Mental health

Butte County has a cash-flow problem, and it wants poor people with mental-health problems to pay for it.

Not literally, of course. But pay they will, if the Board of Supervisors approves a budget proposal that would close Butte County Behavioral Health’s two treatment centers in Paradise and one in Gridley by September.

The 450 adults and 300 youths in Paradise and the 190 adults and youths in Gridley who use the centers for counseling and to obtain medications and other services would be required to go to Chico or Oroville to get help.

The problem is that, although the programs generate income to the county, from both the state and Medi-Cal, there is a long lag between when the service is provided and the money arrives. As a result, the county has been forced to dip into its general fund for BCBH operating expenses. With the governor’s new budget, it can no longer afford to do so.

It fell to Ed Walker, the newly hired interim director of BCBH, to come up with a proposal—to wit: dissolve the three centers, eliminate a total of 55 positions, and outsource services to private treatment companies. Those companies, in turn, would be responsible for meeting the ongoing expenses. The move would save only about $400,000 annually, but it would solve the cash-flow problem.

It would also severely disrupt the continuity of care of nearly 1,000 people with mental-health problems.

Meetings of the Behavioral Health Advisory Board are usually low-key affairs, but that wasn’t the case March 15, when the board was forced to move its meeting to Manzanita Place in Chico because it anticipated—correctly—that hundreds of people, including clients and their families, would show up.

Dozens of them trooped to the lectern to express their opposition to the proposal, with the crowd offering boisterous support. Many of the clients talked about how troubled they were before they became stabilized at one of the treatment centers. There were tears and entreaties to keep the centers open.

Nearly every speaker was opposed to the change. Some noted how hard it would be for clients, who are almost always poor, to get to another town for help several times a week. Others asked why clinicians and services were being cut, but not administrators.

Greg Fagen, a former BCBH employee, noted that until four years ago, services in Paradise were provided by a private treatment company that cut corners and even, at one point, had a cook running a therapy group. “The county didn’t get much for its money,” he said.

A number of speakers pointed out that the inevitable consequence of cutting mental-health services would be more interactions with the police and court system. Capt. John Rucker, of the Chico Police Department, noted that the crisis services the BCBH offers are hugely important.

Patrick Mace, who teaches in the School of Social Work at Chico State, noted out that “cutting whole programs is more than just the cost; you’re cutting the investment, the accumulated knowledge and the belief of people in the community that there’s a place they can go for help.”

And so it went. Only George Seidler, a private mental-health-services provider, offered a different take on the situation: “We’re not the bad guys,” he said, and in fact can provide quality services at lower cost than public bureaucracies can.

This fiscal crisis has shone a light on ongoing problems at the BCBH. That was especially evident Monday afternoon (May 19), when five psychiatrists and one nurse practitioner—out of the agency’s 15 medical professionals—held a press conference at the Shalom Free Clinic on East First Avenue.

They have been upset for a long time, they said, because of an effort on the part of recent directors—before Walker, who’s from Marin County, it was Bradford Luz, from Alameda—seeking to impose a Bay Area model of service on Butte County.

Private treatment centers work well in urban areas, said Dr. Gerald McGuire, himself a former director of the agency, but not in rural counties like Butte. They simply don’t have the quality of service and continuity of care an agency like BCBH has. A turn to outsourcing in Shasta County, he said, has become a disaster.

Dr. Carolyn Kimura, a psychiatrist at the Paradise clinics, worked there when adult services were being provided by a private contractor, Victor Treatment Centers. “Minimal care with maximum billing was the modus operandi,” she writes in a letter to Supervisor Kim Yamaguchi. When the county took over, the number of patients seen “increased from a handful to over 400.”

The current staff is well-trained and experienced, she adds, and has developed strong relationships with patients, especially the youth. Without those relationships, these kids “could easily end up in prison with basically little hope of adequate intervention and rehabilitation"—and at tremendous cost to the taxpayers.

There are better ways to save money, McGuire said. For one, stop sending kids needing hospitalization to expensive inpatient facilities elsewhere. Many times they come back “worse than when they went.”

For at least five years, he added, the medical staff has urged creation of a local inpatient hospital for youth, but its recommendations have been ignored.

That was one reason why the medical staff wrote a letter to the Board of Supervisors stating it had no confidence in Luz, McGuire said. Luz, who had serious health problems last year, resigned in late February, shortly after the letter was sent.

Dr. Ray Cavanagh, a BCBH psychiatrist, said decisions about patient care are being made without any consultation with the medical staff—including this latest budget proposal. “Too often we’re the last to hear about it,” he said, even though “we have more than 150 years of combined experience here.”

There’s good indication that BCBH staff would be willing to take a cut in hours, to 36, to save money, said Laurie Feldman, a nurse practitioner. “If the budget problems had been presented to us earlier, we could have pointed out other ways to solve them.”

In a position statement, the medical staff members called for keeping the three centers open and hiring a local psychiatrist as permanent BCBH director.

Supervisor Maureen Kirk said, in a phone interview, that “nothing’s final” concerning the BCBH budget. If the Board of Supervisors decides the centers should stay open and “it means we need to front some money, we’re going to front the money.”