Mental Health Fixable
The problems facing Alcohol, Drug, and Mental Health Services, ADMHS, are the same problems Mental Health Services had in the mid-’70s to the early ’80s The good news is that things got turned around with new leadership.
Proposition 13, which severely impacted tax revenue for the state and counties, was passed by voters in 1978. Prior to that, Dr. Lawrence Hart, the health care director, closed the Santa Barbara County Hospital and began contracting with hospitals and physicians for inpatient and specialty services because of inability to staff the hospital. The Psychiatric Health Facility, PHF, was opened in a house near San Marcos High School and later moved to the where it is now.
Closing the hospital and contracting-out medical services really improved financial and health care outcomes. The PHF, however, has been a problem from the start because it is not associated with a hospital.
Many mentally ill people are alcohol and drug users and are called dual-diagnosis patients. Treating them is very difficult because they must first detox, and they do not want to do that. Mentally ill people, many of them dual-diagnosis, rotate in and out of the Santa Barbara County Jail. The National Mental Health Association estimates that 29% of mentally ill people are dual-diagnosis. To improve services to this population, the county needs to join with Cottage Hospital to see if locating a facility in a hospital setting might be possible.
Many are concerned that because of county budget problems, money will not be available to bring about the changes needed in ADMHS. In last year’s adopted budget, only 4% of county general fund money was used to finance services. Federal, state, Medi-Cal, Medicare, and private insurance are the primary funding sources for the department, not county property taxes. In prior years, the county provided more funding, but Auditor-Controller Bob Geis and former County Executive Mike Brown stripped the department budget of as much county money as possible. This was a policy decision approved by the Board of Supervisors. Fiscally, 2008 was a very bad year.
The consultants’ reports suggest many areas for fiscal slimming. Finances are important but so are clinical services and acting department head Takashi Wada should commence work on ensuring better clinical outcomes as suggested by the consultants. The PHF should be a top priority. Change should begin prior to bringing in another leader. Dr. Wada cannot do this without the support of concerned citizens and the Board of Supervisors.
Many community members, volunteers, and service providers are ready to help. It is time for the Board of Supervisors to step up to the plate. The dysfunction in the Department of Alcohol, Drug, and Mental Health Services can be fixed.