In Sacramento County, “Suicide rates are up, inmates at the jail with mental illness have doubled, hospital emergency rooms are overwhelmed and police officers are diverted off the streets to deal with mental health crises.”

And the grand jury, which opened its report (pdf) with those words about the county’s mental health crisis, knows why: It is “all attributable to County decisions.” The report, one of six released at the close of the grand jury’s term, specifically blames the decision to cut the county’s mental health budget by $14 million in 2009.

The county shut down its Crisis Stabilization Unit (CSU) and cut in half the number of hospital beds available to mentally-ill patients. The decision was made when social services statewide and at local levels were eviscerated in the budget bloodbaths triggered by the Great Recession.

The aftermath has cost hospitals, law enforcement and other social service agencies far more money than the county saved, and caused pain and suffering to society’s most vulnerable people. “Sacramento County all but eliminated crisis intervention services,” the report says.

As a result, community hospital emergency rooms are overwhelmed. CSU handled 6,869 cases, a combination of walk-ins and police referrals, the year before it closed. Last year, emergency rooms handled more than 16,800 people in mental health crisis.

This is not the first time county officials have heard this account of what the budget cuts have wrought. They heard it from another grand jury in a 2010 report entitled, “A System in Crisis.” But a conscious choice was made to shift responsibility for crisis intervention to community hospitals and law enforcement.

“The County, for over five years, has continued to abdicate responsibility for mental health crisis services, especially for low-income and indigent residents suffering from serious mental health disorders,” the report says.

This indifference to the issue led the county to pass on a variety of funding and revenue sources, including grants, Medi-Cal reimbursement and Proposition 63 money. They generated lawsuits that had to be defended, tied up cops handling patients, damaged relations in the community and negatively impacted patient health.

For example, hospitals have turned into revolving doors. Last year, only 16% of mentally-ill patients coming through the door were first-timers. The county suicide rate spiked 16% the year after cuts. The number of jail inmates receiving a diagnosis of mentally ill has risen from 18% to 34% since 2009. 

Five years later, Sacramento County’s fiscal condition has improved, but the county’s attitude has not. The report points out that resolution of a lawsuit in 2010—just one of several—included the county hiring an outside expert to assess the adult mental health program. The expert’s report in 2011 slammed the county, made a bunch of recommendations and was mostly ignored.

There is no indication this grand jury’s sentiments and its 15 specific recommendations will fare better. It may fall to the next quinquennial report, five years hence, to light a fire under politicians.

–Ken Broder

To Learn More:

Sacramento County Blasted on Mental Health (by Nick Cahill, Courthouse News Service)

Grand Jury: Sacramento County’s Mental Health Cuts Tax Law Enforcement, Hospitals (CBS Sacramento)

Final Report (Sacramento Grand Jury) (pdf)