Sacramento Bee

May 14, 2010

Editorial: Adding to crisis for those in crisis

Come July 1, Sacramento County plans to scuttle a system that provides outpatient treatment to adults with severe and chronic mental illness. There are serious doubts whether the replacement is ready and will work.

Now, about 5,000 patients are served by a network of private nonprofits for individualized care – psychotherapy, counseling, medication and support services – that allows them to live in the community and with their families. Under the county's plan, it would expand its adult psychiatric clinic and open four new mental health "wellness centers."

The change is supposed to save money, $8.9 million of a $17.5 million hit to the county Department of Behavioral Health Services. That's in dispute, however, since the new clinics would be staffed by county workers who otherwise would be laid off and who are far more expensive than nonprofit employees.

To smooth the transition, county officials have met with the nonprofit groups and plan to update their leaders on Tuesday. They have also held several public meetings and are drafting a letter that the nonprofits would give to their patients.

But advocates say the country is not nearly prepared to take responsibility for the patients, most of whom qualify for Medi-Cal and who have schizophrenia, bipolar disorder and other conditions. Some of the most vulnerable in our community would be more on their own and have to find their own way to the new county clinics, whose locations are yet to be determined.

With the new setup, advocates say, more patients would go into crisis and end up in emergency rooms or locked facilities, costing the county much more, or just wander the streets. Some who go untreated could hurt themselves or others.

All the misgivings are detailed in a lawsuit, filed last week on behalf of five mentally ill clients but seeking class-action status, which alleges that the county's plan violates federal and state laws.

Some of the fears and warnings may be overwrought, but if only some of them come true – and that appears likely, based on what happened when the same private programs had their budgets slashed during the past year – the situation will be dire.

Unless the county provides more proof it has its act together, a federal judge should issue a temporary injunction until there are far greater assurances that patients won't fall through the cracks. The Board of Supervisors will consider the cuts in June budget hearings. Even in the throes of a financial meltdown, the county just has to do better.

It's one thing to be surprised by a crisis. It's quite another to see one coming and not head it off. That would be the height of irresponsibility.