Sunday, May 31, 2009

California psychiatric hospital closes its doors to new patients

From the Sacramento Bee:

The steady increase of mentally ill residents combined with Sacramento County's budget woes forced the county's main psychiatric hospital late May 22 to close its doors to new patients.

The doors remained closed through Tuesday – and might stay closed for several more days, officials said, until its caseload falls.

Officials said the scene could repeat itself throughout the year as local and state funding continue their decline.

The situation, officials and advocates say, suggests the state is at the brink of a mental health catastrophe.

"I think that Sacramento County – like all counties in California – is facing a mental health crisis," said Dorian Kittrell, executive director of the Mental Health Treatment Center. "Unfortunately when (budget) cuts are needed, health care is often at or near the top of the list over and over again. And unfortunately, there's only so much a system can bear before it breaks."

The Mental Health Treatment Center handles the most severe psychiatric cases in the county. That's where police or concerned family members take people who pose a danger to themselves or others.

Caseloads have risen in recent years as the region's population has grown. The crisis center now sees about 590 patients a month, compared with 540 a month in fiscal year 2004-05, Kittrell said.

The admission rate from the crisis center to the inpatient unit has remained steady at almost 48 percent, he added.

The growth has pushed the treatment center – which has a capacity of 100 in its inpatient unit – to its limits.

To alleviate overcrowding, the Board of Supervisors allocated an additional $4.3 million to the treatment center in fiscal year 2006-07 to outsource patients to other facilities. Essentially, that paid for beds in other psychiatric hospitals such as Heritage Oaks Hospital, Sierra Vista Hospital and Sutter Center for Psychiatry, Kittrell said.

The county allocated that money again in fiscal year 2007-2008 and in the preliminary budget this year. The county, however, had to cut $1.2 million of that funding from this year's final budget in response to cuts the state made in the fall, Kittrell said.

By midyear the treatment center was out of money to send psychiatric patients to other hospitals.

The center stopped outsourcing patients about four to six weeks ago and the center's average daily census began to top the 100 limit, going as high as 109 patients, Kittrell said.

As a result, the state last Friday sent a letter to the center effectively warning officials to reduce their caseload or face sanctions, Kittrell said.

Late that afternoon, Kittrell sent an e-mail to officials and mental health providers announcing temporary closure of the crisis center.

One frustrated senior mental health worker, Daniel Uselmann, worried that the most severely mentally ill would have no place to go.

"We're the place of last resort, and now we're closed," Uselmann said.

Mental health advocates and officials say the treatment center overcrowding is just part of the larger county and state problem of underfunding mental health.

"I think it's a reflection of the shortage of acute mental health treatment in the community, particularly for those who aren't insured or don't have an alternative to seeking public assistance or public care," Supervisor Roger Dickinson said.

The county has cut almost $10 million from mental health since June last year. The cuts primarily have been to contractors that provide the bulk of outpatient mental health services.

Fewer outpatient mental health services have put an additional strain on the inpatient treatment center, leading to the temporary closure, said John Buck, chief executive officer of Turning Point Community Programs, one of the county's mental health contractors.

The situation could be getting even worse. Sacramento County is facing a projected $180 million general fund shortfall in the fiscal year starting July 1.

As a result, the supervisors will consider a number of cuts, including about $18.4 million to adult mental health services.

About $5.3 million of those mental health cuts could come from the Regional Support Teams – four facilities that currently provide outpatient care to more than 8,700 residents. After the cuts, the county won't be able to treat about 3,000 patients, said Ann Edwards-Buckley, director of the Behavioral Health Services Department.

The state's budget woes could bring additional pain. The state might cut back on so-called managed care funds, which counties rely on for mental health programs, Kittrell said. Almost $19 million of the treatment center's $36 million treatment center budget for fiscal 2009-10 is slated to come from managed care funds.

Decimated outpatient programs and an overburdened inpatient program are severe concerns for the county, Edwards-Buckley said.

"I'm not going to say people will die. I'll say it's certainly a possibility," she said.

Kittrell said the center may need to close the unit, depending on caseloads. Which means scenes like the one Tuesday afternoon could become common.

A worker standing outside the Sacramento County Mental Health Treatment Center on Tuesday afternoon tugged in vain at the locked front doors until a security guard let her in.

"In 17 years I've never seen anything like that," the mental health worker said as she headed inside.