Long waits and treatment shortages plague Sacramento County’s mental health services

A Sacramento County call center that connects residents to mental health treatment regularly falls short when serving the most pressing cases, a Sacramento Bee review of service records shows.

Although the county’s mental health access team is designed to link people with treatment within seven days of their request, county data shows it often takes three times longer. Less than one-third of the 307 adult requests in the last three months of 2019 — the most recent data available — made it to their first appointment on time.

That was a high point during the three-year period reviewed by The Bee, during which 3,340 adults placed urgent requests for services. Less than one of every 10 of those adults reached an appointment within one week.

The access team is widely marketed as an entry point to the county’s mental health services, directing hundreds of people every month to treatment centers. A crucial part of the county’s mental health system, the program employs 27 people with a $4.7 million budget.

The program was where Martin Lackey-Garcia turned for help last February before he was allegedly sent to the wrong clinic. Days after his first in-person assessment, prosecutors say Lackey-Garcia returned to the Wellness & Recovery Center in Carmichael and stabbed multiple people with a knife, killing two.

The county data on treatment times offers a window into the kind of hurdles the most vulnerable might expect when seeking assistance. The services are largely used by people with Medi-Cal or the indigent.

County officials said connecting people to treatment within seven days is a “challenging” goal set by the state that is often complicated by a limited number of providers and clients who don’t always show up for their appointments.

“There are all sorts of different reasons why individuals will not accept the first offered appointment,” said Ryan Quist, the county’s director of the behavioral health services division. “There are also reasons why the day of the appointment things might go wrong and they might no-show — all of those things play a role in our challenge with trying to meet this benchmark.”

The urgent requests are typically reserved for people discharged from psychiatric hospitals and clinics; people who could lose their housing due to their mental illness; and those at risk of harming themselves or someone else. Mental health counselors also have the discretion to exercise “clinical judgment” when expedited cases.

Still, adults experienced wait times as long as 30 days throughout 2019, according to the data published in the most recent report submitted to the county Board of Supervisors. Children and foster youth were hardly served any better with wait times as high as 22 days and 27 days, respectively.

Not enough providers

Adult mental health and substance abuse services had a spotty reputation among consumers, caregivers and staff interviewed for a focus group in late 2019. Nearly 60 people were asked to list things they were satisfied with and areas in need of improvement. What they observed about the mental health system’s shortcomings touched on a theme:

“Counseling without a 3-month wait,” wrote one consumer.

“Waitlist for 1 year to get 1:1 therapy,” said a family member.

“Not enough therapists to meet need, long waitlists,” a staff member wrote.

Quist, who started working for the county in May 2019, said the access team’s lagging performance was one of the first areas targeted for improvement when he arrived. Some things have been easier to fix than others.

Most of the changes didn’t start until early 2020, Quist said. They narrowed the definition of an “urgent” service request to conform with the state’s description, limiting those slots for people who may need hospitalization within 72 hours, he said.

In January, an adult psychiatric support services program began following up with psychiatric patients discharged from hospitals. And in April clinicians working on the access team, which normally screens incoming patients, started conducting assessments normally performed by providers.

In many cases, consumers are screened over the phone and assessed in person before mental health counselors can come up with a care plan. Only then, they can access services.

“They (the access team) are able to take that information and send it to the provider then they (will) not need a full two-hour assessment which would make it easier for them to schedule that time,” Quist said.

Those service changes were meant to deal with a larger problem: a provider shortage.

“Service capacity is definitely an issue,” Quist said. “You have to remember that these providers that are trying to schedule assessments have their existing caseloads scheduled. One of the things we noticed is that it’s easier to find a one-hour time slot rather than a typical 2-hour time slot for an assessment.”

Recognizing the scale of the issue, the county’s Mental Health Board recommended increasing funding, among other things, to improve the timeliness of services. Although the behavioral health division’s budget has increased consistently in recent years, the board pointed to the low amount Sacramento County spends per Medi-Cal enrollee compared with other large counties.

In 2019, the county spent $3,812 for each Medi-Cal beneficiary who sought behavioral health services. Statewide, counties spent an average of $5,154 and larger counties spent $5,338.

“The mental health access team is really behind the eight ball,” said Ann Arneill, a member of the county mental health board. “They don’t have enough staff, they don’t have enough appointment times to give to people. It’s not like they want to have a problem with timeliness. They don’t have enough capacity.”

‘Normal things don’t seem to happen for me very often’

The Martin Lackey-Garcia case shows the consequences of underfunding.

At least two lawsuits have been filed against the county, accusing unnamed employees of neglect and wrongful death, among other things. More than a dozen other people connected to the stabbings at the Wellness & Recovery Center have submitted “public entity claims,” a necessary step before filing a lawsuit.

Instead of an intervention, Lackey-Garcia is now housed at the Rio Cosumnes Correctional Center along with hundreds of other men and women coping with mental illness. He will soon face two murder and two attempted murder charges at trial.

Thinking back on the days before that first appointment, Lackey-Garcia told The Bee from jail that it was the most scared he’s ever been. He said it felt like he was being followed and he believed his phone was hacked.

Lackey-Garcia said he’d been diagnosed with schizophrenia a few years ago while on parole.

He said he had tried reaching the access team once before but was not thinking straight enough to talk so he gave his mother the phone. For reasons that are unclear, he said they never got a referral.

When he tried again in February, Lackey-Garcia thought he would go to Turning Point Community Programs, a large provider in the area, but they sent him to the Wellness & Recovery Center instead, he said.

“I just really wanted somebody to give me a kind word and not exacerbate my condition,” Lackey Garcia said. “I tried to do things to live a normal life. Normal things don’t seem to happen for me very often.”