BY STEVEN MAYER, Californian staff writer firstname.lastname@example.org
Kimberly Brooks-Holder sits on the edge of her bed as she tells her story.
That simple fact -- having a soft, clean bed to sit on and sleep in -- is something of a miracle for the 31-year-old, who lived in dirt and squalor along the Kern River for longer than she cares to remember.
A LOOK BACK
Timeline of mental heath services in California
1950s -- Most patients with a mental illness confined in state-run institutions.
1972 -- Lanterman-Petris-Short Act made it illegal to commit a person with mental illness/substance abuse to an institution without his or her consent.
1957-1988 -- State hospital population dropped 84 percent; burden of care shifted to community support systems. Communities unprepared and underfunded. Many people left homeless.
1999 -- Assembly Bill 34 created pilot program to address growing need for effective community-based treatment programs. Participants showed these improvements: Days in jail down 74 percent; days homeless down 59 percent; hospitalizations reduced by 64 percent.
2000 -- Assembly Bill 2034 expanded pilot program, allowed localities to provide comprehensive services to adults with serious mental illnesses. Rate of hospitalizations for participants fell 78 percent; days in jail were down 85 percent and homelessness fell by 69 percent.
2005 -- Mental Health Services Act (Proposition 63 on the ballot) took effect; categorical funds only.
2009 -- Voters rejected proposal to redirect $230 million from MHSA fund.
Source: Mental Health Services Oversight and Accountability Commission
Governor's May revision -- Impacts to mental health services in Kern
-- Elimination of CalWORKs mental health services would eliminate services to 1,144 individuals.
-- Approximately $12 million in realignment funds would be redirected by the state.
-- Enactment of these proposals would result in loss of services for many local residents:
* 15,964 people could see some reduction in services.
* 3,270 individuals are uninsured and would be at risk for no services.
-- Services other than medication and inpatient hospitalization may be reduced to adults being served by Mental Health Services Act teams. This would dramatically reduce the services to 823 individuals being served by MHSA Full Service Partnership Teams and to 3,932 individuals receiving services from System Development Teams.
-- 6,459 individuals from rural areas are served each year. Services, particularly for adults, may be reduced to medication-only.
-- At a minimum, $6 million in Medicaid would be lost (leveraged, matching income).
-- The Psychiatry Residency and Child Adolescent Fellowship programs may be discontinued resulting in loss of much-needed psychiatrists to assess, treat and prescribe medication. Loss of access to psychiatrists would likely result in increased admissions to hospitals, prisons and the juvenile justice system.
-- Enactment of proposals could result in the discontinuation of the Mobile Evaluation Team and the Psychiatric Evaluation Center. Discontinuance would result in loss of control of inpatient admissions and increase incarceration rates.
Source: Kern County Mental Health Department
"A bed. It seems so simple," she says over the phone. "I'm sitting on it now, because I can."
The Bakersfield mother of three boys suffers from a brain illness commonly known as bipolar disorder. Three years ago, she was in what she refers to as a "very violent relationship." She was dependent on drugs and light years away from any semblance of happiness or stability.
Her three boys were in the care of relatives.
She was saved, Brooks-Holder says, by what some might consider a most unlikely savior: a government program.
"Without the outreach from Kern Linkage, I would probably be dead by now," she says. "I'm proof that these programs work."
Three weeks ago, she moved into a modest duplex with her kids. She attends Bakersfield College and runs educational support groups as a volunteer to help others like her struggling with mental illness and drug or alcohol abuse.
But efforts to reach out to mentally ill residents in Kern County have been pared back heavily or simply eliminated in recent years as budgets have gotten tighter and Californians have shifted funding toward prisons and away from prevention and innovation.
And this year, the assault on funding for the mentally ill is at a crucial stage, say mental health advocates and administrators.
'A BIG BALL OF DISASTER'
Gov. Arnold Schwarzenegger and the California Legislature are facing what is probably the worst fiscal outlook since the Great Depression. That dire reality is reflected in the governor's May revision of the state budget for fiscal year 2011.
While it's not a done deal, if the revision passes as it stands now, the cuts would come down hard on those least able to absorb the impact, said Jim Waterman, director of the Kern County Department of Mental Health.
And what's worse, state dollars are often matched or multiplied by federal dollars, Waterman said. So for every million cut by the state, millions of federal dollars entering Kern County will simply dry up.
Realignment funds that allow discretionary use by the department would be cut from $20 million to approximately $8 million, Waterman said. Dramatic reductions in services would affect thousands. And more than 3,200 indigent -- and uninsured -- clients could lose services altogether.
"I realize we have a $19 billion problem at the state level," said Waterman, who described himself as a fiscal conservative who understands other departments are facing budget pain, too. But by intervening with lower cost mental health services, countless people have been steered away from much higher-cost solutions, such as hospitalization and incarceration in jails or prisons.
In other words, slashing mental health services will only result in higher costs down the line, said Russ Sempell, a Bakersfield therapist and president of the local chapter of the National Alliance on Mental Illness.
"About 1 in 4 families has a mentally ill loved one," Sempell said. "If you're a member of one of those families, you know how important these funds are.
"This is a big ball of disaster."
SENDING COPS TO HANDLE MENTAL ILLNESS
Since Waterman took the helm at Mental Health last year, the agency's workforce has been cut by some 135 employees. The outreach programs that sent teams of trained people out into the community armed with sack lunches and information -- like the one that helped pull Kimberly Brooks-Holder out from under a bridge on the Kern River -- are no more.
"It's already gone," Waterman said of Kern Linkage's outreach efforts.
Now another innovative and potentially lifesaving program could soon go under the ax. The county's Mobile Evaluation Team, made up of mental health professionals who work with law enforcement to deal more effectively -- and more cheaply -- with the mentally ill, could also become a casualty of the cuts.
"The MET team has been a tremendous help to law enforcement," said Kern County Sheriff Donny Youngblood. In the past, the sheriff said, deputies who confronted individuals behaving strangely would often be tied up for half a day processing the individual. By calling the Mobile Evaluation Team, mental health cases can often be handled more quickly without taking valuable patrol officers off the streets for hours.
"Here's what will end up happening if these cuts continue," Sempell said. "Only the most severe cases will receive medical attention.
"These are brain illnesses," he said. "Imagine if it was cancer patients or heart patients we were throwing out on the streets." But mental illness is stigmatized -- and when they cross paths with law enforcement, the outcome can be tragic.
MAKING CRIMINALS OF PATIENTS?
Without proper services and easy access to medication, patients suffering from schizophrenia and other disorders sometimes stop taking their meds. They become disoriented, and sometimes experience delusions or irrational fears or paranoia.
Sempell's own brother, Robert, was diagnosed with a type of schizophrenia. In 2002, Robert was shot and killed by a sheriff's deputy after witnesses said he had been walking in and out of traffic. When the deputy confronted him, Robert reportedly pulled out a knife.
The MET team helps defuse those situations, Sempell said. It must not become a casualty of a bad budget year.
If the deep cuts are realized, Waterman vowed to call together all stakeholders and reprioritize as best he can. He promised to make the best mental health agency possible under the circumstances. Unfortunately, much of the funding he receives is tied to specific programs or services. In those cases, reprioritizing the dollars is not possible.
For Brooks-Holder, the services provided by county mental health probably saved her life. Even if she had survived her life under the bridge, she might instead be costing taxpayers $45,000 a year as an inmate in state prison.
"So many of the programs are gone already," she said. "I'm lucky I came in when I did."
"Three years ago I was living under a bridge," she said. "Without help, I could never have gotten out of there. That's why I'm doing what I'm doing.
"I am living a life I had never foreseen," she said. "I don't know exactly where I'm going. I just know it's right."