The Stanislaus County Board of Supervisors on Tuesday approved a two-year pilot program aimed at providing psychiatric services and drugs to indigent mentally ill patients.
The unanimous action came almost two months after the board voted to stop providing psychotropic drugs to those patients through the Health Services Agency. That practice is not mandated under state or federal guidelines, and the county is trying to resolve budget shortfalls in the HSA.
The psychotropic drugs were costing the county more than $280,000 a year to treat about 157 patients. Psychotropic drugs affect the mind, emotions and behavior and are used to control a range of mental illness, from psychosis and bipolar disorder to depression, anxiety and obsessive behavior.
HSA officials were concerned because primary care doctors in the clinic system are not qualified to evaluate severely mentally ill patients, prescribe drugs for them or adjust their drug regimen, according to HSA Director Mary Ann Lee.
The clinic doctors were helping to treat the mentally ill patients because they had nowhere else to go.
Advocates for the patients decried the decision, and said the cost of the action would outweigh the savings. Without the drugs, the patients likely would require hospitalization, or wind up in the criminal justice system, they said. The toll on the patients and their families would be heavy, they said.
At the supervisors' request, the HSA, along with the county Behavioral Health and Recovery Services and the Community Services Agency, designed the pilot program. The departments hope the program can restore access to drugs to the seriously mentally ill and still save the county money.
Breaking down the numbers
The team discovered that not all 157 patients prescribed drugs through the HSA clinics in 2006-07 were severely mentally ill, and in some cases the psychotropic drugs were not appropriate, according to Lee.
About a quarter of the patients have mostly alcohol or drug abuse problems, Lee said, and 20 percent have moderate or mild mental illness. About 36 percent have more than one disorder -- mental illness combined with a drug problem, for instance -- and just 19 percent were found to be suffering only from serious mental illness.
The new program will have an outreach and advocacy component to try to get Medi-Cal coverage for the patients and a gatekeeper to evaluate and refer patients to psychiatric care.
Those referred will get a psychiatric consultation and limited treatment through Behavioral Health and Recovery Services, and drugs will be dispensed through the HSA pharmacy using free drugs and drugs discounted through a federal program, Lee said.
A stumbling block is the shortage of psychiatrists to provide the service, Lee said. The program will explore using "tele- psychiatry" to make care available, she said.
Telepsychiatry would involve patient interviews and evaluations using video teleconferencing with psychiatrists from another area. So a psychiatrist in San Francisco, for instance, could interview a Stanislaus patient through a video link and prescribe medications.
Telepsychiatry is used by some rural counties in the state with success, said Denise Hunt, director of the Behavioral Health and Recovery Services department.
"The reviews are good," she said. "Patients are generally accepting, and it does work."
The program's first year is expected to cost from $205,000 to $270,000, depending on whether the video conferencing equipment is needed. The second year cost would drop to an estimated $140,000 to $167,000. The savings reflects the possibility of a portion of the patients qualifying for Medi-Cal, Lee said.
The program needs two years to evaluate, Lee said, because of the lengthy process of getting patients qualified for Medi-Cal.
County supervisors praised the three county departments for devising a solution to the problem. Representatives from the county's Mental Health Board and the National Alliance on Mental Illness said they supported the pilot.
Bee staff writer Tim Moran can be reached at firstname.lastname@example.org or 578-2349.