboard Art Festival, organized and promoted by Morro Bay in Bloom, a volunteer-based 501 c(3) organization dedicated to the enhancement of public life in Morro Bay, runs through November with a month-long exhibition and gala-auction finale.

Surfboard-Art1The First Annual Surfboard Art Festival, organized  and promoted by Morro Bay in Bloom, a volunteer-based 501 c(3) organization dedicated to the enhancement of public life in Morro Bay, runs through November with a month-long exhibition and gala-auction finale.

The festival will spotlight 30 pieces of surfboard art, which will be displayed at public locations throughout Morro Bay during November, leading up to an auction of the art on Nov. 29 at the Inn at Morro Bay. Proceeds of the auction will be split between the artists, Project Surf Camp and Morro Bay in Bloom.

The festival features the works of renowned local artists and community groups such as the fifth-grade class of Del Mar Elementary School, three classes of students at Los Osos Middle School, and senior residents of Bayside Care Center and Casa de Flores.

Project Surf Camp, one of the beneficiaries of the auction, is a charitable organization designed to educate individuals with special needs. It uses the beach and surf as a context for helping people with special needs to build self-confidence.

The art pieces will be auctioned on Saturday, Nov. 29, at the Inn at Morro Bay from 2 p.m. until 5 p.m., with a VIP preview starting at 1 p.m.

Morro Bay in Bloom (MBIB) is a wholly volunteer 501 c (3) organization whose members are residents of Morro Bay. Approximately 50 members help to restore and maintain public spaces as part of the city’s “Adopt-a-Park” program, among other projects such as the Surfboard Art Festival. MBIB is an affiliate of the national America in Bloom (AIB) program, which sends expert judges to the city annually year to evaluate progress against standard nationwide criteria. The judges’ report constitutes a consulting report on the progress and opportunities of the city.

For more details visit www.morrobayinbloom.org.
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Catch of the Day: Morro Bay Public Fish Market Opens in November

Come and get ‘em fresh off the boat at a savings – salmon, tuna, rockfish, lingcod, crab – when the Morro Bay Public Fish Market debuts in November in Tidelands Park.

crabsCome and get ‘em fresh off the boat at a savings – salmon, tuna, rockfish, lingcod, crab – when the Morro Bay Public Fish Market debuts in November in Tidelands Park. In a move that could boost tourism and attract fresh-fish-seeking locals, the Morro Bay City Council voted unanimously on August 26 to allow direct-to-the-public, ‘off-the-boat’ fish sales in Morro Bay. The council approved at one-year trail period for the venture. After one year, if the market is deemed successful, it will be continued indefinitely. Modeled after the successful local farmer markets, the fish market will provide a centralized location at Tidelands Park, with its side-tie boat docking, public parking and pedestrian access. According the August 26 city council staff report, “There is potential indirect positive fiscal impact by way of an economically healthier commercial fishing fleet.” Fishermen have been selling fish from their boat slips. The “Fishline” seafood mobile app will be part of an internet-based campaign to spread word of the market and specials to fresh-fish fin-atics. The city hopes the one-stop fish market will help publicize Morro Bay’s “working waterfront, sustainable fishing industry and rich estuarine setting,” and bring more visitors to the bay. Day and time of the first market have yet to be announced. More details should become available later this month.

Chumash Marine Sanctuary Sailing for NOAA Nomination – Without Fishermen on Board

Ironically, the fate of the proposed Chumash Heritage National Marine Sanctuary off the Central Coast may well be decided fishermen to fishermen—the heirs of ancient Chumash fishermen that once ruled the ocean versus the working fishermen and harbors of today—and their ability to untangle crossed lines, repair burned bridges and guarantee local control.

Chumash Marine Sanctuary

By ED OCHS

For more than two decades, creating a Central Coast National Marine Sanctuary has been a major goal of environmentalists seeking to fill the gap between the southern end of the Monterey Bay National Marine Sanctuary at Cambria and the northern end of the Channel Islands National Marine Sanctuary at Santa Barbara.

Now, ironically, the fate of the proposed Chumash Heritage National Marine Sanctuary off the Central Coast may well be decided fishermen to fishermen—the heirs of ancient Chumash fishermen that once ruled the bays versus the working fishermen and harbors of today—and their ability to untangle crossed lines, repair burned bridges and guarantee local control.

A well-organized grassroots campaign led by the Santa Lucia Chapter of the Sierra Club, the San Luis Obispo Chapter of the Surfrider Foundation and their other partners and participants in the Marine Sanctuary Alliance to establish a marine sanctuary between the Channel Islands and Monterey Bay National Marine Sanctuaries has propelled their proposal toward nomination for possible future designation as a national sanctuary by the National Oceanic and Atmospheric Administration (NOAA).

At the same time, regulation-weary Morro Bay fishermen have decided not to support the proposed Chumash Heritage National Marine Sanctuary, even though sanctuary proponents seek no additional regulations on fishing. As a result, though, lack of support by the local fishing community, which has a long and bitter history with the Monterey Bay Sanctuary designation process, could prove to be a critical factor in determining whether the sanctuary is accepted for nomination and seriously considered for future designation.

“We don’t feel another layer of government restrictions in any form is necessary,” Tom Hafer, president of the Morro Bay Commercial Fishermen’s Organization (MBCFO) told The ROCK. “The fishermen of Morro Bay and Avila do not want or need or are in favor of any new sanctuary in the area.”

There have been several unsuccessful efforts over the years to establish a marine sanctuary off the Central Coast by extending the Monterey Bay Sanctuary southward, the Channel Islands Sanctuary northward, or creating of an entirely new, separate sanctuary in the middle that basically connects the two.

Obviously it’s not as simple as it sounds or it would have happened decades ago. Why hasn’t time changed minds? Because, as appealing it may sound to some, as easy as it is for ocean sentinels to embrace, the idea of extending the sanctuaries to the Central Coast belies a host of legal and governmental complications and complexities that threaten to make the journey of the Chumash sanctuary though the NOAA nominating process a stormy passage.

‘The Promise’

When the Monterey Bay Sanctuary (MBNMS) was up for designation in 1992, talks were going on locally and nationally whether to designate it or not. At the time, there was overwhelming opposition to it by the communities of Monterey and Santa Cruz and the commercial fishermen and their organizations, along with those that relied on commercial fishing—unless the sanctuary was going to stay out of the business of fishery management.

Whenever the Monterey Bay Sanctuary designation history is mentioned, based on their years of hard experience, fishermen refer to “The Promise.”

“We were once told by [then-Congressmen] Leon Panetta that there would be no new regulations by the establishment of the MBMS,” said MBCFO director Mark Tognazinni, “but history became an agreed-upon fable and promises have and always will be broken when it comes to sanctuaries.

“So what is the real purpose of this purpose of this proposal? How does it really benefit the Chumash? It is as if there is a need to make the entire ocean some kind of MPA. Just follow the money. It always leads to the truth,” said Tognazinni. “With one exception fishing is NOT ‘unregulated,’ and at least for my 45 years on the ocean, fishing is one of the most heavily regulated businesses in the country.”

When the Monterey Bay Sanctuary was designated, a fairly unanimous consensus was sought amongst all the stakeholders. The fishermen and community where brought on board with “the promise” that the Monterey Bay Sanctuary would not get involved in fishery management or fishery regulation.

MBCFO director Tom Roff has written extensively about fishermen, “the promise” and its impact on creating a new Central Coast sanctuary, on Morro Bay news site SLO Coast Journal, in rebuttal to sanctuary proponents. Wrote Roff in his May 2012 essay, “Bait and Switch? Fishermen’s Difficult Relationship With the Monterey Sanctuary”:

“With new efforts being made by some community members to gather support for an expanded Monterey Sanctuary (MBNMS), or a new ‘central coast sanctuary,’ claims have been heard that the MBNMS has never broken the well-remembered promise made to us fishermen that it would not create regulations that affect us, or otherwise threaten our livelihoods. Central coast fishermen have always wanted a mutually trusting and respectful relationship with the MBNMS, but we have so far been disappointed.

“Has the sanctuary kept this promise over the past 20 years? Most fishermen think that it has not. In recent times high level MBNMS officials have suggested, at public meetings, that fishermen were somehow ‘confused’ by what they heard in the early ’90s. This makes us wonder if NOAA always intended to try and get around the agreement, as soon as the sanctuary was created. Sanctuary officials have also repeatedly claimed that they have never created a fishing regulation, or otherwise harmed the fishing community. Incredibly, this is said during the same time period that the MBNMS called for additional MPAs—fishing closures.

“Fishermen from the west coast and in other parts of the nation have observed what has unfolded with the Monterey Sanctuary’s relationship with the fishing community. It is safe to say that nearly 100% are extremely suspicious and resistive of sanctuary designations for their areas because of these factors. The MBNMS is widely seen as an agency that either doesn’t base its decisions on science, or cherry-picks the science, has significant issues in its public processes, and has broken its promise made to us, in the spirit it was made.”

“The bottom line,” Roff told The ROCK, “is the sanctuary director can change and so do the priorities.”

“Historically, over the years,” said Morro Bay Harbor Director Eric Endersby, “the (Monterey Bay) sanctuary superintendents, and there have been a few of them, have dabbled in fishery management as much as they can and tried to establish marine protected areas and fishery restrictions, and basically, in the words of the fishermen, break the promise.

“The big fear we have as a community and as a fishing community is the affect on commercial fishermen,” Endersby said. “The commercial fishermen are so highly regulated, we are the most regulated fishery pretty much on the planet, with marine protected areas and all the seasons and closed areas, lots of layers of protection both by the state out to three miles, and by the federal government through its regional fishery management councils.”

The other part of ‘the promise,’ according to Endersby, was that the harbors would have a “carve-out,” and wouldn’t be considered in the sanctuary because of industrial activity such as dredging and disposal going on within sanctuary waters “that’s not necessarily in tune with what the sanctuary’s protections typically are. … The sanctuary has historically been another relatively difficult hurdle to get over during the planning and permitting processes, so it’s been a rocky relationship with the sanctuary governance up there and the local fishermen and communities.

“Unfortunately, it’s kind of poisoned the sanctuary waters here on the west coast, and one of the reasons why our fishermen down here in our community have historically stood up so adamantly against sanctuary designations in our waters because we saw the sort of promise getting broken or getting stretched or ignored up north, and basically we didn’t trust the sanctuary governance to keep its promise.”

Fred Collins, tribal administrator of the Northern Chumash Tribal Council based in San Luis Obispo, met with Hafer, MDCFO director Jeremiah O’Brien and Endersby earlier this year about the Chumash Heritage Sanctuary. To gain their support, Collins proposed that the fishers and harbors protect their interests by writing their own parts in the sanctuary bylaws, but it remains unclear, said Enderby, whether that could “functionally” be done under sanctuary designation and the National Marine Sanctuaries Act.

“Fred Collins and his group seem to think absolutely it can. I just don’t know. I haven’t been deep enough into it,” said Endersby. “From what I understand of it, the designation documents can’t be contrary to the National Marine Sanctuary Act. Whether you can write in ‘the sanctuary shalt not ever do fishery regulation’ or not is (unknown) and that’s the concern, and that’s where the fishermen were looking for an answer, so to speak, and us as a community as well, as a harbor.

“Can the designation documents be crafted in such a way that the harbors remain an isolated entity, that (we maintain) our normal activities like boating and everything we do in the water that may be somewhat in conflict with the national marine sanctuary goals, which is basically trying to keep certain industrial and other uses out of the ocean waters and the ecosystem, that may be in conflict with the act?

“Short of some sort of legal ruling and really exploring what it would mean and how that could be done, it’s tough to say whether Fred’s vision of a sanctuary could occur in the way he thinks it can and we would hope it would be.”

Seismic Testing

In September 2012, in a rare partnership of odd bedfellows, fishermen, environmentalists and concerned individuals joined forces to form C.O.A.S.T.—Citizens Opposed to Acoustic Seismic Testing. Fishermen and environmentalists don’t usually sit at the same table, but stopping seismic testing brought all sides together under one umbrella. The grassroots effort paid off.

In November 2012, the California Coastal Commission denied energy giant PG&E a permit to conduct high-energy seismic surveys off the Central Coast to detail earthquake fault lines around the Diablo Canyon Nuclear Power Facility in Avila Beach. Perhaps the most compelling argument against permitting—openly acknowledged by a majority of the Commissioners—came from Fred Collins, who eloquently educated them on Chumash heritage on and off the Central Coast and Native-American rights.

With PG&E in retreat, the essential C.O.A.S.T. Alliance of fishermen and environmentalists broke up, but the remaining members continued to oppose acoustic seismic testing, high or so-called low energy. Concerned that PG&E or some major energy entity might attempt a return to local waters, they coalesced around the Chumash Heritage National Marine Sanctuary, which bans seismic testing and energy exploration including fracking.

“This whole thing started with the threat of high-intensity seismic testing by PG&E,” said MBCFO’s Hafer. “This got the Chumash Indians very involved with protecting the coastline.

“However, prior to this threat we have had several years of protections put in place including the marine protected areas of which we have 27 just on the Central Coast, as well as the rock cod conservation areas, the essential fish habitat on top of draconian quotas, trip limits and catch shares that the Chumash were minimally engaged in.”

Said Endersby: “It became pretty evident that sanctuary designation is a great tool to quickly address those bigger, sort of non-fishing threats, but there’s always the fishing in the background, and the way the Monterey Sanctuary has acted over the decades, they’ve basically burned all the bridges with the fisherman, to a degree with the communities, and the trust that they won’t get into fishery regulation, because they’ve tried and tried and tried, and it’s unfortunate that the trust bridge has been burned.”

“What happens when we try to put a boat yard in or try to get dredging in the harbor?” asked Hafer. “Anything will need permission from yet another unnecessary government entity. There is more to having a sanctuary in the area than just the worry of more fishing restrictions.”

Since the National Marine Sanctuaries Act is by definition a national act, the Chumash Heritage National Sanctuary would be federally, not locally, controlled.
“Making the leap from federal control to local control,” questioned Endersby, “I don’t know how that would functionally work.”

A Work in Progress

The nominations are now open for the federal government to consider new sanctuaries, and it’s nationwide. There are months to go in NOAA’s nominating and review process and several years to go before sanctuary designation. There are nominating criteria and considerations that have to be met, and only a very limited number of those sanctuaries nominated get designated.

The proposed Chumash Heritage Sanctuary includes submerged sacred Chumash sites between 10,000 to 20,000 years old extending from six to 13 miles offshore, as well as contiguous onshore coastal sites such as villages, religious grounds and solstice alignments. Within the sanctuary are whale and dolphin feeding and gathering areas, three major upwellings, a 10,000-foot-deep submarine canyon, prime California sea otter habitat, a plethora of pinnipeds, a rich diversity and density of fish, seabirds and mammals, and timeworn migration lanes. No seismic testing allowed. No oil or gas drilling allowed. And according to Chumash Sanctuary literature: “No regulation of harbors, or recreational or commercial fishing.”

“The way Fred terms it, the Chumash are the original commercial fishermen and, yeah, they were, looking at it in that sense—it’s an interesting way of looking at it. So they have a stake in preserving things, too, in not affecting their brothers and sisters that are out doing it for a living. Definitely the intentions with Fred and his group are good. Whether the concerns of the fishermen and the community can get alleviated or spoken to through the process, I don’t have the answer to that.”

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Map by Karl Kempton

Obama Proposes Bold Expansion of Pacific Ocean Marine Sanctuaries

On June 17 President Obama announced that, by executive order, he intends to make a vast stretch of the Pacific Ocean the world’s largest marine sanctuary.

Launching a broad campaign to address significant maritime issues such as overfishing and pollution, on June 17 President Obama announced that, by executive order, he intends to make a vast stretch of the Pacific Ocean the world’s largest marine sanctuary—off limits to fishing, energy exploration and other activities. The administration also plans to create a mechanism to allow the public to nominate new marine sanctuaries off U.S. coasts.

The proposal, which will take effect later this year, calls for the Pacific Remote Islands Marine National Monument to expand from about 87,000 square miles to almost 782,000 square miles. The designated ocean area encompasses a remote, uninhabited region adjacent to islands and atolls controlled by the U.S. and extends up to 200 nautical miles offshore from these territories.

The proposal faces the objection of the U.S. tuna fleet that operates in the region. Up to 3% of the annual U.S. tuna catch is caught in the western and central Pacific. When the Pacific Remote Islands Marine National Monument was created by President George W. Bush in 2009, sport fishing was exempted to counter industry opposition. If the protected area expands, recreational fishing interests will probably seek to retain the existing exemption to avoid setting a precedent, even though sport fishing activity in the expanse is scarce.

A public comment period this summer will provide the Departments of Commerce and Interior with up-to-date information on the level of commercial activity in the area and make any necessary modifications.

The potential expanded area would include a five-fold increase in the number of protected underwater mountains, halt tuna fishing, and shelter dozens of species of marine mammals, endangered sea turtles, as well as a variety of sharks and other predatory species, and protect some of the world’s most pristine and biologically rich marine ecosystems.

As part of the administration’s increased focus on maritime issues, the President will also direct federal agencies to develop a comprehensive program to fight seafood fraud and the worldwide black-market fish trade, and review of steps the U.S. can take to stop illegal fishing, which does untold damage to marine ecosystems and to coastal nations around the world.

Obama has also been advised to consider expanding the borders of the monuments Bush created in the Northwestern Hawaiian Islands and the Marianas Trench.

Other countries are also creating marine reserves. The British government is moving to protect the area around the Pitcairn Islands in the Pacific, and the small Pacific island of Kiribati plans to close an area roughly the size of California to commercial fishing by year’s end.

“The President’s proposed action is a huge step forward for the ocean,” said Frances Beinecke, President of the Natural Resources Defense Council (NRDC). “Expanding these protections will provide a safe haven for coral gardens, seamounts, and the rich waters that support hundreds of species of fish, sea turtles, giant clams, dolphins, whales and sharks, conserving them for future generations. This represents a commitment to the kind of bold action needed to restore the failing health of our ocean, on which we all depend, and continues the bipartisan tradition of ocean protection. We hope it sets the stage for taking similar action to protect key areas of our ocean around the U.S. and the world.”

 

Obamacare Wrinkle: Bill Seeks to Reduce State's Seizure of Medi-Cal Recipients' Assets

California politicians and federal bureaucrats are scrambling to iron out an unexpected wrinkle in the nation’s health care law that is forcing many Americans to choose between health coverage and depriving heirs of much of their inheritance.

By TRACY SEIPEL

California politicians and federal bureaucrats are scrambling to iron out an unexpected wrinkle in the nation’s health care law that is forcing many Americans to choose between health coverage and depriving heirs of much of their inheritance.

California is one of 10 states that recover a broad array of costs from recipients of Medicaid, the health program for the poor that is called Medi-Cal in California. The policy applies to recipients 55 and older — and only after they die.

The seizure of assets has been going on for years but has suddenly become a heated issue since millions of low-income American adults began enrolling in the expanded Medicaid program created by the Affordable Care Act, commonly known as “Obamacare.”

A bill in the California Legislature is aimed at reducing the amount of assets that can be “recovered” from recipients’ estates. But the proposal faces resistance from the administration of Gov. Jerry Brown, which says the state needs the millions of dollars it collects every year to help fund Medi-Cal.

The federal government, concerned that the issue is deterring many from signing up for Medicaid, is essentially telling states to back off and stop trying to recover much of the money.

In contrast to traditional Medicaid beneficiaries — low-income parents, children, seniors and people with disabilities — the new group includes adults without minor children. Many of them are homeowners who have been laid off or are unemployed and are now getting by on dwindling savings. They are eligible for Medicaid if they earn up to 138% of the federal poverty level, which in 2013 was $15,856 for an individual or $21,403 for a couple.

One of the Medi-Cal recipients is Campbell resident Anne-Louise Vernon, 59. She contends that California’s aggressive cost-recovery program is unjust because people whose higher income levels allow them to get subsidized private health insurance through the new Obamacare health care exchanges don’t have to pay back anything.

Vernon said she requires constant medical care because of severe nerve damage in her arms and arthritis in her legs –conditions that have prevented her from finding a job. The divorced mother of two said her home is her only real asset.

Medi-Cal, she said, has now essentially imposed a “reverse mortgage” on her home in exchange for health insurance.

“What is fair about that?” asked Vernon.

When Medicaid was signed into law by President Lyndon Johnson in 1965, “asset recovery” was optional. In 1993, however, the federal government began requiring all states to recoup the expenses of long-term care for Medicaid recipients ages 55 or older. States were given the option to recover all other Medicaid costs for those recipients — and California jumped at the chance.

State finance and health officials this week declined to comment on the pending legislation. But in the past, they have insisted that the provision doesn’t affect the vast majority of Medi-Cal beneficiaries — and noted that the average recovery amount is about $15,000.

Still, Vernon and Richmond resident Chris Darling, 62, who also enrolled in the expanded Medi-Cal program, worry that their future medical costs will eat up their estates. Darling even started an online petition on MoveOn.org to fight the state’s asset grab.

“It strikes me as horrible to have to choose between having health protection and your estate,” said Darling, who called the situation “Orwellian.”

Now, Darling and Vernon are pinning their hopes on both state and federal efforts to curtail asset recovery efforts.

On Tuesday, a state Assembly health committee will take up proposed legislation that would limit Medi-Cal recovery only to what’s required under federal law: the cost of long-term care in nursing homes.

Authored by state Sen. Ed Hernandez, D-West Covina, SB 1124 has already sailed through two Senate committees.

Should it pass Tuesday and then get the blessing of the Assembly appropriations committee in mid-August, it would be voted on by the Legislature by the end of August. Brown would have until the end of September to decide whether to sign it.

“I don’t know of any other program that demands repayment after a recipient dies,” said Hernandez, who chairs the Senate’s health committee. “We don’t do it for Medicare. We don’t do it for people getting coverage through the (Covered California health care) exchange, and most other states don’t require estate recovery. People are really frightened about this policy.”

In a Feb. 21 memo, the federal Centers for Medicare & Medicaid advised states to eliminate recovery of Medicaid benefits beyond long-term care services for the newest group of low-income adults Medicaid recipients, whose health care costs are being paid 100% by the federal government. That will be reduced to 90% in 2020.

Oregon and Washington have already eased off on their recovery efforts. Brown’s budget advisers, however, are urging him to oppose Hernandez’s legislation. An analysis by the state’s finance department says California would lose $15 million annually.

A Brown spokesman said the state won’t exempt the newest recipients from asset recovery because California has to prepare to cover the 10% of their Medi-Cal costs that the federal government won’t be picking up.

On average, the state in the last decade has collected about $60 million annually from Medi-Cal recipients’ estates. Half of that is returned to the U.S. Treasury because Medicaid is funded equally by the federal government and the states.

Considering that the state now spends more than $26 billion a year on Medi-Cal, Hernandez argues that $15 million is a negligible loss.

“I take my fiduciary responsibility to the state very seriously,” Hernandez said, but that’s “not a lot to spend to do away with a practice that unnecessarily scares needy people out of getting themselves covered.”

WHAT THE BILL WOULD DO

Limit seizure of assets of Medi-Cal recipients age 55 and older to amount spent on long-term care in nursing homes.

Eliminate asset seizure from estates of surviving spouses of deceased Medi-Cal recipients.

Require the state to provide Medi-Cal recipients, at no charge, a list of Medi-Cal expenses subject to “recovery.”

(Source: Office of State Sen. Ed Hernandez)

Article used by permission. Original article by Tracy Seipel appeared June 11 in the San Jose Mercury News.

East Coast Opposition to Seismic Airguns Mounts as Oil Companies Push to Expand Drilling to Atlantic

International, national and local forces are mobilizing up and down the East Coast, and pressure is being placed on President Obama to stop offshore drilling in the Atlantic

While ocean blasting was banished from Central Coast waters (for now) by the California Coastal Commission in 2012, the East Coast hasn’t been so lucky. Fortunately, international, national and local forces are mobilizing up and down the East Coast, and pressure is being placed on President Obama to stop offshore drilling in the Atlantic.

Oceana, the Washington, D.C.-based environmental advocacy organization, recently announced that 110 local elected officials and 155 conservation and animal welfare organizations have joined the mounting opposition against seismic-airgun use along the East Coast.

Six coastal towns have also passed local resolutions opposing or voicing concern with their use (Cocoa Beach, FL, Carolina Beach, NC, Caswell Beach, NC, Nags Head, NC, Bradley Beach, NJ and Red Bank, NJ.), with more local communities expected to join the stand against encroaching oil and gas companies.

In February, the United States government released a final proposal that would allow the use of this controversial technology to look for oil and gas deposits deep below the ocean floor in an area twice the size of California, stretching from Delaware to Florida. According to the Department of the Interior (DOI), these blasts could injure and possibly kill up to 138,200 marine mammals such as dolphins and whales, while disrupting the necessary activities of millions more.

One species of particular concern is the North Atlantic right whale, the rarest large whale species, of which there are only approximately 500 left worldwide.

Local officials from Maine to Florida are voicing their concerns:

“The use of airguns to conduct these seismic tests threatens fish populations and profitable fisheries. In fact, airgun noise has been shown to decrease catch rates of certain fisheries. Commercial and recreational fishing off the mid and south Atlantic generate billions annually and support hundreds of thousands of jobs. The Department of the Interior’s assessment ignores the economic impacts the proposed seismic testing will have on fisheries and the fishermen who rely on the oceans for their livelihoods.”

Conservation and animal welfare organizations, including Oceana, Surfrider Foundation, International Fund for Animal Welfare (IFAW), National Resources Defense Council (NRDC), Clean Ocean Action (COA) and Southern Alliance for Clean Energy (SACE), also sent a letter with the following statement:

“Seismic airgun testing is the first step towards deep-water drilling, which would inevitably bring the Atlantic coast one step closer to the same practice that brought us the Deepwater Horizon oil spill disaster. While proposed seismic airgun testing would span from Delaware to Florida, an oil spill the size of that which flowed from the Deepwater Horizon oil rig would harm sea life, ecosystems, fisheries and coastal economies along the entire East Coast. Furthermore, expanding offshore drilling to the Atlantic will only deepen our dependence on oil and gas, and worsen the impacts of climate change and ocean acidification.”

“When it comes to offshore drilling in the U.S. one overarching theme stands out – Drill, Spill, Repeat,” said Claire Douglass, campaign director at Oceana. “Offshore drilling is no safer than it was four year ago, yet President Obama is taking steps to expand this dirty and dangerous industry to the Atlantic. If the President would simply stop to listen, he would hear that coastal communities have no interest in turning the East Coast into a blast zone.”

The Seismic Challenge

An Oceana report released last year outlined the threats of seismic airgun use and offshore drilling to marine life and coastal economies along the East Coast, including the potential danger to commercial and recreational fisheries, as well as tourism and coastal recreation, which puts more than 730,000 jobs at risk in the blast zone.

In February, more than 100 scientists called on President Obama and his administration to wait on new acoustic guidelines for marine mammals, which are currently in development by the National Marine Fisheries Service. These guidelines are 15 years in the making and aim to provide a better understanding of how marine mammals are impacted by varying levels of manmade sound as well as demonstrate the measures that are needed to protect them. Sen. Cory Booker (D-NJ) and eight additional U.S. senators also sent a letter to DOI Secretary Sally Jewell urging her to hold off on issuing the recent administrative decision until all of the best available science, including these new acoustic guidelines, can be incorporated.

Oceana has also delivered more than 100,000 petitions opposing seismic airguns to the director of the Bureau of Ocean Energy Management. The Mid-Atlantic Fishery Management Council, as well as approximately 50 members of the U.S. Senate and House of Representatives, also called on President Obama to stop the use of seismic airguns last year.

Seismic airguns create one of the loudest man-made sounds in the ocean, each 100,000 times more intense than what one would experience if standing near a jet engine. The dynamite-like blasts occur every 10 seconds, for days to weeks at a time. Seismic airguns are loud enough to kill small animals like fish eggs and larvae at close ranges and can disrupt the behavior of large animals like whales and dolphins from up to 100 miles away.

Oceana is the largest international advocacy group working solely to protect the world’s oceans. Oceana wins policy victories for the oceans using science-based campaigns. Since 2001, Oceana have protected over 1.2 million square miles of ocean and innumerable sea turtles, sharks, dolphins and other sea creatures. Oceana has more 600,000 supporters worldwide, and offices in North, South and Central America and Europe. For more information about Oceana and its global efforts visit www.oceana.org and www.stopthedrill.org.

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Photo:  To commemorate the four-year anniversary of the BP oil spill, the worst environmental disaster in U.S. history, Oceana conducted a three-day nighttime-visual-projection demonstration on government buildings in Washington, D.C. from April 14th to 16th. The image series called on President Obama and Secretary Jewell to stop offshore drilling in the Atlantic before it starts.

THE ROCK REPORT: SLO County Health Leaders Focus on Housing to Treat Chronic Homelessness, Mental Illness

By ED OCHS

As undeniably complex as the issue of homelessness is nationally, what is needed to provide better homeless and mental health services in SLO County is clear: More of everything.

According to a February survey on homelessness and mental illness treatment in SLO County conducted by The ROCK, SLO County officials and professionals working to find pathways to solutions on a daily basis agree: More funding, more affordable housing and more treatment are badly needed to begin to make a serious dent in chronic homelessness shadowing the county.

They also unanimously concur that the Affordable Care Act will offer a huge boost for the chronically homeless in the county as more people become eligible and more services are offered, including mental health, under an expanded Medi-Cal program. (See separate article. Click here.)

More permanent housing for disabled

Last year’s Point-in-Time Count, conducted by the Homeless Services Oversight Council (HSOC), logged 2,186 homeless people in San Luis County in one 24-hour period in January 2013, and an estimated 3.497 people homeless over the course of a year. Of those, 29% were chronically homeless, with many more at risk, while 49% reported experiencing some form of mental illness, according to the count. Significantly, missing from the data, according to Homeless Services, are persons who do not access shelter, case management, or transitional or permanent housing assistance.

“These statistics demonstrate the need for more permanent, supportive housing for persons with disabilities as well as more treatment services,” responded Laurel Weir, Homeless Services Coordinator, Department of Social Services.

According to Weir, approximately 25 homeless patients per month are admitted to the County’s Psychiatric Health Facility (PHF), a short-term-stay, crisis facility for adults and youth who are admitted because they are a danger to themselves or others, have been found incompetent to stand trial, or who have been conserved. Over the past year, homeless persons constituted the overwhelming majority of persons admitted to the PHF under California Penal Code 1370 (incarcerated persons who have been found incompetent to stand trial).

Because of revised questions and an added provider in 2013, comparing 2013 homeless numbers to 2012 is inexact. Over all, though, Homeless Services reported a slight decrease in the number of new persons reporting mental health issues in 2012 (575 out of 1451 new “intakes” or 40%) versus 2013 (483 out of 1258 or 38%). But of clients whose first intake was in 2012, 257 were still being served by one or more Homeless Services programs in 2013. From July 1, 2012 to June 30, 2013, there were 137 homeless persons admitted to the PHF, approximately 16% of all PHF admissions.

“According to the federal Substance Abuse and Mental Health Services Administration, homelessness exacerbates mental illness,” Weir stated. “Therefore, housing is an important part of the treatment. In particular, the Housing First model has shown promise for moving chronically homeless individuals with severe and persistent mental illness off the street.

“As a first step towards increasing resources for people with severe mental illness, particularly those who have co-occurring substance abuse disorders and chronic health conditions, the County recently issued a Request for Proposals to serve 50 of the most vulnerable, chronically homeless persons.”

The RFP explains the program and Housing First model: “The ‘Housing First’ approach has emerged as a favored policy in addressing issues of homelessness. … ‘Housing First’ places people into permanent housing and then provides behavioral health treatment, case management, and other services needed to allow the clients to stabilize in place and to maintain their housing. The model does not require people to be well before putting them into housing, nor does it require clients to participate in any services other than case management as a condition of receiving housing. The ‘Housing First’ model is considered by HUD and other federal agencies to be a best practice for ending homelessness among those who have been chronically homeless, because use of this model consistently demonstrates a decreased use of emergency services, criminal justice resources, and many other public services.”

The RFP continues: “As part of a strategic planning effort in March of 2013, the Homeless Services Oversight Council (HSOC) identified ‘Housing First’ as a priority. To address this priority, HSOC voted in May of 2013 to join the 100,000 Homes Campaign, a national effort that emphasizes a ‘Housing First’ approach to housing highly vulnerable, chronically homeless individuals.”

Explained Weir: “Mental health treatment is not necessarily the first action that should be taken to get homeless persons with mental illness off the streets, nor are clients required to obtain treatment prior to being housed. Treatment often comes after the clients are housed.

“We are also looking at some additional opportunities to expand the number of permanent housing units in the Continuum of Care’s Supportive Housing Program, although whether or not funding is available for this will depend on the aftermath of the federal budget Sequestration.  Additionally, we have asked the agencies that run the existing Supportive Housing Program beds to agree to give priority to chronically homeless persons—who must have a disability, such as mental illness, to be considered chronically homeless—if units become available in their existing Supportive Housing Program.”

“When the HSOC held discussions last year about the Psychiatric Health Facility, it noted that some of the homeless persons being discharged from the PHF were sent to the homeless shelter because of a lack of suitable housing options. The Housing First program and the expansion of permanent, supportive housing would be a first step in helping homeless persons with mental illness to move out of the shelters and off the streets and into more appropriate housing with the supportive help they need to keep them stabilized in housing.

“To be clear, these would be only first steps. In order to fully serve all the homeless persons with mental illness, we would need to significantly increase both our housing and supportive services for this population. We will continue to pursue additional federal and state funding to expand resources needed.”

Finding funding is a full-time, never-ending pursuit for providers, particularly when new funds for new programs can’t keep up with federal cuts that undermine existing programs.

“Recent federal cuts have made our efforts more challenging.” Weir noted. “In particular, the federal Budget Sequestration has put one of our permanent, supportive housing programs at risk of losing its federal funding. Also, a change in the major federal homeless assistance program that funds some of the case management services provided to homeless persons placed into permanent housing has limited the amount of time that case management services may be provided to six months. When someone with a severe and persistent mental illness is placed into permanent housing, they will often continue to need services well beyond six months.

“Cuts to the federal Housing Choice Voucher program have reduced the number of housing subsidies available to place people into permanent housing. Also, cuts at the state level have reduced funding available to build supportive housing for extremely low-income persons with disabilities.”

Limited number of mental health providers

Replied Grace McIntosh, Deputy Director of the Community Action Partnership of San Luis Obispo (CAPSLO): “While some of our programs see relatively few individuals with mental health issues, other programs, such as Homeless Services, see a larger number. Since mental illness is a major contributing factor to homelessness it would make sense that mentally ill individuals remain in our homeless program for longer periods of time and are more challenging to place into permanent housing. The numbers have remained fairly steady as many individuals are in services for a number of years.”

The need for more funding extends beyond the areas of mental health and housing, McIntosh points out.

“I think most non-profit providers and the county would agree that there is a need for more funding, not only in the area of mental health services, but drug and alcohol services and affordable housing as well. Funding for mental health services for children is an area that needs to be increased as some of our programs are seeing a larger number of younger children presenting behaviors that challenge their ability to be successful in preschool and school.”

McIntosh is among several county officials and professionals who believe Medi-Cal will help more homeless receive care. (See separate article.)

Explained McIntosh: “With expanded Medi-Cal now including mental health services, there will be the opportunity for qualifying individuals to receive these services. I think there may be difficulties with access given the limited number of providers in the county. The issue of a limited number of mental health providers is not only in our county—it is a national issue that I believe is going to need to be addressed in the very near future. Funding is always an issue that providers struggle with. In addition to public dollars most non-profit agencies also look to the community for support.”

A little togetherness is helping providers deal with funding issues. Forming a network allows them to continue to provide essential services, individually and collectively, which benefits clients and community.

“Given the obvious funding gaps, service providers countywide are partnering as best they can to meet the needs of the mentally ill,” McIntosh stated.

“The SAFE program is one concrete example of non-profit service providers, schools and county departments working together to provide preventive and therapeutic services to children and their families. Transitions-Mental Health is partnering with County Mental Health in providing outreach to mentally ill homeless individuals to try to get them into services. ECHO is completing the expansion of their overnight shelter to meet the increase in the numbers of homeless individuals and families in the north county coming for services.”

Lack of funding, lack of advocacy for children

“The final judgment in the lawsuit known as ‘Katie A.’ resulted in some additional resources,” responded Lee Collins, Director of the County Department of Social Services and Child Welfare Services (CWS). CWS is not a provider of care. “We are a broker for care, referring children and advocating on their behalf,” Collins explained.

“Now some additional therapists have been added, some additional contracts have been let—primarily to Family Care Network, the organization that is our most trusted provider of services—and we expect to see a gradual, incremental increase in services. We fund a great deal of mental health services out of our own funding, because we decided that we could not let children languish without care until we’d won the battle on their behalf.”

“We funded the Kinship Center’s expansion into San Luis Obispo County, an organization that primarily serves relatives who are taking care of children. (Think grandmothers, taking care of grandchildren who have been removed from their parents, for example.)  We paid for it ourselves and have done so for many years now. We pay for a host of ‘wraparound’ services provided by the Family Care Network, including therapeutic services provided by their staff.

“Still,” Collins added, “the available resources are woefully inadequate. There is a lack of funding—State, Federal and Local—but there also is a lack of advocacy on behalf of these children. They are seen as just one more ‘constituent’ group in need, among many. We see it differently, of course, because we see the pain endured by these children and by their family members.”

Most significantly, more people are eligible and more services will be offered under the Affordable Care Act, including mental health.

“We believe that the Affordable Care Act will be instrumental in expanding access to Mental Health services. (See separate article.)

Collins sees the need to establish an “intensive residential treatment center for children. Not a group home, and certainly not the PHF, but we do need a place where children can be hospitalized and treated in a safe environment.” Combining with Santa Barbara or another county on a regional facility might make it more economically viable.

“And we have to find a way to serve children who are not in CWS or Probation, rather than trying to convince those parents—as has been reported repeatedly—that they should ‘give up’ their children to the CWS system as the only means of getting care…”

He believes the mental health services gap will narrow when the width and breadth of the community comes to the full realization that the problem must become a priority, and a solution is possible.

“Our community—including advocates, the Board of Supervisors, school administrators, policy makers, media—must become aware of the extent of the issue, and of the deleterious effects that untreated mental health conditions can have on the children but also on the community at large. Untreated mental health issues can lead to increased incarceration, drug and alcohol addiction, unplanned pregnancy, domestic violence and the continuation of a cycle of abuse. We need to illustrate the issue in real terms that make sense to the average citizen who will want ‘something to be done.’ Then we have to show that funding really is available, whether through Medi-Cal or private insurance, or from cost avoidance in other systems, to effect a real solution.”

Keeping pace with the growth in needs

Jeff Hamm, Director, County Health Agency, and Anne Robin, Behavioral Health Administrator, County Health Agency, won’t characterize the status of mental health care in the county as a crisis, rather part of a nationwide increase in demand for services.

“We don’t believe there is a crisis. There are rising demands for mental health services statewide, even nationwide, as more people become aware of the benefit of mental health services and the stigma related to seeking these services has reduced. Approximately 1 in 4 adults will have need for mental health services during their lifetime; development of the capacity necessary to provide access to services has not kept pace with the growth in needs.

“Unfortunately, during the recent recession, capacity has remained static or has been reduced. There is reason to be optimistic about the immediate future, however. The Medi-Cal expansion component of federal health care reform (Affordable Care Act) will allow previously ineligible persons (primarily childless adults) to become eligible, and the expanded scope of benefits will be of tremendous help to those with mild to moderate levels of mental illness.

“The Affordable Care Act has increased funding for all levels of mental health services. In the past, only individuals with serious mental health needs have had access to care under Medi-Cal. Now there are additional levels of care available (individual and group psychotherapy, psychiatric consultation) for all Medi-Cal eligible individuals. This will allow the County services to focus more closely on those individuals and families who have the most serious illness and need for rehabilitative services. The ‘primary level of care’ for mental health services, for those individuals with mild to moderate illness, may also prevent individuals from becoming more seriously impacted by their symptoms.

“Not all homeless individuals have serious mental illness. Many do have trauma, anxiety, depression, and substance use disorders. Housing First models provide a safe place to assist individuals to deal with whatever their service needs may be. Shelters are simply a starting place; more permanent supportive housing are a much better solution to the problems of homelessness. Whatever the other challenges a homeless individual may face, the insecurity of day to day life on the streets creates an enormous barrier to recovery/wellness/health.

“The Affordable Care Act is expected to have a tremendous positive effect on bridging the gap between demand and supply. The coming months and years will shed light on the extent to which the problem has been substantively reduced.”

Creating more truly affordable housing

Increased attention of the unwanted variety was drawn to the Central Coast late last year, causing quite a stir in influential circles, when the annual homeless assessment report ranked SLO County third worst in the nation with 90% of the county’s homeless unsheltered.

This resulted in Jerry Rioux of SLO County Housing Trust Fund authoring some recommendations on how to remedy the situation, such as allowing greater flexibility with existing housing to open up more alternative housing opportunities. Rioux agrees with the Housing First concept.

“Individuals who are homeless will be better able to deal will their other challenges if they first have sufficient food and a roof over their heads,” he noted.

The Homeless Services Oversight Council (HSOC) recently adopted his recommendations to directly address the basic needs of “food and roof” as the best step forward out of homelessness.

The motion encourages the County and every city in the county to include various programs/policies in the Housing Elements of their General Plans. The state requires that they all update their Housing Elements by June 30, 2014.

Before his motion was approved by the HSOC, Rioux explained why it was needed.

“I prepared the motion because I am concerned that it will be impossible to make much progress placing people who are homeless—for any reason—into housing unless we create more truly affordable housing throughout the county. I strongly believe that we need more small apartment units, granny flats, rooming and boarding houses, group homes, mobile homes, etc. The motion encourages County and cities to facilitate these types of housing.”

Embracing the ‘village’ philosophy of treatment

The County contracts with Transitions-Mental Health Association to runs its Full Service Partnership Homeless Outreach Team that conducts outreach and screening of homeless persons with mental illness. The team has helped to house 27 individuals with severe and persistent mental illness since January 1, 2013.

Transitions staff—Jill Bolster-White, Executive Director, Transitions-Mental Health Association, San Luis Obispo; Barry Johnson, Division Director–Rehabilitation and Advocacy Programs; Jessica Arnott, Outreach and Education Program Manager; Henry Herrera, Family Services Program Manager; and Shannon McOuat, Marketing and Outreach Coordinator—responded to The ROCK survey as a “village.”

“The term ‘crisis’ may be more extreme than what we are facing currently,” they stated, “but there is certainly a need for a greater spotlight on mental health in our community, and there are some critical gaps that, if filled, would help people get the help they need in a timely way.“

Transitions staff believes that cost-effective preventative and early-intervention services can help avoid the high price tag of chronic mental illness in the future—frequent crisis hospitalizations, incarcerations, broken families, homelessness.

“Housing is a significant problem for many members of the community; but people who are mentally ill and poor are more likely to become homeless than those without a mental illness. For that reason, housing that is safe, affordable and located close to services is paramount to successful recovery from mental illness. When a person is experiencing a mental health crisis, there needs to be a solid system in place to help the person as quickly and effectively as possible, and that is not always the case locally.”

They also expressed the need for “a more warm and welcoming mental health services system, starting with the Psychiatric Health Facility (PHF), which is an institutional and clinical setting. The PHF needs to be a place of refuge and safety for people who are experiencing one of the most devastating times in their lives.”

Transitions’ work as an independent outpatient facility has helped the County narrow the gap by providing the focused treatment that often isn’t available anywhere else.

“Non-profits such as Transitions-Mental Health Association can and do work well with county mental health services, private therapists and family practice doctors. The saying ‘it takes a village’ is truly applicable to community mental health; we must include the family, the school, the employer, friends and our entire community to help anyone who struggles with mental illness.

“Services such as family support groups to help caregivers and families; Wellness Centers that provide support and education about living with mental illness; employment for people who want to work but have been prevented from working due to their illness; SLO Hotline that offers a human voice 24 hours a day; outreach services for those who are homeless and suffer from untreated mental illness—can all provide a basic safety net of services for people here in San Luis Obispo County.

“In many ways, we are well on our way to accomplishing this already. We still have leaps and bounds to go, but we are able to provide a variety of services and programs that can help those in our community who otherwise might not receive services from the county.”

Long waiting lists for subsidized housing

Pearl Munak, President of Transitional Food & Shelter in Paso Robles, works with the physically disabled. Some homeless have both mental and physical disabilities. Munak believes more resources are needed to place against the problem, including building shelters and offering subsidized housing for mentally ill homeless.

“There is not nearly enough subsidized housing in our county for those who need it,” Munak stated. “That is why we are third in the nation in unsheltered homeless. People go to a shelter and caseworkers can’t get them into permanent subsidized housing. The County is supposedly pursuing a Housing First strategy, to get people into housing and then solve their problems, not try to solve their problems before they can get into housing.”

“Subsidized housing is either for families or for seniors. Some senior housing is for seniors-only, some also take disabled. But there are no subsidized apartment complexes devoted exclusively to disabled…”

“Transitions-Mental Health Association provides some transitional housing for homeless, where people can stay for up to two years and have a caseworker working with them. At the end of that time, they should be able to get into permanent housing. However, they have a very long waiting list, about a year. This program also takes persons with physical disabilities. It needs to be expanded and funds are needed to expand it.

“We could pass another proposition to add a surtax on another 1% of high income, or tax highest incomes more.”

Munak recently received a grant check from Paso Robles Wine Country Alliance Foundation for $4,500, to be used for sheltering physically disabled homeless from Paso Robles.

“We serve the whole county,” Munak remarked, “but the Alliance has a program of grants to charities serving Paso Robles, so we will use this grant for our Roblans only. The Alliance raises funds through the Wine Festival Futures Auction and the Wine Country ebay Auction, featuring lots donated by winery, hospitality and associate Alliance members.”

 

More Homeless Eligible, More Mental Health Services Coming Under Expanded Medi-Cal Via ACA

Politics aside, the Affordable Care Act aka Obamacare is finally expanding health care to those who need it most—SLO County’s chronically homeless and mentally ill homeless.

acaPolitics aside, the Affordable Care Act aka Obamacare is finally expanding health care to those who need it most—SLO County’s chronically homeless and mentally ill homeless—and it’s giving SLO County health care officials and professionals a reason for some short-term optimism amid the many ongoing challenges.

Here’s what SLO County health care officials and professionals had to say about the Affordable Care Act in a February survey by The ROCK on the status of homelessness and mental health services in the county:

“There are some changes coming as a result of the Affordable Care Act that may expand both mental health and substance abuse treatment services available to people on Medi-Cal,” stated Laurel Weir, Home Services Coordinator, County Health Department.

“This has the potential to create additional mental health resources, particularly for homeless persons with mental health issues whose issues do not rise to the level of severe and persistent illness. Previously, such individuals generally were not eligible for Medi-Cal. Now, they will be eligible for Medi-Cal for the first time, which may create an opportunity for more mental health services for those persons.”

Grace McIntosh, Deputy Director, CAPSLO: “With expanded Medi-Cal now including mental health services, there will be the opportunity for qualifying individuals to receive these services. I think there may be difficulties with access given the limited number of providers in the county. The issue of a limited number of mental health providers is not only in our county—it is a national issue that I believe is going to need to be addressed in the very near future. “

While the recession has impacted County Health’s capacity to treat more people, Jeff Hamm, Director, and Anne Robin, Behavior Analyst, County Health Department, are optimistic about the immediate future, thanks to the ACA.

“The Medi-Cal expansion component of federal health care reform (Affordable Care Act) will allow previously ineligible persons (primarily childless adults) to become eligible, and the expanded scope of benefits will be of tremendous help to those with mild to moderate levels of mental illness.

“The Affordable Care act has increased funding for all levels of mental health services. In the past, only individuals with serious mental health needs have had access to care under Medi-Cal. Now there are additional levels of care available (individual and group psychotherapy, psychiatric consultation) for all Medi-Cal eligible individuals.This will allow the County services to focus more closely on those individuals and families who have the most serious illness and need for rehabilitative services. The ‘primary level of care’ for mental health services, for those individuals with mild to moderate illness, may also prevent individuals from becoming more seriously impacted by their symptoms.

“The Affordable Care Act is expected to have a tremendous positive effect on bridging the gap between demand and supply. The coming months and years will shed light on the extent to which the problem has been substantively reduced.”

District 3 Supervisor Adam Hill served as the founding chair of the HSOC and chair of the capital campaign for a new homeless services center: “The Affordable Care Act will allow us to increase capacity for both mental health services and for drug and alcohol treatment. A detox is needed, and proposals are being developed for how that could/should happen.”

Lee Collins, Director of the County’s Department of Social Services: “We believe that the Affordable Care Act will be instrumental in expanding access to Mental Health services. More persons are eligible, yes, but more services—and especially MH services—now must be included in health plans in order to implement ‘parity’ provisions. We believe that CHC (Community Health Center) will become—and certainly should become—a primary resource to serve both children and adults. They will not need to consider the ‘medical necessity’ threshold that serves to deny so many children the ‘specialty services’ that our County’s MH staff provide, even though we believe that most of our children in care really do meet the standard of care. The expectation is that CHC will build capacity—and already have begun to do so—and that a certain momentum may be created to help expand care on a community-wide basis.”

“Mental healthcare can be expected to expand now because of the ACA,” responded Pearl Munak, President, Transitional Food & Shelter in Paso Robles.

“Medi-Cal is being expanded thru ACA to cover mental health care, but the pay rate is low. CHC takes Medi-Cal and is about the only doctor that will. Maybe CHC will hire some mental health professionals or County Mental Health will be able to hire more. Counselors at Mental Health are usually licensed clinical social workers.

“The ACA expands Medi-Cal to cover not just families with children and those on SSI, but also any person whose income is below 133% of poverty level, a huge expansion in California and other states which have accepted this expansion. Texas and other Southern states have refused to accept this expansion even though it is 100% paid for by the feds for the first year and maybe beyond that; maybe first two or three years and then it goes down to 90%. … The county will save a bundle because they are phasing out County Medical Services Program because of ACA, since all poor people can now get Medi-Cal and go to CHC. CHC will probably be expanding.”

SLO County Sheriff Parkinson: 'We Can’t Arrest Our Way Out’ of Mental Illness Crisis

America’s jails and prisons have become our mental hospitals, according to a 2010 study by the National Sheriffs’ Association and Treatment Advocacy Center, and almost five years later, “The way we do business, the pure volume alone, has become alarming to everybody at this point,” said San Luis Obispo County Sheriff Ian Parkinson.

UPDATE: The article below was published in March 2014. On May 23, an emotionally-disturbed student attending the University of California, Santa Barbara in Isla Vista, California, killed six UCSB students and injured 13 people before taking his own life. Police visited 22-year-old Elliot Rodger at his apartment in late April and found him calm and polite, offering them no indication that he or anyone else were in danger. Hidden in his room were three guns… Four days later, on May 27, a patient at high-security Atascadero State Hospital was allegedly killed by another patient, and an employee was injured, in a hospital dorm room. An inmate, 34, was booked into San Luis Obispo County Jail the next day on suspicion of murder. The suspect had a history of assault and destructive behavior…

 

America’s jails and prisons have become our mental hospitals, according to a 2010 study by the National Sheriffs’ Association and Treatment Advocacy Center, and almost five years later, “The way we do business, the pure volume alone, has become alarming to everybody at this point,” said San Luis Obispo County Sheriff Ian Parkinson.

“That’s what makes it urgent that we are finally starting to realize that we’ve got a problem,” he recently told The ROCK.

The “problem” in 2014 is defined by a complex mix of laws, regulations, policies and budgetary restrictions, where state and local government bear the brunt of responsibility for treatment of the mentally ill. Finding effective patient care may depend on where someone lives in the state or county. A modern, capsule, historical overview of America’s care, and lack of it, for the mentally ill can be illustrated by the old balloon theory—push in one side and it pops out the other. Empty the psychiatric hospitals—and today there are more than three times more seriously mentally ill people in U.S. jails and prisons than in hospitals.

At least 16% of inmates in U.S. jails and prisons have a serious mental illness. In 1983 the percentage was 6.4%. So in less than three decades the percentage of seriously mentally ill prisoners has almost tripled, according to 2006 Bureau of Justice Statistics.

There is a direct and persistent connection between the lack of treatment for mental illness and the commission of crimes, petty and violent. There are the headline-stealing mass killings that are impossible to ignore, yet continue: the Aurora, Colorado movie theater shooting; the Navy shipyard killings in Washington, D.C.; the mass killings at Sandy Hook Elementary School; and even the Gus Deeds attack and suicide in Virginia, though not a mass killing—for want of one psychiatric bed. Each individual was in a psychiatric crisis and didn’t receive the help they desperately needed when they needed it, before tragedy struck.

Sheriff Parkinson, along with other sheriffs in the California State Sheriffs’ Association, recently discussed the impact of the mentally ill on law enforcement with Governor Brown. “He wants to solve problems,” Parkinson said. “He recognizes the problem. It’s been around and continues to be an issue.”

Atascadero State Hospital

San Luis Obispo County is unusual from a law enforcement perspective because it is the location of Atascadero State Hospital, one of five state hospitals. Atascadero State “provides inpatient forensic services for adult males who are court committed from throughout the State of California,” according to its web site. “The majority of the patient population (capacity 1,275 beds) consists of: mentally ill inmates; mentally disordered offenders; patients who have been found incompetent to stand trial; and patients who have been found not guilty by reason of insanity.” Patients need to be stabilized with medication. They often pose a threat to themselves and others.

A standing shortage of psychiatrists and a staff spread thin have resulted in fewer patients admitted to the facility. Still, with reduced capabilities and a full patient load, working at Atascadero State has occasionally proved dangerous to doctors, staff and inmates.

For Parkinson, who has been dealing with Atascadero State for some time, it’s an all too familiar pattern: Patients are sent there because they’ve been deemed incompetent to stand trial or be prosecuted for a crime because of their mental illness. Then, Parkinson said, they commit another crime by assaulting a staff member, and because Atascadero State doesn’t have an inside lockdown facility, that person is brought to county jail and booked for a crime.

“Which is really ironic,” he said, “considering they’re already in there (at Atascadero State) because they’re not [legally] capable of committing a crime, now they’ve just been booked for committing another crime that they’re not capable of.”

The ironies begin to pile up, one on top of the other. At Atascadero State, if patients are not taking medication voluntarily, they can be force-medicated to stabilize them. That’s not the case in county jail.

“They come down to a facility that is not really set up for the mentally ill, especially that level, and then we can’t force-medicate them,” Parkinson said. “We can only provide voluntary medication. So if they don’t take their medication, they continue to degrade.

“It’s just a vicious loop, and it’s frustrating because it is no solution for the problem.”

Parkinson has been working directly with Governor Brown’s office to deal with the impacts of Atascadero State on the county jail system, and they’ve been helpful, he said.

“We’ve gone from—at times we’ve had in the tens to upwards of almost 20 in custody from Atascadero State—down to a very few. I think at the last count I asked for a couple of weeks ago, we had one from Atascadero State in the (jail) hospital. So that’s a unique problem to us in this county. Couple that with the local problem that everybody’s experiencing, and it’s just a issue.”

Mass shootings

Parkinson is candid about the state of America’s mental illness treatment capabilities. He believes the vicious loop has a momentum that is difficult to stop with legislation and lockup alone.

“I personally believe that our mental health situation throughout the country has been getting worse. We have some obvious indicators of that.

“A while back (in February 2013) I sent a letter (to Vice President Joe Biden) regarding gun control. Obviously, people could interpret that letter the way they want. My problem, not to roll this into a gun-control issue by any means, was the fact that we look for a simple solution to a complex problem, and when you talk about the school shootings that have occurred, those people have been mentally ill, and yet we are trying to regulate our way out of it, and that was the issue I had.”

The extreme cases of school shootings are deeply emotional to everyone, and the typical reaction, Parkinson said, is to attempt “to solve this with regulation, and it’s no resolution to the problem. They’ll never regulate their way out of a situation involving the mentally ill. They have to take a multi-tiered approach.”

Nationally, the high rate of mental illness in jails reflects their role in the criminal justice system. According to the National Sheriffs Association study, jails are a hub. They receive offenders after an arrest and hold them for a short period of time (usually less than a year) pending arraignment, trial, conviction or sentencing, and hold mentally ill persons pending a move to an appropriate mental health facility. State and Federal prisoners typically serve more than one year.

Dealing with the mentally ill in the public sector, on the street on a daily basis, is also a serious concern for local law enforcement. Parkinson said a typical situation starts with someone constantly trespassing because he or she is sleeping on the steps of a closed business and the police are called. If that person doesn’t leave the premises, they are arrested for trespassing and end up in county jail.

“They’re kind of the other extreme. It’s a quality of life, petty crime, but because of their mental illness they end up in county jail. And again,” he emphasizes, “we’re regulating something that we’re never going to get a handle on by arresting our way out of it or regulating our way out of it, and we just don’t seem to get it.

“It’s a point of frustration with all the sheriffs because no matter what size your jail is, you have a percentage of your jail that is mentally ill, and they require special treatment, special care and special security; because in some cases they’re extremely violent and require two staff members to move them when they come out of their cell.

“In some cases they are at the point where they’re rubbing feces all over of the jail and themselves, so we have to get them out, clean them up, clean their cell out, put them back, and they repeat the same behavior. So they’re obviously suffering from severe mental illness, and none of our jails are really built to deal with it.”

No full-time psychiatrist

SLO County Jail holds a daily average of about 750 prisoners, men and women, some with various degrees of mental disabilities. A new, expanded women’s jail for 200 female inmates, which should relieve the overcrowding that existed in the old women’s jail, is under construction and expected to be operational in late 2016. However, generally speaking, rolling out current statistical trends through the second half of the decade predetermines that the prospects for significantly lowering the actual numbers of mentally ill that pass through our jails and prisons remain dim, unless the focus sharpens on solutions that are implemented and begin to chip away at the problem, Parkinson said.

“First, it starts with recognizing that we have an issue and not reacting emotionally with simple solutions to a more difficult problem. Second, we’ve got to realize that in many cases these people are patients, not necessarily inmates. So how do you treat a patient? Obviously by getting him in an environment that’s conducive to them improving their mental illness, in some cases (receiving) medication.”

County jail doesn’t have a psychiatrist on staff at all times, so patients can’t be force-medicated, even when it’s best for them. Medicating them doesn’t mean placing them in a vegetative state; it means they’re behaving, and “that helps improve their understanding of the situation they’re in and their ability to make decisions on their own,” Parkinson said.

“That requires money. You’ve got to have a full-time psychiatrist in the jail, and that’s expensive. We have limited visits from a psychiatrist. We have four full-time mental health therapists in the jail, and we’re challenged by that.”

California courts recognize this challenge, since it is a judge that determines if a person is incapable as a result of mental illness, where they need to go next, and for how long. They could be sent to the 1,287-patient-capacity Patton State Hospital in San Bernadino, a major psychiatric institution, or back to mental health for focused treatment. Yet neither the 14- or 16-bed mental health facility, nor Patton, has the room to house them, said Parkinson.

“So we’re on this waiting list and, of course, the (patients) are longer and longer in jail and deteriorating.

“Then the defense attorney says that the sheriff has not moved this person from the jail, and the judge says (to me), ‘why haven’t you moved this person out of jail into a facility?’ and I say, ‘because I don’t get to force my way into these facilities and drop him off on the doorstep.’ If there’s no room and they’re not going to accept him, I’ve got no choice but to continue to house them.

“It’s a huge challenge, and that’s kind of what we presented to the Governor; that we have to come up with other solutions.”

Prisoners in line for breakfast at CMC, December 2013. (Photo: Andrew Burton/Getty)
Prisoners in line for breakfast at CMC, December 2013. (Photo: Andrew Burton/Getty)

Complex local situation

Located practically across Highway 1 from the County Sheriff’s Department and jail, three miles north of San Luis Obispo, is the CMC, the California Men’s Colony, a sprawling state prison where a new 50-bed mental health center opened in August 2013. [As of February 18, 2014, CMC’s mental health outpatient population was 1,416 and inpatient 48. On February 7, CMC had 42.5 psychologists, 20 social workers and 18.25 psychiatrists.] The CMC facility would seem to be a natural option for the county’s mentally ill inmates, but Parkinson explains that despite the close proximity that’s not how it works out in reality.

“The problem is with the prison count,” he said. “Three federal judges are watching the numbers going into the institutions. Now when something happens at Atascadero State, the easiest solution is you don’t bring them to our facility, you bring them to CMC, into their lockdown mental health facility.

“(But) that means you’re adding numbers to CMC’s count, which is really counter to what the judges are prescribing to the state. So it creates a real dilemma for them as well. We don’t have enough mental health hospital beds, either at the local or state level. We have a growing issue and we’re not prepared to treat it.”

Meanwhile, on the street on SLO, where 90% of the homeless are unsheltered, the mentally ill homeless continue to impact local law enforcement, generating calls to police because citizens either feel threatened by their behavior, or believe the person in question really needs help.

“We go out there (when called),” Parkinson said, “and they don’t qualify as somebody that can be taken to mental health; because they’re definitely suffering from mental illness, but they can take care of themselves to some degree as prescribed by law, and we can’t take people and say, ‘you really need help and we’re locking you down.’ In many cases they are camping out. A lot of them are trespassing type offenses, or they’re walking out in the middle of traffic, not trying to hurt themselves, but just because of their mental illness.”

While most mentally ill people are not dangerous, thousands are institutionalized by court order because they are a danger to themselves and others, and about 10% of homicides and countless suicides can be attributed to individuals suffering from serious mental illness, including the commission of shocking crimes that devastate our society.

“Putting it in perspective, we have a little of both,” Parkinson said. “We have the high-end ones illustrated by the school shootings. Sandy Hook is a great example. [Adam Lanza] was diagnosed with mental illness and decides he’s going to go out and commit the ultimate crime and kill people. He’s not concerned with whether or not he can have a loaded gun in public or even have a gun, and one certainly could argue that his mother probably never should have had guns in the house. Not a good combination.

“But the reality is that’s an extreme case of mental illness that is repeating itself throughout our society, and most or our school shootings and/or mass shootings involve mental illness. So I think we have both extremes, and we certainly have something in the middle.”

When working in jail with mentally ill inmates, the risk of violence is real. A few weeks earlier, one of Parkinson’s deputies was assaulted, a female deputy by a female inmate, leaving scratches all over her face. “It’s not uncommon to have issues like that,” he said. “In that case it’s not a trespassing charge per se now. Now it’s raised the bar to combative and violent, and we’re tasked with caring for these people.”

Outpatient care

Parkinson makes a case for the effectiveness of outpatient treatment. The Sheriff’s Department works with outside mental health facilities to relieve pressure on a crowded jail system not built to provide for the mentally ill, and to get patients the focused treatment they need.

“We work as closely with them as possible,” he said, citing the success they’ve had with San Luis Obispo-based nonprofit, Transitions-Mental Health Association, which offers programs at more than 35 locations in San Luis Obispo and North Santa Barbara counties.

Transitions-Mental Health recently held a class in jail, and about 37% of those that went through the class have since been released from custody and made contact with Transitions for treatment, “which is a huge step,” Parkinson said. “They’re getting the mental health programming in the jail, and now they transition out of custody, and actually made contact, which is ultimately what we really push them to do.

“We also have a half-time deputy that does nothing but work in partnership with mental health in the field. Her job is to identify the people out on the street, try to get them into outpatient treatment, and see if they can get treated out in the field so they don’t end up in custody. For the ones in custody, she works directly with our mental health therapist inside to transition them when they come out in getting them to mental health treatment on the outside.

“Our goal is to manage them when they get out and not just say, ‘okay, you’re done, now go out.’ We really want to hand them off to our mental health people when they get out of jail to get them to continue to take medications, in some cases get them into housing when we can, and obviously treatment.”

Sheriff Parkinson, a law enforcement officer for almost 30 years, clearly recognizes the enormity of the challenge, which is why he stresses the urgency to address it and address it correctly. He sees the gaps in the system widening.

“It’s urgent because we are at capacity in the sense that we’re running out of the means to provide them with treatment as a patient. It’s always been present; we’ve always had mentally ill in jail. That’s not unusual. At some point in time that’s always going to happen, and it’s always going to happen to a percentage. That’s because they’re outside and maybe not popping up on the radar per se. Then they commit a crime that lands them in here.

“I think the way we do business, the pure volume alone, has become alarming to everybody at this point, and so that’s what makes it urgent, that we are finally starting to realize that we’ve got a problem.”

Despite the perils of his department’s task and the ongoing frustrations in trying to manage the diverse mental health needs of inmates, Parkinson believes that good communications with Governor Brown’s office will eventually lead to real solutions.

“I’m optimistic, and I only say that because of the dealings that I’ve had with his office regarding Atascadero State. We put together conference call meetings, we discussed the issues. They did take actions, and it really significantly reduced the number of people that came from Atascadero State.”

Parkinson wants to make it clear that they are not trying to pass along the problem, in this case the patient, when the patient shouldn’t be in jail.

“We’re not trying kiss off our problem on to somebody else. What trying to provide what’s in the best interests of the patient. We do that by not putting them in a facility that’s not set up and capable of providing for their health and welfare.

“The Governor responded to that, and I was very optimistic that they get it. So we’re taking some steps. When we had that discussion with the Governor a couple of weeks ago, and all the sheriffs were there—out of 58 there were probably 45 at the meeting—we all gave him the same message, and I think he heard it. Whether your jail typically houses 50 people, or is in the thousands like L.A., it’s the same problem. It’s all relative to the size of your jail.

“So the message was very clear to the Governor,” Parkinson said, “and he took it very seriously that we’ve got to do something. We’ve got to figure out a plan to solve this. We just simply cannot regulate our way out of this issue.”

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SAN LUIS OBISPO COUNTY JAIL, CAPACITY AND MENTALLY ILL PERSONS SNAPSHOT SUMMARY, MARCH 11, 2014

Board-Rated Capacity: 646 (includes Men’s and Women’s Honor Farm)
Self-Rated Capacity: 797 (includes Men’s and Women’s Honor Farm)

As of 6:00 a.m. 768 inmates were in custody. Although the number does not exceed the Self-Rated Capacity, just because there are 797 beds available does not mean someone can be placed in each bed. Depending on the classification of the inmate, it may not be possible to place a certain inmate in the same cell with other inmates, which means that a double-bunked cell may only have one inmate. In addition, only one of the buildings (40 beds) is used for beds at the female honor farm. The second is used for programming (subtract 40 beds from total). A more telling number would be that the in-custody population this morning was 768 with 35 male inmates and 8 female inmates not having a bed and required to sleep on the floor on a floor bed with mattress.

Total mental health contacts with inmates by mental health staff:
2012, approximately 6,700 contacts
2013, approximately 7,000 contacts
(Source: Undersheriff Tim Olivas, San Luis Obispo County Sheriff’s Department)

 

THE MENTALLY ILL IN U.S. JAILS AND PRISONS – BY THE NUMBERS

• U.S. prisons and jails house 10 times as many people with severe mental illness than psychiatric hospitals.

• At midyear 2005 more than half of all prison and jail inmates had a mental health problem, including 705,600 inmates in State prisons, 78,800 in Federal prisons, and 479,900 in local jails. These estimates represented 56% of State prisoners, 45% of Federal prisoners, and 64% of jail inmates.

• Jail inmates had the highest rate of symptoms of a mental health disorder (60%), followed by State (49%), and Federal prisoners (40%).

• Around 40% of individuals with severe mental illness have been in prison at some time in their lives. Nearly a quarter of both State prisoners and jail inmates who had a mental health problem, compared to a fifth of those without, had served three or more prior incarcerations.

• In 1955 there was one psychiatric bed for every 300 Americans. In 2005 there was one psychiatric bed for every 3,000 Americans—the majority of which are filled by court-ordered forensic cases and thus are not really available.

• Female inmates had higher rates of mental health problems than male inmates (State prisons: 73% of females and 55% of males; local jails: 75% of females and 63% of males).

• State prisoners who had a mental health problem were twice as likely as those without to have been homeless in the year before their arrest (13% compared to 6%).

• Jail inmates who had a mental health problem (24%) were three times as likely as jail inmates without (8%) to report being physically or sexually abused in the past.

• The number of doctors on staff at Atascadero State Hospital has dropped about 33% since September 2012, according to an October 2013 Tribune article. The hospital, which treats mentally ill, violent offenders, has about 22.5 psychiatrists on staff, down from 33.7% in September 2012. The facility is licensed for 1,275 patients.

• Over 1 in 3 State prisoners and 1 in 6 jail inmates who had a mental health problem had received treatment since admission.

(Source: Bureau of Justice Statistics, September 2006 Special Report: “Mental Health Problems of Prison and Jail Inmates” and Treatment Advocacy Center, 2004-2005 data)