Gone mental

As the state budget implodes, Sacramento County prepares to cut mental-health care services for 4,500 patients

Ann Edwards-Buckley, director of the Sacramento County Department of Behavioral Health Services, says looming cuts in mental-health services are “sickening.”

Ann Edwards-Buckley, director of the Sacramento County Department of Behavioral Health Services, says looming cuts in mental-health services are “sickening.”

Photo By anne stokes

Sherrie would like to give her last name for this article, but worries how people will perceive a 40-year-old woman who has been hospitalized for bipolar disorder 25 times during her life.

“It’s unfortunate that I can’t give you my entire name because of the stigma of having a mental illness,” she explains. “If you tell employers, ‘I have a mental illness, and sometimes when I’m sick, I might have to be off for three weeks or a month,’ they’re not going to hire you.”

Nevertheless, with state budget cuts threatening to curtail the public mental-health services that have essentially saved her life and thousands of others, Sherrie feels she has no choice but to speak out.

Sherrie and approximately 8,500 other patients like her receive case management, medication support and therapeutic services via four Regional Support Teams operated by the Sacramento County Department of Behavioral Health Services. When Sherrie learned the department was facing a $20.5 million shortfall for the upcoming fiscal year, potentially denying treatment to her and 4,500 other RST clients as soon as July 1, she took action, firing off a flurry of letters to state and local lawmakers and the media, begging them to listen to the rights of the “unheard.”

In fact, she calls her one-woman campaign SHER—Someone Hears Everyone’s Rights.

“I was feeling less depressed, and I was hopeful,” Sherrie said of the progress she’d been making before the budget cuts were announced. “Now, I feel hopeless, I’m scared. I don’t understand how it’s going to help the budget. There’s going to be more psychiatric hospitalizations, more police intervention, more homelessness. I don’t know what I’m going to do. Your family can only help so much. It’s a lot of stress on them. Without a psychiatrist, what am I going to do?”

According to Ann Edwards-Buckley, director of the Department of Behavioral Health Services, the department’s fiscal 2008-2009 budget was $203 million. The county kicked in $1.2 million from its general fund; the vast bulk of the funding comes from sales tax, vehicle license fees and Medi-Cal reimbursements from the state and federal governments.

Although the cash-strapped county will again contribute $1.2 million for 2009-2010, the department faces a revenue shortfall of $20.5 million. The shortfall is directly tied to the declining economy in the form of reduced sales tax, vehicle license fees and Medi-Cal reimbursements from the state and federal governments. Only funding from Proposition 63, the Mental Health Services Act, has held steady at $27 million annually.

“We’re facing severe, severe cuts in all areas,” Edwards-Buckley said. “The sad reality is that some people may fall through the cracks. It’s sickening.”

Edwards-Buckley and her team don’t hold out much hope of getting extra help from the county, which faces its own budget deficit of $187 million and already has attracted derision for suggesting drastic cuts in law enforcement. So the department has begun discussions with federally qualified health-care centers and primary-care physicians who accept Medi-Cal to provide services to the 4,500 patients who may be thrown off the rolls.

Additionally, the county will petition the state to increase its Prop. 63 funding by $8 million to help mitigate the loss of services, Edwards-Buckley said. But even with all the behind-the-scenes machinations, she doesn’t know how many of the 4,500 slots can be saved, and that doesn’t take into account the new referrals coming in daily.

Adding insult to injury, funding from Prop. 63, which by law was supposed to be used only for statewide mental-health services, is itself in jeopardy, a victim of its own success and the state’s cratering finances.

In 2004, Californians approved Prop. 63, an annual 1 percent levy on any taxable income more than $1 million, with the understanding that the money would never be subject to the whim of the Legislature and could not be used to shore up the state’s general fund. The Mental Health Services Act was born and brought in roughly $254 million in 2004-05; another $683 million in 2005-06; and, for 2009-10, is expected to bring in about $1.4 billion.

However, on May 19, voters will again be asked to go to the polls to pass a string of proposals to bail the state out of its present (and perpetual) fiscal crisis. Included under this umbrella of “reform” is Proposition 1E, which proposes to break the contract the state had with voters by redirecting $234 million from Mental Health Services Act funds to the general fund for one year.

County Supervisor Roger Dickinson didn’t try to put a happy face on the overall situation.

“Knowing that we have to make cuts, yet knowing what the very real consequences are going to be for people when we do is agonizing,” Dickinson said. “Plainly, you know the problems are going to get much, much worse.”

Sherrie began going to Northgate Point, one of the four RSTs in the county, in 2001, shortly after her last hospitalization. She had been hospitalized repeatedly since being diagnosed with bipolar disorder at age 19; finding the right combination of meds was a process of trial and error—mostly error. At Northgate Point, she received a case manager, a psychiatrist and therapeutic support.

“I was homeless for five months before that and felt really alone and really abandoned by my family, but I was determined to get better,” Sherrie recalled. “Shortly after, I hooked up with Northgate Point, and I knew I had a place to go if I was having an episode. I knew I had a psychiatrist to prescribe my medication, and I felt comfortable with that. Having Northgate Point as my clinic has given me hope that someone cares, especially my caseworker, Carrie Garcia; she calls me to see how I’m doing and really cares.”

The constant contact with Northgate Point staff has allowed Sherrie to stabilize. When she’s unstable and her illness breaks out—such as when the medication she’s taking no longer works or if she forgets to take it—she has visual hallucinations, forgets the names and faces of those closest to her and thinks they wish to do her harm. Such behavior has led to frequent hospitalizations, disrupting her efforts to lead a normal life.

She did manage to graduate at the top of her class at Sacramento State in 1997 with a bachelor’s degree in psychology, but it was a struggle. When she’d get sick in the middle of a semester, she’d often have to take those classes over again. Work still eludes her, partly because of the stigma attached to mental illness and partly because her illness isn’t fully arrested.

“I’m not able to work right now,” she said. “Because of my illness, works just brings out too much stress. And you can’t tell too many bosses that, ‘Oh, I’m sick now, and I have to be off for two weeks.’ I’ve gained a lot of weight because of my meds and that makes me insecure as well.”

Still, she’s hopeful that her life will continue to improve.

“I won’t always be this way,” she said. “I’m getting better.”

Since she began receiving services at Northgate Point in 2001, Sherrie has not been hospitalized. She says the one episode she has had did not escalate to hospitalization because she had the support around her necessary to arrest the illness in time. If she’s denied services because of the budget cuts, she’s worried she’ll lose all the progress she’s made.

“My psychiatrist really understands me, as does my caseworker, and I feel they really care,” she said. “I have friends, I have a boyfriend of eight years, my family’s pretty proud of me, my outlook on life is more promising, my episodes are fewer, my ties with my family are stronger. But how will that continue without access to my RST? I feel so helpless.”