A $16-million state grant to Ventura County will dramatically change the way services are delivered to severely mentally ill adults and might serve as a model for other California counties, officials said this week.
The grant, $4 million for each of the next four years, will pave the way for a restructuring of the Ventura County Mental Health Department. It will increase the strapped department's funds for adult care by 50% and allow the hiring of an additional 77 staff members.
"It has the potential to transform the way community mental health is done in California," said Dean Owen, a California Department of Mental Health spokesman.
Assemblywoman Cathie Wright (R-Simi Valley) disclosed the award on Friday during a tour of the county's mental health facilities in Ventura. The county was selected over 11 others competing for the money, which was made available under a bill sponsored by Wright and Assemblyman Bruce Bronzan (D-Fresno). The Los Angeles County Mental Health Assn. and Community Transitional Resources in Modesto also were chosen for demonstration projects.
The announcement came a month after local mental health officials had warned that budget cuts proposed by Gov. George Deukmejian would force layoffs and cause a catastrophic reduction in care to those who need it most.
Create Treatment Teams
Officials now plan to create teams of physicians, psychologists, social workers and other professionals to treat and track about 5,000 clients in Ventura County over a period of years. The 11 10-member teams, which are to be based throughout the county, will deal not only with clients' emotional problems but will help those in need of housing, job training and basic living skills.
The breadth of round-the-clock care offered by one team in one place, with frequent visits to clients' homes, will help to keep people from falling through the cracks of a fragmented and confusing system, said Randy Feltman, Ventura County mental health director.
"We're emphasizing that the seriously mentally ill have a lifelong problem," he said. "Rather than giving them a variety of short-term programs, we're offering one long-term commitment. It will be much easier for a person and a family to get the resources they need."
The additional personnel provided by the grant will reduce therapists' average caseloads from 60 to 25, Feltman said, enabling them to give more intensive, continuous care.
"Until now, we haven't had the money to provide that kind of continuity," he said. "We've been like a MASH unit, responding to today's crises. We've been overwhelmed with needs we couldn't rationally approach."
Specialized teams will focus on ex-offenders, mentally ill people with severe drug and alcohol problems, the homeless mentally ill and people over 60, Feltman said.
While the department's caseload will increase from 4,000 to 5,000, it will continue its yearlong policy of turning away people with only mild mental disorders. Such clients will be referred to private agencies or therapists willing "to see one or two people a year as their contribution to the community," Feltman said.
And the department will continue to treat only people who cannot afford help elsewhere, he said.
If the four-year demonstration is successful as measured in the number of clients living independently, holding jobs and staying out of jail, the state will continue the funding, he said.
The plan is similar to Ventura County's pioneering effort to treat mentally ill children by aggressively involving the schools, the courts and local agencies in a team approach. Started in 1984, that effort has drawn national attention among professionals.
But no city or county has fully implemented such an approach for severely mentally ill adults, said Vincent Mandella, the state Department of Mental Health official in charge of the demonstration projects.
Mandella said Ventura County's plan was chosen because it "did the most in breaking away from strictly defined divisions between local agencies."
"This team idea hasn't been tried," he said. "This is way past forming a local committee to discuss problems. It's not relying on a phone call to your buddy in another agency and hoping there's a free bed or a spot in a program. It's treatment right on the spot, with a mental health person and their peers from other agencies."
However, one of California's most influential advocates for the mentally ill thinks the idea might not go far enough toward offering the treatment most appropriate for each client.
"Ventura County's proposal was superbly crafted, and the key people in the system there are among the best," said Dan Weisburd, vice president of the California Alliance for the Mentally Ill. "My skepticism is that the idea of knitting together various categorical programs is just not what's needed and wanted for people with profound, complex, persistent and exceedingly serious mental illnesses. We're still not creating a system--we're creating a crazy quilt. And what we really need is a new house."