Over the course of nearly three hours on March 4, as a panel of county and city officials discussed mental health services, a number of themes emerged: Humboldt County is brimming with trauma but has limited resources to address it amid a legal framework that gives all but the very sickest among us power over their own mental health care decisions.

These themes were apparent almost from the start of the first-of-its kind town-hall-style meeting hosted in Eureka City Council Chambers, when Mayor Kim Bergel read a submitted question asking panelists whether they believe the establishment of a mental health court would help.

Public Defender Luke Brownfield, who moments earlier had noted that the majority of the clients his office defends in criminal cases suffer from mental health issues, said it would, and it's something his office has been working toward. As implemented elsewhere, a mental health court would essentially oversee a diversion program that gives mentally ill defendants the option of enrolling in treatment programs instead of incarceration.

"We've seen it work," Brownfield said of such diversion agreements, adding that the current impediment to implementing a full-scale mental health court is there aren't enough providers locally to treat everyone who would qualify. "There just aren't enough services available for the amount of people who would be able to utilize them. The court is a little bit hesitant because we just don't have enough providers to give people the help they need."

But Brownfield made clear he believes such a court is in Humboldt County's future: "Eventually, it's coming."

County Department of Health and Human Services program manager Mark Lamers said part of why these programs have proven effective is they provide "some leverage" to get people into care who might otherwise decline it. Pointing out that mental health treatment is voluntary in California up until certain criteria is met — specifically until a person is deemed an imminent risk to the safety of themselves or others, or found incapable of keeping themselves safe and providing for their most basic needs — Lamers said mental health courts can sometimes bridge the gap between what someone wants and what they need.

The court, he said, can ask, "Would you rather access services or would you rather spend time in jail or prison? It encourages folks to see the benefit of accessing treatment voluntarily."

And that can be hugely important, as Lamers later noted that a majority of people with severe mental illness suffer from the symptom anosognosia, also called a "lack of insight" to the presence of their illness.

"One of the first things that often goes when people have significant mental illness is the ability to recognize they're no longer coloring within the lines, that they're no longer doing what everyone else does, that their basic behavior has become disorganized and even frightening to other people," he said. "With that comes a lack of understanding that medications can help. People with mental health issues often feel normal."

Conversely, Lamers said they also feel side effects of the medications they are taking while often not recognizing the benefits. This can result in patterns that see someone placed under an emergency 72-hour hold in a psychiatric hospital stabilize when medicated, only to see their condition decline when they are released and "taking medication once again becomes voluntary."

While the panel took questions and input from a wide variety of community members — almost all of whom said they have personally experienced mental illness or have a loved one who has, or work in mental health care services — the subject of emergency holds and hospitalizations came up repeatedly.

Such involuntarily emergency hospitalizations — known as 5150 holds — can be initiated when it is determined a person is an immediate risk to themselves or others, and allow someone to be held against their will for up to 72 hours until they are evaluated by a mental health clinician.

Eureka Police Department Cmndr. Leonard La France, who oversees the department's Community Safety Enforcement Team, which responds to about 40 percent of the 1,100 or so mental-health-related police calls in the city annually, said the department has been working to divert as many people away from such hospitalizations as possible. Sempervirens, the county's only psychiatric health hospital, only has 16 beds, La France said, and when it is full, folks who meet the 5150 designation have to be held in the emergency room at St. Joseph Hospital until a bed opens up. Last week, La France said, 12 of the hospital's 26 ER beds were taken up with people on psychiatric holds, which places a burden on the hospital and does little to treat the needs of the patients.

Throughout the evening, panelists mentioned some promising developments coming online to deliver additional services. Lamers said a new residential treatment facility will be opening this fall for "youth in crisis," and La France said a "navigation center," or a place outreach workers can bring homeless people to connect them with other services, will be opening in the next 18 months.

Resources and staffing, however, remain huge limiting factors.

A man who identified himself as a successful carpenter addressed the panel and said he has had trouble finding mental health treatment locally, saying both psychiatrists and therapists are in very short supply. Lamers confirmed this is the case, saying he knows people who have spent years looking for a psychiatrist.

"There's a chronic shortage of providers at every level in the state of California — it's not just Humboldt," he said. "Do I have an answer for that? I don't."

That shortage also extends to case managers and social workers, with local psychiatrist Katy Wilson telling the panel she was told DHHS has one case manager per 700 patients in its adult outpatient mental health clinic.

Lamers said case managers offer the return on investment in the system, saying, "If we spent the same amount on case managers as we spend for higher level services, we'd need a lot less higher-level services."

Brownfield said his office received funding to hire a social worker a couple of years ago and that's been hugely impactful, helping clients address their basic needs, whether it be treatment, employment or housing. But it's one position in an office that has hundreds of clients at any given time and it's simply not enough. Ideally, he said, the county would have social workers available to meet people being released from the jail "on the street as soon as they get out," to tell them what they need to do, where they need to go and connect them with services.

A recurring theme of the evening — brought up repeatedly in response to the overlapping issues of mental illness, homelessness and substance use — was trauma.

"Trauma, if you peel back the onion, is really the core for this," La France said.

Later in the meeting, Lamers noted the scientific link between experiencing childhood trauma and "all kinds of series down-stream outcomes," including incarceration, poor health and drug use. This is of particular note in Humboldt County, he said, where the trauma of "multi-generational genocides" and "multi-generational outlaw communities" are prevalent.

"These things have multi-generational outcomes that require healing," he said.

Having already gone well over its allotted time, the meeting ended with most of the questions submitted in advance or by people watching remotely left unasked and unanswered, underscoring the degree to which local residents feel mental health service delivery is a critical issue. Bringing the meeting to a close, Bergel thanked everyone for participating.

"It's an important and robust conversation and I hope we can continue to move forward together to make positive solutions," the mayor said. "Every person in our community — every person — has value. Everyone. ... A health community lifts each other up."

Thadeus Greenson (he/him) is the Journal's news editor. Reach him at (707) 442-1400, extension 321, or [email protected].