Over the past decade, Sonoma County has reshaped its approach toward caring for people with mental illness, increasing its investment in community-based outpatient programs while reducing its reliance on psychiatric hospitals.
County officials say they’ve embarked on a new era, one that hopes to fulfill the decades-old promise of creating a safety net of mental health services robust enough to meet the needs of the community.
“We’re headed toward having an integrated system of care, that involves the whole community here in Sonoma County,” said Michael Kennedy, the county’s mental health director. “Mental health and substance use touches everybody.”
The county now spends more than $71 million annually on programs to treat 5,800 people with some form of mental illness, ranging from mild to severe, and assist their families.
It is a fraction of the people who suffer from mental illness in Sonoma County. Nearly 1 in 5 people in the United States have some type of mental illness — and nearly 1 in 25 a serious mental illness, a number that would equate to more than 20,000 people in Sonoma County — according to the federal Substance Abuse and Mental Health Services Administration.
Most never come into contact with the county’s network of mental health services, relying on private insurance and care from family members. Many receive no treatment at all. Critics contend the county’s programs, while effective, do not reach enough people and have long waiting lists.
“Most of those are boutique programs that serve very limited numbers. This is not effective for a county our size,” said Rosemary Milbrath, former executive director of National Alliance on Mental Illness in Sonoma County.
Kennedy said the county is reaching more people now than ever before. A decade ago, the county treated about 3,000 people annually, spending more than $50 million on mental illness, he said.
And it is spending its money more effectively, he said, prioritizing programs that offer a chance of recovery and involve a broad segment of the community, from nonprofits to other government agencies.
About 45 percent of the county’s $71 million budget for mental health services is directed at “community partners,” primarily nonprofits such as Buckelew Programs, which provides housing with support services for mental health patients, including those participating in a court diversion program aimed at reducing the number of mental health patients in jail.
Nearly 15 percent of the county’s budget is spent on patients placed in psychiatric facilities, board-and-care units and state psychiatric hospitals such as Napa State Hospital.
Inpatient psychiatric care is one of the most costly ways to treat people with mental illness, placing huge budgetary pressures on the county, Kennedy said. Over the past two years, the county has seen the cost of providing psychiatric inpatient and long-term care services jump 21 percent, to $10.3 million in the fiscal year that ended in June. It has budgeted $12.3 million this year for such inpatient stays.
It is more effective and less expensive to treat people in community-based outpatient programs, Kennedy said.
The county now funds 99 beds in homes with mental health support services and an additional 22 residential beds designed for people facing a short-term crisis. Six additional peer-run respite beds are expected to come online soon.
Such beds are a crucial element of the mental health safety net. Some are used by patients released from a secured psychiatric facility, the county’s psychiatric emergency unit, the jail or a hospital. Others are used by patients who have been granted special probation linked to treatment services.