HomeMy WebLinkAboutBoard of Health February 3 20151 Whatcom County Council
2 Board of Health
3
4 February 3, 2015
5
6 CALL TO ORDER
7
8 Council Chair Carl Weimer called the meeting to order at 10:30 a.m. in the County
9 Council Chambers, 311 Grand Avenue, Bellingham, Washington.
10
11
12 ROLL CALL
13
14 Present: Barbara Brenner, Ken Mann, Sam Crawford, Carl Weimer, Pete
15 Kremen, Rud Browne and Barry Buchanan.
16 Absent: None.
17
18
19 1. PUBLIC SESSION
20
21 No one spoke.
22
23 2. DIRECTOR'S REPORT /HEALTH OFFICER'S REPORT — EMERGING ISSUES
24
25 Regina Delahunt, Health Department Director, referenced the report in the Board's
26 packet.
27
28 Crawford asked about the status of hiring a replacement for Dr. Gonzalez. Delahunt
29 stated she is beginning the hiring process. In the meantime, she and Dr. Stern are covering
30 his responsibilities. She described the difference between the position held by Dr. Gonzalez
31 and Dr. Stern's position.
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33 Weimer asked if there are problems filling the vacant positions. Delahunt stated it
34 depends on the positions. They are getting good applicants for most of the vacancies. The
35 position held by Dr. Gonzalez typically takes a long time to fill.
36
37 Mann referenced the mental health court and asked how involved the Health
38 Department is with designing the new jail and how the mental health court will work.
39 Delahunt stated Health Department staff person Ann Deacon is involved in jail development.
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41 Ann Deacon, Health Department, described the mental health court purpose.
42 Identify those who are often in jail and who clearly have mental health problems, and get
43 them into services. Cases are usually identified by the public defender or prosecuting
44 attorney.
45
46 Mann asked what officers do for someone who is clearly suffering a mental health
47 crisis. Deacon stated it is not funded adequately to do what they want, but they are
48 addressing the funding problem and other issues with a local committee. The hope is for
49 officers to divert people from jail through a pre- arrest diversion and to place someone on an
50 involuntary hold for evaluation and treatment. That doesn't happen anywhere in the State
51 now. The Washington Administrative Code (WAC) requirements have made it too expensive
52 for such a facility to operate. There are different efforts in the state to make this process
53 more workable.
Board of Health, 2/3/2015, Page 1
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2 Mann asked if the jail project is the time to think about things like triage and
3 diversion. He worries they are not developing a comprehensive package of law and justice
4 right now, before going to the voters. They must think of everything. Deacon stated the
5 jail has to be part of an entire system of responses. She can bring forward ideas for
6 creating a system of services that might impact the burden on the jail, addressing people
7 who would be better served elsewhere.
8
9 Weimer asked how to weave those levels of service into the request of the voters.
10 Deacon stated she will check with the Sheriff and Facilities Division about that status.
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12 Brenner stated there is a lot of confusion about who is and is not eligible. There are
13 no services for people who are charged with felonies. A huge number of mentally ill people
14 will not be addressed. They need to do better at getting that message out. Deacon stated
15 she is preparing an opinion editorial (op -ed) and public service announcements for the
16 community. The mental health court is one component in a series of services. There are
17 services to treat people in jail.
18
19 Kremen stated he was concerned about the original ordinance for the one -tenth of
20 one percent sales tax for mental health, because it would not be enough to adequately
21 address the critical issues of mental health in Whatcom County. It will be difficult to get the
22 State to accept the responsibilities it used to have regarding mental health issues,
23 particularly when the County passed the mental health tax, which generates only a small
24 fraction of the money needed to thoroughly address the problems. Deacon stated they are
25 specific and purposeful in how they developed programs and services, to make sure they
26 are effective. They've shown some great outcomes. They have also worked with other
27 funding sources to help leverage more money coming in. Third, they meet with the State
28 regularly. Some of the healthcare reform is helping now. On a statewide level, they are
29 talking about it a lot and making it clear.
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31 Kremen stated the State closed Northern State and other mental facilities around the
32 state. Those clients ended up in the community, which has the final burden to address their
33 needs. The State has a history of backing out of these issues. The local community has
34 been resourceful and cost - effective. The County is the role model for the entire state in
35 achieving results with limited funds. He praises the Whatcom County Health Department on
36 this and many other issues.
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38 Browne stated law enforcement officers aren't clear on what to do when they pick up
39 someone who is too drunk or otherwise incapacitated. He asked what the assessment
40 process is. Deacon stated they attempt to get someone into treatment and look for
41 resources for them. For every program they fund, they try to make sure it's a hub for
42 getting people on the road to recovery. She described the officer assessment process.
43 There currently isn't any diversion option other than the hospital and jail. The triage facility
44 is underutilized.
45
46 Delahunt stated they would like a third option to take people to a place where they
47 can engage in treatment.
48
49 Browne stated they are relying on the officers to make the initial evaluation, which
50 they're not trained to do. Deacon stated they are doing everything they can to plug the
51 holes in a broken system. She will prepare a more detailed presentation for the Board.
52
Board of Health, 2/3/2015, Page 2
1 Brenner stated she has a list of questions about elder care, healthcare from a
2 naturopath, whether the flu shots include the new flu, and whether duck hunters can get
3 the avian flu.
4
5 Dr. Greg Stern, Health Department, gave the Board an update on the flu, avian flu,
6 and measles. Everyone should get a flu vaccine. This season, there is a predominance of
7 two strains of flu. The vaccine strain matches about a third of the strains that are
8 circulating. There is not a mid - season adjustment to the vaccine. It takes a year to
9 develop the vaccine. The flu seasons vary between the northern and southern hemispheres.
10 The effectiveness this year at preventing disease is only 23 percent. The effectiveness
11 depends on how well the vaccine generates immune response in addition to how well it
12 matches the virus. Also, there are different waves of viruses and different times of the
13 season. The Centers for Disease Control and Prevention (CDC) has asked providers to use
14 the antiviral medications sooner. It's important that people use their sick leave if necessary
15 to keep other people from getting sick and to wash hands.
16
17 Buchanan asked about the decisions made regarding the flu formula developed each
18 year. Stern stated many factors go into choosing the vaccine strains. It is based on
19 anticipating the prevalent strain next year.
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21 Weimer asked if there have been any local measles outbreaks. Stern stated there
22 are two cases in Washington state. He's concerned about the vaccine exception rates in the
23 schools. They are measles cases waiting to happen. He has data on documentation of
24 vaccination of school children.
25
26 Crawford asked if the trend is against vaccination, and if there is any education the
27 Health Department can engage in. Stern stated the trend to not vaccinate is increasing.
28 Research on evaluating vaccine hesitancy indicates that information isn't sufficient to
29 educate people about vaccines, and may be counterproductive. It's not that people are
30 uninformed. The issue is that they don't trust unvetted sources.
31
32 Delahunt stated each program is putting together improvement reports. They are
33 focusing on immunization rates for kids through the immunization program.
34
35 Crawford asked if a school board in Washington state is allowed to require
36 vaccinations of all its students. Stern stated he's not sure about the legality of that
37 authority. If there is an outbreak, as the County Health Officer, he has authority to not
38 allow people to attend school without proof of vaccination. It would be helpful for the
39 Health Board to make statements supporting vaccination. It's a cultural issue. There are
40 key issues to discuss further.
41
42 Browne stated people need to hear about the consequences of non - vaccination.
43
44 3. PUBLIC HEALTH ADVISORY BOARD (PHAB) ANNUAL REPORT
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46 (11:14:16 AM)
47
48 Ben Schultz, Public Health Advisory Board (PHAB) Chair, stated the PHAB focused
49 last year on healthy planning, decontamination of drug use sites and manufacturing sites,
50 the water action plan, the Health Department budget and strategic plan, and the PHAB work
51 plan. For next year, the PHAB wants to link individual meetings into a more coherent
52 whole, so they can explore issues over time. The Board members have agreed to link all
53 the meetings for 2015 to the Community Health Improvement Plan (CHIP) and Health
Board of Health, 2/3/2015, Page 3
Department Strategic Plan. His message to the Board of Health is that the PHAB's purpose
is to respond to Board of Health requests. They also respond to requests from the Health
Department and staff. The third purpose is to make sure the Board collects the best advice
possible. Build agendas that allow individual members to share their best input. The
biggest impact for creating productive meetings is setting the agenda. The Board can make
requests for their agenda topics. The second impact for productive meetings is the process
of how they conduct business during the meetings. The third impact is to share and act on
the information that the PHAB discussed.
Weimer asked if the PHAB has discussed whether six meetings is enough. Schultz
stated they can add more meetings if needed.
Brenner asked if the PHAB considers suggesting topics for the Board of Health.
Schultz stated the PHAB agenda will include board member - initiated topics. The role of
advising is to identify key points. The PHAB can set an agenda to allow members to share
their expertise on particular issues. A second issue is how the information from the PHAB
gets forwarded to the Board of Health. It's a learning process for the PHAB.
Mann asked if the PHAB would like to talk about a comprehensive approach for
dealing with mental health issues and the jail. Schultz stated the PHAB can adapt to
emergency topics, such as mental health issues and the jail.
Delahunt stated the strategic work plan for the Public Health Advisory Board includes
a policy agenda for the Board of Health.
4. HOMELESS HOUSING UPDATE
(11:25:11 AM)
Ann Deacon, Health Department, submitted and read through a handout (on file) on
homeless housing information. The end goal is to get the homeless into permanent housing.
It saves the County money. They just finished the annual point -in -time count last week.
The number of homeless children is more than last year. Whatcom County is doing better
than average. She read through the handout and described the demographics.
Greg Winter, Opportunity Council Homeless Service Center Director, stated the
statistics from the Department of Commerce are based on housing affordability. For
housing to be affordable, the person or family must spend no more than 30 percent of their
total income on housing costs. When helping any household, they must align an available
housing unit, rent subsidy, and a case management opportunity. That's what they do for
every one of the 3,000 households they've served since 2008.
Deacon continued to read through the handout and described current activities,
which include mental health services in homeless housing programs, training first
responders, mental health court, outreach to opiate addicts, case management, and
working with the City of Bellingham. Effective mental health programs must address
criminal thinking and behavior and also address housing issues. She asked what additional
information the Board needs to understand the complex issue, knowing that there are no
more dedicated funds.
Weimer asked how stable the State and federal funds are and whether the County is
taking advantage of block grant proposals. Deacon stated there is no new money or stable
money. The County and City work closely on proposals. They try to plan on using
Board of Health, 2/3/2015, Page 4
1 resources together. Whatcom County Health Department doesn't have any matching funds
2 to offer.
3
4 Weimer asked if they've considered funding sources they normally wouldn't consider,
5 such as using rural sales tax or economic development investment (EDI) money, since
6 homeless people affect downtown businesses. He asked if they've looked at alternative
7 options for housing, such as micro housing projects. Deacon stated they have looked at
8 those things. The biggest challenge is the lack of resources. They follow national best
9 practices closely.
10
11 Mann asked how the decision is made about mental health sales tax set aside for
12 diversion. Deacon stated there were four main goals in the ordinance that implemented the
13 tax. Also, the communitywide stakeholder forum in 2009 identified the triage facility as the
14 priority concern.
15
16 Browne stated zoning regulations are the biggest barrier to affordable housing and
17 micro - housing. It may be something that staff can look into making more viable. The
18 Bellingham rental housing issue is concerning. There is quite a bit of illegal housing, which
19 are apartments in areas not zoned for that use. He is concerned about losing that inventory
20 if they have a rental registration program. He would like to know the impact and whether
21 the City of Bellingham has examined that impact. According to the report, a person must
22 spend $781 per month for rent for a single person and $1,290 per month for a family,
23 based on the numbers in the report. The data is great. The report should include those
24 numbers.
25
26 Brenner stated neither the mental health services at homeless housing programs nor
27 the outreach to opiate addict program sound very effective. Deacon stated they have
28 gotten quite a few people in treatment because of the opiate addict program.
29
30 Brenner asked if staff works with other veterans organizations or offers grants to
31 those organizations. Deacon stated they work with a number of veterans organizations.
32
33 Crawford asked if these programs are currently funded. Deacon stated they are.
34 She described the funding provided for the case management central registry.
35
36 Crawford asked how the County is doing on ending homelessness. He's skeptical
37 that legislation can eliminate homelessness. He's hearing anecdotally that the homeless
38 situation locally has gotten worse. Cities in California are banning encampments altogether,
39 and it seems to be working. They're saying the opposite here by saying that housing is the
40 solution. He's not sure they've accomplished a lot. He would like to see some evidence of
41 the progress. Deacon stated they must balance the criminalization of homelessness with
42 laws that help promote long -term solutions. Criminalizing homeless or mental illness is not
43 effective. It doesn't make the problem go away. They are not going to end homelessness
44 this year. When the program started in 2005, the recession was not helpful. She will make
45 a presentation about their successes. This is a very complex issue. They do what they can
46 with their current resources.
47
48 Crawford stated he would like to know how long service recipients have lived in
49 Whatcom County, which is the end of the line at the Canadian - American border. Deacon
50 stated they've formed a task force that includes the major stakeholders to address the
51 residency issue in response to a recent request. They are aware of the concerns. They
52 don't want to invite anyone and everyone to Whatcom County. They are paying attention to
53 the concern. They hope to have a response to the issue this summer.
Board of Health, 2/3/2015, Page 5
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Crawford stated use the housing numbers from 2005, subtract the amount of
housing alternatives they've provided in the last decade, and determine if that's the full
reduction. He's concerned that it is backfilled from people new to the area or local folks
who give up trying to earn an income. Trying to end homelessness is a noble gesture. He
will watch the experiment in California to see how that goes. They don't know which
method is more effective. Deacon stated issues this complicated require a multitude of
coordinated responses based on best practices. They are trying to use science to the extent
that it's available.
Weimer stated he would like information on the diversity of people who are homeless
and the trends of who has become homeless in the last ten years, to see if they are making
progress in some areas and not in others.
Browne stated the more they can put a face on homelessness, the more public
support they'll receive. Deacon stated a local videographer has produced a series of videos
about the face of homelessness. Very talented and skilled people have ended up homeless.
She will make a more comprehensive presentation this summer.
Weimer stated they also want to talk soon about diversion and the jail. They must
start making decisions on the jail soon.
Browne stated the public's support of jail funding will depend on the County's
comprehensive approach to dealing with these issues, instead of creating another
warehouse for offenders.
ADJOURN
The meeting adjourned at 12:14 p.m.
it
,., FThq CouH6IM,ppproved these minutes on March 31, 2015.
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aah"a Pr wn -D ie °, Council Clerk
Jill Nixon, Minutes Transcription
WHATCOM COUNTY COUNCIL
WHATCOM COUNTY, WASHINGTON
Carl Weimer, Council Chair
Board of Health, 2/3/2015, Page 6