County Suit Seeks Beds for Mentally Ill

Charging that San Diego County is being seriously shortchanged in the allocation of beds in state mental hospitals, the county on Tuesday sued the state in an effort to obtain the additional beds that officials contend are needed to treat severely mentally ill people.

In a lawsuit filed in Superior Court, county attorneys alleged that because of what Supervisor George Bailey described as the state’s “woefully inadequate . . . and unfair formula,” the county currently receives only about one-sixth of the mental hospital beds to which it would be entitled if the beds were allocated according to population.

Similar to two 1986 lawsuits that the county filed against the state concerning alleged inequities in the distribution of property taxes and other revenues, the new suit points out that San Diego County has been allocated only 32 beds in state mental hospitals--175 fewer than what county officials characterize as their population-based “fair share.” Moreover, other counties with substantially smaller populations than San Diego receive more state mental hospital beds, Bailey noted.

‘Cannot Be on Short End’

“It makes us sad that we have to continue to resort to (lawsuits) to direct the attention of Sacramento to the fact that San Diego County is now the second most populous in the state,” Bailey said at a news conference at the County Administration Center. “It deserves to be treated in that manner. We will continue to take whatever actions are necessary . . . to ensure we (obtain) our fair share of tax dollars. We cannot continue to be on the short end.”

In response, state mental health officials argued that San Diego contributed to its current bed-shortage problem by “selling back” 28 beds--nearly half of its allocation--to the state in the early 1980s in exchange for a payment that now equals about $1.6 million annually.

“San Diego, in effect, reduced its own allocation,” said Dean Owen, a spokesman for the California Department of Mental Health.

But San Diego officials emphasized that, even if those 28 beds currently were available to the county, local mental health needs still would demand far more beds.

‘A Hell of a Difference’

“Even if we had 60 beds, we’re entitled to 207, and that’s still a hell of a difference,” Bailey said.

Tuesday’s lawsuit was the latest chapter in San Diego County’s long-running effort to rectify what it perceives as unfair state funding formulas that have cost the county tens of millions of dollars a year. But the predicament is also the result of the lack of clout carried by the county’s delegation to the Legislature, county officials concede.

In 1986, the county, at Bailey’s urging, filed two lawsuits against the state charging that San Diego County has not received its fair share of property tax and other revenues. Both suits still are in preliminary pretrial stages.

According to county figures, the average per capita allocation of general revenues for counties during the 1985-1986 fiscal year was $220.26. San Diego, however, received only $159.37 per capita, the second lowest of the state’s 58 counties and a figure that, from the county’s perspective, produced a $132-million shortfall. County officials also contend that San Diego received $72 million less in property tax revenues than the statewide average that year.

Last month, Board Chairman Bailey, in his State of the County address, argued that programs mandated but not funded by Sacramento and Washington have significantly worsened the county’s budget woes. In the future, the supervisors may simply refuse to implement new state or federal programs here unless money is provided for their operation, Bailey warned.

In the suit filed Tuesday, the county requested a preliminary injunction that would increase the number of state mental hospital beds allocated to San Diego and prohibit the state from charging the county for using more than its 32-bed allotment. A hearing on the preliminary injunction has been set for March 17.

County Mental Health Director J. William Cox said that San Diego patients typically occupy about 60 state beds, with the additional beds costing the county about $2.3 million annually--money that the state withholds from the county’s general mental health funds.

In addition to the 32 state beds allotted to the county, there also are 119 local mental health hospital beds, Cox said. But the mental health director added that the county needs “a minimum” of 200 additional beds to “deal with the severely mentally ill who require periodic hospitalization.”

Saying that the current bed shortage has reached crisis proportions, Cox and Bailey charged that the state’s bed allocation formula has resulted in mentally ill people--some of them dangerous to themselves and others--being denied needed medical treatment, a situation that poses potentially dire consequences.

Many Remain on Streets

The “bedlock,” to use Cox’s term, means that many severely mentally ill simply remain on the streets, county officials said. Others, Cox said, are picked up by local police officers, “deflecting them from their safety duties,” or are held in local hospital emergency rooms “at great risk to staff and other patients.”

Because of the insufficient mental hospital space to provide lengthy treatment for such patients, Cox added: “The consequences (are that) more of them will go off the bridge, more of them will drive their cars into others driving the wrong way on the freeway and more of them will resort . . . to violence on themselves and others.”

At the heart of Tuesday’s lawsuit is the county’s contention that the most equitable manner to distribute state mental health beds among counties is on the basis of population. But under the current allocation formula, set by the Legislature in the early 1980s, even many counties that are much smaller than San Diego receive more state beds. For example, San Francisco County is allocated 246 beds, Contra Costa County 96 and San Mateo County 75, even though each of their 1986 populations was only about one-third of San Diego’s 2.2-million figure, according to county figures.

Building their statistical case, county officials also noted that San Diego’s allocation equals only 1.5 beds per 100,000 population, contrasted with 33.2 for San Francisco and 13.2 for Los Angeles, which has 1,080 state beds available to it.

Communities’ mental health needs, as well as their legislative delegation’s clout, influenced the Legislature’s decision on how to divide the approximately 4,800 state beds--nearly half of which, Owen said, are devoted to criminally insane patients institutionalized by the courts.

Lack of Clout in Sacramento

While San Diego can document its need for the beds, county officials conceded Tuesday that a lack of clout in Sacramento is one of the reasons that the county has been unable to secure the needed mental health hospital space.

“We just want to be treated fairly,” Bailey said. “I’ll guarantee you that if this was happening in San Francisco or Los Angeles, something would have happened in Sacramento to correct it. We frankly up until recently have not had the political power to exert when it’s necessary to make it happen for San Diego . . . . But we are finally recognizing the problem and making some noise about it.”

State Mental Health Department spokesman Owen said that state officials sympathize with San Diego’s plight and have offered to allow the county to “buy” additional bed space from counties not needing their full allocation.

Although the state would pay 85% of the $175 daily cost for the additional beds, the county has rejected that offer because of the severe budget constraints facing it.

“Plus, why should we pay anything for beds that we’re entitled to for free?” Bailey asked rhetorically. “That’s why we’re going to court.”