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The Fresno Bee

August 22, 2009

Fresno County budget cuts to end mental health program for kids

By Brad Branan

Fresno County will end a mental-health program for children and delay plans for a psychiatric unit for adults as part of an expected series of cuts in response to the state budget, officials say.

Counties across the Valley are cutting mental-health services as a result of Gov. Arnold Schwarzenegger's decision last month to slash $64 million in managed-care funding from this year's state budget.

Fresno County will see its managed-care funding, which goes to programs for low-income residents, cut in half this year to $4.9 million. The loss in funding represents less than 7% of the county's mental-health budget, but the cuts will follow several years of reductions in mental-health services.

And more cuts are coming. Fresno County officials are awaiting key details from the state on other cuts to mental-health programs. The state plans to defer payment of $52 million to counties across California for the care of emotionally disturbed children and reduce funding by $28 million for early treatment programs.

Fresno County officials said they're not cutting any services mandated by the state. State officials, however, point out that the definition of what is mandated is open to interpretation.

Fresno County officials said they're revamping programs so they can continue to provide services that have already sustained deep cuts in recent years.

"The county has been very generous in the past," said Catherine Huerta, director of Children and Family Services. "It's going to be more limited in the future."

Kathy Sullivan, a psychologist and founder of the Sullivan Center for Children, doesn't doubt that Fresno County will try to minimize the harm.

But she said the cuts will further hobble a system that already fails to meet the needs of many.

"There are so many children out there who are not getting the care they need," said Sullivan, once a member of a county mental health task force. "Children's mental health is always at the bottom of the list, until someone does something -- until someone gets shot."

Outpatient problem

As a result of the managed care cuts, the county will not seek a contractor to replace Genesis Family Center as a provider of outpatient care for children, Huerta said. The county canceled the Genesis contract earlier this year, citing questionable spending at the agency.

County psychologists will take care of an additional 100 children when the Genesis contract expires next month, Huerta said.

About six weeks ago, the county changed the way it delivered children's mental health care, relying more on group therapy than individual counseling, she said.

The approach applies to children with nonsevere illnesses, such as depression and conduct disorder. Seriously disturbed children will continue to receive individual therapy.

The approach, also being considered by county Behavioral Health for adult patients, allows the county to serve more patients for less money, officials said.

Emphasizing group therapy has eliminated a waiting list that had grown to about 100 patients, said Huerta.

Limiting layoffs

Huerta and her counterpart at county Behavioral Health plan to tap another funding source, the Mental Health Services Act, to minimize layoffs of county employees.

The act, approved by voters is 2004, created a tax on personal income of $1 million or more.

"We've cut so deep that we don't have enough front-line workers," said Giang Nguyen, county Behavioral Health director. "Who's going to see the patients?"

Since 2005, Behavioral Health has lost more than half of its budgeted positions, down to 196. Nguyen expects to lose a handful of employees due to the managed care cuts.

Since 2007, Children's Mental Health has lost nearly 100 positions, down to 159.

Huerta said she plans to avoid layoffs, but she still needs to identify almost $400,000 in cuts from managed care funds alone. And she faces further reductions, in part because the early prevention funding also cut by Schwarzenegger is the county's biggest source of children's mental health funding.

"My biggest concern is that we're going to lose the ability to do preventative care," Huerta said. "I don't want to become a county that waits until children become severely mentally ill before getting treatment."

In response to past budget cuts, the county decided to restrict care to severely mentally ill adults.

Cuts in Behavioral Health funding led the county earlier this year to close its crisis center for adult psychotic patients. As part of a replacement system, Nguyen proposed a new 16-bed psychiatric unit for adults in Sanger.

But the county will have to put plans for the unit on hold because of the state budget cuts, Nguyen said.

Although the county's existing 16-bed facility in Fresno is often full, the county can handle the short-term needs for such care through Community Behavioral Health Center in Fresno and a hospital in Tulare County, Nguyen said.

As a result of the managed care cuts, Merced County is reducing the number of beds from 16 to 10 at its inpatient psychiatric unit, said Katie Albertson, county spokeswoman. The county's managed care funding went from $2.4 million to $1.2 million this year.

Madera County is planning to cut 12 mental health employees, because of the managed care and other state cuts, said Janice Melton, the county's mental health director.

Tulare County's managed care funding dropped from $4 million to $2 million.

Allison Lambert, county spokeswoman, didn't respond to repeated requests about how the county will reduce spending as a result.