SR-301-004-04
F:\HumanServices\Share\CD PROGRAM-PROGRAM AREAS\Homeless Programs\Staff Reports\sobering center public inebriation 2005.doc
Council Meeting: January 11, 2005 Santa Monica, California
TO: Mayor and City Council
FROM: City Staff
SUBJECT: Status of Evaluation of the Feasibility and Effectiveness of the "Sobering
Center" Concept and Opportunity for Further Discussion and Direction to
Staff
Introduction
This report provides the status of staff's evaluation of the feasibility and effectiveness of
establishing a "sobering center" concept and encourages public input on and Council
discussion on goals for such an effort.
Background
The intent of a sobering center is to address the problem of acute public inebriation.
The resources expended by the City and local hospitals in responding to this problem
are considerable. In Santa Monica:
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Public safety and hospital personnel respond to an average of five to seven
chronic public inebriates daily. 90% of these inebriates, who are referred to
hospital emergency rooms, are homeless; with approximately 20% of those with
serious mental illness (e.g. schizophrenic) and many more with other untreated
and debilitating mental illness (e.g. bipolar).
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Public safety and hospital personnel report an increase in incidents of chronic
public inebriation early and later in the month, on weekends and in the evenings.
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In 2003, the Fire Department’s Paramedics responded to 478 “alcohol-related”
calls – with over 90% of those being homeless people.
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In 2003, 1,213 arrests were made in Santa Monica for public inebriation. Of
those, 69% or 836 of those arrested were confirmed “transients.” Of the
confirmed transients, approximately 50 people were arrested five or more times.
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Local hospitals also treat inebriates from surrounding cities including Culver City
and Los Angeles – who are then discharged onto Santa Monica streets.
In 2003, Fire department personnel began to explore the sobering center concept
employed in cities such as Santa Barbara, Escondido and Chula Vista. Briefly stated, in
those communities inebriates are transported voluntarily to a staffed facility to "sleep-
off" the intoxicants. Trained service personnel, generally staff of a contracted non-profit
organization, provide oversight and a brief counseling session to encourage the
inebriate to enroll in treatment for their addiction. Inebriates are not incarcerated or
restrained and are free to leave the facilities at any time. (The latter distinguishes the
concept from use of the limited space for holding inebriates provided in the jail in the
new public safety facility.)
A local service provider, the CLARE Foundation, currently provides service of this
nature and expressed interest in expanding the concept at their existing facilities on 900
block of Pico Boulevard. The Santa Monica Chamber of Commerce and Bayside
District Corporation endorsed the sobering center concept. Neighbors of the area
protested that an over-concentration of services already existed, negatively affecting
their quality of life. Recently, suggestions have been made that a new facility could be
located in the now-vacant wing of City Hall formerly used as a jail.
One expectation is that a sobering center could substantially reduce the public safety
personnel time required to respond to inebriates and therefore on-duty public safety
personnel could be more strategically deployed. Opportunity costs associated with
following the current procedures, rather than direct costs, are the most significant costs
to the City. To the extent that overtime is necessitated by booking procedures and
transport, the City also experiences direct costs. Staff continues to develop a consistent
method to produce an accurate assessment of City expenditures related to addressing
this problem and the anticipated cost benefit of a new sobering center program.
The Medical Director of the Santa Monica Hospital Emergency Room estimates that it
costs the hospital approximately $900,000 annually for the public inebriates in that
hospital’s emergency room. There are further and even more significant costs if an
inebriate is fully admitted to the hospital from the emergency room. These costs may
be $40,000 to $50,000 per person depending on the length of stay and type of medical
conditions under treatment. While a sobering center might not eliminate the unfunded
full hospital admission costs, reducing the number of inebriates who consume hospital
emergency room beds for 6 to 8 hours of “sobering up”, would be of significant value to
the hospital.
The persistence of large numbers of chronic homeless people – including those who are
chronic inebriates - are among the factors that cause residents to question the ultimate
benefit of services provided to the homeless with City funding. On December 14, the
City Council directed staff to expeditiously evaluate the feasibility and potential
effectiveness of establishing a "sobering center" as a means to reduce the impact of
public inebriation on the community.
Representatives of Fire, Police and Community and Cultural Services, with assistance
from the City Attorney, have:
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assessed the current problem in Santa Monica;
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charted current departmental procedures;
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begun to define goals for better managing public inebriation against which to test
the sobering center concept;
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researched models for sobering centers in other cities;
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spoken with local hospital, social service and County providers;
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initiated research on judicial mandates that might assist with the concept; and
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begun to look at time and cost estimates for use of the former City jail.
Discussion
In order to inform the Council’s discussion about this issue, this report provides a
summary of the current process for handling public inebriates; goals for such an effort
from a successful program; preliminary research results and a summary of next steps.
Current First Response Process
: The current process for handling public inebriates
in Santa Monica is outlined on the flow chart at Attachment I. Briefly, a preliminary
determination is made regarding whether an individual should be transported to jail or a
hospital, based on their ability to care for their own safety or care for the safety of
others. Transport to jail is handled by police. Transport to the hospital may be handled
by police or paramedics. A public inebriate with medical problems or medication
requirements will not be booked in the Santa Monica Jail. An individual taken to the
hospital may subsequently be transported to the Jail by police following observation and
treatment.
Today in Los Angeles County, an individual charged with public drunkenness and found
guilty may be sentenced to the Los Angeles County Jail. However, those that are
sentenced to serve time tend to be released immediately by the LA County Sheriff after
serving little or no time due to the overcrowding of the jails. The consequences of
public inebriation are not serious enough to encourage inebriates to seek treatment and
consequently public safety personnel and hospitals tend to see the same individuals
repeatedly.
The time consuming nature of the enforcement of public inebriation laws, and the
"revolving door" phenomenon described above, may discourage public safety personnel
from engaging in enforcement activity. Unless an inebriate is causing a disturbance
requiring police response, or when police respond to a call for service from a member of
the public, inebriated individuals may remain on the streets or in parks.
Goals
: It will be important to determine goals and objectives for a sobering center or
other more comprehensive program to address public inebriation. In researching
successful models in other cities, San Diego emerged as a program to consider. The
San Diego Serial Inebriate Program (SIP) employs a very strong linkage between law
enforcement and the courts in diverting homeless inebriates off the streets, out of
hospitals and into effective treatment. The goals of the San Diego Serial Inebriate
Program (SIP) are as follows:
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“to slow or stop the revolving door cycle of chronic alcoholics going in and out of
detoxification centers, jail and emergency rooms
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to divert this population off the street and into County-funded treatment programs
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to significantly reduce the uncompensated costs, time constraints and manpower
burdens to San Diego County’s healthcare, law enforcement and judicial
infrastructure caused by homeless chronic alcoholics
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to give people who routinely live on the street an opportunity to create a stable
mainstream lifestyle.”
It is clear that in order to meet such goals a strong interdisciplinary partnership must be
established. San Diego’s SIP is overseen by a partnership of City and County
departments representing public health, human services, housing, legal, law
enforcement and judicial disciplines.
Research about Sobering Centers in Other Communities:
Staff research has
focused on programs and lessons learned in Santa Barbara, Escondido, San Diego,
San Francisco and Santa Cruz. Staff has been reviewing materials and contacting
these communities to learn about their efforts. Preliminary review indicates that models
vary. Recently created programs (San Diego) seem to employ a comprehensive
approach to improve long term success for public inebriates. While a sobering center
can provide a place to sleep off one incident of intoxication, it does not treat chronic
inebriation, although it can provide voluntary referral to treatment. Based on the
experience of other cities, a stand alone sobering center without a strong
interdisciplinary partnership with the “teeth” of court mandates may do little more than
create a revolving door for public inebriates. This ensures that each time a serial
inebriate faces a judge, the sentencing is progressively longer. San Diego reports that
once most serial inebriates are facing threats of 120 to 180 days in jail, they are more
apt to choose a treatment alternative. Jail beds are funded for this effort – therefore, it
is understood that the sentences will be implemented. With this model, there is a
reported success rate of 36% - which assumes there are detoxification beds and
treatment programs including sober living facilities available in the community.
Homeless chronic inebriates require access to transitional housing and supportive
services in order to stabilize. A more thorough review of programs is underway.
Next Steps:
Staff is actively assessing the following options, as well as others directed
by the Council in consideration of this item:
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models and options for a sobering center
Assess and related models.
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existing “sobering” resources
Improve the use of by Police and Fire
personnel. This includes ensuring that public safety personnel take those public
inebriates who are willing to accept help to the CLARE Assessment and Referral
Center during regular business hours. CLARE staff is willing to work with any
inebriate identified by City personnel who wishes to enter treatment.
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Retool existing programs
to better address Santa Monica chronic “street”
population – including consideration of support for more weekend and evening
hours for existing programs and review of the current intake protocols at
SAMOSHEL.
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Homeless Court
Develop interest in and achieving a available to Santa Monica
could add to the number of chronic inebriates seeking recovery and leaving the
streets and parks. Because criminal cases are now handled at the sub-regional
courthouse near LAX, such a court would likely deal with offenders from
neighboring jurisdictions as well as Santa Monica and could actually add to the
number of chronic inebriates participating in Santa Monica based programs, not
an ideal outcome. The feasibility of a truly local chronic inebriate court program
or cooperation with other jurisdictions will be considered.
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new County 24/7 Urgent Care Facility
Participate in the intended as an
alternative to the costly and inefficient use of hospital resources for mentally ill
people. The proposed project, currently in development, has identified a
potential site on the Westside. City staff and County Department of Mental
Health staff have had preliminary discussions about the feasibility of including a
sobering center within this project. Police and Fire department routinely transport
people to various facilities in Los Angeles County and this approach would be
consistent with that practice. It furthers addressing this problem as a region
rather than siting additional services in Santa Monica.
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Consideration of locations:
The north wing of the historic City Hall building
includes space long-used as a jail. That space is under consideration for a
variety of potential uses and location of a sobering center there was raised when
neighborhood objections to siting at CLARE emerged. Should a determination
be made that a new sobering center can achieve important community
objectives, this would be one potential location. Alternatively, reliance on the
new LA County 24/7 Urgent Care facility should be pursued.
Budget/Financial Impact
The recommendations contained within this report do not include any budget or financial
impact at this time. Budgetary impacts will be identified as a recommended program is
developed.
Recommendation
It is recommended that the City Council discuss goals that a sobering center should
address so that staff may complete research and analysis and return with a
recommended program.
Prepared by: Barbara Stinchfield, Community and Cultural Services Director
Julie Rusk, Human Services Manager
Setareh Yavari, Administrative Analyst
James T. Butts, Chief of Police
Phil Sanchez, Deputy Chief
Jim Hone, Fire Chief
Bruce Davis, Captain
Attachment I: Current First Response Protocol
Attachment I
Current First Response Protocol
911 Call
Person Down
SMFD/PD
Response
Medical
Yes
Problem?
No
"Unable to care for
"Unable to care for
personal safety or the
personal safety or the
safety of others"
safety of others"
(Non-Mobile)
(Mobile)
Intoxicated
Penal Code
647f PC
Assess
Treat
JAIL
Transport
Patient Walks
Hospital
Booked &
Away
Evaluation
Released
PD pick-up @
when Sober
Hospital
or
72 hour hold
Yes
for
No
Mental
Evaluation
Illness
Court and
and
Sentencing,
Treatment
Probation, Stay
Away Orders
Time Served