The consequences of a failing mental health system are apparent to us every day. Law enforcement officers are forced into violent confrontations. Our neighborhoods see increased transient activity. Some self-medicate with alcohol and other drugs, while their families worry for their loved ones, and some fear for their own safety.
Clearly, Sacramento County needs to think differently about mental health care. After providing basic law enforcement needs, this is our most pressing concern. But we have competing demands. Recently, an impassioned group pleaded for repairs to our mental health system. A week earlier, hundreds packed the chambers of the Board of Supervisors advocating that the county cease requiring proof of lawful residency for county-funded health care services, the same restriction included in the Affordable Care Act.
The county cannot afford both programs at meaningful levels.
To be clear, all county residents have access to emergency health care including dialysis, immunization and treatment for communicable diseases – critical services that must be available to all people, regardless of immigration status.
We arrive at this decision point as a result of the Great Recession, which cut our general fund from $625 million to $475 million. After laying off 122 sheriff’s deputies in 2009, the most severe cuts were to adult mental health services, homeless services and substance abuse programs.
The state simultaneously cut critical county health care funding by $16 million. As we struggled to maintain minimal law enforcement, human assistance and other essential programs, we could not backfill this reduction.
Combined, these cuts eliminated 50 percent of the Mental Health Treatment Center capacity and imposed significant limitations on the crisis stabilization unit.
The result? As confrontations with law enforcement increased, psychiatric patients in crisis had only one resource: emergency rooms. While our region’s ERs are top notch, they are inappropriate venues for psychiatric crises.
There was hope that the Affordable Care Act might provide respite, but this hope was short-lived. Because federal law prohibits Medi-Cal from funding psychiatric care at facilities with more than 16 beds, a number exceeded by all but one of the region’s psychiatric facilities, Sacramento County cannot take full advantage of ACA benefits.
When these patients were uninsured, the county cost for this service was about $150 a day. Upon their enrollment in Medi-Cal, the county cost for the same patients increased to $950 a day.
This cost increase, along with a larger-than-projected caseload, compelled the Board of Supervisors to increase this year’s inpatient mental health services by $10 million over budget, raising total funding to $16 million. The board provided clear direction to staff that the status quo is unacceptable and that new solutions are needed.
Sacramento County needs a new approach. We must support establishment of additional Medi-Cal-eligible facilities. We must partner with hospitals, our region’s largest private-sector employers, to improve patient care and efficiency. The status quo harms patients, distresses families, endangers law enforcement, and burdens communities with avoidable blight and crime.
Those advocating for services for the undocumented have yet to identify a funding source and should focus their efforts on the state and federal governments, which created this unworkable situation and are better positioned to act. California’s Legislature has signaled an intent to address these concerns through Senate Bill 4. It makes sense to await the outcome of this bill rather than obligating the county general fund to a new program.
With the county still struggling to maintain fiscal balance, we cannot afford to fix the mental health system for our entire community and provide additional health care services with unforeseeable costs. Rebuilding the mental health continuum is a point on which there is a consensus to proceed and an urgency to act.
Let’s keep moving forward.
Roberta MacGlashan is a member of the Sacramento County Board of Supervisors, representing District 4.