Tough assignment: How I reported on the dire lack of mental health care in Santa Barbara County

Throughout this past year, I frequently felt much like a blind Eskimo chipping away at an iceberg, not having much of a clue how big it was or even what I was going to do with all the ice shards when done.

Make snow cones?

My focus issue has been the mental health care system in Santa Barbara County, the very significant gaps in service, and the serious challenges confronting anyone hoping to access treatment when it was available.

From January 2017 to the present, I have written 41 news articles on health care issues presenting themselves in southern Santa Barbara County. Many of these had to do with the fight over health care repeal and reform and the local response.

Some had to do with a proposed merger of the two largest health care providers in Santa Barbara that ultimately fizzled. Many were wonky and worthy, but some were sensational and lurid, like the county jail health czar who was forced to quit when I disclosed that he’d had his medical credential revoked after trolling for prostitutes while on the job at previous posts.

More than half, however, dealt with various aspects of the mental health care debate taking place, the focus of my project. For the project proposal itself, I produced two cover stories highlighting key gaps in mental health care plus a lengthy inside feature.

I’d like to be able state that my reporting made a significant difference, that it helped move the needle. There were times I thought it did, but the needle has a way of moving back and forth. For those directly involved in the issue, I know the coverage mattered. How much is hard to say. Those looking for a media-inspired Eureka moment had best look elsewhere.

The background

I got into this issue for all the obvious reasons. Over the past 20 years, various grand juries have been exclaiming unhappily over the acute shortage in acute psychiatric care beds in Santa Barbara County: only 16. For a county our size, the bare minimum is closer to 45. As a result, countless Santa Barbara residents have been shipped to out-of-county facilities at a cost of millions of dollars annually.

In recent years, the unhappy intersection between mental health treatment and the criminal justice system has become a dangerous place to be.  For anyone covering local government — and where the dollars were going — Santa Barbara’s dysfunctional mental health system could be considered ground zero. Only a few years ago, the federal government was threatening to cut off funding to the county’s mental health department. Since then, the department has been rebranded and renamed “Behavioral Wellness, “or “Be Well” for short. Those seeking help don’t much care for the name and aren’t so sure the department is all that better run. 

Like politics, reporting is deeply personal despite all the best efforts to pretend otherwise. In my case, I have an adult daughter who was diagnosed with bipolar issues at age 13. Despite my family’s relative advantages — education, income, bureaucratic savvy, and connections — our efforts to secure effective treatment at the onset were decidedly less than successful. We engaged; we tried, and we stumbled along. My daughter still struggles. So do we. But the situation is manageable.

For others, the road has been far more treacherous.

For a host of reasons, I chose not to go the personal first-person route.

Instead, I opted to focus on the system. That approach presents several significant challenges.

First, there’s the issue itself: mental health. In Santa Barbara, that’s become background noise. The inclination by many readers is simply to block it out. That’s a natural response to problems that never go away. Why read about issues that have been proven to be impervious to change?

The second is the sheer complexity of the constellation of mental health care providers. It’s an alphabet soup of bureaucratic acronyms. And the lingo behind the acronyms is even more daunting still.

The third is penetration. With so many providers and so many layers of command, it’s time consuming in the extreme just making the right connections, understanding the movable parts, and establishing trust.

For readers, my solution was to find stories that allowed me to focus on individuals rather than systems and bureaucracies. It’s hardly original and kind of obvious. But sometimes the obvious makes sense.

For my first story, I wrote about an autistic 17-year old with schizophrenia — Everett Hickey — who’d been charged with attempted murder after he tried to strangle his mother. He’d just been released from the Cottage Hospital ER when he attacked; Cottage released him after multiple holds because there was no psychiatric facility in the state that accepted minors with autism. When I initially reported the story, I was shocked that prosecutors would file adult-felony charges against a 17-year-old when the crime was committed by someone who was clearly in the throes of an acute psychotic episode. Later, I would discover that doing so was the only way the prosecutors thought they could secure long-term treatment. In hindsight, they were proven correct. Either way, there’s something seriously wrong with this picture.  

The facts of this story were dramatic, the characters vivid and outspoken, and the situation cruelly absurd. I felt I had the material to get past readers’ shut-down reflexes when it comes to stories about the mental health system.  

As a reporter, my challenge was getting any of the medical and mental health officials to talk.  I needed corroboration. They cited HPPA confidentiality rules. Defense and prosecution attorneys were reluctant to speak as well. Ironically, they cited confidentiality rules that applied to minors. And once Everett Hickey was placed in a court ordered conservatorship, they didn’t have to talk to his father either. My only source of documentation was the father. Although he was a trained medical professional, he came across as somewhat unhinged. I worried he was using his son’s legal predicament to re-litigate global ideological and legal issues that had caused him serious professional heartache. He did take detailed verbatim notes of his son’s medical history, however. Ultimately I got a key psychiatrist involved in the case to speak off the record; he corroborated the accuracy of the father’s notes. I also got the assailant’s mother to speak. She was then in the process divorcing the father, but despite clear differences of perspective, she backed up key recollections of events and added new details. Ultimately — and much to my surprise — I also wound up getting an interview with the assailant himself, then held in a long-term treatment facility.

Of the three project stories, this was the most successful. It got the most readers and they stayed with it the longest of the three. Was it a game changer? No. It did, however, put the DA, the public defender, Cottage Hospital, and County Mental Health (“Be Well”) on notice. For readers, it successfully transcended the background din effect that I’ve generated with the many of the articles I’ve published on mental health.

One story leads to another

Interestingly, the publication of this first story generated my third project piece: the article about Santa Barbara County Sheriff Lt. Eddie Hsueh and his efforts to change the culture from inside law enforcement when dealing with the mentally ill. After reading the first article, Hsueh contacted me to discuss the training efforts he’d been pushing from within to deescalate conflicts between deputies and the mentally ill. He’d been tangentially involved in finding a place for Everett Hickey. He’d been pursuing this initiative within the department with the blessings of administrators but no money. (Similar efforts in a neighboring county are funded to the tune of $300,000 a year.) This uphill battle added to the dramatic appeal. His own life story — both parents were mentally ill — also added to the story. In many ways, it was a feel-good, man-bites-dog story: cop works from within to reform system. How could I not write about it?

The challenge here was finding the time. After my first interview with Hsueh, Santa Barbara had two major wildfires — one cataclysmic — and a flood of Biblical proportions. We also had a major city council and mayoral election. The Eddie Hsueh story had been scheduled to run several times before it actually did. Those delays helped.

A week before it ran, the DA released a reporting exonerating five sheriff’s deputies who shot a knife wielding 26-year old 20 times after he’d refused orders to put it down. I suspected he had a history of mental illness; I had been told this was the case, but none of the official channels would confirm this. To do so, I was told, would violate HIPAA confidentiality rules.

The decedent’s father refused to talk and his attorney had put me off several times. I spoke to the victim’s co-workers and other family relatives. I got nothing clinically conclusive. Eventually, the family’s attorney called me. He had secured incident reports written the year before the shooting demonstrating that deputies had been called on the decedent at his home two times because of concern he might kill himself. Two of the five deputies involved in the shooting participated in these calls for service. This information was not just a scoop, but underscored the need for the training program Hsueh has been pushing.

That being said, I feel I could have done a better job writing the Hsueh story and the images and lay-out all screamed “Danger: Worthy story up ahead.”

The last major — and abiding — challenge I encountered was that of Cottage Health and its skittishness in dealing me in particular, and the media in general. Cottage is unusually averse to making its officials available for stories that may put them in a less-than-positive light. To be fair, I have on occasion cast Cottage as the 8,000-pound gorilla in a weekly column I write and have accordingly kicked its ankles. Even so, Cottage’s media posture has been unduly protective and defensive, especially for a health care monopoly. My failure as a reporter and columnist to get past this posture, however, has not served the community well. It’s undermined my ability to report meaningfully on health care issues. The silence between Cottage and myself has not aided and abetted a meaningful exchange of information regarding health care choices.

As a tactical response, I decided to unilaterally enact a tactical freeze on covering Cottage in my news column. In the meantime, I would pursue off-the-record contacts with individuals within the organization who were less defensive and prickly. And to the extent our interest intersected, I’d pursue such stories.

In the past couple years, Cottage has embarked on an ambitious population health campaign that transcended the company’s typical comfort zone. In some ways, Cottage was motivated by changes in federal health care reimbursement rules that penalize hospitals that with high readmission rates. Whatever the motivation, Cottage embarked on a very ambitious public listening process, albeit in a very a controlled setting that minimized public events where critical comments were likely to be made.

Early on in this process, it became excruciatingly clear that mental health care was identified by a large majority of the stakeholders as the biggest single unmet health care need in the community.

In September, I published a lengthy inside feature on the results of this population health survey. The results were striking: Santa Barbara’s depression index was significantly higher than state and federal numbers. It was identified as the number one unmet need by more than 80 percent of the stakeholders. Cottage officials admitted they had to do more; they just weren't sure exactly what that looked like.

For this article, I managed to secure an interview with Cottage CEO Ron Weft. It had been years since he’d consented to a one-on-one interview with me. The heavens did not move, but it was a start. While Cottage still remains wary where I am concerned, the thawing process continues. It’s very clear the community at large is looking to Cottage to play a larger role when it comes to population health in general and mental health in particular. Certainly, the police department and sheriff’s office have both expressed frustration that Cottage has not done more. One official with the police department has been willing to express this — however guardedly — on the record. As a result, Cottage officials are now starting to reach out to me. Where that winds up, I have no idea.

For this story I chose not to write a wonky article about the population health survey, in deference to readers’ attention spans. Instead, I opted to fuse it onto a separate but related story about the opening of the first integrated care facility in downtown Santa Barbara that provides both mental and dental health care. It’s a small initiative that targets a major void. Cottage was not directly involved but helped fund the two smaller nonprofits that joined forces to make this happen. Given that one of the CEOs of these nonprofits started his career helping dispense electro-shock treatments at New York City’s Bellevue Hospital, I thought this provided an accessible entry for readers into an article that would otherwise shriek of wonkdom.

No doubt this approach helped, but again, I’m not sure how much. The article was rich in nutrient content, but of the three project pieces, it was the least compelling. Strategically, it might prove the most helpful, however, in terms of generating better lines of communication between me and Cottage, even when the kid gloves come off.  

Getting back to the blind Eskimo and the iceberg, I’d say my fellowship succeeded in the broader context of getting a lot out there, more than in the specific project pieces. In other words, I dished up a lot of snow cones.

From the outset, I have found myself overwhelmed — paralyzed really — by the vastness of the health care subject. The fire lit by the California Fellowship helped goad me into taking the necessary first steps that inevitably beget the second, third, fourth, and fifth. In the process, connections got made, synapses connected. While I am proud of the major projects — aforementioned qualifications not withstanding—these connections and relationships will constitute the lasting impact of the fellowship.