Mental Health Programs May Be Casualties of Budget Plan : Funding: A clinic in Garden Grove is among those on the cutting block in a fiscal proposal the Board of Supervisors will consider at a Tuesday hearing.

The nights were the worst.

During a hellish few days last month, Lori Orona could only sleep with the light on for fear of the dark. She always wanted a radio nearby for fear of the silence. And she sometimes went with her husband on his nightly newspaper delivery rounds for fear of being alone. And it was getting worse.

Then, with the depression reaching what she termed a “crisis,” the 34-year-old Orange woman returned to the county-run Garden Grove Mental Health Clinic. Her psychiatrist put her back on an antidepressant and--perhaps just as important--let her know “that it’s OK to cry . . . and that I’m not the only crazy one in the world,” she recalled, with a nervous laugh, in a recent interview.

“If this place weren’t here,” Orona said as she sat in the clinic last week with her husband, Dan, 44, “I don’t know where I’d be. I don’t know where else I would go.”

But soon, Orona and about 1,500 others--most of whom use the Garden Grove clinic because they cannot afford such treatment or lack private insurance--may have to face that reality. The site is one of several dozen county programs threatened with closure or severe reductions under a bare-bones fiscal plan that the Board of Supervisors will consider at a hearing Tuesday.

A place of refuge and hospice for the mentally ill, the Garden Grove clinic and other programs like it now find themselves on the front line in the county’s battle against an increasingly bleak budget picture.

“What we’re seeing is the government backing away from health services and placing the responsibility on the private sector,” said Russell Inglish, vice president of the Orange County region of the Hospital Council of Southern California.

Representatives of seven Orange County groups that are active in mental health issues have announced a press conference today to protest the proposed cuts. And officials predict many people will turn out for Tuesday’s hearing to voice concern about the direction of county spending.

County government must grapple with declining revenues for its recession-influenced budget. An array of county programs face cuts as the Board of Supervisors considers a half-billion-dollar package of general-fund spending. The entire county budget totals more than $3 billion, but officials have broad discretion over only those monies in the general fund.

The budget proposals for the fiscal year, which starts July 1, were released last week by the County Administrative Office and come after months of deliberations on how to balance spending. The fiscal plan calls for a general-fund budget of $488 million and cuts designed to eliminate a projected revenue shortfall that had once been estimated to run $108 million for the coming fiscal year.

That the county was able to propose a balanced budget at all “was a real accomplishment. That wasn’t easy,” said budget director Ronald S. Rubino.

One county official quipped: “We looked at every scenario short of printing our own money.”

With a high priority placed on public safety, the budget for the district attorney, sheriff and other law-enforcement areas felt the budget ax far less severely than health and social services. In fact, even as many programs face extinction, the county will spend millions this year to move ahead with new jail, courtroom and other justice facilities for adults and children.

Some budget-cutting measures--like a huge increase in the jail booking fees charged to cities, or a delay in the opening of some new county facilities--were considered but rejected for now.

Even so, the measures that are being proposed have been severe enough to spark concern in and out of the county government since the budget plan was released Tuesday.

“People are very upset, and they want to know what we’re doing about it,” said Richard Munoz, business agent for the Local 787 Service Employees International Union, which represents about 450 county workers.

“We’re hoping nobody will get laid off, but with the economy the way it is, it wouldn’t surprise me,” he said.

Custodians, painters, supervisors and technicians all face possible layoffs as the county looks at eliminating 258 positions--although many slots are already vacant, and the county hopes to reassign workers into other openings.

The 4H Youth program and other agricultural services under Cooperative Extension might have to close if the county cuts $55,000 in funding as proposed. And prospective parents would have to go to the state, instead of the county, to find a child through a public adoption.

Community and social services face cuts of more than $6 million, or 7% of their budget, although much of this money might have to be restored depending on what the state allocates for welfare programs. And in-house government services and administration could be slashed $5.7 million, or 6.2%.

But county administrators say health services could feel the hardest and most visible budget hit. For instance, the supervisors will consider cutting funding to local hospitals for care of indigents by 5%--or $1.85 million.

Mental health in particular may bear “the lion’s share,” said Ronald R. DiLuigi, assistant director of the County Health Care Agency.

The budget proposals would cut health services by $5.85 million, or 11.6% of the total budget. Mental health programs alone would be cut by $3.7 million, officials said, and funding for some programs in this area could be eliminated.

Some fear such drastic reductions only portend worse times ahead, as counties continue to lose state funding that had gone toward non-mandated health programs.

“This is much more serious than anything we’ve faced in some time,” said Doug Barton, the county’s manager of adult community mental health services. “If everything comes to pass (as proposed), mental health care in Orange County will be dramatically different than it has been.”

If the cuts go into effect, Barton predicted that patient loads for some caseworkers could go up 15%, visits for patients could grow shorter and farther between, and emergency response time could grow.

Patients would suffer most, he said.

“There’ll be more people who end up homeless, perhaps in the criminal justice system. And some of those people may end up in local emergency rooms, as they get desperate and there’s no care available,” Barton said.

If more mentally ill do end up out on the streets, there may be less care available for them there, too, officials said.

The budget proposals would mean a 75% reduction for the county’s homeless outreach program, in which eight staff members regularly search out the mentally ill at parks, under bridges, by railroad tracks and outside jails and get them treatment. This could save $277,375 a year.

Some day-care programs around the county for the mentally ill and 16.5 county-funded hospital beds in Norwalk for more seriously disturbed children and adults could also fall victim to the budget ax.

The only clinic due to close totally, however, is the one in Garden Grove.

In operation for the last two decades, it is now one of eight in the county that provides medication, therapy and treatment for the mentally ill--most of them poor people whose bills are covered by Medi-Cal. Closure of the clinic would save about $731,000 a year, officials estimate.

“It’s been an anchor for me--it’s a place that’s so solid,” said Theresa Makinen, 50, who lives in a board-and-care facility in Garden Grove and has been a patient at the clinic for 20 months.

Once a week, Makinen meets with her caseworker, Pamela Sellers, 32, to discuss such daily tasks as buying clothes and getting dental care, and to learn broader lessons like controlling her temper and her mood swings.

Makinen cried when asked in an interview what it would mean if the Garden Grove clinic closed, forcing her to go to another clinic in Anaheim or Westminster and, perhaps, have a new caseworker assigned to her.

She said just the idea of finding her way to a new clinic on a different bus route scares her. “I don’t like to go out. It freaks me out, (the prospect) of getting lost or getting killed,” she said.

Sellers, her caseworker, worries that she could be out of a job come July 1 if the county doesn’t find a new position for her in another clinic, but she worries more about her patients.

“For some of them, we are their life. They don’t know what they’ll do without us here,” she said. “You’re dealing with paranoid people here. It takes them so long to trust people. We finally build a rapport with them, and now we tell them: ‘You have to go somewhere else.’ It doesn’t seem fair.”

Facing the Knife

County supervisors Tuesday will consider millions of dollars in cuts that have been proposed to balance the county’s ailing budget. Health services in general--and mental health in particular--are among the areas that may be hardest hit. County officials have proposed slashing $5.86 million in health services, or 11.6% of the total budget. Here are some of the major health programs and services that are threatened by the proposed cuts: Proposed for elimination/reductions: Savings Adult mental health day-care programs in Anaheim, Costa Mesa, Santa Ana: $230,429 Anaheim residential therapy center, Western Medical Center services: $853,900 16.5 beds for children, adults at Metropolitan State Hospital (Norwalk): $702,276 Six-month lease/purchase agreement at Royale Therapeutic Residential Center: $191,170 Garden Grove Mental Health Clinic: $731,723 Mentally Disabled Homeless Outreach Program: $277,375 Treatment for severely disturbed children: $680,600 5% reduction in hospital reimbursement for care of indigents: $1,850,000 Source: County administrative office