County seeks savings in boost of mental health care for homeless

Sonoma County wants to help thousands of mentally ill people who are homeless or at risk of becoming so by bolstering aid programs that serve them under a new initiative supported through $17 million in federal and local funds.

The four-year effort is intended to address the outsize strain that a small number of people with complex medical problems place on public resources by providing them with more comprehensive care - treating their mental health problems in tandem with immediate physical health issues, for example. It’s one of 15 similar programs across California approved last month by the Centers for Medicare and Medicaid Services.

The county’s work will target Medi-Cal patients who are homeless, or at risk of losing their housing, and who have a serious mental illness, particularly the elderly. Patients served by the program must also must have other health conditions, such as substance abuse disorders, or be high users of emergency services or be served by multiple county agencies.

“We know a lot of the homeless people, or people who are at risk, have these behavioral health issues, and today the behavioral health system doesn’t have enough capacity to serve them,” said Margaret Van Vliet, executive director of the county’s Community Development Commission, one of 13 public agencies and community organizations participating in the local effort. “Putting more juice in the system means we can hire more professional staff, either on the county’s payroll or through contractors, so that there’s more bandwidth in the system to actually get people the care they need.”

The county expects to cover half the cost of the program, which will support 26 new staff positions across the participating agencies, including about ?18 county posts.

The funds also will add five beds to expand capacity at a Santa Rosa detoxification and substance abuse facility - a service the county largely privatized seven years ago under recession-era budget cuts.

The county expects to serve more than 3,000 people over the next four years through the effort.

“There’s a recognition within the state and nationally that, for individuals suffering from serious mental illness, there is a need for us to beef up our service delivery and strategy to meet the complex needs of the population,” said Barbie Robinson, the county’s director of health services. “These individuals also happen to be high utilizers of different systems. For example, using our emergency department as a source of primary care support - that is a very expensive model.”

Robinson said she hoped the so- called whole-person care approach would become the model for how the county provides services in the long run.

By adopting a more preventative strategy and reducing the amount of expensive psychiatric crises experienced by Medi-Cal patients, the program could produce savings that would be used to continue it beyond the four-year pilot effort, she said.

Robinson said the program’s federal funding, which covers half the total cost, is secure.

But the program’s impact could be blunted if Republicans in Congress succeed in their attempts to repeal the Affordable Care Act, President Barack Obama’s signature health -care law. Tens of thousands of previously uninsured or underinsured county residents secured Medi-Cal coverage under an expansion triggered by Obamacare.

“It would limit the effectiveness of the program in terms of reaching all individuals who may qualify,” Robinson said of a potential repeal of the federal health care law. “It definitely would limit the impact in our community, because there would be less people who would be eligible to participate.”

Jennielynn Holmes, the director of shelter and housing for Catholic Charities in Santa Rosa, said the increased staffing offered through the program is sorely needed to get more people connected with the right services.

“For somebody who’s experiencing mental illness, it’s extremely hard to navigate these things on your own, so having the person at the place where you’re living, or having a person out in the community with you - that can sometimes be a total game changer with getting the care that you need, because they usually can’t navigate those things on their own,” Holmes said.

You can reach Staff Writer J.D. Morris at 707-521-5337 or jd.morris@pressdemocrat.com. On Twitter @thejdmorris.