Mind games

With all apologies to Yogi Berra, “It’s déjà vu all over again” for Sacramento County mental-health clients—4,000 of whom will be left to fend for themselves after July 1, if a proposal seeking to close the county’s remaining four mental-health clinics due to a $15 million budget shortfall is approved.

The announcement, in the form of an internal March 16 memo drafted by Mary Ann Bennett, deputy director of the county’s Behavioral Health Services Department, cited numerous reductions in county, state and federal funding as reasons for the proposed cuts.

“I can tell you that what’s happening in mental health here and nationwide is difficult,” Bennett said. “And what we’re trying to do is redesign our system within the resources we have available to mitigate the impacts.”

The reality is grim and purposefully so—in order to show the county board of supervisors just what is at stake if these cuts go through, said Behavioral Health Services director Ann Edwards-Buckley.

“We’re working very hard to meet the mental-health needs for all who need support,” said Edwards-Buckley. “We will be doing that kind of intensive planning effort again, like we did last year. Unfortunately, there will probably be people who need services who will not get it.”

Surprisingly, given the very real consequences of not having access to medication and therapeutic support, there is no state law mandating a certain level of care be given to adults or children in counties that receive Medi-Cal funding to provide mental-health services, according to research conducted by SN&R and confirmed by Senate President Pro Tem Darrell Steinberg.

Steinberg co-authored the wildly popular Proposition 63—which passed overwhelmingly in 2004 and provided a dedicated pot of money for mental-health services to counties. The measure imposed an annual 1 percent levy on any taxable income more than $1 million, with the understanding that the money would never be subject to the whim of the Legislature and could not be used to shore up the state’s general fund.

But the Mental Health Services Act also has a catch: Its funds cannot be used to shore up programs already in place. In other words, Sacramento County cannot use its 2010-11 MHSA funding (about $18.8 million for 2010-11) to shore up the county clinics, Edwards-Buckley said.

“I think any reduction in mental-health services has serious adverse consequences,” said District 1 Supervisor Roger Dickinson, “For the individual and for the community as a whole. I can say that I will work to prevent this from happening—to do whatever I can to prevent this from happening.”

SN&R caught up with Renee (she did not want to give her last name) at one of four remaining regional support teams March 19, and asked her what she thought of the impending cuts.

“For the past eight years, I have faithfully been going to Northgate Point for my meds and psychiatrist appointments,” she said. “I can’t believe that Sacramento County has the audacity to shut my clinic down and leave me hopeless and possibly psychotic! I am important … and I vote.”

To John Buck, director of Turning Point Community Programs—a public/private organization partially funded by the county—the thought of closing the remaining RSTs is abhorrent.

“In 30 years of working in adult mental health, I’ve never seen anything like this,” said Buck. “As for the fact that there’s no mandate for a minimum level of care—to me, the right thing is that if there’s people whose sole source of income is Social Security disability, and they have a psychiatric disability, then we should be providing our fellow citizens with the support they need to have meaningful, productive and safe lives.”

Buck says that if county mental health “does its job really well,” a third of the clients will have no real problem maintaining services, as long as they jump through some additional hoops. Another third will struggle with and probably not be able to complete all the steps required, while the remaining third: “You can flip a coin, it’s anyone’s guess what will happen to them. There’s just too little time to make this transition.”

Buck fully expects bad outcomes if this proposal comes to fruition.

“I expect increased crises,” he said. “Increased hospitalizations. The ERs in hospitals will be overflowing. Law enforcement will be called out more often for things they never wanted to be involved in. There will be an increase in the homeless population and an increase in lives lost—I’m talking about our clients taking their own lives, not hurting someone else. Those are the most obvious and immediate things we’ll see.”