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Sacramento Bee

August 23, 2010

Viewpoints: County must fix plan for mentally ill

Sacramento County's mental health system is in crisis. Budget choices by the county have disrupted the lives of the mentally ill. The Mental Health Treatment Center Crisis Unit has been closed, flooding unprepared hospital emergency rooms and pushing many vulnerable people into life-threatening situations in the community. Inpatient programs are overbooked. More contacts with law enforcement have resulted in threats to the safety of both the mental health clients and officers. The Mental Health Court has been shuttered, forcing more clients into jail rather than community treatment. Jail inmates with mental health problems are increasing, and, according to local press reports, there has been a jump in suicide attempts by the mentally ill. The system is lurching toward chaos.

In response, the county has attempted to implement a restructuring plan that needlessly disrupts services to the mentally ill. The county budget plan, based on a flawed legal interpretation of County Charter Article 71J, guts the existing private contractor-based service system, while it saves the jobs of public employees and hikes their salaries. It is not cost-effective because salaries and benefits of public employees are two times more than those of private contractor employees. If the counsel's opinion is rejected and public employees forgive salary raises, the drastic changes in mental health services might be avoided.

The county admits that its plan has prompted fear and trepidation among mental health consumer clients. It not only will increase the cost of services, but also will overburden law enforcement. There will be costly hospitalizations, inappropriate incarceration of the mentally ill and increased suicide risk. The flawed plan violates the Mental Health Services Act because it was created and enacted behind closed doors. The plan has prompted lawsuits, and letters from the state Mental Health Department questioning its legality.

We have obtained a copy of a recent letter from the state dated July 16 via the Freedom of Information Act that tells the county that the Department of Mental Health "will need to review and consider the proposed changes. prior to these changes being instituted." Despite this letter and another threatening loss of $40 million in state funds, the county chose proceed.

Fortunately, the federal court intervened and has issued an injunction. We support the court's action. The supervisors should not rely on the counsel's opinion, but decide for themselves what is best for the county.

We recommend:

• The Board of Supervisors should withdraw the flawed plan and should start a new planning process that conforms to law.

• The state mental health department should reject the county plan because it does not conform to the Mental Health Services Act requirements for public input.

• Public employee unions receiving pay increases should agree to concessions that will make more funds available for less-expensive private contractor services to the mentally ill.

• Hospitals should develop better ways to treat mental health patients flooding emergency rooms.

• The county should maximize the use of federal funds available to support mental health services provided by Federal Qualified Health Centers.

• The county should place a high priority on using Mental Health Services Act funds to support training for law enforcement officers on how best to respond to problems presented by the mentally ill.

• Family members, consumers and the many public and private agencies serving mental health clients should work together to plan for how to respond to future budget stringency.

Recent laws such as the MHSA were designed to treat people in the community and avoid costly hospitalization. The goal was to de-institutionalize mental health. Sadly, we may be moving to re-institutionalize it in jails. We should stop that in its tracks.