State warns Sacramento County budget cuts could forfeit funding

chubert@sacbee.com

Published Thursday, Jun. 03, 2010

Sacramento County's plan to cut $17 million from mental health programs is illegal and could trigger a loss of $40 million in state funding, the chief counsel for the California Department of Mental Health has warned.
"The nature of these proposed program and budget cuts could cause irreparable harm," Cynthia Rodriguez wrote in a searing letter to county counsel Robert Ryan.
In the May 5 letter, Rodriguez asked the county to respond "immediately" to her concerns about the cuts – or risk losing critical state mental health funding.
The county's director of Health and Human Services, Ann Edwards-Buckley, wrote back this week. She said Rodriguez's letter was based on an "erroneous understanding" of proposed changes and emphasized that no decisions have been made final by the Board of Supervisors.
The county's Department of Behavioral Health is scheduled to bring its final recommendations for the 2010-11 budget to supervisors on June 15.
In an effort to slash $17 million from its behavioral health budget, Sacramento County earlier this year proposed severing ties to four nonprofit community clinics that provide outpatient care to people with severe mental illnesses. Some 6,500 clients with diagnoses such as schizophrenia and bipolar disorder would be affected.
To make up for the cuts, the county proposed expanding its Adult Psychiatric Aftercare Clinic and opening four new outpatient mental health "wellness centers" staffed by county workers.
The plan drew sharp criticism from private-care providers who said the proposed new system would cost more to run and disrupt care to numerous patients.
County administrators said they have no choice but to make wrenching cuts to resolve a suffocating $181 million budget deficit. They said they are confident that most patients will adjust and do well in a streamlined system.
But Rodriguez cautioned that the plan appeared to violate state laws and regulations and could seriously harm patients.
Among other things, transferring clients from longtime private providers to county workers who are unskilled in mental health matters "is not a reasonable application of the county or state requirements," she said.
"Please inform DMH how the county intends to follow state law," she wrote.
In her response dated June 1, Edwards-Buckley confirmed the county is considering a revamped mental health system in which services are provided "primarily through county employees," but said officials also are pondering other approaches.
Among the possible alternatives, she said, is a "hybrid" system using both county employees and private contractors to provide treatment.
"The county is committed to the recovery model that has been utilized so effectively" for 17 years and intends to keep it in some form, she said.
Ken Eskow, executive director of El Hogar, one of the four programs that have contracts with the county, said he is unsure what the developments mean for the future of his program and patients. "Things seem to change every day," he said.
Edwards-Buckley's letter to state mental health director Stephen Mayberg addressed other concerns raised by Rodriguez, including how it has proposed using various pots of state money. In each case, she said the county's proposals are proper and legal.
Efforts to reach Rodriguez or Mayberg on Wednesday were unsuccessful.
"I strongly urge you to approve the county's plan updates and contracts," Edwards-Buckley concluded in her letter. "Failure to do so only further impacts the ability of the county to provide for the mental health needs of its clients."
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