Stop us if this sounds familiar.
These mental health homes have grown exponentially in California — but especially in Orange County. They provide 24-hour-a-day, nonmedical care and supervision to adults recovering from mental illness who need assistance, guidance or counseling. And the government’s well-intentioned eagerness to get mentally ill and addicted folks off the streets promises that thousands more will open in the near-ish future, with regulators paying more attention to the number of fire extinguishers than to ensuring programs actually work.
This may sound a lot like the (fraud-riddled) residential addiction treatment homes found in so many SoCal neighborhoods — but, technically, it’s not. Addiction treatment centers are licensed by the state’s Department of Health Care Services and must abide by an increasingly stringent (though not nearly stringent enough) set of laws aiming to protect vulnerable addicts from exploitation — many of which came in the wake of the Southern California News Group’s reporting on fraud, sexual assault and death on the Rehab Riviera.
These, however, are “social rehabilitation facilities” — a different beast, licensed by a different branch of state government. Social rehabs say they can treat the very serious behaviors that often accompany addiction — depression, anxiety, trauma, grief, schizophrenia, bipolar disorder, suicidal ideation, psychotic disorder, personality disorder, “dual diagnosis and co-occurring disorders,” and so on.
They tout “exceptional clinical teams” providing “a unique and effective combination of psychiatry, psychotherapy, and integrative therapy” at luxurious homes offering gourmet meals, swimming pools, yoga, meditation, massage, acupuncture, full gyms.
They’re often found in tract homes. They’re often run by some of the same businesses that run licensed addiction treatment centers. They often accept some of the same private-pay insurance. And they’re expressly non-medical, despite the very serious health issues they try to address — just like California’s licensed addiction treatment centers.
These DSS-licensed facilities must be certified by DHCS, but they aren’t licensed as addiction treatment facilities, a spokesman for the DSS said. If social rehab residents need addiction recovery services, the social rehab has to “ensure that those services are arranged.”
We asked for more clarity on any spillover between the laws governing addiction treatment and social rehabs, but that was not forthcoming from either DHCS or DSS by deadline.
Avoiding the teeth
The growth in these facilities has been stunning, especially in Orange County.
In the spring of 2013, there were just 96 “social rehabilitation facilities” licensed by the California Department of Social Services in the state. Only two of them were in O.C. Much larger Los Angeles County had 10, Riverside had three and San Bernardino had none, according to DSS data.
Fast forward one decade. Orange County has been declared the nation’s center of addiction industry fraud by the federal government. New laws have passed. And the number of social rehabs has tripled — to 286, with another 34 licenses pending. (View interactive map)
O.C., which had just two social rehabs in 2013, now has 61.
Los Angeles County — with three times O.C.’s population — also has 61. Riverside has 11. San Bernardino, 15.
But 12 more social rehabs have licenses pending in O.C., while only 10 more are pending in L.A. — which will make O.C. home to the greatest concentration of these facilities in the entire state of California.
It’s important to note that the overwhelming majority of them — more than two-thirds — sprang up in 2017 and afterward, when harsh light illuminated bad practices in the addiction treatment industry and new laws began rolling out to curb them.
Those new laws do things like require residential addiction treatment centers to adhere to standards set by the American Society of Addiction Medicine (imagine!), forbid them from misrepresenting or making blatantly false claims about the services they offer or where they’re located (imagine!), and require them to provide a “client bill of rights” to folks seeking treatment (can you imagine needing this at your doctor’s office?).
The bill of rights, by Sen. Tom Umberg and signed by the governor last year, spells out the right to safe, ethical, evidence-based services and must be signed by the client. Like other laws before it, it prohibits false or misleading advertising. Unlike other laws before it, it packs penalties of up to $20,000 per pop for violations and expressly allows clients, families and the California Attorney General to take providers who violate its provisions to court.
“That bill of rights put teeth into the addiction treatment laws,” said Bill Lyon, a Newport Beach resident who has been watching the growth of social rehabs with unease. “If you’re looking at opening one of these, you have all kinds of dos and don’ts and big fines for violations — but there’s much less involved with a mental health house.”
And it can be lucrative. After finishing 30 days or so of addiction treatment, billed to insurance, folks struggling with substance abuse can come to these mental health homes for another 30 days or so of mental health treatment, billed to insurance, pointed out Erica Keane, who is working with Lyon on the issue in Newport Beach.
Operators aren’t allowed to bill insurance companies for sober home living after a formal addiction treatment cycle is complete — but they could charge for this.
Worry
Lyon and Keane have been watching all this unfold with concern. Their city now has four licensed social rehabs, and one with a license pending — in addition to 39 licensed addiction treatment facilities and an untold number of sober living homes.
They worry.
In the spring, California voters will consider a ballot measure to create housing and treatment for homeless folks with serious mental illness. It will include a nearly $6.4 billion bond to build 10,000 treatment units and supportive housing.
Will these new facilities be as well-regulated as the current ones — which is to say, not very? Will Orange County again be home to a huge and disproportionate share of these facilities — far more than is needed to address local needs?
“They want to build 10,000 units, but they’re feeding them into a broken system,” Lyon said. “Are there that many qualified people that can run these? It’s a huge concern.”
California’s mental health system has been plagued with dysfunction since psychiatric hospitals were shuttered in favor of more friendly — and less expensive — community-based treatment centers decades ago, experts say. The pursuit of profit among private-pay mental health providers, and the sloppiness of state regulatory systems tragically ill-equipped to oversee them, fail patients and cost lives.
Many in Newport are still on edge over the death of Henry Lehr. Just days before a delirious Lehr bolted from a licensed detox, forced his way into a neighbor’s house and was killed, the detox operator was cited for eight deficiencies by state regulators. Its facilities are still open, and a new one has been licensed.
“What does it take to lose your license?” Keane asked.
Brandon Nelson committed suicide in a Sovereign Health facility that was supposed to treat his severe mental illness. His parents recently settled a wrongful death suit for $11 million with the defunct company, and have many of the same worries.
Allen Nelson, Brandon’s father, fears that many operators will swarm into the market for the wrong reasons — money — and tens of thousands of people will be funneled into substandard programs. “They know there’s not going to be any oversight. There’s not any oversight now. Given our experience, it could be very detrimental to many people,” Nelson said.
We reached out to several operators of social rehabs to chat about this, but folks weren’t keen to talk. Lawmakers were also mum — this is a hard one to juggle.
It’s clearly critical that we have more housing and mental health treatment for the 170,000 or so homeless people in California. But a radical increase in small, nonmedical facilities is not the answer.
When will we treat mental health and addiction as the illnesses they are? And when did we decide it’s OK to treat illnesses without medical personnel?
Source: Orange County Register
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