What mental health rehabilitation centers are like

Over the past weekend my wife and I took the opportunity (at our own expense) to visit three separate Crestwood Mental Health Rehabilitation Centers (MHRC) in Angwin, Vallejo, and San Jose, for the purpose of getting a better feel for what these facilities are like and how they manage challenges that might pique community concern.

These visits each took several hours and included tours and interviews with the clients and staff, as well as discussions with local law enforcement officials. The settings in Angwin and Vallejo could best be described as similar to that of Fallbrook, albeit different sections of the community, with Angwin being more rural in character.

Both surrounding neighborhoods would be described as relatively clean, safe and well-kept for comparable Fallbrook neighborhoods. Consistent with what we've seen and been told by others, one is not really aware of their presence as they strive to maintain a low profile.

Their facilities are neat, clean, and well-kept, and while walking among the clients at no time did either of us feel the least bit uncomfortable; many of them would indeed remind you of friends, neighbors, sons and/or daughters that were going through some significant life struggle.

Crestwood maintains a 3-yearCommission on Accreditation of Rehabilitation Facilities (CARF)accreditation, and apparently has done so since they initiated their MHRC facilities years ago. We have been told this would be equivalent to a "5-star rating" attained by well-managed skilled nursing facilities, which they also maintain.

One of the key elements of either rating is safety for the clients and the community, which is achieved through use of a "program model" of teaching coping skills, to include sobriety counseling for "dual diagnosis" clients. This in turn reduces recidivism and AWOLs.

While rare, when such AWOLs do occur the clients either attempt to return home or go back to the MHRC; we have been told that the only significant negative outcome was a client that took their own life upon returning home.

Where such challenges do arise is in facilities that maintain a more traditional medical model, which focuses primarily on medicating clients and less emphasis on rehabilitation.

Part of the program model at the MHRC includes gradual incorporation back into the community so that they can successfully reintegrate into society. Such outings are a privilege and are "earned" based upon success in achieving behavioral objectives and occur at the final stages of care.

Clients are screened by staff prior to engaging in such outings and are supervised and generally include some type of volunteer work with entities that are willing to accept them.

One of the justifiably consistent concerns that has been raised has to do with the housing of those with a sexual offense history. While these facilities do occasionally house such clients, we have been told that they are screened to a much higher level, and won't be considered for admission unless there is a discharge plan that includes a destination within their area of origin that is capable of providing the appropriate level of care and supervision.

Of note, a preschool has recently opened next door to the Vallejo facility which is only a few blocks away from an elementary school. While Vallejo does have a higher crime rate than Fallbrook, and is more urbanized, their real estate market has been reported by the Mercury News to be the "#1 hottest U.S. housing market."