SAN DIEGO COUNTY: Mental Health System Draws Criticism
The number of involuntary hospitalizations for poor, mentally ill patients in a northern San Diego County hospital has nearly doubled in the last year, a sign that the county is not spending enough on outpatient care and day treatment, according to mental health experts. "What we have is a revolving door of mental health care in a system that has become a monumental failure," said James Greeley, director of the psychiatric unit at Palomar Medical Center in Escondido. In the 800-square-mile inland North County region, patients seeking mental health assessments face six-day delays, and waits for medication assessments stretch to one and one-half weeks. The number of psychiatrists willing to see poor patients has fallen due to low reimbursement rates. Moreover, the North County area has no government-funded crisis residential program, though there are six elsewhere in the county.
Sherry Harrison, director of the county Department of Mental Health, said the county is working with United Behavioral Health, the private contractor hired to manage mental health care for the county, to address the problems. She noted, however, that the $80.2 million the county has received in state funding is insufficient to meet the community's needs. State and federal officials, as well as advocates for the mentally ill, are not satisfied that the county is doing enough to address the problems. State Deputy Director for Care Systems Gary Pettigrew has sent two letters to Harrison expressing his concerns. Officials from the state Department of Mental Health make monthly visits to review problems with Medi- Cal patients' access to services, and officials from HCFA are also monitoring the issue. "County officials are going around saying everything's fine, that there is care. But in reality there's not. The reality is that they just dump people, put them back out into the community, with no follow-up care," said Katherine Smith-Brooks of the North County Alliance for the Mentally Ill (Clark, San Diego Union-Tribune, 2/21).
Op-Ed Pages Call for Reform
Noting that a growing number of the mentally ill are languishing in jail, an editorial in the Union-Tribune argues that the Lanterman- Petris-Short Act of 1967, which essentially barred involuntary hospitalizations and deinstitutionalized the mentally ill, "has been no cure at all." Instead, the Union-Tribune backs a proposal before the a joint state Senate-Assembly committee that "would allow involuntary hospitalization only after a person had agreed to a supervised treatment program and had failed to follow that program" (2/22). A separate editorial in the Sacramento Bee concludes, "Lawmakers will have to be careful that reform does not damage the due-process rights that protect all citizens against arbitrary confinement and abuse. But on one thing all sides in the mental health debate agree: No reform will work if the state fails to make more funds available. The money California now spends to arrest, book, transport, adjudicate, house and treat the mentally ill in prisons and jails could be more usefully and humanely be spent to build the comprehensive community-based mental health system that was promised by the earlier generation of reformers who passed the Lanterman-Petris-Short Act" (2/22).