COUNTY AMASSES MENTAL HEALTH FUNDS AMID NEED
By Lauren Mascarenhas | 6 a.m. Aug. 22, 2015
While San Diego County struggles to keep up with demand for mental health services, more than $170 million has collected unspent in a special fund to help with the cause.
The money comes from a 1 percent tax on the income of millionaires, collected for mental health services under a 2004 statewide ballot measure.
The county’s most recent tally, for 2013, lists $172 million fund balance, which exceeds the amount identified for a “prudent reserve” of $42.2 million. That’s down from $176 million in 2011.
Revenue and expenditure reports from nearby counties —Los Angeles, San Bernardino, Riverside and Orange — show similarly high amounts of unspent funds.
According to San Diego County’s behavioral health director, Alfredo Aguirre, there are plans to spend the money, but the fund cannot legally be used for certain direct services such as inpatient care or 24-hour locked facilities.
The program reserves the funds for community services and support, prevention and early intervention, capital facilities and technological needs, workforce education and training and innovation.
Aguirre said the county plans to introduce and enhance mental health services in the next year. In January, Laura’s Law will allow for court-ordered assisted outpatient treatment. In addition, officials plan to launch new crisis services and innovation efforts including faith-based services and treatment for hoarders.
The county also plans to enhance existing programs, such as expanding its Psychiatric Emergency Response Teams for crisis situations.
Advocates say more can and should be done.
“Taxpayer dollars have not been appropriated in the most fiscally responsible manner when it comes to this very hard-to-treat population,” said Theresa Bish, former chair of the county Mental Health Advisory Board. “The rates of homelessness and recidivism speak for themselves.”
San Diego has its mental health challenges. Amid an extensive suicide reduction campaign, the county saw the number of suicides increase from 366 in 2008 to 420 in 2014. Crisis calls, which often result in police response, increased 62 percent between 2008 and 2014.
San Diego County contains the fifth largest population of homeless individuals in the U.S., almost 9,000 people, and about 36 percent of them are mentally ill, according to the U.S. Department of Housing and Urban Development and the San Diego County Regional Task Force on the Homeless.
The county has made major prevention efforts with the “It’s Up to Us” public awareness campaign, which focuses on reducing stigma and catching mental health issues at their onset. But many who have already descended into serious mental illness wander the outskirts of the system, bouncing between the streets, hospital rooms and jails. This cycle is emotionally draining for those involved and financially draining for taxpayers.
“Our readmission rate is 25 percent within 30 days. That’s a problem,” said Dr. Michael Plopper, chief medical officer of Sharp Behavioral Health Services. “Something isn’t working in the community. Otherwise, they wouldn’t be coming to the emergency departments to get care.”
According to Plopper, upon discharging patients, hospital staff refer them to overcrowded regional county clinics, on a walk-in basis, which is not ideal for continuity of care. He suggested the mental health fund balance could be put to better use.
“We have not been able to spend all the money we have,” Plopper said. “On the other hand, our course, services are shortchanged. It’s a huge irony and it needs to be addressed.”
One family with needs in the mental health system is that of Shelley Linde, of Encinitas. She has been desperate to get long term care for her 38-year-old son, who suffers from mental illness. With waiting lists to see a psychiatrist spanning months, he resorts to drop-in care or hospital visits.
“He’s been in the hospital five times a month. You know how much money that costs the county?” Linde said. “It doesn’t make sense. You can’t put him in the hospital for three days and think that all of a sudden he’s well enough to not have to come back.”
The county’s behavioral health department, which receives over half of its mental health care funding from the millionaire tax, offers a range of programs that aim to appropriately address varying levels of mental health challenges.
Peggy Marcus, a peer support specialist in a county’s short-term acute residential treatment or START facility, said these programs work for those who can access them. After seeking help as a client in a START facility, Marcus now uses her experience recovering from severe depression to help others.
In recent months she has tried to help her 45-year-old son access county care for his severe depression and anxiety. She says the process can be daunting, even for someone working within the system.
“Every place I’ve been is absolutely packed,” Marcus said.
When the family tried scheduling an appointment at a neighborhood clinic in June, the answer was that nothing was available until September.
“One thing about the mental health system is anywhere you go, there are so many requirements and so many hoops you have to jump through,” Marcus said. “When you’re sick, and downtrodden, and feeling alone, a lot of people give up. They don’t have the strength left to fight the system.”
When a START facility is full, Marcus says the staff refers clients elsewhere. If all the facilities are full, they can only ask a client to keep calling back in hopes that something else will open up. This was the case with a woman who recently called.
“We were in tears in the office,” Marcus said. “We all sat there the rest of the day feeling really defeated that there was this woman who was possibly suicidal, and there was nothing we could do about it.”
Dr. Mark Marvin, director of the county’s Psychiatric Emergency Response Teams, has noticed the overcrowding of services that PERT refers clients to.
“The availability of resources is really tough,” said Marvin. “The whole thing gets kind of backlogged.”
The county’s expansion plans for the PERT program will face the same challenges, he said.
“There are going to be more PERT officers,” Marvin said. “That means there are going to be more people that we find in need, and we’re taking them to places that can’t handle the current flow... but you can’t really turn your back on people either. It’s tough out there.”
Family members and patient advocates say it’s upsetting to learn of large amounts of unspent funds when loved ones are spending months struggling to access care.
“That number is staggering,” said Randall Hagar, director of government relations with the California Psychiatric Association. “Certainly as an advocate, I would want to know that there is proper oversight and accountability in place.”
Many suggest that difficulty providing care at the county level is a symptom of a statewide problem.
“As far as care that is needed for people who are very very ill, the system is in crisis,” said Carla Jacobs of Los Angeles, a board member for the national Treatment Advocacy Center organization. “It has been in a building crisis for decades, and we are really beginning to see it.”
State oversight of funds from the 2004 ballot measure has come into question. A 2013 audit criticized supervision and accountability for the funds from the 2004 ballot measure, known as the Mental Health Services Act.
“We have shifted to a model where the state no longer controls the dollars. The counties control the dollars,” said Toby Ewing, executive director of the MHSA Oversight and Accountability Commission. “There should be a very robust accountability system at the local level.”
Twelve community input forums regarding MHSA program are planned for this October. Stakeholders and community members can raise concerns, comments and suggestions about funding and other aspects of the program and how it’s managed locally.
Some family members hope that greater community involvement will inspire reform and improved access to the county mental health care system.
“It is not fair for just families to be responsible,” Linde said. “This takes a team to handle.”