Mental Health Officials Say System Is Disintegrating

In a rare public unburdening, two top Los Angeles County mental health officials told a national conference of psychiatrists Tuesday that Southern California is leading the nation in the “degradation and dismemberment” of the public mental health system.

The two psychiatrist-administrators, speaking at a meeting in Los Angeles, traced the erosion of hospital and outpatient services not only to federal, state and county cost-cutting but also to naivete and misguided idealism on the part of professionals such as themselves.

They suggested that well-intended policies, such as those aimed at shifting patients out of state psychiatric hospitals and into community-based care, had been allowed to be subverted to a point where the very core of the mental health system had been all but eliminated.

“Everyone should know our mistakes,” Dr. Rodney W. Burgoyne, medical director for the Los Angeles County Department of Mental Health and a professor at USC, wrote in a paper made available at his presentation. “No one can afford to ignore them.”

Dr. Maurice Weise, medical director for adult services for the department, traced the dwindling of state psychiatric hospital beds for Los Angeles County residents and simultaneous cuts in outpatient services that might have helped make up the loss.

Burgoyne and Weise made their comments at the annual meeting of the hospital and community psychiatry division of the American Psychiatric Assn., attended by more than 1,200 psychiatrists and other mental health professionals from across the country.

It was not the first time that attention had been drawn to the troubled state of the county’s, and California’s, once pioneering mental health system. In recent years, it has been ravaged by highly publicized cutbacks, clinic closings and upheaval.

What was remarkable was the frankness of the two psychiatrists in their account of the decline of the system and its complex causes, and in their characterization of the depth and breadth of the damage they said has been left behind.

“We are once again the leader, only this time, we are leading in the slow, and sometimes not so slow, degradation and dismemberment of our public mental health system,” Burgoyne said at the opening of his talk.

Bearded and bespectacled, Burgoyne indicated he was balancing an inclination to be honest with an interest in remaining employed. Both he and Weise joked fleetingly during their presentations, and Burgoyne commented to a colleague afterward, about jeopardizing their jobs.

In an interview afterward, Burgoyne said he chose his topic--”Public Psychiatry--Does It Exist in Los Angeles County?”--in part because he felt such views are rarely aired and also because many psychiatrists seemed oblivious to the problem.

“You have to understand that much of organized psychiatry has abandoned the public sector,” Weise explained to a reporter. “They’re more than willing to discuss the superficialities.”

Burgoyne traced the decline of the system to more than the usual suspects--the development of psychotropic drugs, the rise of patients’ rights and the process of deinstitutionalization aimed at moving the mentally ill out of state hospitals into community-based care.

He also cited the Social Security Act of 1965, which allowed federal funds to go directly to the disabled for the first time. Since money could go only to people not already receiving publicly funded care, the law created an incentive to discharge patients from hospitals.

California became a leader in planning a new mental health system. Its “California model” outlined the range of services that would be needed. But, according to Burgoyne, the absence of adequate support for all the parts led to the cannibalizing of those already there.

Chic psychiatric catch phrases became a cover for further dismantling, Burgoyne said. Take the emphasis on “alternatives to hospitalization”--a well-intended concept that Burgoyne contended was carried so far as to become dangerously unrealistic.

“There is no such thing as ‘alternatives to hospitalization’ when hospitalization is needed,” Burgoyne said. “. . . It’s ludicrous. Why don’t we have an ‘alternative’ to cardiac care?”

Los Angeles County has access to 1,700 so-called acute- and subacute-care beds--compared to 5,000 such beds for a similarly sized population in New York City, Weise said. Those beds include 1,080 in state hospitals, down from 3,076 in 1970.

In 1988, he said, 10,000 patients needing hospitalization had to wait.

At the same time, fewer and fewer patients use the beds available, in part because of difficulties in finding facilities for discharged patients. The average hospital stay for county patients rose from 73 days in 1987-88 to 149 days in 1990-91, Weise said.

Meanwhile, funding for outpatient adult services in the county has dropped from $40 million in 1987-88 to $30 million. Full-time staffing has dropped from 900 to 600. Whereas 90,000 patients were treated in 1987-88, about 71,000 were treated in the last fiscal year.

“I believe we did this to ourselves,” said Burgoyne, who said he believes that the worst of the deterioration may have come to an end. “We should have seen this coming. In essence, we (removed) the head of the system--the medical part.”