The concentric circle of dark green semicolons covering Carleen Neuman’s left wrist has become a source of pride and a symbol of resiliency. Each of the six punctuation marks represent a time when she could have chosen to end her life, but didn’t.
Neuman’s intricate tattoo covers up a long series of deep, jagged scars that evidence a lifetime of razor blade cutting and burning. It provides a daily reminder that her story isn’t over yet—and that she should tell it.
“There’s a lot not right with the mental health system in Santa Cruz,” Neuman says. “Second Story was the one thing that worked. If it weren’t for my three stays at Second Story, I’d probably be dead. My story would be over.”
The news that Second Story Peer Run Respite House—Santa Cruz’s only alternative to inpatient psychiatric hospitalization—is closing its doors at the end of November is hitting guests like Neuman, as well as the program’s 14 staffers and other members of the mental health community, extremely hard.
“The funding for Second Story is no longer available,” Santa Cruz County Mental Health Director Erik Riera wrote to county staff in an Aug. 23 email. “The decision to close Second Story was very difficult for me as the county behavioral health director, as we have been very invested in building and expanding peer services in our community”
Many leaders in Santa Cruz County’s mental health system are angry about the decision to close Second Story.
“It was essentially done behind closed doors, so to the community it came as a brutal shock,” says Yana Jacobs, who was instrumental in establishing Second Story a little over eight years ago. “And the closure notice is such a short time frame. A few months. This announcement has been traumatic, and people are having difficulty processing it.”
Leaving a Void
As the first entirely peer-run respite house in California, Second Story quickly became a flagship program, and a model for almost a dozen other respite houses across the nation. It was an experiment that worked—until now.
The men and women who run Second Story have always prided themselves on making it a sanctuary; a safe place where men and women with a mental illness can go when they feel like they need extra support, someone to talk to, a shoulder to cry on, or a place to go when they feel things are starting to unravel.
Guests can stay at the six-bed residential program for up to two weeks. There, they can get 24-hour-a-day community, advice, and comprehensive support from highly trained individuals who truly understand the people they’re serving and have helped many of the people they serve avoid inpatient hospitalization.
The November closure of Second Story “is going to leave a huge hole that can’t be replaced,” says Jacobs. “People will isolate in their homes, and by the time someone notices, they will end up in a hospital. Which might be avoided if there was a peer respite to go to early on.”
The decision to cut Second Story was made in collaboration with Riera, Director of Adult Services Pam Rogers Wyman, and Encompass CEO Monica Martinez.
Like many things, it came down to money. Multiple employees providing services around the clock make the annual cost to run the program around $700,000—and that number has been rising in recent years.
The grant from SAMHSA that supported the full cost of operating the program expired in 2015. Since then, Santa Cruz County has provided cash to keep the program going, while also searching for a long-term sustainable source of funding. Because peer services are not considered Medi-Cal eligible, there haven’t been any matching funds to help the county support it.
When Encompass, which does contract management for Second Story, received a grant from the California Health Facilities Finance Authority (CHFFA) to buy a new permanent home in Aptos earlier this year, hopes were high for Second Story’s future. The facility even moved into its new home. However, the CHFFA grant required expansion from six to eight beds, which turned out to be impossible due to the permit process and license requirements. The CHFFA grant also required a 20-year commitment and the county was unwilling to sign on to spending more than $700,000 each year for two decades.
Riera recognizes that the demand for services in other areas of the mental health system continues to increase, and says that Encompass will transition Second Story from a facility- based program to a community-based one starting Dec.1. The house will be sold, and Reira says the 14 workers who have made Second Story their home and community for more than eight years will be offered other positions with the county and Encompass.
Compounding a Crisis
The prospect of shuttering Second Story—essentially gutting the program—is not going over well with many of its current staff. Fanne Fernow, who has worked at Second Story for two and half years, says that she is “pretty certain that [she] would not feel comfortable working in a more traditional model of care.”
The red headed 65-year-old started as a volunteer at Second Story—baking cakes and cooking food for staff events and birthdays—and quickly fell in love with the program. She says that she treasures the community, her late-night chats over cookies and milk and working on her art with guests. “The powers that be are trying to convince us that there can be such a thing as a ‘non-residential peer respite,’” she says. “I do not agree.”
Fernow says that by definition, “respite” means a place of rest. The proposed field-based program would be a huge shift, and the lack of a permanent home could eliminate any sense of community. “Community is what makes Second Story so special,” she says.
The six “beds” that Second Story provides men and women in the local behavioral health system are unique—and, by most accounts, vital to the Santa Cruz County mental health system. The demand for beds at Second Story is consistently strong and the program operates at capacity year round.
Carol Williamson, president of NAMI Santa Cruz, has been closely monitoring the events surrounding Second Story’s closure. “We desperately need more beds at all levels, not fewer. It is unacceptable to lose any beds now. Whenever a bed is lost or a program closes, the impact is tremendous,” she says.
Williamson notes that Santa Cruz County already has a shortage of crisis beds—only 16 in the locked psychiatric health facility—and many people in crisis (estimates say half of them) are sent out of county to Fremont and as far as Sacramento. The 12 beds at the county’s only step down facility, El Dorado Center, are always overbooked. As are those at Telos—Santa Cruz County’s only crisis residential program.
Mental health beds of all kinds are scarce and overbooked with waiting lists,” says Williamson. “If six beds are not available at Second Story, where will clients go to stabilize when an episode is coming on—suicidal depression, psychosis?”
The effects of Second Story’s closure may reach far beyond county lines. There’s a chance that the local closure could be one domino in a larger statewide chain reaction.
“This is a national issue, particularly for states that do not have peer services as a Medicaid-reimbursable service,” wrote Riera. “We have heard from other counties that they are facing the same challenges and are moving toward other models.”