Community Columns

Funding issues weigh on mental health agency

The Bee posed questions to Denise Hunt, director of Stanislaus County's Behavioral Health and Recovery Services, formerly known as the mental health department.

Q: Briefly explain the department and why the name was changed.

A: Every county has public mental health and alcohol and other drug services, funded through the state. Behavioral Health and Recovery Services is the Stanislaus County department that provides these services.

In 2000, the department changed its name to Behavioral Health and Recovery Services to reflect the fact that many clients have both mental health and alcohol and drug service needs and to underscore the philosophy that individuals can and do recover from mental illness as well as from alcohol and drug problems.

Q: Who are your clients?

A: We serve Medi-Cal beneficiaries who need specialized mental health services; individuals with a serious mental illness or emotional disturbance; people in crisis; and people with alcohol and drug problems. We include family members in treatment as well. It is estimated that approximately 35,000 people in Stanislaus County have a serious mental illness or emotional disturbance. We served about

10,000 individuals last year.

We served about 3,188 people with alcohol and other drug problems, although the estimate of that population is much higher. The need for behavioral health service has always outstripped available resources.

Q: Who pays for all these services? Is the county required by law to do all of these things?

A: As in every county, most of the funding for Behavioral Health comes directly from the state and federal governments, with a very small county contribution. Revenue also includes a small amount of client fees.

Stanislaus County is required by state law to ensure that residents can access certain types of psychiatric care. We are required to provide specialty mental health services for Medi-Cal beneficiaries, mental health crisis and hospitalization services to individuals without health insurance, and to make psychiatric crisis services available to any county resident. In addition, to the extent resources are available, we provide other mental health services to residents.

Alcohol and drug funding is dedicated to prevention programs for youth and treatment services for adults. Some counties provide behavioral health services directly, while in other counties services are provided through contracts. Stanislaus has a mix of county-run programs and contracted programs.

Q: When we ran a list of the 100 county employees who make the most money, there were a number of psychiatrists listed making more than $200,000 a year. Does the county really have to pay that much to find and retain psychiatrists?

A: We cannot operate without psychiatrists, and one of our biggest challenges is recruiting them. We compete for a small number of doctors in this medical specialty willing to live and work in the Central Valley and to provide services to individuals with little or no income.

Because it is so difficult to recruit psychiatrists, the state of California recently raised the salaries for a newly employed psychiatrist, just out of school, who works at a state hospital or state prison to approximately $250,000 a year. Nearly every county in California has openings for psychiatrists. It is not anticipated that salaries for psychiatrists will decrease, and we expect to continue to have vacancies.

Q: The county has just sold the former Modesto Psychiatric Hospital, now known as the Behavioral Health Center. Will the county still be able to help people who are suicidal or otherwise in need of hospitalization for mental illness?

A: The sale of Stanislaus Behavioral Health Center to Doctors Medical Center should have little or no effect on people being able to access psychiatric hospitalization services. The county will continue to provide crisis intervention. The sale was designed to keep the hospital open and available to Stanislaus County residents.

Q: We used to hear a lot about how hard it was to find treatment programs for alcoholics and drug addicts. Is that still the case?

A: We operate the Stanislaus Recovery Center, a 72-bed adult residential substance abuse treatment center that includes First Step, a 13-bed treatment program for pregnant and parenting women and their young children. Several adult beds in the center are specified for individuals with co-occurring mental health and alcohol and drug problems.

In addition, outpatient programs and partial day programs are available. Private providers also operate substance abuse treatment programs in Stanislaus County. There is often a waiting list for county residential beds, and there are few substance abuse treatment resources available for teens in our county.

Q: We hear that your department has had to cut services, and yet you are getting additional money from Proposition 63. What's going on?

A: Proposition 63, the Mental Health Services Act, created a 1 percent state income tax on individual incomes greater than $1 million. The goal is to transform the public mental health system to provide access to services to those most in need and, often, the least able to get treatment.

The act forbids counties to use this money to supplant other funding in place when the initiative passed. While this was designed to expand mental health services in California, it comes at a time when other services are at risk. The cost of doing business increases every year, while state and federal revenues for county mental health programming stay the same or decrease. Over time, this results in creating a deficit spending pattern. Our savings were depleted a couple of years ago, and currently, it costs slightly more to provide services than we have revenue. For this reason, we have made service reductions in some programs.

Our department needs to do what it is best at doing -- providing high-end services to individuals with a serious mental illness, and then we need to support community providers in building prevention, early intervention and supportive services.

We aim to focus on the parts of our community that historically have had the hardest time accessing services: individuals of all ages who have a serious mental illness or a serious emotional disturbance; and individuals who are older, who speak a language other than English and who are homeless.

Q: What does your department do to help the homeless?

A: Since 1999, our department has offered specialized services to individuals who have a serious mental illness and are homeless or at risk of homelessness. For example, the Stanislaus Homeless Outreach Program provides a focus on "housing first" to individuals who live on the street and have a mental illness. The premise is simple: People who have an illness and no place to live want the same things we all do -- a safe and decent place to live, enough to eat, relationships, something to do each day (work/school) and access to medical care. Our staff has been able to engage people who are homeless and who have a mental illness so that they accept housing, appropriate medication and assistance with employment.

Results are good -- 280 Stanislaus County residents with serious mental illness and a history of chronic homelessness receive intensive mental health services and/or housing. Many of them are working or in school because of the support they receive. Public money also is saved by decreasing days spent in jail or in the hospital.

More than anything, this work has taught us that by truly partnering with the people we serve and helping to meet their basic needs of housing, employment and health, we can directly contribute in a meaningful way to making Stanislaus County a healthier community.