The furor over Los Angeles County’s proposed dismantling of its mental health network escalated Monday, with hospital administrators, lawmakers and patients condemning the decision as shortsighted and dangerous.
At a news conference on the steps of County-USC Medical Center, administrators and residents at the mammoth hospital’s psychiatric clinic sharply criticized the County Board of Supervisors for its decision to cut mental health services at county hospitals so much that only stripped-down psychiatric emergency rooms will remain.
“It is unconscionable that the largest medical center in the United States refuses to have psychiatric services critical to the community,” said chief resident Dr. Cindy Slominski, who runs programs for mentally ill children at County-USC.
“They are planning on washing their hands entirely of all inpatient and outpatient psychiatric services,” Slominski told more than 100 mental health employees at the facility. “This is unacceptable, and we demand continued care at this facility.”
Also Monday, county Chief Administrative Officer Sally Reed released a proposal to close all 11 remaining health clinics and all remaining outpatient services at the county’s six hospitals.
Reed had been directed by the supervisors to prepare two proposals--for $25 million and $75 million in further cuts--by today’s board meeting. The supervisors have said they will need to move quickly to reduce spending if funding cannot be found to replace $75 million in transit money vetoed by Gov. Pete Wilson in the state budget this month.
Because the county already plans to close all six of its comprehensive health centers and the other 28 of 39 clinics by Oct. 1, Reed’s proposals would effectively eliminate all outpatient services for the county’s poor and indigent. Reed also has proposed slashing public health services another 18%.
Reed’s proposals are at odds with Health Services Director Robert C. Gates, who said Monday that eliminating all outpatient services is “medically and economically unacceptable” and would force nearly everyone needing care into emergency rooms.
Police chiefs in the San Gabriel Valley met with mental health care providers from the private sector, saying they need to make sure enough beds are available for patients who may be forced out of treatment by the cutbacks.
“They’ve been gutting the system, as far as I’m concerned, for the last 20 years. This is just the coup de grace ,” said Monrovia Police Chief Joseph Santoro, among those who met with private providers. “You will be reading about it when an officer shoots and kills a mentally ill person. It’s not fair that my officers will have to assume the role of mental health [providers] because they cut the budget.”
Controversy over the county’s proposed downsizing of its mental health system has escalated since Friday, when The Times disclosed that the county plans to eliminate its huge outpatient psychiatric headquarters at County-USC as well as inpatient and outpatient psychiatric services at all other county hospitals.
The Times also reported that law enforcement authorities are bracing for waves of the mentally ill to hit the streets, saying much more police intervention will be needed to defuse potentially volatile situations involving mentally ill people lacking treatment and medication.
By late Monday, county mental health officials said they were still trying to find ways to provide a basic safety net for the tens of thousands of mentally ill people in the county. Although they are looking for an outpatient site to replace parts of what is offered at County-USC, no such site has been located, said Dr. Rod Burgoyne, medical director of the county Mental Health Department.
At the Monday news conference, Slominski and other administrators were joined by Assemblyman Antonio Villaraigosa (D-Los Angeles) and Los Angeles City Councilman Richard Alatorre, both of whom called on the county not to shut down inpatient and outpatient psychiatric facilities. The closures at County-USC, Olive View Medical Center, Martin Luther King/Drew Medical Center and Harbor-UCLA Medical Center are slated to take effect Oct. 1.
Representatives of the state and local psychiatric associations and advocacy groups also decried the cuts at the news conference, contending that the effects of the closures will be felt for decades and will cost far more in the long run than they will save.
Besides lack of patient care, they said, the county’s decision last month to help wipe out a $1.2-billion deficit by downsizing mental health programs would jeopardize the county’s well-respected training program for psychiatric residents at County-USC.
It also could scare away many researchers--and the federal and state money that comes with them, some warned.
As hospital administrators, officials, health advocates and even satirist Mort Sahl decried the proposed cuts, a man who asked to be identified as W. Smith calmly read Tolstoy’s “War and Peace” at the hospital outpatient clinic as he waited for his doctor to arrive.
An eloquent man who said he had a Harvard law degree and 20 years of lawyering in his past, Smith, 53, said he has come to the clinic at least once a week since he was hospitalized there more than a year ago for depression.
No one has officially told him that the outpatient clinic will close in six weeks, but Smith said he has read about it in the papers and knows he will have to find somewhere else to go, even though he cannot pay for the treatment and his bus probably won’t go there.
“You take the people least able to resist or to do anything about what is happening and you put upon them,” he said, fingering the worn pages of his book and gesturing at the others waiting for help. “It is the most politically expedient option available. We are the politically disenfranchised.”
The changes come after the supervisors approved transferring responsibility for all mental health care from the Department of Health Services to the Department of Mental Health, which has provided mostly outpatient and residential care since 1978.
At least 2,500 patients at County-USC will be forced to fend for themselves, with the lucky ones who have insurance having to take buses to far-flung locations for treatment. Although Department of Mental Health Director Areta Crowell said she is trying to find a site in Alhambra for outpatient services, health advocates questioned how many of the mentally ill will be willing to board several buses just to get to treatment and medication.
They added that many of the mental health outpatient clinics expected to bear the brunt of the hospital closures lack the medication and treatment facilities needed to treat those with serious mental illnesses.
Crowell said she is trying to find ways to ease the effect on the mentally ill by contracting with private hospitals for inpatient services and by finding other places to provide outpatient care, but she conceded that 40% of those acute patients receiving inpatient care will be forced to go without.
Some in law enforcement complained that county officials are abdicating their responsibility to care for those with paranoid, schizophrenic and delusional tendencies--people who will “act out” in public once their medication and treatment stops.
“We in law enforcement are pounding on the table, saying, don’t do this, don’t cut mental health,” said Santoro, who helped create the Mental Illness Law Enforcement Task Force four years ago. “It makes law enforcement more dangerous and our communities more dangerous. It is not fair for these people to be left on our streets where we have to be mental health providers, the bastion of last resort. If we send them to jail, what good does that do? We wind up wasting our time and the patients get absolutely no treatment.”
Already, the Los Angeles County jail system is described by advocates as the largest de facto mental institution in the United States, where more than 3,000 mentally ill individuals crowd into dimly lit cells, without much treatment for their various disorders.
Law enforcement authorities said Monday that they fear that as the jails get so crowded that none but the most violent felons get sent there, the mentally ill will be caught in a revolving door of being picked up by police, taken into custody, held and released. As their conditions deteriorate, Santoro said, there will be more violent confrontations with police, with deadly results.
“They are going to get in trouble with law enforcement,” Santoro said, “and sometimes we’ll end up having to use deadly force because there is no way to deal with a person coming at you with a gun or a knife.”
Recently, several police departments have taken steps to anticipate the problems. The Los Angeles County Sheriff’s Department is preparing a contingency plan, and Santoro’s department has a training video on how to defuse volatile situations with the mentally ill.
On Monday, Santoro also called for more widespread use of a relatively new program called Mental Evaluation Teams, or METS, in which an officer and mental health worker go out on calls together to quickly diagnose a person to see if he or she requires hospitalization or other treatment.
In the absence of such programs, authorities said, police will be forced to drive mentally ill people from hospital to hospital, seeking a psychiatric emergency room for them to be evaluated and then held at if necessary.
Such problems are not new, but the result of more than two decades of neglect of the mentally ill, advocates and authorities said.