Mental Health Earns Budget Priority : Skid Row Program Is Example of Bright Spot in Bleak Outlook

As work on the $6-billion 1985-86 Los Angeles County budget begins and officials pour out a stream of bleak forecasts, psychiatrist Howard Barton represents a tiny bright spot in an uncertain sea of numbers.

One recent day, as he often does, Barton was shopping for new clients among the Skid Row street people who had sought refuge at the Weingart Center’s storefront drop-in center.

“Does anyone need mental health services?” he asked several times as he circled the room.

A few men cautiously raised their hands and minutes later one was upstairs in Barton’s office in the county’s new Skid Row mental health clinic. Dale, 33, said he has lived on Skid Row off and on for 10 years and, during that time, has been in and out of state mental hospitals--Metropolitan, Atascadero, Camarillo.

Talking in rapid, jumbled sentences, Dale said he was being bothered by voices--voices telling him things “too personal” to repeat. He stopped taking medicine to control the problem because, he claimed, “they put something in it” that makes him impotent.

After an evaluation, Barton suggested an alternative drug with fewer side effects. Dale at first agreed to take the medicine but later became agitated and stormed out.

Clinic workers, who visit missions, halfway houses and other gathering spots on Skid Row to help the mentally ill, said they will try to coax Dale back for counseling. He is, Barton said, “exactly the kind of person” the clinic wants to reach.

Until the new Skid Row project was begun last year, the county was doing little to reach out to people like Dale--the estimated 30% to 50% of the homeless who have major mental problems.

William Morrison, who supervises the Weingart drop-in center, said that when someone appeared disturbed, “We’d call the police but they’d say, ‘We can’t do anything.’ They (the counselors) have helped us quite bit.”

The Skid Row project is part of a quiet expansion of county mental health programs begun last year--in notable contrast to the trend of cutbacks since the passage of Proposition 13 in 1978.

In the five years after Proposition 13 was approved, the county Mental Health Department took $21 million in reductions and lost more than 250 staff positions. Even with increases this fiscal year and proposed increases for next year, officials say, the department would scarcely be back to its 1978 level. And since that time, responsibility for many additional patients has been shifted from the state to the county.

While most county departments continue struggling to hold their own, however, the mental health program expanded about 10% this fiscal year. The rebuilding was a result of the high priority that mental health--like education and toxic waste--is being given by Gov. George Deukmejian and the Legislature.

On top of an increase for inflation, about $35 million in new mental health money was allocated statewide in 1984-85 for local programs. Los Angeles County received $10.2 million, which it is using to increase services at clinics, add critically needed beds at live-in treatment centers and create new programs such as the Skid Row project.

“The governor feels the taxpayers’ money should be spent for those people most in need of state services,” said Michael O’Connor, Deukmejian’s director of mental health services. “The chronically and severely mentally ill fit the description well. . . . We are in a window period where we are recognizing the real need out there.”

And the governor’s recently released $33.6-billion 1985-86 state budget calls for an additional $40-million after-inflation increase for county-run mental health programs, which will mean $13 million to $15 million more for Los Angeles County.

However, the outlook is not as optimistic for the rest of the county budget, officials say.

After two relatively stable years of maintaining most existing programs, county budget analysts are warning that a new round of deep cuts may be ahead.

The problem stems from the combined effects of President Reagan’s proposed federal spending reductions, yet-to-be-negotiated employee salary increases and soaring demand for jail space, health services, homeless shelter programs and services for victims of child abuse.

Ted Reed, who was acting chief administrative officer until James C. Hankla was named to the post last week, recently ordered a freeze on hiring after an analysis revealed projections that spending could outstrip revenue by $3.3 million by the end of the current fiscal year.

“L.A. County is in deep trouble,” Reed told the supervisors last week.

Among the revenues that helped balance this year’s budget were $33 million in surplus funds and $26 million in one-time revenues, neither of which will be available in 1985-86, Reed said.

Reagan’s proposed elimination of general revenue sharing, a no-strings grant program that the county uses to help fund health services for the poor, could cost the county $60 million in federal aid next year.

Looking to a Crunch

Also, state and local money sources are expected to fall $36 million to $116 million short of projected needs, depending on what actions the Board of Supervisors takes on salary increases and expansion of departments that are straining to meet service demands.

The crunch is expected to be particularly acute in two areas:

- Overcrowding in county jails. As a result of tougher sentencing practices, the Sheriff’s Department, expects to overspend its budget by about $12 million this year largely because of jail crowding.

- Services for children. The caseload in protective services for children increased 46% last year to about 14,000. Lola Hobbs, director of the new Department of Children’s Services, said her department could experience a “substantial shortfall”--perhaps as much as $30 million--next year.

Some departments expect to avoid major cuts, although officials in those areas complain they will have no new money to deal with problems created by earlier reductions.

Case Is Overstated

Some observers are dubious about the current projections. County officials traditionally overstate the severity of their financial problems in hopes of getting more state money.

Among the most skeptical are those representing county employees in upcoming contract talks. All of the major contracts are up for renegotiation this year and Phil Giarrizzo, general manager of the largest county union, claimed that is part of the reason for the gloomy forecasts. “We believe there is a lot of saber-rattling and posturing going on,” he said. “While there are some problems that must be addressed, they are overstating the case. They have the ability to hide money in thousands of ways.”

Despite trouble on these fronts, mental health is almost certain to expand again next year. And this year’s new and expanded programs indicate how that money may be used in the 1985-86 fiscal year.

In addition to the Skid Row project, some of the major program changes have included:

- Doubling mental health screening and counseling services at the Central Jail, expanding services at Sybil Brand Institute, the women’s jail, and creating a new program to evaluate the mentally ill after they are arrested in the Central City area.

Studies have shown that one out of eight inmates is severely mentally ill and requires attention, said Richard Kushi, director of the outpatient mental health program in the county jails. The new money has made therapists available on weekends and provided follow-up on inmates when they are released. “We’re providing more service to a larger group of people; trying to hook them up in the community instead of having them breaking the law and having to come back to jail,” Kushi said.

- Beefing up emergency response teams made up of mental health specialists. The plan is to have the teams available countywide 24 hours a day, seven days a week. “That’s absolutely a top priority,” said Roberto Quiroz, acting director of the Mental Health Department.

The teams, which have only been available during working hours in limited areas, respond to requests from police and civilians. “A family may call and say their son is going bananas,” Quiroz said. The teams “try to stabilize the individual so they do not require intensive hospitalization.”

- Adding a wide variety of improved services for children and adolescents. These include better diagnosis and case management to ensure that children receive appropriate care, as well as new community residential treatment facilities designed to keep young people out of state institutions.

- Issuing new contracts to expand adult residential treatment facilities by 100 beds or more countywide. The shortage of such live-in community programs has been a major problem because state mental hospitals have sharply cut back beds in recent years and discharged thousands of patients into the community.

Few Are Satisfied

While the new spending on mental health programs may be, as Quiroz described it, an “upbeat” element in the county budget, virtually no one familiar with the field appears satisfied.

The Mental Health Assn. in Los Angeles County, a nonprofit organization of parents, patients, professionals and agencies, has endorsed a long-term plan for care that would require about three times what is now spent in Los Angeles County.

Richard Van Horn, executive director of the association, said that “the system is so underfunded it’s going to take several years of augmentations like these and larger” to reach adequate service levels.