Plugging deadly holes in California’s drug treatment system – Orange County Register


They tried a wilderness program in Idaho. Boarding school. Expensive private treatment programs and sober homes in Orange County, San Fernando Valley, Beverlywood.

After spending nearly $ 200,000 trying to free him from the tyrannical grip of addiction, Juli Shamash’s son Tyler died in 2018 of an overdose in the bathroom of a sober house just around the corner. from his house. He was 19 years old.

“They don’t teach you that in ‘Mommy and Me’,” Shamash said. “You don’t know where to start, what to do, when your child is addicted to drugs. Which programs are good? What are bad? I am a researcher, that’s what I do. I’ve watched all I can, but you’re blind. You just don’t know.

After years of study, a one-of-a-kind coalition of more than 50 groups – including the California Hospital Association, the California Medical Association, county health directors, public safety officials, and family organizations – has intend to change that. the Behavioral Health Action’s New Action Plan for Behavioral Health offers a new avenue for drug addiction treatment and much more. The need for a new approach is evident in public parks, under highway viaducts and even in low-key homes.

How did Tyler get the money to buy the drugs that killed him? A “friend” brought him to a program in Laguna Hills that accepted Tyler’s insurance – and received $ 2,000 for his troubles, Shamash said. Being a “friend” he shared the money with Tyler.

Juli Shamash and her son Tyler, who was 19 when he died in 2018 (Courtesy Juli Shamash)

The tragedy has brought a most unpleasant clarity. “What I’ve learned is that the best places aren’t these private programs,” she says. “It’s the public programs that take MediCal for low income people where you get better care.

“I would have liked to know.

Coalition members want everyone to know it, and they are talking about it.

“They’re in a different world,” said Steve Fields, executive director of the Progress Foundation, referring to California’s vast network of private treatment programs backed by private health insurance payments.

“If you are part of the public behavioral health system because you don’t have insurance, or you are on Medicaid, you have a better chance of getting recovery-based treatment than in a private program.”

Flip the triangle

The Blueprint aims to “reverse the triangle” on how California invests in mental health, which includes addiction treatment.

Right now, the bulk of mental health spending is directed to acute care – helping patients after a crisis has already occurred. Instead, the coalition wants spending to be focused on prevention and education, to prevent cases from getting worse initially.

It also requires measurable results for mental health programs in order to be clear about what is working, what is not working, and whether we are progressing towards goals – an idea that has historically met fierce resistance from health care providers. mental health – as well as greater transparency for consumers seeking help, like Shamash.

“We need to do better in the state of California,” said Carmela Coyle, co-chair of the BHA and president and CEO of the California Hospital Association. “We are offering a new and better way forward.”

Much of this is bridging the divide between mental health and physical health systems, which are widely separated from each other.

In the latest example of something gone terribly wrong, former Mater Dei High and Saddleback College quarterback Colt Brennan died early Tuesday morning, May 11, at age 37, of what appears to be an overdose.

Brennan, who played at the University of Hawaii and had a brief NFL career, struggled with substance use. Before his death, he spent months in a private treatment center in Costa Mesa. Last week he ended up at his parents’ house in Orange County, appearing to be intoxicated. His father took him to a hospital emergency room, where Brennan was apparently stabilized and, because he was an adult, was released without the family knowing. He then apparently went to a hotel, ingested something with fentanyl and never regained consciousness, his father said.

“We do not have an involuntary treatment process for substance use disorders, no matter how severe,” said Aimee Moulin, director of behavioral health for the emergency department at UC Davis Medical. Center and Director of CA Bridge. “For mental illness, we can treat a person against their will if they meet certain criteria. There is a lot of overlap between overdose and suicidality which is underestimated.

“However, if the patient has the capacity to make their own decisions, and does not meet the criteria for mental health care, they can make their own decisions,” said Moulin.

It’s unclear what happened in the ER and what should have happened, but experts suggest different rules in the mental health system could have changed Brennan’s tragic outcome.

“We really need to start treating people with behavioral health needs like we treat people with physical health needs from start to finish,” said Jessica Cruz, Behavioral Health Alliance co-chair and CEO of the National Alliance on Mental Illness California.

Hawaiian quarterback Colt Brennan (15) celebrates after defeating Boise State 39-27 in their college football game in Honolulu, in this photo from Nov. 23, 2007. (AP Photo / Ronen Zilberman)

“You would never reject someone who has a heart attack and needs services. It would never happen if someone showed up with a broken arm. You would get it fixed. “

Many problems arise from the way mental health services are funded, she said. “We have to make sure that the public and private systems work together the same way they would when a person is suffering from a physical illness.”

Action, the coalition said, cannot be delayed.

Signs of hope

State Senator Pat Bates, R-Laguna Niguel, was once a social worker. She saw the devastation caused by mental illness and addiction firsthand, long before she started pushing for California’s addiction treatment system to be reformed in the legislature. This plan, she said, is a step in the right direction.

“Reversing the triangle – that’s essential,” Bates said. “We’ve been investing in education and prevention for years, but we need to do something different.

“With fentanyl in everything, it has to be seen as poison, a step into the abyss of despair and the first lives lost,” she added.

One key will be to educate parents to recognize the signs of potential mental illness while their children are still young, and to mobilize entire community networks – schools, lawmakers, community leaders – in this effort. “We can make a difference,” Bates said. “I’m convinced.”

Half of all cases of mental illness start at age 14 and 75% at age 24, according to the Blueprint. This requires much earlier individual screenings for signs of risk and trauma – which often precede mental illness and addiction – as well as the active involvement of their parents and caregivers and careful case management to provide people with help. they need and avoid seizures.

These are all good ideas, said Laurie Girand of Advocates for responsible treatment in San Juan Capistrano. Prevention is clearly better than treatment, and involving families in the process – privacy laws often make this very difficult – is vitally important.

But Girand has been pushing for better quality control, better monitoring, and better enforcement of private treatment programs in California for years, and doesn’t see those issues addressed here.

There’s a lot of talk about not having enough beds to treat addiction, but the elephant in the room is, how many people who come to California for treatment are actually from here? Private programs have paid people from other states to come to California for treatment – so the programs can bill their insurance companies – and no one has attempted to quantify that.

Josh Page holds a photo of his friend Timmy Solomon who died of an apparent drug overdose on September 2 at the age of 31. Solomon’s struggle was featured in the cover of SCNG’s Rehab Riviera. (Photo by Mindy Schauer, Orange County Register / SCNG)

“Drug addicts are vulnerable to predation,” Girand said. “There’s really nothing here about it.”

Blueprint supporters say the details are up to policymakers – they’re just trying to build the guardrails’ at a time when California faces a behavioral health ‘tsunami’ due to the impacts of the global COVID-19 pandemic .

Early data suggests the country’s drug crisis exploded during the pandemic. Almost 90,000 Americans have died of drug overdoses over the 12-month period ending in October, according to data from the Centers for Disease Control – a 30% increase from the previous year.

And in California, the response to this crisis – before and as we emerge from the pandemic – has been chaotic. Mental health issues (including drug treatment) are typically dealt with one county at a time, often resulting in 58 different approaches, varying quality, and inconsistent offerings from county to county. This, the coalition said, requires a comprehensive statewide solution.

Shamash’s son Tyler was a super bright kid who was fascinated by electronics, always making things up, fixing anything that was broken. Now Shamash is trying to get something right out of his family’s tragedy. She founded WE ARE CRAZY (MomsAgainstDrugs) serving bereaved parents and families through advocacy, honoring lost loved ones, raising awareness, ending stigma and propelling a paradigm shift in society’s view of addiction. A story told, she says, is a life saved.

In addition to setting quality standards, increasing transparency, and understanding the differences between public and private treatment programs, Shamash’s reform wishlist would ensure that all hospitals test any potential fentanyl overdose victims. . Such a test might not have saved his son, but he might be able to save others.

“There is no consistent standard of care,” Shamash said. “Something’s not working. The system must change. “

Updated 05/16 with the name of the coalition

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