Mental health care is suffering on county, state and national levels due to lack of funding, lack of access and a lack of trained professionals.

   "It's a whole national trend," said Rita Scardaci, director of the county's Department of Health.

   Those in the mental health-care industry say the root of the problem stems from the fact that mental health care is not treated with the same attention or resources as physical health care.

   "The political system has not treated mental illness and the treatment of mentally ill the same as physical health. Never have, still don't," said Dr. Richard Kirk, a Sonoma-based psychiatrist and chair of the Sonoma Valley Health Care District board. "If equity for mental health services was really put in the system, it would be a huge change."

   All too often mental health care is considered a private insurance matter, with little access to ongoing psychological care. However, experts say even those with private insurance are not necessarily getting the care they need. Even worse, those who need access to care the most are all too often the ones with no insurance at all.

   "Sonoma County is like many other places in the nation, struggling to meet the needs of the seriously mentally ill and just beginning the new frontier: How to prevent mental illness, how to grow a healthy child, how to provide access to mental health care in the absence of 'parity' laws, (which require) insurance companies to cover mental illness on par with physical illness," said Art Ewart, mental health service director for the county. "In the face of poor private insurance coverage, the community will continue to look to an underfunded public system and be disappointed."
Up until the closure of the inpatient unit at Santa Rosa's Psychiatric Emergency Services (known as the Norton Center), the facility acted as a sort of "holding pen" for all patients, regardless of what level of treatment was necessary. Although the facility is still open to patients in crisis, a majority of outpatients are being sent to other treatment facilities depending on what level of care is needed.

   "Public mental health programs around the country are developing a far greater system of care than the private insurance sector can provide," Ewart said. That includes "everything from crisis intervention, to overnight care, to short-term stays of 10 to 14 days in a residential setting, to traditional outpatient case management."

   Without parity laws to provide quality mental health care at least to those with insurance, the county is trying to get creative by launching mental health-care programs that cover a wider variety of needs. County officials say they are in the process of moving away from large mental hospitals in favor of smaller treatment programs that provide patients with an appropriate treatment for each specific situation.
"Clients treated in 'facilities' for long periods become institutionalized," Ewart said. "The age of 'Cuckoo's Nest' is long, long over."

   In this vein, the county developed a six-bed residential crisis intervention program, where patients can voluntarily commit themselves to treatment in a smaller, more home-like environment.

   "That has been huge," Scardaci said. "It's really a much more therapeutic environment."

   While many county health-care professionals see this change as a positive move for adult patients, there is still the problem of juvenile mental health care. Children cannot be treated in the same facilities as adults, and the newly developed programs are mainly designed for adults. There is nowhere in Sonoma County to take a juvenile experiencing a mental health crisis. Ewart said even when a problem exists, the county tries everything possible to avoid hospitalizing a minor.

   "Hospitals are not good places for children. They learn better how to threaten suicide, how to cut themselves, how to act out, and how to hear voices," he said. "So, we do everything possible to support to the family and keep the kid at home before considering a hospital." When keeping a child at home is not an option, juveniles are sent to the St. Helena Medical Center in Vallejo. Experts say this can compound the problem, by taking the patient away from his or her home environment.

   "The farther away you take a patient, the more it adds to the problem," Kirk said.
Even with a more progressive mental health-care treatment plan, funding remains a concern. In May the Department of Mental Health Services released a report to the county's Board of Supervisors that stated plans to discontinue several mental health-care programs, including the Adult Service Team, which is estimated to serve at least 600 clients and the Resource Team, which aids 500 adults and 50 children. Despite slashing programs, more funding is still needed. The report estimated the Department of Mental Health, despite cutting nearly $7 million in programs, will still need around $2.5 million in additional funding for the current fiscal year.

    Jennifer Hedgepeth, president of the Sonoma County chapter of the National Alliance on Mental Illness, said her organization, along with other advocacy groups, has felt added pressure from the loss of these programs. "There is not enough money available to fund the services that the mentally ill depend on," she said.

   Despite the county's attempts to develop unique treatment facilities, it is apparent mental health care will be a problem lawmakers continue to struggle with. First District Supervisor Valerie Brown summed it up when she said, "It's a broken system."

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