Friday, February 15, 2008

The Collapse of Public Mental Health Treatment

This comes from Sonoma County, where I used to live. From the February 14, 2008 Santa Rosa Press-Democrat:
Santa Rosa Memorial Hospital will close the only inpatient psychiatric care unit in Sonoma County and lay off 212 employees as part of cost-cutting efforts, hospital officials announced Wednesday.

George Perez, the hospital's president and chief executive officer, said the cutbacks will save $7.7 million and help stave off a looming deficit.

In addition to the psychiatric unit, Memorial plans to close its skilled nursing and acute rehabilitation units. The closures and layoffs take effect in 60 days.

"We are at a loss situation," Perez said at a news conference at the hospital. "We have been able to mask the losses in these programs over 18 months, but we are losing money."

The closure of the 18-bed psychiatric care unit comes less than a year after Sonoma County essentially closed its only mental health facility, retaining only emergency services.

Memorial officials conceded the closure creates a void in the county's health care system but said it was increasingly difficult to staff a psychiatric unit.

"It is clearly a gap, we see that," said Dr. Gary Greensweig, the hospital's medical director. "It became a bigger gap when the county closed their program a year ago."

The gap has become a concern for advocates and law enforcement, with police and sheriff's deputies often being call on to assist people with mental health problems.

Three such calls have ended with officer-involved shootings in the past 11 months.
Dr. Greensweig used to be my doctor when I lived in Sonoma County.

The Februrary 15, 2008 Santa Rosa Press-Democrat has this additional reporting:
Sonoma County Sheriff Bill Cogbill said Thursday that closure of Santa Rosa Memorial Hospital's inpatient psychiatric unit could result in more mental health patients ending up in jail.

"There's not enough mental health services right now," Cogbill said, adding that jails are becoming "de facto secure mental health facilities."

...

Supervisor Mike Kerns echoed Cogbill's concern and noted that the county eliminated 16 positions in mental health services last year and closed its inpatient facility, the Norton Center, because of state cutbacks.

"We were counting on some of these other facilities to provide that service within the county," said Kerns, adding that Cogbill is "exactly right" about the implications.

"And the cost of putting people in jail is a lot more than treatment facilities," he said.

Kerns said the planned closure is further cause for concern because it comes at a time when Memorial is negotiating with Sutter Health to take over Sutter's contracted county health care obligation.

"How are they going to pick up the needed services that Sutter is now providing if they're reducing their personnel by 212 people?" Kerns asked. "That is a concern."

The Fulton Road psychiatric unit is a secure facility that employs 55 people and, its director said, provides mental health services to those who are either a danger to themselves or others; in some cases, they can no longer feed or clothe themselves.
Now, let me emphasize: this isn't evil Republicans doing this. For many years, Republicans often ran only token candidates for legislative seats that included Sonoma County, because the chances of winning a seat were so small. I think the last time a Republican represented any part of Sonoma County in Congress was because the Green Party pulled so many votes away from a Democrat who hadn't been far enough left for them to be happy. This isn't a poor county, either. I lost track of the number of multimillionaires (and at least one billionaire) that I had worked with that lived there.

Public mental health treatment has been destroyed in this country over the last forty years, with catastrophic effects. The problem is that mental illness often takes a while to become obvious--and in the meantime, that person with a good job and health insurance has either quit his job, or been fired. By the time it is apparent that this person has a serious problem, they are often uninsured--and Medicaid has a very limited level of assistance for mental illness.

One of the problems is a lot of people who need help can't afford it. The other problem is that the most seriously mentally ill--including some of those who become headlines--don't think that they need any help.

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