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We’re getting close to wrapping up a series on the City of Eureka’s current efforts to address homelessness and the mental health crisis. We’re trying to get a sense of what the city is hoping to accomplish on a variety of fronts — policing, economic development, mental health services, etc.

Last week we spoke with a couple of people working on this front:

and

Today we’re talking with Jacob Rosen, coordinator of the city’s new Crisis Alternative Response of Eureka (CARE) program. Once it’s fully operational, CARE will be able to dispatch trained mental health workers to assist people who are experiencing an active mental health crisis on the streets of Eureka.

How’s it going so far? Video above, transcript below.

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JOHN KENNEDY O’CONNOR:

Welcome to another Humboldt Conversation. I’m here today with Jacob Rosen, who is the Managing Mental Health Clinician for the Crisis Alternative Response of Eureka. That is quite a title.

JACOB ROSEN:

It is.

O’CONNOR:

You’ve only just recently joined up with Eureka, and you’ve created a new program.

ROSEN:

Yeah, so I started with the city on August 1st of last year, and was brought over to kind of start this mental health team to be out in the community, kind of a sister program to Uplift, and then also working with the Community Safety Engagement Team with the Eureka Police Department.

O’CONNOR:

Yes, we’ve actually spoken to Commander La France on a different conversation, and you are partnering very closely with the police.

ROSEN:

Yeah, very closely. In fact, when our team is fully up and running, our calls will actually be dispatched through their dispatch center.

O’CONNOR:

Okay, now, it’s currently a pilot in the pilot phase, I should say, but what results are you seeing so

ROSEN:

So far we’re seeing really positive results. We kind of soft launched things in January, middle of January. We got two case managers on board and so it’s been myself and two case managers, and I’ve been having to split my time between development and then being out in the field. And so, I mean, we’ve been able to see a lot of clients. We’ve been kind of carrying probably on average about 15 clients a week. Where we’re kind of having routine check-ins. We’re able to kind of dive in a little deeper just because we don’t have as many kind of barriers to starting services. You know, we don’t need a beginning assessment. We’re not doing insurance. We’re not going to work with a lot of the stuff that that causes hoops to jump through before folks actually can start to get help. And so we’ve been able to really kind of deep dive and work with some clients, you know, even daily sometimes to get them to substance use treatment or to get the medical treatment and it’s we’ve seen some really really nice success rates. We’ll be able to … I’m actually in the process of pulling our kind of first couple months of data right now. So I don’t have any juicy tidbits to throw out as far as percentages go. But it’s overall it seems positive so far.

O’CONNOR:

Now, it’s called “Crisis Alternatives,” so what alternatives are you able to offer people who are indeed in crisis?

ROSEN:

Yeah, so depending on the crisis and the safety situations, you know, there will be situations where law enforcement can’t be removed from that situation, right? There’s a safety concern, either the client or staff safety is at risk. And so we will have law enforcement accompany us for things that where there isn’t a safety concern, we can actually respond to that independently. So if there’s, you know, a concern that someone is speaking nonsensically and just seems really confused and is having a difficult time at a local store in Old Town Eureka … eventually, when our team is up and running, that would be something that we can just respond to without law enforcement showing up. And then that way that frees their their team up to be able to go and do law enforcement things. And then we can spend more time with that individual and help connect them to services and kind of provide more of a mental health approach than a legal approach.

O’CONNOR:

And how many people are on your team? Is it growing?

ROSEN:

It is growing. So our end goal is going to be three to four mental health clinicians and five to six mental health case managers. Right now we have two case managers and then myself. As we kind of sort out funding, either through grants or contracts, then we’ll be kind of moving into hiring more folks and getting it up and running.

O’CONNOR:

Now, we spoke to the mayor recently, and she has said that mental health is something that she’s just passionate about. So this is something that I think is going to develop more in the future. How will the program expand in the future?

ROSEN:

I think the program will expand in, I mean, just through phase one, at least getting, you know, full staff, being able to provide seven day a week crisis coverage, and really being able to kind of dive in and help a lot of the folks in the community, collaborating with agencies, networking, that kind of thing. What I keep in the back of my mind, and that I’d love to see is eventually getting some method established to be able to have a psychiatric prescriber out in the field with us so that we can kind of almost operate like a one day a week, we have like a psychiatric urgent care, where maybe folks who they lost their meds or they had stopped taking their meds, you know, a year ago, but they’re ready to start again. And we can kind of help identify these folks through the week. And then on the day that we have the prescriber, we can kind of go out into the field and we can kind of bring the doctor’s office to the individual instead of having to bring the individual to the doctor’s office. 

O’CONNOR:

Now, it’s mental health that you’re focused on, but obviously that can be triggered by other things — for example drug use etc. We’ve seen quite a lot of negative commentary from people who just say, well, these people should help themselves if they’re using drugs etc. That seems a very non-compassionate way to react to these issues.

ROSEN:

I would agree with that. And I think what’s difficult is when we look at heart disease or we look at lung disease, we can identify the organ that is having illness. And when we look at mental health, it’s really difficult to identify that organ. We know it’s the brain, but we don’t know everything about the brain. We’ve never scanned the brain. We don’t have the technology to look at every neuron connection and all that. And so when the brain goes wrong, it goes wrong in many ways quite fabulously in the sense that it’s a wide range of things that can happen, whether it’s a chemical imbalance and we become depressed or whether because of a past experience we have really profound anxiety and our threat response system is just firing nonstop. There are so many different things in that singular organ that can present with different symptoms it’s kind of hard to understand.

The other piece of that is that our brain controls decision making. That’s where our judgment is centered. And so when we have an issue with our lungs, we can talk to a doctor and then we can make an informed decision around treatment. When our brain, the decision making organ, is having difficulties of its own, it’s really difficult for some folks to actually have the capacity to make those decisions. And they develop a symptom called anosognosia, which is the symptomatic lack of insight. So that individual loses the ability to kind of like step outside of themselves in retrospect or look at their behavior and really see like, oh, I’m sick or this behavior is abnormal. This doesn’t fit with society. And so when they lose that ability to recognize that, that’s when they kind of keep going along in that path of their symptom. And it’s difficult for them to actually engage in treatment. And so for those folks who are experiencing that, when you say, well, they just need to make better decisions and pull themselves up, they literally can’t. It’s very hard.

O’CONNOR:

Now, what other initiatives would you like to see in the future that will help with alternative responses?

ROSEN:

I think that doubling down on the idea of housing first is really important. I think that, you know, a lot of substance use treatment and mental health treatment is not effective if folks do not have a roof over their head. And at the same time, we also need to make sure that when we take a housing first approach, it’s not housing last, right? We can’t just put folks in housing and then pull back. We need to be able to help get folks into housing and then also pour resources in, help them get connected to mental health services, substance use services, but then also connect them to resources in the community and make sure they can feel involved again.

I mean, if we don’t help folks have motivation to buy into society and re-engage and work or volunteer or participate in some group, then it’s really difficult to have motivation to continue buying into all these other treatments because mental health treatment and substance use treatment is not easy. And so giving folks motivation, giving them that buy-in, it’s really helpful.

O’CONNOR:

And that’s I think one of the strong things that Uplift Eureka is doing. We’ve spoken to Jeff Davis, we’ve spoken to Sierra Wood, and there are a number of different programs that are all dovetailing to help people in different aspects. Maybe it’s finding a job once they’ve found a home, once they’ve found support for their mental health issues.

ROSEN:

Absolutely. And the City of Eureka is really trying to intentionally have some overlap, right? There’s the law enforcement and mental health piece with the CSET team, right? So there’s kind of the accountability mental health component and then you have a mental health team that also can do some case management kind of bridge into uplifts territory and then you have uplift which is, you know, really diving into a lot of this homeless services and social services, but then also they, you know, they’re outreach workers. I mean, they’re frontline mental health workers. If someone’s having a crisis they’re the first ones who are going to see it.

And, you know, whether that’s calling in our team or whether that’s calling law enforcement or whether that’s just talking to them and, you know, de-escalating in that moment, they’re the first kind of the frontline out there. And so, you know, with the city kind of dovetailing all these resources together, we can really provide a more comprehensive service to the community, which is our goal.

O’CONNOR:

Well, there’s a lot happening and as I say, you’re very new in the role, it’s a very new program, but we’d like to talk to you again in the future.

ROSEN:

That’d be great.

O’CONNOR:

Perhaps got some stats on how this is being affected.

ROSEN:

Yeah, I’d love to do that. That’d be excellent.

O’CONNOR:

Well, Jacob, really a pleasure to meet you. Thank you so much for having a Humboldt Conversation with us today, and join us again for another Humboldt Conversation soon.