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BREAKDOWN

Rural areas reap little from Prop. 63

New funds to help the mentally ill are no salve in counties struggling to provide core services.

September 17, 2007|Lee Romney and Scott Gold | Times Staff Writers

LOOKOUT, CALIF. — Adismayed Chuck Finck stood at his daughter's hospital bedside in Redding, a winding two-hour drive from his home in the alfalfa-rich Big Valley.

It was Cheryl Medeiros' fourth hospitalization for psychiatric-related problems in the last few years, each time hours from the family's home in Modoc County, in the state's remote northeastern corner.

This time, Medeiros, 34, who has been diagnosed with schizophrenia, bipolar illness and severe postpartum depression, had been rushed to the hospital by ambulance after swallowing half a bottle of anti-anxiety pills. She then contracted pneumonia from inhaling vomit, which meant days in intensive care.

Finck, 58, and his wife, Chelley, 57, knew from experience that their daughter would soon be returned to the same rural void in mental health services that had virtually ensured her repeated hospitalizations.

In some parts of the state, Proposition 63, a voter-approved surtax on those with income above $1 million, is pumping millions of dollars into innovative new treatments for the mentally ill.

But many rural residents have been left out of Proposition 63's richest benefits. Not only do rural counties receive far less of the new funding because of their smaller populations, they also have enormous needs, lagging far behind more populous counties in the types of services offered. The Proposition 63 money can't begin to fill those chasms.

Five of California's 58 counties don't have a single psychiatrist. About 30 have no inpatient psychiatric beds, necessitating costly and traumatic trips for patients in crisis. Follow-up care is difficult to coordinate. There is little or no supervised housing that would allow the severely ill to live independently yet close to home. Mental health professionals are difficult to recruit and nearly impossible to retain.

Exporting severely ill patients for both short- and long-term care dramatically increases costs. Sending one resident to a state mental hospital for a year, for example, would consume about 10% of Modoc County's budget, depriving others of basic services.

Adding to the burden is a disproportionately needy population, spread over thousands of square miles mostly unserved by public transportation.

In Siskiyou County, mental health staffers traveled 840,000 miles last year to retrieve clients for care and take them to far-off psychiatric hospitals. As officials there noted in their Proposition 63 grant proposal, a "huge unmet need" remains in a place where poverty, suicide and depression rates exceed state and national averages.

The new funds help, say the counties; it's just that demand far outstrips their potential. In Trinity County, $455,600 in Proposition 63 money in the coming year will go in part to a consumer drop-in center and to comprehensive treatment for four patients. But the county -- which relies on video sessions with tele-medicine consultants -- will still lack the services of even a visiting psychiatrist.

In Modoc County, where Medeiros and her parents live far from the county seat, the $412,000 Proposition 63 boost this year is offset by a budget crisis that recently caused the county to lay off half its mental health clinicians. Even with the new funds, Modoc County's mental health budget is about 25% smaller than it was in 2004.

"The perception was, 'There's all this new money that's being added," said Karen Stockton, Modoc County Health Services director. "People think we can do all these wonderful things. But we're looking at them and telling them, 'We can't.' "

As Medeiros' hospital discharge date neared in late May, a frustrated Finck called the county department seeking help.

Wasn't there some kind of intensive help they could offer to keep Medeiros safe, he asked? Something to end the cycle of ambulance trips and short-term hospital stays?

The county told Medeiros it had one avenue remaining. It could seek to become her conservator and place her in a board-and-care home. Because Modoc has no such facilities, the placement would be at least 330 miles away in the Central Valley.

For the Fincks, who can barely afford gas to Redding, taking that option would cut their daughter off from family support.

Mental illness hit

Medeiros' large blue eyes and flashes of childlike innocence offer a glimpse of the happy teen she once was, glamorous in her feathered blond mane and content in her Christian faith.

Then, in her early 20s, mental illness hit. She once lay in bed in horror, convinced her organs were slowly dying. During one hospitalization, she believed she was encased in a glass box that might shatter.

In four counties over seven years, she learned firsthand about the gaps in rural mental health services.

In Tehama County, a visiting psychiatrist tossed a book on the table and told Medeiros to pick her own medication, she and her parents said.

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