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June 4, 2010
Sacramento County's idea to scrimp on mental health services doesn't just threaten vulnerable patients. It turns out the plan may well be illegal and end up costing the county more than it would save.
If those stop signs aren't enough to get county officials to scuttle the proposal, it's hard to imagine what would.
Yes, the county is grappling with a budget deficit of $181 million, a figure that seems to keep rising. But it's also abundantly clear that the plan to wring about $9 million in savings from the Department of Behavioral Health Services should be a non-starter.
Currently, about 5,000 adults with severe and chronic mental illnesses such as schizophrenia and bipolar disorder go to nonprofit groups for individualized care that allows them to live in the community. The county, which contracts with the nonprofits, plans to take over by expanding its adult psychiatric clinic and by opening four "wellness centers" staffed by county workers.
The chief counsel for the state Department of Mental Health has warned the county that its proposal is illegal and "could cause irreparable harm" by shunting patients to county employees lacking "specific mental health skills." The counsel also cautioned that the shift could lead to a loss of $40 million in state funding the county wants for 2010-11.
In her response Tuesday, county Health and Human Services Director Ann Edwards-Buckley stressed that no final decisions have been made and made some significant concessions. She opened the door to a "hybrid" system involving both the county and private nonprofits. Also, instead of the new system starting July 1, she said changes would take effect no sooner than Aug. 1 and would be phased in to "minimize the impact on clients."
Already, advocates for the mentally ill are suing the county, saying that the plan would violate federal and state laws and throw patients into crisis.
County officials are to make their final recommendations to the Board of Supervisors on June 15. If this ill-advised plan isn't further overhauled by then, supervisors should send officials back to the drawing board.
This mess is also another sign that something has to be done about 71J, the county charter provision that prevents the county from replacing county workers with private sector ones.
While voters approved 71J in 1996, they have now seen county workers protected at the expense of essential services and taxpayers. County workers are valuable, but in times of crisis, Sacramento County leaders need flexibility that, barring a change to 71J, they will never have.