Mental health patients turn to community clinics

Cuts in state funding have prompted Sonoma County to begin shifting hundreds of mental health outpatients to private, community-based treatment centers.

The move is expected to save as much as $900,000 this budget year but won't affect the quality of care, a county official pledged. However, a mental health advocate said it's too soon to say how well the new arrangement will work.

"The community clinics do a terrific job if they have funding," said Rosemary Milbrath, who leads Sonoma County's chapter of the National Alliance for the Mentally Ill.

The county should track its clients to ensure they're being adequately served, she said.

The outpatient shift is part of a larger cutback that has previously focused on inpatient services for the mentally ill. Counties across the state are slashing programs because of California's budget crisis, and Gov. Arnold Schwarzenegger has warned of additional 10 percent cuts beginning in July.

Last year, Sonoma County closed its psychiatric hospital, Norton Center. This year, it has announced plans to close inpatient services at Orenda Center, which serves drug and alcohol abuse patients. It also has disclosed plans to eliminate funding for A Step Up, a private program that provides the county's only inpatient care for people suffering both substance-abuse and mental-health problems.

Private programs also are facing pressure. Santa Rosa Memorial Hospital has begun to close its acute-care mental health facility in Santa Rosa, the area's last such program for psychiatric inpatients. It will cease operations April 13.

In the latest development, about 300 county outpatients are being shifted to community providers, said Art Ewart, the county's mental health director. They are not considered seriously disturbed, he said.

"They are really quite stable on medication," Ewart said. "They don't require a lot of service."

The county will provide some staff and psychiatric services at the community centers to help with the additional patient load, Ewart said.

Overall, county spending on mental health programs is dropping, from $56 million budgeted in fiscal 2006-2007 to $54 million in the current fiscal year. Although inpatient spending is decreasing, the state Mental Health Services Act has provided some funding to allow the county to hire 12 staff members to handle community-based treatment, such as for client support, case work and clinical social work.

Ewart said the outpatient shift should improve care by letting patients get mental health and medical services at the same place.

Southwest Community Health Center, a Santa Rosa-based nonprofit that serves more than 12,000 mostly low-income patients a year, is taking more than 200 of the county mental health clients.

"This patient population is not the severely mentally ill," said David Anglada-Figueroa, who heads Southwest's mental health program. "They are capable of doing well as outpatients."

They are being assigned to primary care physicians before being referred for mental health services, he said.

The influx of new patients at Southwest has led to longer waits to see a psychologist or psychiatrist, said Anglada-Figueroa. Southwest is looking for ways to cut the delays, he said.

Clients who do well on medication can continue being treated by Southwest's primary care physicians, he said. The arrangement promises to improve their health by making it easier to get medical care, said Anglada-Figueroa.

Ewart said funding from the Mental Health Services Act enabled the agency to re-establish regional intervention teams in Sonoma, Petaluma, Guerneville and Cloverdale. The agency had closed that program in 2003 because of budget cuts.

Working with community health centers in those areas, Ewart said the county's mental health workers are in contact with local providers and can put patients back in county programs if they need more care.

About 200 outpatients with more serious conditions continue to get county mental health services, he said.

The mental health agency came up with the plan last year after county leaders ordered departments to submit budget-cutting proposals. The shift will save $500,000 to $900,000 this year, Ewart said.

Other counties also are sending mental health clients to qualified community providers because the private programs get more reimbursement from state and federal sources, he said.

"This is a national trend," Ewart said.

Staff Writer Bleys W. Rose contributed to tgis report. You can reach Staff Writer Steve Hart at 521-5205 or steve.hart@pressdemocrat.com.