Drastic measure

Sacramento County is preparing to cut $17.5 million from area mental-health programs, leaving thousands with mental illness unsure of what will happen to them.

Part of the cut includes a plan to redesign the county’s mental-health system, closing some privately run mental-health clinics in order to save money and public employee jobs.

By June 30, the county plans to shutter four outpatient programs run by outside nonprofits, which serve some 6,500 clients. Many have severe mental illness, such as schizophrenia or bipolar disorder. These clinics are called “regional support teams,” or RSTs. Officials at the county Behavioral Health Department have offered to replace the centers with four new mental-health “wellness centers” that will offer case management and medication support services similar to what the RSTs have provided.

But clients and mental-health service providers are skeptical, and wonder why existing programs have to close at all.

“What the county said it plans to do, in all reality, I’m not sure it’s possible,” said Alex Bolte, program director for El Hogar Community Services, one of the existing programs set for closure, which serves about 900 clients.

“We’ve been around a long time. We have the expertise to meet the unique needs of adults with mental illness and provide recovery services,” Bolte said. She added that with the new system, she fears that “people will fall through the cracks and take huge steps backwards.”

“You take someone’s stability out, and their world crumbles,” she said.

But due to budget constraints—and a rule called Measure 71J, which prevents contracting out services if it displaces public employees—the county says its hands are tied, and it had to redesign the mental-health system. All of the RSTs are funded by the county, but all are private contractors and employ no county staff.

By introducing the wellness centers, the county can eliminate about 151 contract positions—all people working for the RSTs—and add about 80 to 85 county employees. Some of those county positions will be filled by employees moving from other departments. The county says this will save $8.9 million and 28.6 county jobs. Cuts to other county mental-health services would bring the savings to $17.5 million.

“It’s unfortunate they picked the plan they did, because I think it will destabilize a lot of people who are currently stable,” said Wendy Hoffman-Blank, program manager for Visions Unlimited—one of the programs slated for closure. “Also, it’s quite a job to set up a clinic; we started out small and grew gradually. How are they going to give birth to a full-grown clinic?”

With the closures just about a month away, the county has yet to settle on any permanent sites for its new programs. Proposed sites are in Bowling Green, Carmichael, Del Paso Heights and at the Sacramento County Mental Health Treatment Center on Stockton Boulevard.

They would be staffed by former RST doctors contracted through UC Davis, though it is unclear whether many of the current RST psychiatrists will go along with the plan.

County officials also say there will be a new hotline number to assist those patients who fall through the cracks.

At a public meeting of the Sacramento County Mental Health Board on April 8, county mental health director Mary Ann Bennett tried to reassure clients that county staff is working diligently to see that everyone who needs services receives them.

But distraught and angry clients approached the microphone, one by one, to tell their personal stories of tragedy before—and success after—finding help at the RSTs.

“Myself and others would definitely fall through the cracks,” said Patricia Boynton. “I just don’t see how they’re going to have the clinics open July 1. It’s going to be too hard for people to make the change. They won’t get the social support they’ve been getting at El Hogar and the other RSTs.”

A client named Ken said bluntly, “If you close the RSTs, suicide rates are going to go up, homicide rates are going to go up. There’s no other way around it.”

Added Hoffman-Blank, “Anyone I talk to about to about this plan thinks it’s a bad plan, but I can’t find anybody with the power to stop it.”

Somebody might try, however. An advocacy group called Disability Rights California is collecting information and conducting interviews with clients throughout the county for a possible lawsuit against the county to stop the closure of the RSTs.

“Our concern is that we haven’t heard a clear plan from county mental health about what they’re going to provide as of July 1 to the mental-health community,” said the group’s attorney, Sean Rashkis. “Without the ongoing services that [the current programs provide], the clients will end up hospitalized, or needing a higher level of care than what is currently needed.” Rashkis added that “it’s really concerning that the county thinks it will be able to start on July 1.”