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Mental Health Weekly

May 24, 2010

Advocates sue Sacramento County over termination of services

Disability advocates in California this month filed a lawsuit alleging that Sacramento County's planned cuts for outpatient mental health services at the end of June would leave thousands of low-income patients without critical services.

The lawsuit, Leslie Napper v. County of Sacramento, was filed in U,S. District Court by Disability Rights California, the Western Center on Law and Poverty and Cooley LLP. The lawsuit is seeking to prevent the termination of essential mental health services to 5,000 consumers with severe mental illness. According to the lawsuit, the county intends to end all funding for the Regional Support Team programs and the Transitional Community Opportunities for Recovery and Engagements programs, These programs provide most of the outpatient mental health services to Medi-Cal recipients in Sacramento County.

According to local news reports, the county's new outpatient program includes four new wellness centers with transitional and ongoing services provided by county staff. Mary Ann Bennett, director of mental health for the Department of Behavioral Health Services in Sacramento County, said she cannot comment on the lawsuit. but she told MHW that the county's Division of Behavioral Health Services is grappling with a $15.5 million budget reduction.

"Because of the county's budget problems we have to find a way to not negatively impact county employees subject to this provision," she said. As part of the county's new plan, county employees will provide some of the services previously provided by counselors on the regional support teams, she said.

Bennett said she is unsure how many providers will be laid off as a result of the new plan for outpatient services. "This is a very stressful and painful process for consumers and clients because of the budget problem," she said.

"Because of civil service rules, you cannot contract for outside services if it would negatively impact a county employee that can provide that same service," she said. Bennett said under the new plan, consumers will receive the services from county-operated staff. "We're taking care of everyone who's receiving services now as well as new people in this new plan and proposal." she said.

Lawsuit issues

While the county plans to open new clinics, very few details about staffing and capacity have been provided, according to the lawsuit. "It is impossible for the defendants to establish a fully functioning outpatient mental health system for 5,000 people in the time remaining before July 1, 2010," according to the lawsuit.

The lawsuit alleges that the county's planned termination of services violates numerous federal and state laws, including the Americans with Disabilities Act (ADA), the Medicaid Act and federal and state constitutions, The named plaintiffs are five indigent residents of Sacramento County who currently receive outpatient mental health services provided by the county, which receive federal and state funding to provide these services to adults with severe and chronic mental illness.

The program provides each client with an individually tailored program that combines psychotherapy, counseling, medication and support services. These programs include four regional teams, which have had much success in stabilizing clients with a long history of repeated hospitalizations, so that they can return to productive lives and rejoin families in the community, according to the lawsuit.

County officials say that the programs will be terminated on June 30 due to budget cuts. Replacement services will be available on July 1, however lawyers said they have not seen any information regarding what services will be provided, by whom or even where the services will be located, and how patients will be assured of the continuity of treatment.

"The county has not released any concrete plans or informed us about what transition services will be available." Stuart Seaborn, managing
attorney of Disability Rights California's Sacramento regional office, told MHW, "It's important that this be a well-developed process for transitional services so that there's some continuity."

Seaborn said attorneys on the case are starting to talk to county officials now. "We want to make sure that continuity of care is provided [for these] medically necessary services the way it was provided before," he said. "If we can't get any concrete [information] we will have to seek an injunction and ask the court to stop the planned cuts until something is developed."

Anybody in Sacramento County eligible for mental health services from the county would be affected, including the state's Medi-Cal recipients, Seaborn said. "A lot of people in these programs were going in and out of the hospital, emergency rooms or inpatients services, prior to receiving the county's outpatient services," he noted.

"We're worried that [the county's new program] won't be up and running in time," he said.

Bennett said the county has hosted public forums over the last couple of months and heard public testimony about the proposed plan. Bennett did indicate that the Sacramento County Board of Supervisors still has to consider the department's proposal.