Cutting funding, shifting costs: Mental health care in Stanislaus County

Earlier this year, Kim Krisberg wrote about cuts to mental health funding in states across the country, and what that means for public health. Via Reporting on Health, here's a devastating portrait of the impact of mental health cuts to one California county, in a Modesto Bee series by Jocelyn Wiener:

Mental health care breaking down in Stanislaus County
Help eludes father until son ends up behind bars
A family's never-ending cycle
A shining light in Modesto

Wiener gives voice to people who suffer from mental illness and can't get help until they're in crisis, families who struggle to get their loved ones the care they need, and providers who confront an endless frustration of not having enough resources to serve all who need help. As I read the series, I was reminded again and again that cutting spending on mental health care doesn't actually cut costs -- it just shifts them elsewhere. Here's one example from her piece "A family's never-ending cycle":

Joyce Plis, executive director of the Stanislaus County chapter of the National Alliance for the Mentally Ill, said families often seek help before their loved ones get in trouble with the law. But it can be "almost impossible" to find them services, she said, especially for those who don't recognize how sick they are.

Instead, some individuals with mental illness end up committing crimes — petty theft, drug use, threatening or assaulting a friend or family member — and then landing in jail. Only there do they finally get some basic care, she said.

She describes life behind bars as "horrendously awful" for someone trying to get well, with inmates who are off their medications hallucinating and yelling. Treating individuals in jail and hospitals because they can't get services beforehand also ends up being extremely expensive for the public, Plis said.

"People with mental illness don't serve their time and get out," she said. "They get stuck in there."

Madelyn Schlaepfer, director of Stanislaus Behavioral and Recovery Services, said the county is working to find ways to keep sick people from cycling back into psychiatric hospitals and jails. The challenge, she says, is the scarcity of resources.

"It is really a struggle to find aftercare," Schlaepfer said.

Law enforcement officials say those problems are being amplified by public safety realignment. Starting last fall, state prisons have been granting early release to increasing numbers of nonviolent offenders, adding additional pressures to county probation departments and jails. Stanislaus County expects to absorb 500 to 600 inmates every year. Many of them, said Sheriff Adam Christianson, have mental illnesses. Frequently, they land back in jail.

The jail system had a bed capacity problem before realignment, Christianson said. "Now that problem has been exacerbated exponentially," he said.

Dr. Antoun Manganas, medical director of Doctors Behavioral Health Center in Modesto, said the psychiatric crisis center has begun seeing very ill inmates appear at their doors on the day they are released from prison.

"All of a sudden they show up and they say, 'I don't have my medication, I don't have money and I don't have a home,' " he said. "And they are in a crisis."

Spending less on mental health care means spending more on courts, jails, and prisons. It imposes costs on the victims of crimes that could've been prevented if the perpetrators had gotten help sooner, and it increases the burden on families with a member who suffers from mental illness. The toll of poorly controlled mental illness is also visible in emergency departments and homeless shelters.

To some extent, the reductions in mental-health funding will show up elsewhere in state and county budgets -- prison spending will increase, as will expenditures on homeless care that jurisdictions are required to provide (e.g., shelter during hypothermia season). But many of the costs will be shifted to individuals and families, and to the healthcare providers who face overburdened practices and facilities and don't always get paid for all the extra time they put in.

Like other public health prevention efforts, mental health care helps a relatively small number of people directly and an entire population indirectly. And like many public health efforts, it doesn't get enough investment.