After years of incoherent policies driven by budget cuts and misguided decisions, Sacramento County is on the verge of moving smartly to improve services for people who suffer from mental illness. The change can’t come soon enough.
The biggest problem with the county’s system of care is that it relies too much on hospital emergency rooms, which are the most expensive and least effective way of helping the mentally ill.
Because programs run or funded by the county are difficult to navigate and often filled to capacity, the easiest way for a person with a mental health crisis to get help is to go to an emergency room.
But that’s good for neither the patient nor the system, because emergency rooms are ill equipped to deal with them and their behavior can be disruptive to others who are waiting for treatment.
Responding to this flood of patients, emergency rooms have been transferring people to local psychiatric hospitals, which are expensive and can be more than a person in distress really needs. The county pays $950 per day for a patient’s care at these facilities.
The county’s own Mental Health Treatment Center, meanwhile, can keep patients for only 23 hours before discharging them or transferring them to a psychiatric hospital.
What’s needed are more places where people in crisis can get care and become stable in a supportive environment before returning to their homes, a homeless shelter, or even back to the streets – if that’s where they are inevitably headed.
These places are commonly known as Residential Crisis Units, and Sacramento has just one, which is woefully inadequate for the need.
Last week, the Sacramento County Board of Supervisors approved a tentative plan to begin fixing this dysfunction by adding at least two more residential units and putting a new emphasis on prevention and support to keep people from spiraling into crises that can be managed only in the most restrictive, expensive facilities.
The county’s staff is expected to return to the board with a full plan within 90 days. That strategy is expected to include sending county mental health staff members to emergency rooms and the Mental Health Treatment Center to better assess patients, determine their needs and direct them to the best possible treatment options.
All of this sounds like a healthy change. The county also should consider reopening its own Crisis Stabilization Unit, which would be one more option for intermediate-level care that would have more support than a residential facility but not be as expensive as a psychiatric hospital.
The long-term goal should be to make sense of a hodgepodge of overlapping and sometimes conflicting priorities and programs, so people in crisis can find the help they need, and the people who are expected to treat them can do so in a way that does more than just patch them up and send them back where they came from.