Wednesday, April 16, 2014

El Dorado County mental healthcare


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.


Letters to the Editor


Discussion | 4 comments

  • CatherineApril 03, 2013 - 10:19 am

    It's not either/or, both must be funded, as they serve somewhat different groups. Diseases like schizophrenia, when they first appear, often in a person's teens or youth, may well need to be addressed with hospital care. People who are managing their neurobiological disorders conscientiously sometimes have problems and need hospitalization. Laura's Law needs to be implemented for the chronically I'll who can't seem to stay in treatment and especially for those who end up in the criminal justice system, where they never belonged in the first place. But most of all, regular people need to understand these illnesses as neurodevelopmental or neurodegenerative, that is, no-fault physical ailments like epilepsy or Parkinsons. They should receive the same funding streams we'd give for any other illness.

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  • CatherineApril 03, 2013 - 10:21 am

    *** ill not I'll

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  • Steve WilsonApril 03, 2013 - 10:45 am

    John, many of us see these huge contracts being awarded routinely on the Board of Supervisors agenda and wonder what is going on with the way the County spends money like water these days. They seem like huge sums of money. I agree that improved outpatient service would be a much cheaper, more cost effective solution that would reach and serve far more people than a few expensive hospital beds. Unfortunately, the County in its infinite wisdom is also now considering relocating the centrally located Mental Health Outpatient Center on Placerville Drive to a remote part of Diamond Springs where many clients will not be able to access it. Also, the top people in the County are resisting implementing Laura's Law. Unfortunately there is a huge disconnect with the current County bureaucrats decisions and providing a true continuum of care that properly centralizes the preventative public health services, primary outpatient care, and cost effective local inpatient psychiatric care so that those in need have readily available, safe, effortless access to the healthcare they need.

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  • CatherineApril 03, 2013 - 3:10 pm

    I don't want to burst anyone's bubble, but $375,000 isn't all that much for medical care. Inpatient and Outpatient care target differing illnesses and symptoms, and you can't really save money by using an outpatient process for someone who needs inpatient care (the case of Ms. Lomax is a recent reminder). However, the county should be utilizing Proposition 63 / MHSA funds. That Billion dollar a year fund was intended to enable communities to care for the seriously ill, and often the funds have been squandered. Advocates for quality care need to insist that there be provision of health care for all the illnesses currently managed under the 'mental health' umbrella.

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