It’s an issue that’s been simmering under the surface at Santa Barbara County’s Department of Alcohol, Drug and Mental Health Services for the past several weeks, and on Monday, members of a standing committee had the opportunity to ask pointed questions of the department’s director.
Cuts in services for mental health patients who lack insurance are at the heart of a series of cost-saving measures enacted by the county last month. Noozhawk broke the story two weeks ago, reporting that the number of beds for involuntary patients had been reduced without notice to the larger public and without approval from the Board of Supervisors.
The reduction in beds affects cases termed “5150,” meaning patients are a danger to themselves or others because of mental illness, and must be checked in involuntarily.
More than 400 patients per year are transported to Vista del Mar, a psychiatric hospital in Ventura, because of a lack of facilities in Santa Barbara. But reducing the beds to five for uninsured patients from 12 would mean $800,000 per year in savings for the department.
“It’s unacceptable that people without insurance are being denied services,” Roger Thompson, chairman of the county Mental Health Commission’s System of Care Standing Committee, said Monday.
Monday’s meeting was nothing short of historic, taking into account the fact that the commission hasn’t met in more than five years, and the reformation could signify more oversight for the department.
Just after its first meeting, committee member Mike Foley asked that the group be privy to monthly financial reports on the agency. The focus of Monday’s meeting centered on getting clarity from ADMHS director Ann Dietrich about the recent changes, which all come back to money.
Dietrich said that only about 3 percent of the department’s funds come from the county’s General Fund. Most of its operating costs come from various state sources, such as vehicle license fees.
The department is facing a $6.6 million budget shortfall next year, according to Dietrich. “We’re really struggling,” she said.
In addition, 38 percent of the people the department sees are indigent, meaning they have no medical insurance, and the county doesn’t get reimbursed by the state for beds it uses at Vista del Mar because of federal guidelines.
Inpatient care is expensive, and keeping just one patient in a bed at Vista del Mar or at the county’s 16-bed facility equals $237,000 per year. Use of Vista del Mar was especially high in the first part of the year, she said, and exceeded budget projections.
Another issue brought up Monday was why the department went ahead with changes before the Board of Supervisors had granted approval. Dietrich said the department is often going before the board to amend contracts, and will formally amend it at Tuesday’s supervisors meeting.
When asked directly about the Noozhawk article that cited the bed reduction that had begun in March, Dietrich said she didn’t know where the number had come from and that measuring by beds available wasn’t accurate, because the hospital bills the county only for the days people are in them. She added, however, that five beds was the average number currently being used.
“We’ve started behaving as if we aren’t going to use more than five a day,” she said. “We’re telling staff to manage length of stay.”
Of the patients admitted to the county’s inpatient facility and to Vista del Mar, Dietrich said a third of the patients are new and haven’t used mental health facilities before. Committee members pressed Dietrich about the other two-thirds of patients, and she said they were ADMHS patients who were having relapses.
Despite the lack of funds, the needs for a facility of Vista del Mar’s type are great. In addition to adults requiring involuntary care, a recent trend has shown an increase in children and adolescents — up to four a month — needing to be hospitalized. Dietrich said that could be in part because of the South Coast’s suicide issues, and that parents and friends are more vigilant about the signs of a potentially suicidal child.
To deal with demand, placing people in neighborhood clinics in Santa Barbara and in North County facilities are an option the department is discussing.
Getting to the root of why beds had been reduced unofficially was the focus of Monday’s meeting, but other changes were discussed, too.
Patients will no longer be processed as 5150 cases if they have a blood-alcohol level of .08 or higher. Vista del Mar isn’t a drug and alcohol treatment center, so a 5150 won’t be issued until the blood-alcohol level is lower, Dietrich said.
That led to questions from the committee about people with mental illness as well as substance abuse issues, and what would happen if they need to be admitted involuntarily.
“It just seems to me … these people are really falling through the cracks,” committee member Suzanne Riordan said.
Another cut taking place is the discontinuation of services for 600 of 900 indigent people. As alarming as that number sounds on first glance, Dietrich said that “a fair number” of people are seen who don’t follow a strict diagnosis of mental illnesses, such as schizophrenia.
The department will keep “very limited medication management support” for 300 of the 900 indigent adults who are being served, and the priority will go to those most affected by mental illness.
In June, ADMHS will find out if American Recovery and Reinvestment Act funds it has been granted will extend until December, which will determine what can be restored from earlier cuts.
Another source — from state funding this time — also is a possibility. Aptly named “Innovations” funding, it would total about $900,000 a year for the next three years, if the county can present ideas that address mental health issues in a new and effective way.
The Mental Health Commission will meet Friday to talk about ideas for Innovations. The Systems of Care committee also will meet again, at a time to be determined, about how to proceed and what alternatives might exist for cuts to the indigent.
But Dietrich said the current lack of realignment funds represents “a hard reality” for the department.
“It’s really putting a strain on our system,” she said. “We’ve got a level of service now that’s not sustainable with the amount of money we have.”
— Noozhawk staff writer Lara Cooper can be reached at email@example.com.