Report blasts county for underfunding mental health

BY COLBY FRAZIER
DAILY SOUND STAFF WRITER

In a report titled, “16 Beds… And Deeper in Debt,” a Santa Barbara County Civil Grand Jury blasted county leaders for chronically underfunding the Department of Alcohol, Drug and Mental Health Services.
One of the primary results of years of underfunding, the report says, is a steep lack of inpatient psychiatric treatment beds, of which there are only 16 for the entire county.
“The Grand Jury believes that the mental health needs of the county have been given a low priority,” the report says. “The Grand Jury notes that Santa Barbara County contributes less to its mental health program than most California counties.”

The report comes just as the Board of Supervisors is scheduled to commence June budget deliberations, at which more than $26 million in cuts are on the table, $8.4 million of which are expected to come from adult mental health services.
Some predict the cuts could purge hundreds of mentally ill people from the services they receive. While many of these will likely find alternatives, critics of the cuts say it’s inevitable that others will end up being thrust into homelessness, or die.
While the exact amount of budget cuts won’t be known until the books are closed at the end of June, the Grand Jury report recommends the county increase funding, not decrease.
According to the report, Santa Barbara County funds 2.4 percent of the Department of Alcohol, Drug and Mental Health (ADMHS) budget, while other counties in the state average 6 percent.
But the most recent proposed cuts are an exclamation point to years of fiscal neglect, which have resulted in inefficient practices.
The report focuses on roughly 400 psychiatric patients, that due to lack of beds in this county, were transported last year by ambulance to the Vista del Mar hospital in Ventura to receive psychiatric care. This process cost Santa Barbara County nearly $2 million, the report says.
As it stands, the 16-bed psychiatric health facility, which is located near the main county jail, is the only of its kind to house involuntary patients in this county.
The number of beds used to be 24, but the report says it was chopped to 16 after MediCal payments were cut from facilities with more than 16 beds.
While the cost of transporting patients to Ventura is steep, — the county is billed about $650 per bed day plus $50 to $80 for physicians’ fees — it is compounded by the fact that out-of-county transports are not subsidized in any way by the state. The report says 50 percent of the costs to house patients in the 16-bed facility are shared with the state, but when patients go to Ventura, the entire cost falls on the county.
The Grand Jury also found discrepancies with how many patients were transported to Ventura and how many were paid for. During 2006-2007, there were 473 ambulance trips to Vista del Mar, but county statistics show 392 admissions. Total bed days reported by the county were 3,268, but only 1,638 were reported as paid.
The report does not give a dollar amount for these discrepancies, but based on $650 per bed day, the difference is between $2.1 million, and a little over $1 million.
The report says part of this discrepancy could be attributed to a new data collection system that was implemented in July 2007. But while county staff has had, “difficulty learning to use it,” the report says, these problems could, “lead to loss of revenue due to insurance or third party payer status (including Medicare) being overlooked or incorrectly recorded.”
It seems the deteriorating condition of mental health services in the county, at least when dealing with psychiatric care beds, has been brought to the county’s attention in the past.
The report cites a Grand Jury report in the late 1990s that found a shortage of facilities for the acutely mentally ill and recommended county leaders fund new facilities.
But that didn’t happen.
“Ten years and several department heads later, the county has not only not added, but has lost psychiatric beds, so that today there are only 16 locked beds in the county,” the report says. “The current budget crisis notwithstanding, it is time the Board of Supervisors and ADMHS develop a long-range plan to provide adequate psychiatric inpatient facilities for the county.”
The report also weighed in on the county’s practice of charging ADMHS interest on money it borrows from the general fund.
The report says many of the fiscal challenges facing ADMHS are the result of, “erratic” and late MediCal reimbursements, which constitute a significant portion of the budget.
The Board of Supervisors recently bailed the department out to the tune of $6.9 million — a deficit that came to the surface in roughly five months.
While ADMHS officials await MediCal payments each year, the report says it is forced to borrow from the general fund — a practice that is routine when compared to other counties, which also face late payments from the state.
What is somewhat unique to Santa Barbara County is the charging of interest, which totaled $400,000 last year and is expected to top $800,000 this year, the report says.
“The Grand Jury believes that the county should stop charging interest to ADMHS and should increase its contribution to the budget to at least match the state average,” the report says.
The entire report is available at www.sbcgj.org. The Board of Supervisors has 90 days to offer an official response to the report.