Proposal Offered to Save County Mental Services

Seeking to avert the collapse of Los Angeles County’s mental health network, some county officials said Friday that they now want to keep open smaller inpatient psychiatric wards at county hospitals and preserve their huge outpatient services headquarters at County-USC Medical Center.

Meanwhile, a coalition of health advocates said it plans to file suit Monday in U.S. District Court to block the Board of Supervisors from a similar dismantling of basic health services.

By Sept. 1, all of the county’s six comprehensive health centers and 28 of 39 health clinics are scheduled to begin turning away patients in anticipation of shutting down Oct. 1, the same date the mental health closures are to become effective.

Supervisors have been bracing for such a lawsuit since legal advocates for the poor have warned that public health care services are being slashed so badly that they will fall below legally acceptable levels.

The supervisors, however, say they must make the cuts to close an unprecedented $1.2-billion budget deficit and to ensure that the county does not go into bankruptcy by continuing to spend more money than it has.

The last-minute mental health proposal marks a dramatic turnabout within the Department of Mental Health, which became embroiled in controversy last week after The Times disclosed that it planned to shut down all its inpatient and outpatient operations at county hospitals.

Unless the new proposal by mental health officials is approved, the only remaining piece of the county’s hospital-based mental health system would be scaled-down psychiatric emergency rooms at four hospitals. Mental Health Director Areta Crowell acknowledged in a memo to her staff this week that this would be “a catastrophe.”

Crowell and her chief deputy director, Kathleen L. Snook, have told county Health Services Director Robert C. Gates that they need his cooperation to keep open inpatient and outpatient mental health services at county hospitals.

With time running out before the Oct. 1 deadline, Snook said mental health officials need an answer by Monday or they will be forced to pursue a far less desirable option of contracting for inpatient psychiatric beds at private hospitals, and establishing some scaled-back outpatient clinics elsewhere.

“It is terribly important that we do this,” Snook said of the new proposal.

Mental health officials said they are having to make such decisions because the supervisors voted last month to transfer all mental health services from the Department of Health Services to the Department of Mental Health without allocating nearly enough money to pay for them. The Department of Mental Health traditionally has provided mostly outpatient and residential care.

Crowell hopes the new plan will ease the impact of the cuts on the mentally ill. She has said in the past that many of the county’s mentally ill, including 40% of those who now use acute-care inpatient beds at county hospitals, would be forced to go without care with the full slate of cuts.

Mental Health Department officials had planned to move outpatient operations from county hospitals to private sites because they thought they would have to pay too much in overhead costs to the Health Services Department for the space, Snook said. But as part of the new proposal to keep scaled-down outpatient services at the hospitals, health officials are looking for ways to reduce costs to the Mental Health Department.

“We’ve told them how much we can spend,” Snook said, “and they need to tell us how much it would cost us to do it. If they can bring down the charges . . . we have told them we would like to stay.”

The two departments also are discussing a scenario in which the Mental Health Department would finance inpatient beds at county hospitals instead of at private facilities. Snook said such an arrangement would be far more desirable because the beds would be just a walk--and not an ambulance or police-car ride--from the psychiatric emergency rooms where the mentally ill often are taken by police or others.