Item No. 5 on the El Dorado County Board of Supervisors March 12 agenda, approved on the consent calendar, allows an increased expenditure of $367,500 through June 30, 2013 “for the provision of inpatient mental health treatment for county clients” at the Sacramento-based Heritage Oaks Hospital. The funding source is state and federal funds (i.e., us, the tax payers). This is but one of several high-cost contracts the county has with psychiatric hospitals in other counties.
El Dorado County recently closed its six-bed “crisis residential treatment” center, presumably because it cost too much to operate. It was created originally to prevent expensive hospital readmissions by providing temporary housing and intermediate care for patients discharged from the Psychiatric Health Facility (the PHF). Ironically, it was replaced by adding six beds to the PHF for patients requiring more intensive (i.e., expensive) mental health treatment. The paradox, of course, involves replacing a lower-cost, readmission prevention facility with a higher-cost extension to the inpatient unit. This begs the question of whether the need for additional inpatient beds would be necessary with better, more comprehensive outpatient care.
There is no question that inpatient mental health treatment is very expensive. It typically accounts for the largest percentage of costs incurred by both for-profit behavioral healthcare insurers and publicly supported, county-run mental health plans. In the 1990s and early 2000s, cost-conscious share holders and taxpayers demanded controls be placed on these inpatient expenditures. Managed behavioral healthcare resulted and instituted cost-limiting tools such as annual limits and concurrent utilization review. While the inpatient costs may have been contained, severe mental illness persists and necessitates less-costly outpatient alternatives to hospital (re)admissions and jail incarceration.
Laura’s Law became effective in California in 2003 and allows local courts to mandate treatment for residents with severe mental health conditions and a history of violence or hospitalization. California’s counties are allowed to decide whether to implement the law. So far, Nevada County is the only county to do so. In September 2012, Gov. Brown signed a bill (AB 1569) that extends Laura’s Law until 2017.
In March 2013, the Los Angeles County Board of Supervisors threw “its weight behind Laura’s Law saying in a resolution that such programs have been shown to ‘significantly reduce’ homelessness, hospitalization and arrest.” The California legislative bills cited by the LA BOS resolution clarify that local counties 1) can use existing revenue and Proposition 63 for Laura’s Law, 2) eliminate the need for local board of supervisors approval, 3) expand the period of court-ordered treatment from six months to a year and 4) add those treated under Laura’s Law to the database of people prohibited from owning firearms.
So, an obvious question is this: Would El Dorado taxpayers receive a better return on their mental healthcare investment by implementing Laura’s Law locally rather than funding “the provision of (more expensive) inpatient mental health treatment?” Specifically, is it not the right time to reexamine spending millions on inpatient hospital costs and consider implementing assisted outpatient treatment services (Laura’s Law) instead?
As a licensed psychologist involved in managing and providing mental healthcare in this county for the last several years, I urge our county Board of Supervisors and the taxpaying citizens they represent to conduct an open and exhaustive cost and quality analysis of how and to whom publicly funded mental healthcare is delivered here; and to determine whether implementing Laura’s Law would lower the costs and improve the quality of that care.
JOHN BACHMAN, Ph.D.