County to Sue State for More Mental Health Funds

Decrying the shortage of mental health services in Orange County, the Board of Supervisors on Tuesday agreed to sue the state in an effort to obtain additional beds that officials contend are sorely needed to treat mentally ill patients.

County health-care advocates praised the decision to file suit as a significant departure from the way the county has dealt with the state and its method of funding health-care programs. For years, Orange County has ranked among the lowest of California’s 58 counties in per capita spending by the state on local health and welfare programs. It currently ranks next to last. But local officials’ past attempts at letter-writing, lobbying and promoting legislation have largely failed to increase the county’s share of state funding.

The supervisors’ decision to sue was unanimous.

“This is a very, very important action,” said Chauncey Alexander, chairman of the United Way’s Health Care Task Force. “This may be a significant sign that the Board of Supervisors is getting more aggressive about claiming its fair share of state health-care money.”

Meanwhile, the supervisors delivered a rather critical review of efforts by the county’s Sacramento representatives to help secure more money for programs such as mental health. To focus attention on the county’s plight, the supervisors also decided on Tuesday to send each local legislator a letter outlining the situation.

The intent, said Supervisor Don R. Roth, is to inform those lawmakers that “they have not done enough battles for us.”

“We want to get their attention,” Roth said. “The facts are very clear. We’re the third largest county in the state of California but rate almost at the bottom in terms of state spending on mentally ill people. That’s intolerable and we need help. We need their help--right now.”

At least one member of the county delegation, State Sen. John Seymour (R-Anaheim), took exception to Roth’s remarks.

“I take a little offense to that attitude,” Seymour said in a telephone interview from Sacramento. “I can’t ever remember not responding to them when they have come to me with a problem. If they’ve got a new problem, why didn’t they call?”

The aim of the county’s suit, which officials said will be filed within a week, is rather narrow, though it illustrates the county’s predicament when it comes to providing adequate health care for thousands of poor, disabled and mentally ill residents.

The suit seeks a preliminary injunction against the state, requiring immediate restoration of two beds--the equivalent of $200,000--to the county’s current annual allocation of 146 state-subsidized hospital beds for county mental patients. The two beds were lost this year when state officials were ordered by a San Diego judge to increase the number of hospital beds for mental patients in that county. While not contesting San Diego’s need for more beds for the mentally ill, Orange County officials say it is unfair to take those beds from a county with an acute shortage of hospital beds and services for mental patients.

In the current fiscal year, Orange County is receiving $17.71 per capita--about $39 million--for mental health services from the state. That is well below the per capita state average of $25.47. Only Amador County, a tiny county in the Sierra foothills of Central California, has a lower per capita spending rate, $14.14, than Orange County.

“Basically, we have a very bare-bones mental health program,” Orange County mental health Director Tim Mullins said. “We are running a rather shortchanged program for the residents of the county. I think it’s fair to say the situation is grave.”

Experts say that much of the problem is rooted in the county’s decision not to initially participate in state-supported health-care programs. In the 1960s and 1970s, county officials chose not to accept state money for programs such as mental health services and indigent medical care, citing the lack of demand and clinging to a belief that the county could take care of its own. But by the 1980s, when the county decided to participate, much of the state money was already allocated to other counties. Therefore, under current funding formulas set by the Legislature in the early 1980s, many counties that are much smaller than Orange receive substantially more money per capita.

This year, for example, San Francisco County, with a population of 741,300, received per capita $56.31 and has 246 state-subsidized hospital beds for mental patients.

Orange County officials contend that returning two beds to the county’s allocation is significant because up to 60 patients a year, on average, may use those beds.

“In a county where thousands of individuals are going without adequate mental treatment, every bed helps,” said Douglas C. Barton, a county mental health official.

The county is allocated money to provide 146 beds for long-term mental patients. But because there are no state mental hospitals in Orange County, the money pays for adults to be treated at Metropolitan State Hospital in Norwalk and children to receive care Camarillo State Hospital in Ventura County. The county also contracts locally with several private health-care providers for the treatment of mental patients for up to 90 days.

STATE MENTAL HEALTH FUNDING

Per **Preliminary Capita Allocation ‘88-89 Per Rank County *Population Incl. State Hosp. Capita THE TOP 10 1. San Francisco 741,300 $41,744,905 $56.31 2. Alpine 1,210 66,446 54.91 3. Napa 105,800 4,432,253 41.89 4. Inyo 18,100 750,031 41.44 5. Modoc 9,250 378,105 40.88 6. Marin 228,400 8,731,320 38.23 7. Colusa 14,950 564,561 37.76 8. Sierra 5,320 126,277 35.87 9. Alameda 1,134,800 40,144,947 35.38 10. Mendocino 75,600 2,641,706 34.94 THE BOTTOM 10 48. Riverside 946,100 18,507,274 19.56 49. Nevada 75,300 1,445,501 19.20 50. El Dorado 116,700 2,181,524 18.69 51. San Luis Obispo 204,300 3,818,792 18.69 52. San Bernardino 1,240,000 22,676,822 18.29 53. Ventura 637,400 11,479,776 18.01 54. San Diego 2,327,700 41,821,182 17.97 55. Lassen 26,450 473,782 17.91 56. Orange 2,238,700 39,637,349 17.71 57. Amador*** 27,150 383,976 14.14 -- Statewide 28,108,580 713,696,520 25.47

* State Department of Finance estimate as of Jan. 1, 1988

** Preliminary allocation by State Department of Mental Health. State Hospital allocation reflects cuts due to San Diego law suit.

*** While there are 58 counties in California, there are only 57 listings because the state combines Sutter and Yuba counties.

Notes: Los Angeles County ranks 17th with $247,206,232 for 8,555,900 people, $28.89 per capita.

Source: Orange County Health Care Agency