County to Cut Most Services for Mentally Ill

Financially ailing Los Angeles County has quietly begun dismantling its system of treating the mentally ill and plans to eliminate the huge outpatient psychiatric headquarters at County-USC Medical Center as well as inpatient and outpatient psychiatric services at the county’s five other hospitals, according to documents and interviews.

Many of the free-standing mental health clinics scattered countywide also are likely targets for cutbacks expected in coming weeks.

As a result, officials said Thursday, tens of thousands of the county’s most seriously mentally ill will be cast adrift, with little direction and few established places to go for counseling, treatment, needed medication and medical care.

Because of continuing budget problems, the beleaguered Department of Health Services will cease its decades-long practice of providing services for the mentally ill, except for crisis care at a downsized psychiatric emergency room at County-USC.

Instead, the Board of Supervisors has approved transferring responsibility for mental health services to the county Department of Mental Health, which has serious budget problems of its own.

Mental Health officials have yet to come up with a contingency plan for handling the patient load. Mental Health Director Areta Crowell estimated that only 40% of those receiving acute in-patient care will continue to get it after Oct. 1, when the cutbacks go into effect.

“With the DHS meltdown, we have to develop an alternative system to what they had provided,� Crowell said. “A lot of people won’t get served. They will fall through the cracks. I can’t describe it any other way.�

Raoul Caro, County-USC’s administrator for psychiatric services, offered an equally grim assessment. “The mental health system is going down the tubes,� he said. “We are ratcheting down, to possibly providing some form of emergency triage psychiatric services in an emergency-room setting. But that is it.�

Dr. Marc Graff, president-elect of the Southern California Psychiatric Society, said his members are so concerned that they are preparing a letter asking the county to reconsider. “A system that has been built up for decades, with research, education and patient care, is being absolutely dismantled right in front of our eyes, with little thought about the consequences of anyone involved,� said Graff.

“It is a sacrifice to moola, to money. And these are the least-able patients to take care of themselves,� Graff said. “They will not be protesting in the streets. They will be sitting in front of their own doorways, in despair.�

All of the closures are slated to be completed by Oct. 1. And with no alternative system yet in place, county doctors are growing anxious. They say they don’t know what to tell patients, who are beginning to ask questions about whether they’ll continue to receive care, and if so, where.

At Dr. Nolan Thompson’s group therapy session Thursday for the seriously and chronically mentally ill at County-USC, nearly all of his nine patients asked him what will happen next. “They were all asking, ‘Where are we going to go? What are we going to do?’ � Thompson said. “And I could not tell them. We have been given no direction on that.�

With so much silence regarding what will be left of their safety net, patients are panicky. Many fear that even temporary breaks in their medication and treatment will break a precarious cycle of stability that could send them back to the streets.

*

“If they close [the center], I don’t know where to go. I don’t know where to get my medicine. I am going to have a lot problems,� said Victor Soriano, 21, a schizophrenic who said his mood disorders often make him violent. Added his doctor, John M. Murphy: “They don’t have a clue where patients like him would go. They have just completely dropped the ball on this.�

The near-shutdown of the entire mental health system, county officials say, is the result of an unfortunate confluence of many factors, most significantly the budget deficit in the Health Services Department, which is far worse than the original $655-million estimate.

The health department had run much of the county’s mental health system because many of the mentally ill need hospital care, medical treatment or prescription drugs that hospitals and clinics can provide. But all that changed when the supervisors earlier this month adopted a report by the Health Crisis Task Force, which recommended that all mental health services be transferred to the Department of Mental Health.

On Wednesday, Mental Health Director Crowell officially broke the news to her management staff that they would now have to take over inpatient and outpatient services once provided by the health department with all of its hospitals, comprehensive health centers and clinics, most of which also are closing.

“Please be aware that the transfer of these services to DMH was not our recommendation or our preference,� Crowell said in a management memo obtained by The Times. “Since we have been given the task, we must now proceed to do the best we can.�

Now Crowell must come up with a contingency plan for where to send the mentally ill for outpatient treatment and continuing care. She must also determine where to house all of the hundreds of inpatients, many of them violent or so mentally ill that they need hospitalization, medical care and constant attention.

And she has to do it without any extra money in her $350 million budget, she said Thursday, even though the costs associated with providing the treatment are enormous.

Because there are so many functions that the mental health department cannot provide, such as the inpatient services at County-USC, Crowell said she is trying to negotiate contracts with other hospitals and mental-health clinics. She hopes that they will accept the inpatients, as well as the constant stream of violent and seriously mentally ill people who pour into county hospitals and require immediate treatment. But she said that with without additional funding, she cannot afford to buy treatment for at least 40% of them, even if she can find places that will accept them.

“We had a reasonably well-functioning system of care for those seriously mentally ill in the county,� Crowell said, wearily. “But this is a massive disruption. Even if we can purchase services and make some alternate arrangement, it will be a long time before it will function as efficiently and effectively as what we have had. We are just trying to get this network set up.�

Doctors at County-USC praised Crowell for trying so hard to replace the system that they say is being dismantled. But they said Thursday that that is impossible, that many private health-care providers will only take those patients who are insured by Medi-Cal or some other carrier. They also said many of their patients have such specialized requirements, including the need for a combination of psychiatric and hospital care, that they will be in danger if they are sent anywhere else.

“This is a nightmare; these people are going to end up in jail, or under freeway overpasses,� said Dr. Calvin Flowers, chief resident in County-USC’s psychiatry department. “What concerns me is that [Crowell] admits she cannot provide these services. But she doesn’t say what she is going to do.�

Some Department of Health Services administrators, although they continue to have problems of their own, said they are watching the unfolding dismantling of the mental health system with disgust.

*

“The whole is such a disaster I don’t even want to talk about it,� said one top administrator in the Department of Health Services, Dr. Jonathan Weisbuch. “There are 200,000 people in this county with serious mental illnesses. To try to close down the mental health resources in our six hospitals to save a few pennies in the broad scheme of things is unconscionable.�

In other developments Thursday:

* A week after dodging a more severe financial threat, the Metropolitan Transportation Authority agreed to sit down with county officials to negotiate a one-time transfer of $50 million to the county’s depleted coffers. The move grew out of a proposal by Gov. Wilson, who last week vetoed a broader measure that had passed the Legislature, that would have allowed the county to raid the MTA budget for $75 million a year for five years.

“It’s a compromise that says [to state lawmakers] ‘Don’t bring back any more legislation to take money from us,’ � MTA board Chairman Larry Zarian said in an interview.

* The supervisors began the process of trying to raise $22 million through increased taxes in the county’s unincorporated areas--the only place they can raise taxes without state approval.

At a hearing on the issue, there was little opposition to an entertainment surcharge at Universal Studios and Six Flags Magic Mountain. However, Jack Kyser, chief economist at the nonprofit Economic Development Corp., said a proposed 2% tax on ticket sales at the two theme parks would scare away tourists and provide little in the way of additional revenue.

If approved, the entertainment tax would generate about $2 million this year and nearly $3 million in future years for the county. In all, the board is considering raising eight different taxes to help reduce a $1.2-billion budget deficit.