The Serial Inebriate Program in San Diego, California removes the barriers between corrections, public defenders, prosecutors, social workers, emergency response teams, police officers, mental health care providers, and other medical professionals. Jail time is replaced with medically supervised detoxification, medical assessments, and transfers to a six-month treatment center. The program reduces costs for everyone and improves results.
What do you need to start a program that can create a fifty-five thousand dollar per month reduction in uncompensated health care expenses? To create a model that can improve the lives of people who have been living on the streets for 16 years? To implement a strategy that can break down the silos between medicine, emergency services, law, and social services? You talk to Deni McLagan, CATC, Program Manager, at Serial Inebriate Program (SIP) of Mental Health Systems, Inc.
Deni tells the story of the program’s initiation. “We have a meeting in San Diego County for alcohol and drug treatment providers. Two police officers were repeatedly arresting the same men for intoxication and shared this at the meeting. You could hear crickets chirping when they requested our help… They did not get the response they wanted,” said Deni. She had seen this before: “problems” being passed from agency to agency without a system in place to break the cycle. She gave the officers her card and said “bless your hearts.” “When I returned to my office, my assistant said, ‘There are two police officers here waiting for you.’” With a surprised smile, Deni asked the officers, “What IS your plan and how can we help you?”
“There is nothing so powerful as an idea whose time has come.”- Victor Hugo.
This was the birth of the Serial Inebriate (SIP) program. Initially the group wanted to name the program the Repeat Alcoholic Program until a judge suggested the program’s current name. Coming from a judge, the name stuck. From Deni’s experience, starting such a program begins with communicating across disciplines. It is a complex and graceful machine. The program transitions individuals who are chronically using substances from the street to jail. At jail they are offered detoxification with medical oversight. They then receive medical care with dually certified doctors and transition to six months of treatment.
Initially, when the city decided to arrest people for public intoxication, public defenders said, “I don’t think so, Skippy.” They were concerned that someone might have a few drinks and end up in jail. The county responded by defining “chronic” substance use as individuals who had been to the sobering center for four-hour periods more than five times in one month. When people fit this criteria, treatment is offered in lieu of custody time. All of the people who are arrested in this situation are arraigned within 72 hours; this first step of the street to jail is the open door to treatment, the door to hope, rather than the repetitive cycle of jails, to the unforgiving streets, to hospitals, repeat again.
While at the jail, there are medical services to assist with the detoxification process. People who are detoxing are given a “kick pack” of medication. The primary piece is Librium, a drug that assists in the process of helping the body as alcohol leaves the system. Additionally, the kick-pack contains Compazine to settle an upset stomach and a combination of vitamins including thiamine, magnesium, folic acid, and a multi-vitamin. Medical professionals check vitals, as patients are at risk for cardiac arrest.
“We found that the participants only needed to stay for about eight hours, were model inmates, and simply wanted to fit in. If the jail ever saw them again at all, they did not see them again for six months. For the jail, it was a positive experience.” Having consulted with other participating communities, there has been a reduction in utilizing services across the board; they are now receiving treatment that works.
After detoxification, the individuals move to medical care. Since 2004, the primary health care and out-patient psychiatric care for SIP patients has been provided at the St. Vincent de Paul Village Family Health Center. A treatment plan is sent in advance with a medication list from the detoxification center for consistency. There are three to four dual board certified doctors available at the health center. The doctors work two days a week in positions funded by a partnership with Healthcare for the Homeless. The dual certifications are in primary care and psychiatry. At SIP they like to call their dually certified doctors “everything you need under one white coat.” Evaluations are conducted to create a clear treatment plan that outlines mental health, substance use, and medical needs.
From medical care, the individuals move into a six-month treatment program. Six months in a program for men who have been drinking and living on the streets for an average of 16 years is often not enough. Participants may be working to address mental illness and other medical conditions. This is a short time to find renewal, but the program focuses on habilitation rather than rehabilitation. “The reality,” says Deni, “is that most participants are in the program three or four times before they achieve success. We do have people who achieve success the first time.” SIP’s goal is that if a person seems unable to stay with the program they seek him out before it’s too late. “We never say no… If I had cancer and I went into remission and the cancer came back, I certainly hope that my doctor would not say, ‘No, you can’t come back; I am not going to treat you now.’”
Police officers still arrest people for crimes. The public defenders still defend. The prosecutors still prosecute. “The difference now is that we are all talking to each other on a regular basis about how we are going to help ‘Joe.’ Before everyone was doing their own thing—no communication and disconnected. We all do our jobs, but we are on the same team.”
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